Medical treatment of infertility generally involves the use of fertility medication, medical device, surgery, or a combination of the following. If the sperm are of good quality and the mechanics of the woman's reproductive structures are good (patent fallopian tubes, no adhesions or scarring), a course of ovulation induction maybe used. The physician or WHNP may also suggest using a conception cap cervical cap, which the patient uses at home by placing the sperm inside the cap and putting the conception device on the cervix, or intrauterine insemination (IUI), in which the doctor or WHNP introduces sperm into the uterus during ovulation, via a catheter. In these methods, fertilization occurs inside the body.
Those fearful of conceiving with multiples should strongly consider IVF and only transferring one embryo at a time. In these circumstances, just 1% of pregnancies lead to twins, and triplets are even more rare. Alternatively, 8 - 30% of medicated IUI pregnancies lead to twins. Finally, the least preferable circumstance is do to IVF with multiple embryo transfer, where in women under 38 years of age, 30% of pregnancies culminate in a multiple birth.
Amongst these two patient populations (which we’ll refer to now as PCOS), IUI with clomid and letrozole generally shows no improvement versus when these drugs are taken without IUI. When IUI is coupled with gonadotropins, success rates reach 14 - 26% per cycle, which is higher than almost any other patient class, but still pales in comparison to IVF. It’s also worth noting that PCOS patients who are taking gonadotropins have a very high risk of multiples.
When you know your menstrual cycle, you improve your chances of getting pregnant. The first phase starts with the first day of bleeding during your period. Your body releases hormones, like follicle-stimulating hormone (FSH), that make the eggs inside your ovaries grow. Between days 2 and 14, those hormones also help thicken the lining of your uterus to get ready for a fertilized egg. This is called the follicular stage.
By 2017, many centers have adopted embryo cryopreservation as their primary IVF therapy, and perform few or no fresh embryo transfers. The two main reasons for this have been better endometrial receptivity when embryos are transferred in cycles without exposure to ovarian stimulation and also the ability to store the embryos while awaiting the results of pre-implantation genetic testing.
Most couples develop a willingness to conceive a child at some point in their life. Generally, couples conceive within the first year, and around 7% of couples conceive in the second year. The inability to conceive within 12 months is defined as infertility. It is recommended to seek help from a reproductive endocrinologist if you are unable to conceive within 12 months. Our modern technology in healthcare has opened a lot of options for women who are facing infertility issues.
Heavy, as in a pad and a tampon still doesn’t feel like enough. Certain medical conditions, like thyroid problems or kidney disease, can cause excessive menstrual bleeding, medications (such as anti-inflammatory drugs or anti-coagulants) may as well; or the reason may be a condition linked to infertility. In a normal menstrual cycle, the hormones estrogen and progesterone work together to regulate the buildup of the lining of the uterus—that’s the stuff that sheds during your period. But if, for example, your ovaries don’t release an egg, the dominoes are tipped: your body produces less progesterone, hormones become imbalanced, the lining in your uterus over-develops, and you end up bleeding extra heavily. Fibroids in your uterus can also cause heavier or longer-than-normal periods; some types of these benign tumors can block fallopian tubes or interfere with the implantation of a fertilized egg. Up to 10 percent of infertile women have fibroids, according to the American Society for Reproductive Medicine. If you soak through at least one pad or tampon an hour for more than a few hours, see your doctor. This is the worst health advice gynecologists have ever heard.
Other health related problems could also cause poor egg health, low ovarian reserve, or abnormal immunological responses, which can affect conception. Stress could also play a role. We all know that menstrual cycles can be altered during times of extreme duress- and this can be emotional, physical, or environmental stressors. In these instances, the first steps should be to avoid life stressors, maintain a healthy weight, routinely exercise, avoid smoking, and reduce alcohol intake, all of which may be contributing to unexplained infertility issues.
In IUI, this natural sequence of events is given some assistance. A sample of sperm is prepared in the laboratory so that only the best moving sperm are concentrated together. This sperm is then deposited directly into the uterus without having to swim there on its own, which can be challenging, especially if the sperm do not swim well. IUI places a higher concentration of moving sperm closer to the ovulated egg. Often a woman will have taken medication prior to the IUI procedure to ensure she will ovulate around the time of the procedure, so egg and sperm can meet.
This is less extensively studied. It is not yet known whether the ovarian stimulation and the insemination have independent beneficial effects or whether their beneficial effects are only seen when they are used in combination. Most likely they both independently increase fertility potential, with relatively more fertility benefit coming from the IUI component.
Most parents have a mental image of their ideal family, and if they find themselves unable to make that happen, it can be devastating. Infertility is heartbreaking and stressful, whether you have a child or not. In fact, being a parent adds a layer of complexity. For one thing, parents are immersed in the world of kids, so it's impossible to avoid all the babies and pregnant bellies that remind you of what you're missing. Plus, "parents with secondary infertility don't often get much sympathy, so they end up feeling as though they don't have a right to be sad," says Marie Davidson, Ph.D., a psychologist at Fertility Centers of Illinois. In fact, they're often told to appreciate the child they have (as if they don't). Finally, many parents feel guilt on two fronts: for not giving their child a sibling and for directing some of their focus and resources away from that child.
Unlike the simpler process of artificial insemination -- in which sperm is placed in the uterus and conception happens otherwise normally -- IVF involves combining eggs and sperm outside the body in a laboratory. Once an embryo or embryos form, they are then placed in the uterus. IVF is a complex and expensive procedure; only about 5% of couples with infertility seek it out. However, since its introduction in the U.S. in 1981, IVF and other similar techniques have resulted in more than 200,000 babies.
After the retrieval procedure, you'll be kept for a few hours to make sure all is well. Light spotting is common, as well as lower abdominal cramping, but most feel better in a day or so after the procedure. You'll also be told to watch for signs of ovarian hyperstimulation syndrome, a side effect from fertility drug use during IVF treatment in 10% of patients.
IVF is a type of assisted reproductive technology used for infertility treatment and gestational surrogacy. A fertilised egg may be implanted into a surrogate's uterus, and the resulting child is genetically unrelated to the surrogate. Some countries have banned or otherwise regulate the availability of IVF treatment, giving rise to fertility tourism. Restrictions on the availability of IVF include costs and age, in order for a woman to carry a healthy pregnancy to term. IVF is generally not used until less invasive or expensive options have failed or been determined unlikely to work.
West states that the "hardest thing about secondary fertility issues is that you want a sibling for your child." Fiona, who has a son of five and has been trying to conceive a second child for two years, says she can no longer look out of the window at her son playing in the garden. "It breaks my heart. He just looks so alone out there. All I want is a sibling for him but I don't think it's going to happen."
ART techniques generally start with stimulating the ovaries to increase egg production. After stimulation, the physician surgically extracts one or more eggs from the ovary, and unites them with sperm in a laboratory setting, with the intent of producing one or more embryos. Fertilization takes place outside the body, and the fertilized egg is reinserted into the woman's reproductive tract, in a procedure called embryo transfer.
In some cases, laboratory mix-ups (misidentified gametes, transfer of wrong embryos) have occurred, leading to legal action against the IVF provider and complex paternity suits. An example is the case of a woman in California who received the embryo of another couple and was notified of this mistake after the birth of her son. This has led to many authorities and individual clinics implementing procedures to minimise the risk of such mix-ups. The HFEA, for example, requires clinics to use a double witnessing system, the identity of specimens is checked by two people at each point at which specimens are transferred. Alternatively, technological solutions are gaining favour, to reduce the manpower cost of manual double witnessing, and to further reduce risks with uniquely numbered RFID tags which can be identified by readers connected to a computer. The computer tracks specimens throughout the process and alerts the embryologist if non-matching specimens are identified. Although the use of RFID tracking has expanded in the US, it is still not widely adopted.
The diagnosis is one of exclusion — that is, one which is made only after all the existing tests have been performed and their results found to be normal. This is why the frequency of this diagnosis will depend upon how many tests are done by the clinic — the fewer the tests, the more frequent this diagnosis. And the better the tests, the more likely you are getting a diagnosis instead of being told it's "unexplained."
4. IVF or In-Vitro Fertilization - IVF means eggs are collected and fertilized outside the body, in a laboratory. This is followed by transferring the embryos into the uterus. This advanced technology has resulted in many successful pregnancies in women who had lost hope. During IVF - In-Vitro Fertilization, women can choose to freeze their healthy eggs for future use.
However, those percentages are from studies in which all the women had laparoscopy surgery to investigate the pelvic cavity for pelvic scarring and endometriosis. Laparoscopy surgery is no longer done as part of the routine fertility workup. Therefore, we are not finding all of the causes of infertility that we used to - leaving many more couples in the unexplained category.
The sperm and the egg are incubated together at a ratio of about 75,000:1 in a culture media in order for the actual fertilisation to take place. A review in 2013 came to the result that a duration of this co-incubation of about 1 to 4 hours results in significantly higher pregnancy rates than 16 to 24 hours. In most cases, the egg will be fertilised during co-incubation and will show two pronuclei. In certain situations, such as low sperm count or motility, a single sperm may be injected directly into the egg using intracytoplasmic sperm injection (ICSI). The fertilised egg is passed to a special growth medium and left for about 48 hours until the egg consists of six to eight cells.
Pelvic inflammatory disease (PID) is the most common and serious complication of sexually transmitted diseases (STDs), aside from AIDS, among women. The signs and symptoms of pelvic inflammatory disease include: fever, vaginal discharge with a foul odor, abdominal pain, including pain during intercourse, and irregular vaginal bleeding. Pelvic inflammatory disease can scar the Fallopian tubes, ovaries, and related structures and lead to ectopic pregnancies, infertility, chronic pelvic pain, and other serious consequences. Pelvic inflammatory disease treatment includes several types of antibiotics.
Risk of ovarian hyperstimulation syndrome (OHSS). OHSS can happen when women respond too well to fertility drugs and produce too many eggs. About 10 to 20 percent of women who take gonadotropins develop a mild form of OHSS, a condition marked by weight gain and a full, bloated feeling. Some also have shortness of breath, dizziness, pelvic pain, nausea, and vomiting. If you have OHSS, your ovaries swell to several times the normal size and produce fluid that accumulates in your abdominal cavity. Normally this resolves itself with careful monitoring by a physician and bed rest. But in rare cases it's life threatening, and you may have to be hospitalized for more intensive monitoring or treatment.
While PGD was originally designed to screen for embryos carrying hereditary genetic diseases, the method has been applied to select features that are unrelated to diseases, thus raising ethical questions. Examples of such cases include the selection of embryos based on histocompatibility (HLA) for the donation of tissues to a sick family member, the diagnosis of genetic susceptibility to disease, and sex selection.
Ovarian stimulation – You’ll take stimulation medications to increases both the quantity and quality of eggs. This usually begins during days 2-4 of your cycle and continues for around ten days. You’ll be closely monitored during this time to track your uterine lining, follicular development, and hormone levels. Once the follicles are optimal size, a trigger medication is given to fully mature the eggs.
The average cost of an IVF cycle in the U.S. is $12,400, according to the American Society of Reproductive Medicine. This price will vary depending on where you live, the amount of medications you're required to take, the number of IVF cycles you undergo, and the amount your insurance company will pay toward the procedure. You should thoroughly investigate your insurance company's coverage of IVF and ask for a written statement of your benefits. Although some states have enacted laws requiring insurance companies to cover at least some of the costs of infertility treatment, many states haven't.
Undergoing fertility treatment requires precise scheduling of frequent tests and procedures—a tricky proposition when you're a parent. "I've had to go to the doctor early in the morning three times a week for testing," says Bozinovich. "Who can you find to babysit at 7 a.m. on a weekday?" (The answer: a grandparent or, when all else fails, a nurse at the doctor's office.) Your instinct might be to keep your treatment a secret, but it can make your life easier to enlist a friend or relative to help with child care. Also, choose a doctor's office you're comfortable with. You'll be spending a lot of time there; a compassionate staff can make treatment easier.
Egg retrieval and sperm collection – Egg retrieval happens 35 hours after the trigger shot. It is done under light anesthesia and takes just 5-10 minutes. During retrieval, a tiny hollow needle is pierced through the vaginal wall towards an ovary. At this point, the fluid that contains the developed eggs is drained from the follicles and immediately taken to the IVF laboratory, where they will be fertilized and developed. Sperm is collected the same day as the procedure by ejaculation into a sterile specimen container, frozen ahead of time, via a donor, or through more advanced sperm retrieval procedures. Next, the sperm is washed, placed in a solution similar to the fallopian tubes, and used for fertilization.
Gene mutations in men and obscure viruses in women can cause infertility. Here’s a basic list of the most commonly known reasons men and women can’t get pregnant, plus four research studies that describe lesser known causes of male and female fertility problems. If you’ve been trying to get pregnant for more than a year,… Read More »Causes of Infertility for Men and Women Who Can’t Get Pregnant
Secondary infertility can be traced to either partner or both partners. About one-third of cases originate in women and about one-third originate in men. In the remaining one-third, the cause is due to a combination of factors or isn’t known. Increased age, complications from a prior pregnancy or surgery, increased weight, medications, sexually transmitted diseases, impaired sperm production, alcohol abuse, and smoking are all examples of secondary infertility in women and men.
One, two or three IVF treatments are government subsidised for women who are younger than 40 and have no children. The rules for how many treatments are subsidised, and the upper age limit for the women, vary between different county councils. Single women are treated, and embryo adoption is allowed. There are also private clinics that offer the treatment for a fee.
There are many studies comparing success rates between clomid, letrozole, or gonadotropins for patients with unexplained infertility, but two stand out as the best and most informative. The first study was conducted at multiple sites across the country and was termed the AMIGOS trial. In this study, gonadotropins produced the highest pregnancy rate, followed by clomid, and then letrozole. However, almost one third of all pregnancies in the gonadotropin arm was either a twin or triplet gestation. This was significantly higher than the clomid or letrozole arms.
This chart is US national average data on success rates per IVF cycle by female age for 2014. The dark blue line (triangles) shows pregnancy rates per cycle by age. The orange line (circles) shows live birth rates per cycle by age. The rate of singleton live births per cycle is shown by the light blue line. The difference between "pregnancy" rate and "live birth" rate is due to miscarriages.
A genetic disorder. If you or your partner is at risk of passing on a genetic disorder to your child, you may be candidates for preimplantation genetic testing — a procedure that involves IVF. After the eggs are harvested and fertilized, they're screened for certain genetic problems, although not all genetic problems can be found. Embryos that don't contain identified problems can be transferred to the uterus.