Of course, if you have a history of infertility or any factors that might impede fertility, it makes sense to arm yourself with the right help right from the start. Once you make that appointment with a fertility specialist, you and your doctor will follow the same treatment plan that would be put into place if you were dealing with primary infertility.
When weighing the options, the pros and cons of intrauterine insemination (IUI) and in vitro fertilization (IVF) will, of course, be explored fully in discussion with your physician. In general terms, you can expect IUI to be a simpler process, less invasive, and lower cost. Some fertility specialists recommend attempting one or more cycles of artificial insemination before moving to IVF but this does not apply to everyone. For example, for an older woman, to try artificial insemination first may take up valuable time and the recommendation could well be to move straight to IVF. But before you can compare the two treatments, you need to know what exactly you could expect from IVF.
Each case of infertility is different from the other. Hence it is extremely crucial, to be honest with your doctor about all your symptoms and problems. The doctor needs to know all the details regarding your reproductive health including any previous miscarriages, or abortions if any. This helps in diagnosis and formulating a correct treatment for infertility.
Success varies with many factors. The age of the woman is the most important factor, when women are using their own eggs. Success rates decline as women age, specifically after the mid-30’s.  Part of this decline is due to a lower chance of getting pregnant from ART, and part is due to a higher risk of miscarriage with increasing age, especially over age 40.  
Studies show that sperm count and sperm movement decrease as men age, as does sexual function. But there isn't a cutoff age that makes a man too old to father a child. One study found that it took men age 45 or older longer to get a woman pregnant once the couple started trying. If your partner is older, you may want to talk to your doctor about ways to boost your chances.

Impaired sperm production or function. Below-average sperm concentration, weak movement of sperm (poor mobility), or abnormalities in sperm size and shape can make it difficult for sperm to fertilize an egg. If semen abnormalities are found, your partner might need to see a specialist to determine if there are correctable problems or underlying health concerns.
IVF may be used to overcome female infertility when it is due to problems with the fallopian tubes, making in vivo fertilisation difficult. It can also assist in male infertility, in those cases where there is a defect in sperm quality; in such situations intracytoplasmic sperm injection (ICSI) may be used, where a sperm cell is injected directly into the egg cell. This is used when sperm has difficulty penetrating the egg. In these cases the partner's or a donor's sperm may be used. ICSI is also used when sperm numbers are very low. When indicated, the use of ICSI has been found to increase the success rates of IVF.
Monitoring of egg development is usually done with E2 and LH blood hormone tests and ultrasound scans of the ovaries to determine when the egg is mature. The ultrasound allows the physician to visualize the thickness of the uterine lining and the ovaries, more specifically the number of follicles within them. The bloodwork shows the trend of pre- to post-stimulation hormone levels; increased levels of estrogen indicate follicular development.
Antisperm antibodies (ASA) have been considered as infertility cause in around 10–30% of infertile couples.[23] In both men and women, ASA production are directed against surface antigens on sperm, which can interfere with sperm motility and transport through the female reproductive tract, inhibiting capacitation and acrosome reaction, impaired fertilization, influence on the implantation process, and impaired growth and development of the embryo. The antibodies are classified into different groups: There are IgA, IgG and IgM antibodies. They also differ in the location of the spermatozoon they bind on (head, mid piece, tail). Factors contributing to the formation of antisperm antibodies in women are disturbance of normal immunoregulatory mechanisms, infection, violation of the integrity of the mucous membranes, rape and unprotected oral or anal sex. Risk factors for the formation of antisperm antibodies in men include the breakdown of the blood‑testis barrier, trauma and surgery, orchitis, varicocele, infections, prostatitis, testicular cancer, failure of immunosuppression and unprotected receptive anal or oral sex with men.[23][24]
During an infertility workup, you and your partner will be asked questions about your current health and medical history. "We're looking to see what might have changed from previous pregnancies," says Dr. Tan. "If we find something we can fix—say, removing scar tissue—we'll start there." Also expect blood work and ultrasounds to determine whether you're ovulating and to check your egg supply, an X-ray to look for blocked fallopian tubes, and a semen analysis to measure sperm count and quality.
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.
Connect with your partner. Remember that he is also coping with secondary infertility along with you, and while your partner may be dealing with it differently, it can be extremely helpful to check in with each other emotionally. Set aside some time to talk about how your infertility problems are affecting each of you — that can help you both work through your emotions. Tired of talking about infertility or channeling all your collective energy into that second pregnancy? Plan a date night — totally unrelated to any baby-making duties. Since secondary infertility problems can take a toll on any relationship, date nights are needed now more than ever to keep the love and fun flowing. An added bonus: Since less stress often improves fertility, enjoying just being a couple could even increase your odds of achieving that second pregnancy.
We don't know what causes most cases of secondary infertility, says Jamie Grifo, M.D., Ph.D., program director of the New York University Fertility Center, in New York City. "The majority of the time, though, it reflects the fact that you're older now, so it's simply more difficult to get pregnant." The reality is that for women, fertility peaks at age 25 and drops by half between ages 30 and 40. As we age, egg quality declines and we're more likely to develop fibroids and endometriosis, which contribute to infertility. Other factors such as adding extra weight, taking new meds, or having surgery since your last pregnancy can be an issue. It may also be that your partner's sperm quality or production is now poor.
Around one in 7 couples that require artificial reproductive treatment (ART) have "unexplained" infertility and doctors often first use approaches like ensuring the female partner's ovulation occurs at the same time as natural sex or artificial insemination/intrauterine insemination (IUI). They may then recommend IVF where thousands of the male partner's best sperm are purified and incubated with the egg — this is the preferred initial ART procedure in cases of "unexplained" infertility.

I used to have a neighbour I would do almost anything to avoid. An elderly lady, she was given to jam-making, church-going and patrolling the local streets. If I saw her coming, I would dive back inside my front door or seize my son's hand and gallop to our car. I once twisted my ankle in an effort to escape her. Whenever she saw me she would utter the words, "If you don't get your skates on and give that child a brother or sister he's going to be a lonely only." Even now, it's hard to say what was more loathsome. Was it the boisterous intrusion of her tone, the inexcusability of the phrase "lonely only", or the idea of strapping on skates as a euphemism for – what exactly? Unprotected sex?
Endometriosis implants are most commonly found on the ovaries, the Fallopian tubes, outer surfaces of the uterus or intestines, and on the surface lining of the pelvic cavity. They also can be found in the vagina, cervix, and bladder. Endometriosis may not produce any symptoms, but when it does the most common symptom is pelvic pain that worsens just prior to menstruation and improves at the end of the menstrual period. Other symptoms of endometriosis include pain during sex, pain with pelvic examinations, cramping or pain during bowel movements or urination, and infertility. Treatment of endometriosis can be with medication or surgery.
Your doctor will also monitor whether or not the treatment led to a multiple pregnancy. IVF has a higher risk of conceiving multiples, and a multiple pregnancy carries risks for both the mother and the babies. Risks of a multiple pregnancy include premature labor and delivery, maternal hemorrhage, C-section delivery, pregnancy induced high blood pressure, and gestational diabetes.
Success rates vary with the number of embryos transferred. However, transferring more and more embryos at one time does not increase the chance of live birth significantly, but may only increase the risk of a multiple pregnancy, and its associated risks. The impact of the number of embryos that are transferred also varies with the age of the woman.  

Antisperm antibodies (ASA) have been considered as infertility cause in around 10–30% of infertile couples.[23] In both men and women, ASA production are directed against surface antigens on sperm, which can interfere with sperm motility and transport through the female reproductive tract, inhibiting capacitation and acrosome reaction, impaired fertilization, influence on the implantation process, and impaired growth and development of the embryo. The antibodies are classified into different groups: There are IgA, IgG and IgM antibodies. They also differ in the location of the spermatozoon they bind on (head, mid piece, tail). Factors contributing to the formation of antisperm antibodies in women are disturbance of normal immunoregulatory mechanisms, infection, violation of the integrity of the mucous membranes, rape and unprotected oral or anal sex. Risk factors for the formation of antisperm antibodies in men include the breakdown of the blood‑testis barrier, trauma and surgery, orchitis, varicocele, infections, prostatitis, testicular cancer, failure of immunosuppression and unprotected receptive anal or oral sex with men.[23][24]
Alternatives to donating unused embryos are destroying them (or having them implanted at a time where pregnancy is very unlikely),[90] keeping them frozen indefinitely, or donating them for use in research (which results in their unviability).[91] Individual moral views on disposing leftover embryos may depend on personal views on the beginning of human personhood and definition and/or value of potential future persons and on the value that is given to fundamental research questions. Some people believe donation of leftover embryos for research is a good alternative to discarding the embryos when patients receive proper, honest and clear information about the research project, the procedures and the scientific values.[92]
In IVF, a woman is given more medications to develop lots of eggs. Ideally, they develop around 15 mature eggs. The eggs are removed from the ovaries, fertilized and developed in a lab for a number of days, and subsequently put back into the uterus as an early-stage embryo. While this may sound like a relatively minor difference, it leads to leads to a large number of noteworthy differences.

The industry has been accused of making unscientific claims, and distorting facts relating to infertility, in particular through widely exaggerated claims about how common infertility is in society, in an attempt to get as many couples as possible and as soon as possible to try treatments (rather than trying to conceive naturally for a longer time). This risks removing infertility from its social context and reducing the experience to a simple biological malfunction, which not only can be treated through bio-medical procedures, but should be treated by them.[104][105] Indeed, there are serious concerns about the overuse of treatments, for instance Dr Sami David, a fertility specialist, has expressed disappointment over the current state of the industry, and said many procedures are unnecessary; he said: "It's being the first choice of treatment rather than the last choice. When it was first opening up in late 1970s, early 80s, it was meant to be the last resort. Now it's a first resort. I think that it can harm women in the long run."[106] IVF thus raises ethical issues concerning the abuse of bio-medical facts to 'sell' corrective procedures and treatments for conditions that deviate from a constructed ideal of the 'healthy' or 'normal' body i.e., fertile females and males with reproductive systems capable of co-producing offspring.
One of the biggest challenges is balancing enjoying the child you have with wondering if you'll ever get the larger family you want. "I watched my daughter take her first steps and thought, 'Maybe I'll never have this again,'"‰'' Bozinovich says. (Her problem was never pinpointed, but, happily, she went on to have two more children.) That is tough, the experts agree. "Worrying about what's happening next robs you of the pleasure of the moment," says Dr. Davidson. "It's not easy, but counseling and talking yourself through the rough moments can help you say, 'I'm doing the best I can, and meanwhile I'm living my life.'"‰"
When it comes to fertility care, you deserve only the best. At CNY Fertility, we empathize with you and understand how stressful it is to be dealing with infertility. That’s why we never treat our patients as numbers or nameless visitors. From the moment you enter our doors, you’ll be welcomed by our friendly staff and receive only high-quality, personalized care. We believe that fertility treatments aren’t a luxury reserved for a select few – It’s a human right that you wholeheartedly deserve, no matter your history or situation. 

Insemination – This is done as close to the day of ovulation as possible. During insemination, washed and concentrated sperm is injected into the top of your uterus through a small catheter inserted through the vagina and cervix. Once injected, the catheter is removed. You can expect the insemination to take just a few minutes. It is possible to experience mild cramping post-procedure. The sperm used in your IUI can usually be collected at the office performing the IUI (preferred if possible), frozen and shipped to the center, collected fresh at your home and shipped to our centers using our sperm shipping kits (not advised), or ordered and sent to our office from a donor agency. Fresh semen samples are prepared in our laboratory to obtain a concentration of active sperm.


An IUI procedure is the process of directly injecting sperm into the top of the uterus. This increases the odds of conception by reducing the distance the sperm must travel to meet the egg. That said, when most people talk about IUIs, they’re referring to the steps leading up to and after the actual procedure. An IUI treatment can be summarized into a few steps:
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Assess your preconception prep. Have you been on top of the preconception game or are you just too busy for baby-planning activities like charting and timing baby-making sex (or any sex for that matter)? Given that you have a little one underfoot, it's understandable if you're more exhausted than ever. It’s not easy for wannabe second-time parents to devote as much time and energy to TTC as they likely did on the first go-around, but it would be helpful to take a step back (and a hard look) at what's going on. Are your cycles still regular, or have there been any changes that might be hurting your chances for conception success? Have you been able to pinpoint ovulation with accuracy, or are you just having sex whenever (which would make conception less likely)? Getting back on track with tracking your fertility signs may be enough to put you back in the game.
When I think back to that time, I recall an almost constant sense of grief. Every 28th day represented another failure, another loss. All around me my friends were having their second and then third babies. My son looked at his classmates with their siblings wistfully, he wished with every birthday candle for a brother or sister and one day he asked, "Can you play tig on your own?"
3. Painful Periods: We’re not talking about normal cramping here. But, severe pain that stops you in your tracks and even causes nausea or vomiting. Alone this may not be a sign of infertility, but combined with other symptoms like pain during intercourse, blood in the urine or during bowel movements, or irregular periods, can be signs of endometriosis–a condition that accounts for 20-40% of female infertility cases.
IVF increasingly appears on NHS treatments blacklists.[160] In August 2017 five of the 208 CCGs had stopped funding IVF completely and others were considering doing so.[161] By October 2017 only 25 CCGs were delivering the three recommended NHS IVF cycles to eligible women under 40.[162] Policies could fall foul of discrimination laws if they treat same sex couples differently from heterosexual ones.[163] In July 2019 Jackie Doyle-Price said that women were registering with surgeries further away from their own home in order to get around CCG rationing policies.[164]
An IUI procedure is the process of directly injecting sperm into the top of the uterus. This increases the odds of conception by reducing the distance the sperm must travel to meet the egg. That said, when most people talk about IUIs, they’re referring to the steps leading up to and after the actual procedure. An IUI treatment can be summarized into a few steps:
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.

Though there are some risk with older women pregnancies, there are some benefits associated with caesareans. A study has shown that births over 40 have a lower rate of birth trauma due to increased delivery by caesarean. Though caesarean is seen to benefit mothers over 40, there are still many risk factors to consider. Caesarean section may be a risk in the same way that gestational diabetes is.
I had a wonderful experience at CHA Fertility Clinic and got pregnant on my first cycle.  My son will turn two this year and I immediately contacted them when we were thinking of having a second child.  The doctors and staff are so kind, informative, and helpful, and they really put my mind at ease.  We had looked at other fertility clinics … Read More
Apart from poor egg quality at advanced maternal age, older women are also less likely to respond to ovarian stimulation hormones that cause the release of multiple eggs. Being able to produce a dozen of eggs significantly increases the odds of success. It allows your fertility practitioner to choose the egg with normal genetic makeup and best likelihood of implantation. In both nature and IVF, not all eggs are suitable to produce a pregnancy. Ideally, you would produce 8-15 eggs after ovarian hyperstimulation so that some of them are genetically normal and perfectly matured.

IVF success rates are the percentage of all IVF procedures that result in a favourable outcome. Depending on the type of calculation used, this outcome may represent the number of confirmed pregnancies, called the pregnancy rate, or the number of live births, called the live birth rate. The success rate depends on variable factors such as maternal age, cause of infertility, embryo status, reproductive history, and lifestyle factors.
We know this is a touchy subject, but unfortunately, there’s no way around it. Science says that age does play a role in fertility. This 2018 study correlated age as a statistically significant factor in secondary infertility compared to primary infertility. In the study, the average age of couples was higher among those experiencing secondary infertility.
The diagnosis of infertility is often very overwhelming for patients. There is a plethora of information served to them. First is, they can conceive a child only through medical treatment. Second is, the insurmountable amount of information that is hard to comprehend. New medical jargon along with recommendations for treatments and tests that are completely unfamiliar can be very intimidating for the newly diagnosed. Indira IVF's Reproductive Specialists believe in creating a partnership with the patient, and we have found that the most successful partnerships occur when the patient is well-informed and can play an active role in their treatment. We value an open and ethical relationship with each patient in an environment that fosters trust and mutual respect, an environment where questions are welcome and encouraged.
Once the semen sample is ready, it'll be put through a special washing process, which separates the sperm from the other stuff that is found in semen. The embryologist will choose the “best-looking sperm," placing about 10,000 sperm in each culture dish with an oocyte. The culture dishes are kept in a special incubator, and after 12 to 24 hours, they are inspected for signs of fertilization.
^ Baker VL, Luke B, Brown MB, Alvero R, Frattarelli JL, Usadi R, et al. (September 2010). "Multivariate analysis of factors affecting probability of pregnancy and live birth with in vitro fertilization: an analysis of the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System". Fertility and Sterility. 94 (4): 1410–6. doi:10.1016/j.fertnstert.2009.07.986. PMID 19740463.
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