^ Jump up to: a b Moreton C (14 January 2007). "World's first test-tube baby Louise Brown has a child of her own". Independent. London. Retrieved 21 May 2010. The 28-year-old, whose pioneering conception by in-vitro fertilisation made her famous around the world. The fertility specialists Patrick Steptoe and Bob Edwards became the first to successfully carry out IVF by extracting an egg, impregnating it with sperm and planting the resulting embryo back into the mother
Ovary stimulation. For eight to 14 days near the beginning of your menstrual cycle, you take a gonadotropin, a type of fertility drug that stimulates your ovaries to develop multiple mature eggs for fertilization (instead of just one). You also need to take a synthetic hormone like leuprolide or cetrorelix to keep your body from releasing the eggs too early.
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.
For women, problems with fertilisation arise mainly from either structural problems in the Fallopian tube or uterus or problems releasing eggs. Infertility may be caused by blockage of the Fallopian tube due to malformations, infections such as chlamydia or scar tissue. For example, endometriosis can cause infertility with the growth of endometrial tissue in the Fallopian tubes or around the ovaries. Endometriosis is usually more common in women in their mid-twenties and older, especially when postponed childbirth has taken place.[55]
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With egg donation and IVF, women who are past their reproductive years, have infertile male partners, have idiopathic female-fertility issues, or have reached menopause can still become pregnant. After the IVF treatment, some couples get pregnant without any fertility treatments.[3] In 2018, it was estimated that eight million children had been born worldwide using IVF and other assisted reproduction techniques.[4] However, a recent study that explores 10 adjuncts with IVF (screening hysteroscopy, DHEA, testosterone, GH, aspirin, heparin, antioxidants in males and females, seminal plasma, and PRP) suggests that until more evidence is done to show that these adjuncts are safe and effective, they should be avoided.[5]
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.  
Initial blood work, cycle tracking and fertility analysis is done. To begin IVF, your doctor or fertility specialist will evaluate your hormone levels and menstrual cycle to determine what medications and plan of action may be needed. You may also undergo a transvaginal ultrasound to examine your ovaries and reproductive system, ensuring that they are healthy.
Sit down with your partner and make a "fertility road map" that outlines what you're willing to try and for approximately how long, suggests Dr. Davidson. "Would you do in vitro fertilization? Would you consider an egg donor? How much money can you spend on treatment? Then build in a timeline," she says. "When you at least loosely define a time frame, dealing with infertility doesn't feel like an endless void."
s ohledem na poslední informace ohledně šíření koronaviru 2019-nCoV jsme zavedli zvýšená hygienická opatření za účelem ochrany pacientů i personálu kliniky. Klinika i nadále poskytuje zdravotní péči v plném rozsahu, avšak u pacientů ze zasažených oblastí, případně pacientů, kteří tyto oblasti v poslední době navštívili, bude léčba odložena. V případě příznaků respiračních onemocnění žádáme pacienty, aby před příjezdem na kliniku kontaktovali svého lékaře, případně koordinátora a dohodli se na nejvhodnějším postupu.

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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.


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.[94] 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,[95] it is still not widely adopted.[96]
Acknowledge your feelings. When dealing with secondary infertility, it’s very common to feel shock or denial. After all, making one baby might have been a piece of cake for you, so you probably assumed that having a second one would be easy, too. Your friends and even your doctor may also downplay your current infertility problems (telling you not to take it so hard or to “just keep trying”) since you had no trouble before. But secondary infertility is much more common than most people realize. So allow yourself the chance to accept the idea that you may be battling secondary infertility — because once you do, you can tackle the problem head-on.
One of the worst parts of infertility – or the fear of being infertile – is friends and family members getting pregnant accidentally! “Today, my child-hating friend who vowed never to have kids no matter what, announced that she’s pregnant,” says Charity. “I’ve had three IVF (in vitro fertilization) cycles, spent $90,000 in fertility treatments, and still can’t conceive a baby. WTF?”
^ Hozyasz, K (March 2001). "Coeliac disease and problems associated with reproduction". Ginekol Pol. 72 (3): 173–9. PMID 11398587. Coeliac men may have reversible infertility, and as in women, if gastrointestinal symptoms are mild or absent the diagnosis may be missed. It is important to make diagnosis because the giving of gluten free diet may result in conception and favourable outcome of pregnancy.
Intrauterine insemination (IUI) is one of the simpler, “low-tech” treatments for infertility and the starting point for many individuals and couples who are having difficulty with conception on their own. Patients who have been diagnosed with unexplained infertility, mild male factor infertility, a cervical factor, or irregular or absent ovulation are often good candidates for IUI.

^ Lasa, JS; Zubiaurre, I; Soifer, LO (2014). "Risk of infertility in patients with celiac disease: a meta-analysis of observational studies". Arq Gastroenterol. 51 (2): 144–50. doi:10.1590/S0004-28032014000200014. PMID 25003268. Undiagnosed celiac disease is a risk factor for infertility. Women seeking medical advice for this particular condition should be screened for celiac disease. Adoption of a gluten-free diet could have a positive impact on fertility in this group of patients.(...)According to our results, non-diagnosed untreated CD constitutes a risk factor significantly associated with infertility in women. When comparing studies that enrolled patients previously diagnosed with CD, this association is not as evident as in the former context. This could be related to the effect that adoption of a gluten-free diet (GFD) may have on this particular health issue.
When transferring more than one embryo, the risk of pregnancy and newborn complications also increases.1 Among IVF babies, twins are 12 times more likely than singletons to be delivered prematurely, 16 times more likely to be underweight and 5 times more likely to suffer from respiratory complications. Among IVF mothers, mothers of twins are 2.5 times more likely to have pre-eclampsia, over 8 times more likely to have premature preterm rupture of membranes and 4 times more likely to require a Caesarean section.
Treatment depends on the cause of infertility, but may include counselling, fertility treatments, which include in vitro fertilization. According to ESHRE recommendations, couples with an estimated live birth rate of 40% or higher per year are encouraged to continue aiming for a spontaneous pregnancy.[63] Treatment methods for infertility may be grouped as medical or complementary and alternative treatments. Some methods may be used in concert with other methods. Drugs used for both women and men[64] include clomiphene citrate, human menopausal gonadotropin (hMG), follicle-stimulating hormone (FSH), human chorionic gonadotropin (hCG), gonadotropin-releasing hormone (GnRH) analogues, aromatase inhibitors, and metformin.

Headaches and mood swings: Headaches and mood swings are common IVF treatment side effects. Over-the-counter medications can ease headaches, and while no medication can help with mood swings, knowing that they’re a normal part of IVF treatment helps. If you find mood swings are disrupting your day, be sure to seek out self-care practices such as enjoying alone time, reading a book, taking a nice bath, or sharing feelings with a friend or loved one.


Many people have never heard the term "secondary infertility"; fewer understand it. I discovered it a year into my struggle to conceive a second child and fell on it, amazed. What I was undergoing had a name! I wrote it down and immediately felt better, as if the phrase exuded a talismanic power that might protect me from the likes of my neighbour.
In the well-established fertility treatment of IVF, unlike IUI, the meeting of sperm and egg takes place outside the body, in the laboratory (in vitro). This gives fertility practitioners a lot more control over the selection of a genetically normal embryo that has the best chance of establishing a successful pregnancy. IVF is the fertility treatment with the highest likelihood of taking home a healthy baby. These are the stages involved in IVF:
Once the medications take their effect, your doctor will use a transvaginal ultrasound to guide a needle through the back wall of your vagina, up to your ovaries. She will then use the needle to aspirate the follicle, or gently suck the fluid and oocyte from the follicle into the needle. There is one oocyte per follicle. These oocytes will be transferred to the embryology lab for fertilization.

Sometimes problems getting pregnant for a second or subsequent time are related to a complication that occurred in a prior pregnancy or prior to delivery (damage to the uterus, for instance). But most often, secondary infertility is caused by the same factors that would cause primary infertility — issues like advanced age, obesity, ovulation problems and so on.
In the laboratory, for ICSI treatments, the identified eggs are stripped of surrounding cells (also known as cumulus cells) and prepared for fertilisation. An oocyte selection may be performed prior to fertilisation to select eggs that can be fertilized, as it is required they are in metaphase II. There are cases in which if oocytes are in the metaphase I stage, they can be kept being cultured so as to undergo a posterior sperm injection. In the meantime, semen is prepared for fertilisation by removing inactive cells and seminal fluid in a process called sperm washing. If semen is being provided by a sperm donor, it will usually have been prepared for treatment before being frozen and quarantined, and it will be thawed ready for use.
If you're overweight or obese, losing weight can boost your chances of getting pregnant. A study found that women whose body mass index (BMI) was above normal took twice as long to get pregnant as those with a normal BMI. But a drop in weight of 5%-10% can dramatically improve ovulation and pregnancy rates. Obesity can also cause infertility and low testosterone in men. Being significantly underweight can also lead to infertility.

Sunni Muslim nations generally allow IVF between married couples when conducted with their own respective sperm and eggs, but not with donor eggs from other couples. But Iran, which is Shi'a Muslim, has a more complex scheme. Iran bans sperm donation but allows donation of both fertilised and unfertilised eggs. Fertilised eggs are donated from married couples to other married couples, while unfertilised eggs are donated in the context of mut'ah or temporary marriage to the father.[176]
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.
Women are born with about 1 million to 2 million eggs but release only 300 to 400 through ovulation during their lifetimes. Usually, you release just one each month. The egg travels along one of the two fallopian tubes that connect your ovaries to your uterus. If the timing is right, sperm may fertilize it on its way to the uterus. If fertilization doesn't happen within 24 hours of the egg leaving the ovary, the egg dissolves. Sperm can live for about 3 to 5 days, so knowing when you are ovulating can help you and your partner plan sex for when you're most likely to conceive.
^ Siristatidis C, Sergentanis TN, Kanavidis P, Trivella M, Sotiraki M, Mavromatis I, Psaltopoulou T, Skalkidou A, Petridou ET (2012). "Controlled ovarian hyperstimulation for IVF: impact on ovarian, endometrial and cervical cancer—a systematic review and meta-analysis". Human Reproduction Update. 19 (2): 105–23. doi:10.1093/humupd/dms051. PMID 23255514.
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]
Obesity: The obesity epidemic has recently become is a serious issue, particularly in industrialized nations. The rising number of obese individuals may be due in part to an energy-rich diet as well as insufficient physical exercise.  In addition to other potential health risks, obesity can have a significant impact on male and female fertility. BMI (body mass index) may be a significant factor in fertility, as an increase in BMI in the male by as little as three units can be associated with infertility. Several studies have demonstrated that an increase in BMI is correlated with a decrease in sperm concentration, a decrease in motility and an increase DNA damage in sperm. A relationship also exists between obesity and erectile dysfunction (ED). ED may be the consequence of the conversion of androgens to estradiol. The enzyme aromatase is responsible for this conversion, and is found primarily in adipose tissue. As the amount of adipose tissue increases, there is more aromatase available to convert androgens, and serum estradiol levels increase. Other hormones including inhibin B and leptin, may also be affected by obesity. Inhibin B levels have been reported to decrease with increasing weight, which results in decreased Sertoli cells and sperm production. Leptin is a hormone associated with numerous effects including appetite control, inflammation, and decreased insulin secretion, according to many studies. Obese women have a higher rate of recurrent, early miscarriage compared to non-obese women.
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