^ 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.

1. Changes to Your Menstrual Cycle: This may be an absence of your period, heavier than normal flow or irregular menstrual cycles may be signs of infertility. Consider tracking your menstrual cycle to help you identify patterns or changes early on. This will also be helpful in case you ever seek guidance from a physician, as he or she will inquire about your medical history.

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.


Success rates for IVF also vary according to individual circumstances, with the most significant factor again being the age of the woman. At RMA, the likelihood of live birth after transfer of a single, genetically normal blastocyst is 60-65% on average. It is a legal requirement in the US for success rates of fertility clinics to be reported to the CDC. This includes live birth rates and other outcomes. The Society for Assisted Reproductive Technology also reports on these statistics. All of our RMA clinics report their results individually and you can check them in the published data. You should remember that results for different clinics are not always comparable with each other because of differences in the patient base.
Women who switch from IUI to IVF sooner or begin with IVF get pregnant quicker than those who stick or start with IUI. One study found that undergoing immediate IVF resulted in superior pregnancy rates with fewer treatment cycles compared to those who did two rounds of IUI before switching to IVF.  While the immediate IVF group got pregnant quicker, the overall success after up to 6 IVF cycles was similar.
We also care about not only your physical well being, but also your emotional health. In fact, these issues as important enough to us that one of our core team members is a psychologist. Julianne Zweifel is an expert in addressing the mental aspects of secondary (and primary) infertility and she can promote emotional well being in a way that few others have the training or experience to do. If you should feel you do not wish to talk a specialist, but are struggling emotionally, please at least let other team members know-the more we hear from you, the easier it is for us to help.  
In general, the cost of IVF is higher than for IUI, but IVF confers the highest pregnancy rates per cycle. It is impossible to put a precise figure on the two treatments for comparison as much will depend on your personal treatment program. You can see some ballpark figures on the website of the Society for Assisted Reproductive Technology. It also contains an overview of the differences between IUI and IVF.
Step on the scale. Have you put on some extra pounds since your last baby was on board? Or maybe you’ve lost a lot of weight (because after all, who has time to eat when you’re running after a little one)? Your weight can impact your fertility, so getting as close as possible to a healthy BMI can also help get you closer to that second pregnancy you’re hoping for.
In vitro fertilisation (IVF) is a process of fertilisation where an egg is combined with sperm outside the body, in vitro ("in glass"). The process involves monitoring and stimulating a woman's ovulatory process, removing an ovum or ova (egg or eggs) from the woman's ovaries and letting sperm fertilise them in a liquid in a laboratory. After the fertilised egg (zygote) undergoes embryo culture for 2–6 days, it is implanted in the same or another woman's uterus, with the intention of establishing a successful pregnancy.
I conceived my first child, a son, with no trouble at all. When he was two, we thought we might have another. A year or so later, when nothing had happened, we saw a fertility specialist, who gave us every test there was. We passed each one, as the consultant put it, "with flying colours". Which left us relieved but also confounded. All I had was a new adjective to add to my diagnosis: Unexplained Secondary Infertility.
Deciding whether to undergo in vitro fertilization, and how to try if the first attempt is unsuccessful, is an incredibly complicated decision. The financial, physical, and emotional toll of this process can be difficult. Speak with your doctor extensively to determine what your best options are and if in vitro fertilization is the right path for you and your family. Seek a support group or counselor to help you and your partner through this process. 

Coping with secondary fertility can be tough. Endless doctor appointments, tests, procedures, and medications. Sleepless nights. Time and energy away from your little one. Guilt over wanting another pregnancy when many women are struggling to have just that. Stress between you and your partner. Sadness when you get invited to yet another baby shower — and guilt for even feeling that way.
Fertility expert Zita West has noticed this increase at her London clinic. "The main reason," she explains, "is age. Women are having babies later." Exhaustion also plays a part. "The sleeplessness of life with a small child can't be underestimated," she says. "You might still be breastfeeding, you might be sharing a bed with a toddler, you might be holding down a job at the same time. Basically, there's not a lot of sex happening." 

Egg Development – This step is either part of the woman’s natural egg development or stimulated with medications and lasts roughly 5-14 days. Once your follicles are optimal size, a trigger medication may be given to finalize egg maturation and trigger ovulation. This phase of egg development may or may not be accompanied by ultrasound and bloodwork monitoring.
For five to six days following fertilization, the developing embryos are cultured in the laboratory until the blastocyst stage of development has been reached. This represents growth of about 200 cells. We at RMA culture embryos exclusively to the blastocyst stage, because published data demonstrates that extended embryo culture results in improved implantation rates and pregnancy outcomes. This means we will never do an embryo biopsy – or an embryo transfer – at three days, or anything less than the blastocyst stage.
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.[154] Single women are treated, and embryo adoption is allowed. There are also private clinics that offer the treatment for a fee.[155]
From the patient experience perspective, IVF is a more time-consuming process overall, although the length of time before pregnancy is achieved varies greatly according to how many cycles are necessary. However, because IVF is a more direct and effective route to pregnancy than IUI, it is often a less time-consuming process. For example, a patient could spend many months trying to succeed at IUI, only to succeed during the first cycle of IVF. While many patients opt for IUI at the start of their fertility journey because it is less invasive and more affordable, success rates for IVF are considerably higher.
IUI is a procedure during which processed and concentrated motile sperm are inserted directly into a woman’s uterus. This procedure is timed according to a woman’s ovulation, and may be performed one to two times in the days immediately following the detection of ovulation. After ovulation a woman’s egg is picked up by the fallopian tube and waits there for the sperm. Since the IUI procedure deposits higher concentrations of good quality sperm close to where the egg is waiting, the chances that the egg and sperm will find one another are increased.
Because not each IVF cycle that is started will lead to oocyte retrieval or embryo transfer, reports of live birth rates need to specify the denominator, namely IVF cycles started, IVF retrievals, or embryo transfers. The SART summarised 2008–9 success rates for US clinics for fresh embryo cycles that did not involve donor eggs and gave live birth rates by the age of the prospective mother, with a peak at 41.3% per cycle started and 47.3% per embryo transfer for patients under 35 years of age.

Primary infertility is defined as the absence of a live birth for women who desire a child and have been in a union for at least 12 months, during which they have not used any contraceptives.[14] The World Health Organisation also adds that 'women whose pregnancy spontaneously miscarries, or whose pregnancy results in a still born child, without ever having had a live birth would present with primarily infertility'.[14]
Wondering if it’s time to seek fertility help from a specialist? Your age can help clue you in to the answer. If you’re younger than 35, it’s perfectly normal for it to take six months to a year to conceive. If, after a year, you haven’t accomplished your conception goal, you’ll want to talk with your practitioner and/or get a referral to a fertility specialist. If you’re older than 35, experts recommend that you seek help from a fertility specialist after six months of regularly trying to conceive without birth control — and you may even want to go after three months. If you’re over 40, you’ll probably want to start off your quest for a second pregnancy with a fertility evaluation from your doctor. Ditto if your partner is over 40, since 35 to 40 percent of fertility problems can be traced back to the man, and a guy’s age affects the quality of his sperm.

Intracytoplasmic sperm injection (ICSI): This procedure involves direct injection of a single sperm of the male partner into the eggs of the female for fertilization. Just like IVF procedure, in ICSI, the sperm and egg are collected from both the partners. The only difference is the fertilization process as in IVF the sperms and egg are mixed naturally, and in ICSI the sperms are injected into the egg using a needle.


Spend quality time with your child. In the midst of your infertility problems, you may feel especially upset about shifting your focus from the child you already have to the child you’re longing to have in the future. You may even feel guilty about your inability to give your little one a sibling or about the sadness you are sure is spilling over into her life. The best thing you can do for your child in this situation is to keep life as normal as possible, and ideally, find some quality time to be together. Whether it’s a chat about her day before you tuck her into bed or an afternoon romp in the park, those rituals will go a long way toward keeping your tot’s world stable and happy — even if you sometimes feel your world is spinning out of control. (You might find that focusing on your child lets you live in the moment — at least for a little while — which can help you cope with secondary infertility.) If you’re in a particularly bad place and fear that you may have a hard time handling your true emotions in front of your child (say, your pregnancy test just came up negative for the zillionth time in a row), see if you can arrange to send her to a friend’s house, or enlist your partner or mother-in-law to take over for a bit. Allowing yourself the time to compose yourself can make it much easier to face your little pride and joy with a smile.
A recent controversy in California focused on the question of whether physicians opposed to same-sex relationships should be required to perform IVF for a lesbian couple. Guadalupe T. Benitez, a lesbian medical assistant from San Diego, sued doctors Christine Brody and Douglas Fenton of the North Coast Women's Care Medical Group after Brody told her that she had "religious-based objections to treating her and homosexuals in general to help them conceive children by artificial insemination," and Fenton refused to authorise a refill of her prescription for the fertility drug Clomid on the same grounds.[111][112] The California Medical Association had initially sided with Brody and Fenton, but the case, North Coast Women's Care Medical Group v. Superior Court, was decided unanimously by the California State Supreme Court in favour of Benitez on 19 August 2008.[113][114]
Many people of sub-Saharan Africa choose to foster their children to infertile women. IVF enables these infertile women to have their own children, which imposes new ideals to a culture in which fostering children is seen as both natural and culturally important. Many infertile women are able to earn more respect in their society by taking care of the children of other mothers, and this may be lost if they choose to use IVF instead. As IVF is seen as unnatural, it may even hinder their societal position as opposed to making them equal with fertile women. It is also economically advantageous for infertile women to raise foster children as it gives these children greater ability to access resources that are important for their development and also aids the development of their society at large. If IVF becomes more popular without the birth rate decreasing, there could be more large family homes with fewer options to send their newborn children. This could result in an increase of orphaned children and/or a decrease in resources for the children of large families. This would ultimately stifle the children's and the community's growth.[134]
Nowadays, there are several treatments (still in experimentation) related to stem cell therapy. It is a new opportunity, not only for partners with lack of gametes, but also for homosexuals and single people who want to have offspring. Theoretically, with this therapy, we can get artificial gametes in vitro. There are different studies for both women and men.[65]
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.
A lot goes into determining your odds of IVF success. No matter how small or big each factor is, you should try to optimize all of them for a happy outcome. Don’t forget, you can also use the success rate calculator for a personalized predication. It is also important to plan multiple full IVF cycles no matter what the first IVF cycle outcome is. 3 full IVF cycles are generally recommended to improve your cumulative success rates. About two thirds of patients will be successful after six or more cycles of IVF.
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.

While ICSI is a more invasive procedure, some have suggested it may help by reducing the risk of failed fertilisation. However, it's emerging that IVF is probably the preferred treatment, at least in the first cycle, in "unexplained" infertility. IVF allows for healthy competition between sperm, is less expensive, avoids trauma to the egg and may produce more embryos, with better pregnancy and live birth rates  


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.

The AMIGOS study suggested that clomid provided the best balance of a high pregnancy rate with a reasonably low multiple rate among couples with unexplained infertility. However, the authors of the Huang study concluded that on balance letrozole was better. From our vantage point, given that clomid more commonly causes multiple eggs to be ovulated, it seems like the slightly better option between the two because the whole point of treatment in unexplained infertility patients is to increase the odds of delivery by increasing the number of eggs ovulated.


Give in to the grief. While you probably feel incredibly disappointed and sad about your infertility problems, you may feel guilty giving in to those emotions. Parents facing secondary infertility often feel they don’t have the “right” to feel sad about their struggles because they should be grateful for the child they already have. But if you want more children and are having trouble getting pregnant again, you are just as entitled as anyone else to feel depressed or angry. The last thing you need when you’re coping with secondary infertility is to let guilt weigh you down even more.
Gonadotropins are another drug used to trigger ovulation. Gonadotropins are used if other drugs are not successful or if many eggs are needed for infertility treatments. Gonadotropins are given in a series of shots early in the menstrual cycle. Blood tests and ultrasound exams are used to track the development of the follicles. When test results show that the follicles have reached a certain size, another drug may be given to signal a follicle to release its matured egg.
May you accept your body – even if you are an infertile man. We struggled with male factor infertility in our marriage, and it strengthened our marriage and our faith in God. May you feel God’s blessing on you even if you can’t conceive children naturally. May you walk in faith, and trust that He knows what He is doing. Don’t give up on your God, for He is loving and compassionate.
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.
Luteal support is the administration of medication, generally progesterone, progestins, hCG, or GnRH agonists, and often accompanied by estradiol, to increase the success rate of implantation and early embryogenesis, thereby complementing and/or supporting the function of the corpus luteum. A Cochrane review found that hCG or progesterone given during the luteal phase may be associated with higher rates of live birth or ongoing pregnancy, but that the evidence is not conclusive.[79] Co-treatment with GnRH agonists appears to improve outcomes,[79] by a live birth rate RD of +16% (95% confidence interval +10 to +22%).[80] On the other hand, growth hormone or aspirin as adjunctive medication in IVF have no evidence of overall benefit.[30]
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