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.

The percentage of cycles cancelled between egg retrieval and embryo transfer is an indication of failed fertilization. This figure is halved with ICSI as compared to conventional IVF, indicating that it can indeed improve fertilization when the sperm is at fault. However, there are no differences in pregnancy, miscarriage or live birth rates between conventional IVF and ICSI, indicating overall similar success rates1.
Ovarian hyperstimulation syndrome (OHSS) occurs in 10% of women going through IVF treatment. For most women, symptoms will be mild, and they will recover easily. For a small percentage, OHSS can be more serious and may require hospitalization. Less than 1% of women going through egg retrieval will experience blood clots or kidney failure due to OHSS.
First, consider where the information about the success rates is coming from. Generally speaking, IVF success rates in the United States comes from the clinics themselves or from the Center for Disease Control and Prevention. The Society for Assisted Reproductive Technology and the American Society for Reproductive Medicine both contribute to the CDC data.
^ Tan K, An L, Miao K, Ren L, Hou Z, Tao L, Zhang Z, Wang X, Xia W, Liu J, Wang Z, Xi G, Gao S, Sui L, Zhu DS, Wang S, Wu Z, Bach I, Chen DB, Tian J (March 2016). "Impaired imprinted X chromosome inactivation is responsible for the skewed sex ratio following in vitro fertilization". Proceedings of the National Academy of Sciences of the United States of America. 113 (12): 3197–202. Bibcode:2016PNAS..113.3197T. doi:10.1073/pnas.1523538113. PMC 4812732. PMID 26951653.
The major complication of IVF is the risk of multiple births. This is directly related to the practice of transferring multiple embryos at embryo transfer. Multiple births are related to increased risk of pregnancy loss, obstetrical complications, prematurity, and neonatal morbidity with the potential for long term damage. Strict limits on the number of embryos that may be transferred have been enacted in some countries (e.g. Britain, Belgium) to reduce the risk of high-order multiples (triplets or more), but are not universally followed or accepted. Spontaneous splitting of embryos in the womb after transfer can occur, but this is rare and would lead to identical twins. A double blind, randomised study followed IVF pregnancies that resulted in 73 infants (33 boys and 40 girls) and reported that 8.7% of singleton infants and 54.2% of twins had a birth weight of less than 2,500 grams (5.5 lb).[35]
In the United States, expect to spend an average of $12,400 for one cycle of IVF if you're using your own eggs and your partner's sperm. The amount you'll pay depends on how much medicine you need, where you live, and whether your state mandates insurance coverage for fertility treatments. If your insurance doesn't cover them, you'll probably have to pay the entire cost up front.
Time. The factor of time cuts both ways when you are weighing up these two options. IUI is a much shorter process than IVF, so if your first cycle is successful, it could be the quickest route to bringing home a baby. However, because of the gap in success rates between the two treatments, some patients in their late 30s to early 40s may get pregnant faster by going directly to IVF rather than waiting until they have had several failed IUI cycles.
The Catholic Church opposes all kinds of assisted reproductive technology and artificial contraception, on the grounds that they separate the procreative goal of marital sex from the goal of uniting married couples. The Catholic Church permits the use of a small number of reproductive technologies and contraceptive methods such as natural family planning, which involves charting ovulation times, and allows other forms of reproductive technologies that allow conception to take place from normative sexual intercourse, such as a fertility lubricant. Pope Benedict XVI had publicly re-emphasised the Catholic Church's opposition to in vitro fertilisation, saying that it replaces love between a husband and wife.[127]
Along with being physically demanding, fertility treatments can also spark a roller-coaster of emotions each month, including hope, anger, disappointment, sadness, and guilt. Just the sight of a pregnant woman can evoke strong negative and stressful feelings. During this time, those struggling with infertility may pull away from friends and family who remind them of their difficulty with reproduction; some of their closest relationships may suffer.

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.
A closer look at the data suggest that the benefit of letrozole over clomid depended on the BMI of the participants. For patients with a BMI of less than 30 kg/m2, the cumulative live birth rate was approximately 30% for each group. However, for patients with a BMI over 30 kg/m2, twice as many patients had a live birth in the letrozole group than the clomid group.

Along with being physically demanding, fertility treatments can also spark a roller-coaster of emotions each month, including hope, anger, disappointment, sadness, and guilt. Just the sight of a pregnant woman can evoke strong negative and stressful feelings. During this time, those struggling with infertility may pull away from friends and family who remind them of their difficulty with reproduction; some of their closest relationships may suffer.
Fertility has long been considered a “woman’s problem.” This is simply not true, and men are in fact, equally as infertile as women. Traditionally the metrics for male fertility have been mostly limited to sperm count, morphology, motility, and, occasionally, DNA fragmentation. For females, on the other hand, a vast array of tests are available. These include ultrasound, cervical position, basal body temperature, hysteroscopy, laparoscopy, cycle tracking and a diversity of hormonal tests.
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.

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.

• Male factors causing infertility. Male infertility is due to the reduced number of sperms or low-quality sperms. In such cases, TESE is performed in which by making a small incision single sperm is extracted from the testis and is injected through intracytoplasmic sperm injections (ICSI) directly into a mature egg. This ICSI-IVF enabled method can help you achieve pregnancy.
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.

Having no period means ovulation isn’t taking place at all, so a pregnancy can’t happen because no eggs is making itself eligible to be fertilized. Similarly, having irregular periods makes achieving pregnancy difficult, because it’s hard to time intercourse properly -- if sperm and egg aren’t at the same place at the same time, there is no chance of pregnancy.
Within the Orthodox Jewish community the concept is debated as there is little precedent in traditional Jewish legal textual sources. Regarding laws of sexuality, religious challenges include masturbation (which may be regarded as "seed wasting"[129]), laws related to sexual activity and menstruation (niddah) and the specific laws regarding intercourse. An additional major issue is that of establishing paternity and lineage. For a baby conceived naturally, the father's identity is determined by a legal presumption (chazakah) of legitimacy: rov bi'ot achar ha'baal – a woman's sexual relations are assumed to be with her husband. Regarding an IVF child, this assumption does not exist and as such Rabbi Eliezer Waldenberg (among others) requires an outside supervisor to positively identify the father.[133] Reform Judaism has generally approved IVF.[129]
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.

Advanced technologies add to your IVF bill but may also make a huge difference to your success rate. Pre-implantation genetic screening (PGS) can improve implantation rate by selectively transferring genetically normal embryos. For couples with male factor infertility, Intracytoplasmic sperm injection (ICSI) can help deliver a sperm directly into the egg. Nevertheless, ICSI only improves success rate in couples with severe male infertility.

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.

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.
Infertility may have psychological effects. Partners may become more anxious to conceive, increasing sexual dysfunction.[17] Marital discord often develops, especially when they are under pressure to make medical decisions. Women trying to conceive often have depression rates similar to women who have heart disease or cancer.[18] Emotional stress and marital difficulties are greater in couples where the infertility lies with the man.[19]
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]
The Rand Consulting Group has estimated there to be 400,000 frozen embryos in the United States in 2006.[83] The advantage is that patients who fail to conceive may become pregnant using such embryos without having to go through a full IVF cycle. Or, if pregnancy occurred, they could return later for another pregnancy. Spare oocytes or embryos resulting from fertility treatments may be used for oocyte donation or embryo donation to another woman or couple, and embryos may be created, frozen and stored specifically for transfer and donation by using donor eggs and sperm. Also, oocyte cryopreservation can be used for women who are likely to lose their ovarian reserve due to undergoing chemotherapy.[84]

Male infertility may be caused by trouble with sperm delivery due to structural difficulties like testicle blockage or damage to the reproductive organs, sexual function concerns such as premature ejaculation, or genetic conditions including cystic fibrosis. Another root of male infertility may be abnormal sperm function or production, often due to genetic defects or health problems including diabetes or certain sexually transmitted diseases. Other risk factors include overexposure to certain environmental factors, such as alcohol, cigarette or marijuana smoke, chemicals, and pesticides, as well as frequent exposure to high temperatures (hot tubs and saunas). Specific cancers and their treatments can also be harmful to male fertility.


IVF Michigan Fertility Centers, one of the leading fertility clinics in the world, provides a wide variety of infertility treatments as well as in vitro-related procedures. With over 60 years of collective experience and locations in Bloomfield Hills, Ann Arbor, Dearborn, East Lansing, Macomb, Petoskey, Cheboygan, Saginaw and Toledo, Ohio, the fertility experts at IVF Michigan Fertility Center are available to help couples throughout the Midwest and abroad. Treatment options available at IVF Michigan Fertility Center include IVF-ICSI, IUI (artificial insemination), gender selection, comprehensive chromosomal screening through PGT, screening for hereditary diseases through PGT-M, diagnosis of and treatment for male infertility, egg donation, fertility preservation and much more.
The Rand Consulting Group has estimated there to be 400,000 frozen embryos in the United States in 2006.[83] The advantage is that patients who fail to conceive may become pregnant using such embryos without having to go through a full IVF cycle. Or, if pregnancy occurred, they could return later for another pregnancy. Spare oocytes or embryos resulting from fertility treatments may be used for oocyte donation or embryo donation to another woman or couple, and embryos may be created, frozen and stored specifically for transfer and donation by using donor eggs and sperm. Also, oocyte cryopreservation can be used for women who are likely to lose their ovarian reserve due to undergoing chemotherapy.[84]
More doctors are suggesting having just one embryo transferred and then freezing the rest. This is known as elective single embryo transfer (eSET), and it can reduce your risk of a multiple pregnancy. When you get pregnant with just one healthy baby, you reduce your risks for pregnancy complications. Speak to your doctor to find out if elective single embryo transfer is best for you.
Progesterone elevation on the day of induction of final maturation is associated with lower pregnancy rates in IVF cycles in women undergoing ovarian stimulation using GnRH analogues and gonadotrophins.[23] At this time, compared to a progesterone level below 0.8 ng/ml, a level between 0.8 and 1.1 ng/ml confers an odds ratio of pregnancy of approximately 0.8, and a level between 1.2 and 3.0 ng/ml confers an odds ratio of pregnancy of between 0.6 and 0.7.[23] On the other hand, progesterone elevation does not seem to confer a decreased chance of pregnancy in frozen–thawed cycles and cycles with egg donation.[23]
Post transfer – You’ll likely take progesterone and estrogen to improve implantation and pregnancy rates. If the transfer is successful, a blood pregnancy test will be positive in 10-14 days. From there, ultrasounds are used to ensure the implantation site as well as check for a heartbeat. The good news is that once a heartbeat is detected, the pregnancy has a 90-95% probability of the pregnancy resulting in a live birth.
The number to be transferred depends on the number available, the age of the woman and other health and diagnostic factors. In countries such as Canada, the UK, Australia and New Zealand, a maximum of two embryos are transferred except in unusual circumstances. In the UK and according to HFEA regulations, a woman over 40 may have up to three embryos transferred, whereas in the US, there is no legal limit on the number of embryos which may be transferred, although medical associations have provided practice guidelines. Most clinics and country regulatory bodies seek to minimise the risk of multiple pregnancy, as it is not uncommon for multiple embryos to implant if multiple embryos are transferred. Embryos are transferred to the patient's uterus through a thin, plastic catheter, which goes through her vagina and cervix. Several embryos may be passed into the uterus to improve chances of implantation and pregnancy.
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.
Along with being physically demanding, fertility treatments can also spark a roller-coaster of emotions each month, including hope, anger, disappointment, sadness, and guilt. Just the sight of a pregnant woman can evoke strong negative and stressful feelings. During this time, those struggling with infertility may pull away from friends and family who remind them of their difficulty with reproduction; some of their closest relationships may suffer.
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