Mutations to NR5A1 gene encoding Steroidogenic Factor-1 (SF-1) have been found in a small subset of men with non-obstructive male factor infertility where the cause is unknown. Results of one study investigating a cohort of 315 men revealed changes within the hinge region of SF-1 and no rare allelic variants in fertile control men. Affected individuals displayed more severe forms of infertility such as azoospermia and severe oligozoospermia.[27]

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.
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.

At RMA, once the embryos reach the blastocyst stage, they are tested through a process called Preimplantation Genetic Testing for Aneuploidy (PGT-A), which lets doctors know which embryos have a normal number of chromosomes. While genetically normal embryos are much more likely to lead to pregnancy and healthy babies, the transfer of abnormal embryos will either result in no pregnancy, miscarriage, or an affected baby. While testing is occurring on a small part of the embryos, the embryos themselves are frozen, awaiting a receptive uterus. A large, prospective study performed recently at RMA confirmed that performing an embryo biopsy does not harm the embryo and does not decrease the likelihood of implantation.


Very slight elements of risk are associated with any medical intervention but for IVF the most notable risk in the past has been multiple births. The impact of multiple births on birth weight, premature delivery, and post-natal complications is well known. This is largely due to the practice over the past 30 years of transferring two or more embryos during IVF. Thanks to PGT-A testing and Single Embryo Transfer (SET), however, doctors can now feel confident about transferring just one normal embryo. At RMA, we have established SET as the standard of care going forward. With SET, the risk of multiple births is drastically reduced.

3-6 months of treatment with Clomid pills (clomiphene citrate) might improve fertility by as much as 2 times as compared to no treatment. This is a very low level infertility treatment. Infertility specialists do not usually recommend Clomid treatment( without insemination) for unexplained infertility for women over the age of about 35. Most fertility specialists do not use it (without IUI) on any couples with unexplained infertility. If a woman is already having regular periods and ovulating one egg every month, giving Clomid, which will probably stimulate the ovaries to release 2 or 3 eggs per month (instead of one) is not really fixing anything that is broken - and is not likely to be successful.

For example, a deaf British couple, Tom and Paula Lichy, have petitioned to create a deaf baby using IVF.[99] Some medical ethicists have been very critical of this approach. Jacob M. Appel wrote that "intentionally culling out blind or deaf embryos might prevent considerable future suffering, while a policy that allowed deaf or blind parents to select for such traits intentionally would be far more troublesome."[100]


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.

4. Significant Hair Growth (or Hair Loss): Polycystic ovarian syndrome causes small cysts to form on the outside of the ovaries, and it also causes the body to produce an excess of male hormones. If you notice hair growing in unusual places like your face, arms, chest or back, this could be a warning sign. On the flip side, hair loss or thinning could be a sign of other infertility related conditions like thyroid issues, anemia or autoimmune disorders.
Repeated failed rounds of IVF can help identify causes of infertility. For example, if sperm and egg quality are normal, then the conception issue may be rooted at the embryonic or implantation level. In other words, if IVF fails to result in pregnancy despite successful fertilization, embryonic development or implantation may be to blame. Still this is a very expensive way to start getting answers.
Take a look at your lifestyle. Have any of your habits changed since you conceived baby number one? For instance, is your diet still on track, or is there room for improvement? Getting your eating plan up to baby-making speed may help you close in faster on conception. Has your caffeine consumption gone up now that you’re a mom? That’s understandable, but too much caffeine isn’t great for fertility. Has your smoking habit returned? If yes, it’s time to kick butt, since smoking ages your eggs and decreases fertility. Are you getting way too little sleep? That may be likely, especially if your first child is keeping you up at night, but skimping on sleep can mess with your hormones — and possibly your fertility. If any new unhealthy habit has slipped into your lifestyle, now’s a great time to put the brakes on it. And it’s not just about your habits. Is your partner kicking back one too many beers each night? That could be affecting his sperm quality. Ditto for smoking or an unhealthy diet. If your partner’s lifestyle needs a little fine-tuning, make efforts to get his back on track, too.

I found that I couldn't avoid the sense that we were not yet all here, that there was a person missing. In one of those strange confluences, I was, at the same time, writing a novel about a woman who had just given birth. I was spending my days at the fertility clinic and my evenings writing about the strange, shadowy world of early motherhood. My husband, coming into my study and finding me in tears again, laid his hand gently on the manuscript and said, "Do you ever think that writing this book might not be helping?" But you don't choose the books; they choose you. And if I couldn't bring a baby into being in real life, I was damn well going to do it in fiction.
The main durations of embryo culture are until cleavage stage (day two to four after co-incubation) or the blastocyst stage (day five or six after co-incubation).[71] Embryo culture until the blastocyst stage confers a significant increase in live birth rate per embryo transfer, but also confers a decreased number of embryos available for transfer and embryo cryopreservation, so the cumulative clinical pregnancy rates are increased with cleavage stage transfer.[30] Transfer day two instead of day three after fertilisation has no differences in live birth rate.[30] There are significantly higher odds of preterm birth (odds ratio 1.3) and congenital anomalies (odds ratio 1.3) among births having from embryos cultured until the blastocyst stage compared with cleavage stage.[71]
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.

The Catechism of the Catholic Church, in accordance with the Catholic understanding of natural law, teaches that reproduction has an "inseparable connection" to the sexual union of married couples.[128] In addition, the church opposes IVF because it might result in the disposal of embryos; in Catholicism, an embryo is viewed as an individual with a soul that must be treated as a person.[129] The Catholic Church maintains that it is not objectively evil to be infertile, and advocates adoption as an option for such couples who still wish to have children.[130]


Fertilization. An embryologist (a scientist who specializes in eggs, sperm, and embryos) will examine your eggs before combining them with your partner's sperm and incubating them overnight. Fertilization usually happens during this time, but eggs that aren't normal may not be fertilized. (If sperm quality is poor, or if fertilization was unsuccessful during previous IVF cycles, your doctor may recommend using a technique called intracytoplasmic sperm injection (ICSI). With ICSI, a single sperm is injected directly into each mature egg.)

A 2013 review and meta analysis of randomised controlled trials of acupuncture as an adjuvant therapy in IVF found no overall benefit, and concluded that an apparent benefit detected in a subset of published trials where the control group (those not using acupuncture) experienced a lower than average rate of pregnancy requires further study, due to the possibility of publication bias and other factors.[34]

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.

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.

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