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.
Couples experiencing infertility have a range of treatment options. Women can take fertility drugs to stimulate ovulation, or undergo certain surgeries and procedures, like intrauterine insemination, which carefully places healthy sperm in the uterus right before an egg is released to increase the chances of fertilization. Men can also take fertility medication or undergo surgery to increase the chances of conception.
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. 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. 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.
Intercourse must take place frequently, particularly before and around the time of ovulation, and the couple must have been trying to conceive for at least one year (6 months if the woman is over 35 years old). Using these criteria, about 10-20% of all infertile couples have unexplained infertility. However, the percentage of couples classified as having unexplained infertility will depend upon the thoroughness of testing and the sophistication of medical technology.
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.
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.
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. Single women are treated, and embryo adoption is allowed. There are also private clinics that offer the treatment for a fee.
A genetic disorder. If you or your partner is at risk of passing on a genetic disorder to your child, you may be candidates for preimplantation genetic testing — a procedure that involves IVF. After the eggs are harvested and fertilized, they're screened for certain genetic problems, although not all genetic problems can be found. Embryos that don't contain identified problems can be transferred to the uterus.