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.

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. Adriana Iliescu held the record as the oldest woman to give birth using IVF and a donor egg, when she gave birth in 2004 at the age of 66, a record passed in 2006. After the IVF treatment some couples are able to 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]
Amenorrhea (including hypothalmic amenorrhea) is a condition in which there is an absence of menstrual periods in a woman. There are two types of amenorrhea: primary and secondary. Treatment of amenorrhea depends on the type. In primary, surgery may be an option and in secondary amenorrhea medication or lifestyle changes may be treatment options. We go over the definition of amenorrhea, causes, and treatment options for amenorrhea.
Kym Campbell is a Health Coach and PCOS expert with a strong passion for using evidence-based lifestyle interventions to manage this disorder. Kym combines rigorous scientific analysis with the advice from leading clinicians to disseminate the most helpful PCOS patient-centric information you can find online. You can read more about Kym and her team here.

Intrauterine insemination is less successful if the cause of infertility involves decreased egg quality, diseased Fallopian tubes, or endometriosis. IUI treatment cannot improve the quality of the eggs within the ovaries or repair damaged anatomical structure. As with advanced age, it may be advisable to move to IVF earlier in the treatment timeline with these diagnoses.
Intrauterine insemination (IUI) and in vitro fertilization (IVF) have been the therapeutic mainstays for those with unexplained infertility. The former involves inserting sperm directly into the uterus, while the latter works by uniting the sperm and the egg cells in a laboratory dish. IVF is expensive, but has a higher success rate. However, some patients continue to struggle and suffer the associated financial burden of repeated cycles.
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]
The treatment options for unexplained infertility are several and the treatment results are promising. Expectant management can be recommended if the woman is under 28-30 years of age and the infertility duration is less than 2-3 years. In vitro fertilization (IVF) has revolutionized the treatment of infertile couples, as well as profoundly increasing the basic understanding of human reproduction. IVF can be used as both a diagnostic and a therapeutic tool in couples with unexplained infertility. The pregnancy rates with IVF are good, at 40% per treatment cycle. In addition, the outcome of pregnancies among women with unexplained infertility is generally comparable to that of spontaneous and other pregnancies using assisted reproductive technologies.
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.
It’s not because you just ate a whole lot of greasy food (myth!). Sudden, out-of-control acne could be blamed on fluctuating hormones (from your period or menopause), a whole lot of stress, or a medication side effect. It may also be a sign of polycystic ovarian syndrome. That’s because in women with PCOS, ovaries make more androgen—the “male hormone”—than normal. Elevated levels may lead to adult acne flare-ups, as well as excessive facial or body hair, and even male-patterned baldness. These natural acne remedies may help your skin.
Success rates for IVF depend on a number of factors, including the reason for infertility, where you're having the procedure done, and your age. The CDC compiles national statistics for all assisted reproductive technology (ART) procedures performed in the U.S., including IVF, GIFT, and ZIFT, although IVF is by far the most common; it accounts for 99% of the procedures. The most recent report from 2016 found:
People who have suffered primary infertility tell me that the only way they can get by is to avoid everything and anything to do with babies. But for the secondary infertility sufferer, this is not an option. You are confronted on a daily basis at the school gates by pregnant women, people with babies, large families squashed into multiple buggies. School drop-off becomes a terrible tableau of everything you want but cannot have.

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.
Abdominal adhesions (scar tissue) bands of scar tissue that form between abdominal organs and tissues. Symptoms of abdominal adhesions are pelvic or abdominal pain. Abdominal adhesions on the intestines can cause bowel obstruction, which is a medical emergency. Treatment for abdominal adhesions is generally surgery to cut the adhesions away from the internal tissues and organs. There is no way to prevent abdominal adhesions.
Patients with hypothalamic dysfunction are not producing signals within their brains to tell the ovary to mature an egg. They are diagnosed because they have an extremely low FSH and a low LH (almost zero). Neither clomid nor letrozole will help them. For these patients, IUI must be accompanied by gonadotropin to be effective. From here on in this section, none of the data we’ll reference refers to patients with hypothalamic dysfunction.
Success rates for IVF depend on a number of factors, including the reason for infertility, where you're having the procedure done, and your age. The CDC compiles national statistics for all assisted reproductive technology (ART) procedures performed in the U.S., including IVF, GIFT, and ZIFT, although IVF is by far the most common; it accounts for 99% of the procedures. The most recent report from 2016 found:
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.
For example, untreated Celiac disease may in some cases of unexplained infertility. A 2016 reanalysis of previous research studies have found that Celiac disease may be diagnosed about six times more frequently in women with unexplained infertility compared to the general public. The study authors noted, however, that previous studies were small so it's hard to know exactly how accurate those odds are. In addition, it also appeared that women with any type of infertility were more likely to be diagnosed with celiac disease.
Treatment with Clomid tablets plus IUI improves fertility rates. For unexplained infertility, studies have shown that for women under 35, monthly success rates for Clomid plus insemination are about 10% per cycle. This pregnancy rate holds up for about 3 tries and the success rate is considerably lower after that. More about success rates with IUIs is on the insemination page and on the Clomid for unexplained infertility page. The insemination component boosts fertility more than the Clomid does - but success rates are higher when both are used together. 

There are multiple treatment options including using oral or injectable medications, intrauterine insemination (IUI), assisted reproductive technology using in vitro fertilization (IVF), or a combo of these solutions to help. A 2010 study called the FASTT trial indicated that in vitro fertilization might be the quickest and best route to pregnancy for couples with unexplained infertility.(4)
Intrauterine insemination is less successful if the cause of infertility involves decreased egg quality, diseased Fallopian tubes, or endometriosis. IUI treatment cannot improve the quality of the eggs within the ovaries or repair damaged anatomical structure. As with advanced age, it may be advisable to move to IVF earlier in the treatment timeline with these diagnoses.
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.
The educational health content on What To Expect is reviewed by our medical review board and team of experts to be up-to-date and in line with the latest evidence-based medical information and accepted health guidelines, including the medically reviewed What to Expect books by Heidi Murkoff. This educational content is not medical or diagnostic advice. Use of this site is subject to our terms of use and privacy policy. © 2020 Everyday Health, Inc
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.
However, the more you understand about what's coming next, the more in control you'll feel. While every clinic's protocol will be slightly different and treatments are adjusted for a couple's individual needs, here is a step-by-step breakdown of what generally takes place during in vitro fertilization, as well as information on the risks, costs, and what’s next if your IVF treatment cycle fails.
Regardless of pregnancy result, IVF treatment is usually stressful for patients.[42] Neuroticism and the use of escapist coping strategies are associated with a higher degree of distress, while the presence of social support has a relieving effect.[42] A negative pregnancy test after IVF is associated with an increased risk for depression in women, but not with any increased risk of developing anxiety disorders.[43] Pregnancy test results do not seem to be a risk factor for depression or anxiety among men.[43]
The cost of an IUI is almost certainly less on a per cycle basis, but because IVF has much higher success rates and IUI is a poor option for some, the higher per cycle cost of IVF can actually be more affordable in the long run – in terms of the cost to bring home a baby.  Because most successful IUIs happen in the first three or four-cycle, it eventually becomes very expensive to bring home a baby with an IUI.

IVF is complicated and, while we wish we could say that it's possible to absorb all the details during the 5 - 30 minute visits with your doctor, that's really not the case. This comprehensive guide to IVF boils down every major issue you'll encounter -- a high level overview of the IVF process, a deeper dive into the IVF process, IVF success rates and how they differ depending on diagnosis and age, the medication protocols that can be used during IVF, the choice of inseminating eggs either using ICSI fertilization or conventional insemination, the pros and cons of growing embryos to Day 3 cleavage stage or Day 5 blastocyst stage, the decisions around genetic screening of embryos, deciding which embryo to transfer, deciding how many embryos to transfer at once, the ways the IVF laboratory can impact your odds of success and the things you need to know up front to avoid going to the wrong lab for you, the risks of IVF, and the costs of IVF. We're always sure to provide details about how data might be different depending on different unique types of patients -- because in the world of fertility, it's really not one-size-fits-all. We truly believe this guide is the foundation every fertility patient should start with when they're navigating the world of treatments.
ART techniques generally start with stimulating the ovaries to increase egg production. After stimulation, the physician surgically extracts one or more eggs from the ovary, and unites them with sperm in a laboratory setting, with the intent of producing one or more embryos. Fertilization takes place outside the body, and the fertilized egg is reinserted into the woman's reproductive tract, in a procedure called embryo transfer.
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.
A woman normally produces one egg during each menstrual cycle. However, IVF requires multiple eggs. Using multiple eggs increases the chances of developing a viable embryo. You’ll receive fertility drugs to increase the number of eggs your body produces. During this time, your doctor will perform regular blood tests and ultrasounds to monitor the production of eggs and to let your doctor know when to retrieve them.
If both partners are young and healthy and have been trying to conceive for one year without success, a visit to a physician or women's health nurse practitioner (WHNP) could help to highlight potential medical problems earlier rather than later. The doctor or WHNP may also be able to suggest lifestyle changes to increase the chances of conceiving.[62]
Since most IVF cycles start with collecting a number of eggs after ovarian stimulation, you should have on average 12-15 eggs to use. This means that you do not need to use all of them for ICSI or conventional IVF. A Split-ICSI strategy incorporates both – some eggs are injected with selected sperms using ICSI, where the rest are incubated with sperm in the conventional way. Trying both provide a safety net against failed fertilization with either strategy.
1. Educating About Infertility - Educating yourself about infertility is the first step towards your treatment. We believe that educating the patients about the problem associated with their pregnancy and the available treatment options can empower them to make better choices. When you understand better about the reproductive process, you will be able to decide when to seek help. We aim to achieve a healthy pregnancy for every patient.
Clomiphene citrate (Clomid, Serophene) is a medication commonly used for the treatment of women with ovulation disorders as reflected by infrequent or irregular menstrual cycles. Clomid is a pill taken orally for 5 to 7 days, typically on day 3 of a woman’s menstrual cycle to induce ovulation. Clomid works at the level of the brain and pituitary gland and facilitates the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). FSH and LH, in turn, stimulate the ovaries to produce eggs and the ovarian hormones estradiol (E2) and progesterone (P4). The initial prescribed dosage of clomid is 50 to 100 mg (one or two tablets) daily at bedtime, or as prescribed by your physician.
Infertility is a medical condition, and a fertility specialist can help with thorough, focused examinations directed at discovering the underlying cause. For every couple that begins an evaluation, about 35% discover that there is an issue with the man which is contributing to the couple’s infertility. 50% is related to female factor while 5% is due to rare causes. The remaining 10% (1 in 5 couples) is due to unexplained infertility despite completing a full infertility work-up.(2)
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]
Today, with assisted-reproductive technology, the chance of successful treatment is very good. Intrauterine insemination with superovulation is the simplest approach since it increases the chances of the egg and sperm meeting, but some patients may also need GIFT and IVF. IVF can be helpful because it provides information about the sperm's fertilizing ability; GIFT, on the other hand, has a higher pregnancy rate and is applicable in these patients since they have normal fallopian tubes.

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]

Embryos are transferred to the uterus. Embryos that have developed from the fertilization process will be placed in the uterus, normally 3 to 5 days after retrieval, so that they can embed. If this process is successful, pregnancy will occur and IVF is considered a success. If it’s not, you may use a frozen embryo that you have saved from a previous round of IVF to try again.


In 2006, Canadian clinics reported a live birth rate of 27%.[11] Birth rates in younger patients were slightly higher, with a success rate of 35.3% for those 21 and younger, the youngest group evaluated. Success rates for older patients were also lower and decrease with age, with 37-year-olds at 27.4% and no live births for those older than 48, the oldest group evaluated.[12] Some clinics exceeded these rates, but it is impossible to determine if that is due to superior technique or patient selection, since it is possible to artificially increase success rates by refusing to accept the most difficult patients or by steering them into oocyte donation cycles (which are compiled separately). Further, pregnancy rates can be increased by the placement of several embryos at the risk of increasing the chance for multiples.


It is possible that a significant contributor to unexplained infertility can be attributed to changes in sperm epigenetics. Methylation patterns in sperm DNA which affect the expression of various genes may be the missing link for this unique patient population. By employing epigenetic analysis, we may be able to identify more causes of infertility and suggest the optimal course of therapy. Preliminary evidence even suggests that these epigenetic signatures influence the probability of conception, embryogenesis, and successful carrying of pregnancy to term. Future research on sperm epigenetics holds the promise of revolutionizing reproductive medicine and empowering patients in the process.
For most couples having difficulty achieving a pregnancy their chance of achieving a pregnancy is not zero, it is just lower than the average rate of conception—unless both Fallopian tubes are completely blocked, there is no sperm, or the woman never ovulates. Ovulation induction (or superovulation) with IUI helps patients to achieve pregnancy rates closer to the natural per cycle chance of pregnancy for women in their age group who do not have infertility (see fig 1).
Ovarian stem cells: it is thought that women have a finite number of follicles from the very beginning. Nevertheless, scientists have found these stem cells, which may generate new oocytes in postnatal conditions.[67] Apparently there are only 0.014% of them (this could be an explanation of why they were not discovered until now).[citation needed] There is still some controversy about their existence, but if the discoveries are true, this could be a new treatment for infertility.
Are you infertile, or just having trouble getting pregnant? If you go to the doctor, here’s how a diagnosis of infertility will happen. “Infertility” is a term that describes when a couple is unable to conceive a child after a year of having sex without birth control. In women who are older than age 35, infertility… Read More »How Doctors Diagnose Infertility
Secondary infertility is the inability to become pregnant or carry a pregnancy to term after you’ve already had a baby, and it's more common than you might think, accounting for about 50 percent of infertility cases. In fact, more couples experience secondary infertility than primary infertility (infertility the first time around). It’s especially common in women who wait until their late 30s or even 40s, when fertility takes a nosedive, to have their second babies.
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.
^ 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.
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.
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