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).
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.
Vibratory stimulation or electric ejaculation: Vibratory stimulation is a painless and non-sedative procedure adapted to collect the sperms of men with spinal cord injuries who cannot experience natural ejaculation. Electric ejaculation is used for men who do not respond to vibratory stimulation process. The collected sperm is then transferred to the woman’s uterus for fertilization.
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.

Risk of multiples. IUI with fertility medication carries a significant risk of multiple pregnancies, including higher-order multiples (triplets or more). A good clinic will carefully monitor your follicles to make sure that only a safe number are mature before the IUI, but they cannot entirely eliminate the risk. Recent advances in IVF (including blastocyst transfer) mean that most modern fertility clinics now transfer only one or two embryos per IVF cycle. As a result, the risk of multiple pregnancies for IVF patients is much lower than it used to be.

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]


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.
Studies have indicated that IVF mothers show greater emotional involvement with their child, and they enjoy motherhood more than mothers by natural conception. Similarly, studies have indicated that IVF father's express more warmth and emotional involvement than fathers by adoption and natural conception and enjoy fatherhood more. Some IVF parents become overly involved with their children.[136]
The stress of secondary infertility on an individual's life and relationships can be significant. It can be hard to find support from family and friends, especially when a woman or couple already has/have children. Sentiments such as, "you should be grateful for what you have," or, "just keep trying," almost never serve as useful advice or support. Couples and single parents can even experience resentment from other couples with infertility who are unable to even have their first child.
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]
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.
Our specialized team of andrologists prepare each sperm sample with a procedure commonly known as "sperm washing" in one of our andrology laboratories. Sperm washing involves placing the sperm sample in a test tube and then a centrifuge, which results in the sperm collecting in a "pellet" at the bottom of the test tube. The andrologist removes the seminal fluid and places the fluid (media) above the sperm. The most active sperm will then swim up into the media. The final sample consists of the most active sperm concentrated in a small volume of media. A single IUI is usually performed when a patient is using fresh sperm. If a patient is using a frozen sperm sample, the clinician can likely perform one or two IUIs.
The eggs are retrieved in a simple process which takes about 15-20 minutes and is carried out in the doctor’s office under light sedation. The ovaries are accessed through the vaginal cavity and each of the follicles containing an egg is punctured. The fluid containing the eggs is aspirated through a very fine needle. The patient rests for a brief time and can then go home with an escort. Usually, the patient feels back to normal the day after.
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.
Bloating: Fertility medications can heavily impact how your body retains water, leading to the dreaded side effect of bloating. This is especially common in your midsection, where fluid can build up near the ovaries (creating abdominal tenderness, too). You can combat bloating by increasing your fluid intake and participating in light exercise such as walking.
Fertility preservation for cancer or other health conditions. If you're about to start cancer treatment — such as radiation or chemotherapy — that could harm your fertility, IVF for fertility preservation may be an option. Women can have eggs harvested from their ovaries and frozen in an unfertilized state for later use. Or the eggs can be fertilized and frozen as embryos for future use.

In order for pregnancy to happen, sperm has to meet the egg. This normally takes place at the end of the fallopian tube, and this is called fertilization. There are a number of obstacles that can prevent this from happening, and the process itself even in healthy young fertile women is very complex- hence the low pregnancy rate each month. Obstacles such as cycle timing, low sperm count, poor sperm motility, blocked fallopian tubes, or endometriosis must be overcome to achieve a pregnancy. Timing is often the most common obstacle to conception. What does it mean for you when common causes of infertility are ruled out and you’re told you have unexplained infertility? It should mean a time of hope.
In the well-established fertility treatment of IVF, unlike IUI, the meeting of sperm and egg takes place outside the body, in the laboratory (in vitro). This gives fertility practitioners a lot more control over the selection of a genetically normal embryo that has the best chance of establishing a successful pregnancy. IVF is the fertility treatment with the highest likelihood of taking home a healthy baby. These are the stages involved in IVF:
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.
The take home message of these studies is that when gonadotropins are given to this patient population at a dose that doesn’t put the patient at significant risk of twins (like the 75 units in the Huang study), they are no better than oral medications (clomid and letrozole) at producing successful pregnancies. This is important because clomid and letrozole are also cheaper to purchase (hundreds vs. thousands of dollars) and easier to administer (oral rather than injectable). For this reason, many clinics have moved away from using gonadotropins in IUI cycles.
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.
Dr. Gorka Barrenetxea provides us with a practical case of secondary infertility that occurs more commonly than one may think. A couple, throughout their lifetime, can have children with 20, 25, 30 and 35 years, but when they decide to have a second or third child, they may encounter trouble conceiving due to the passage of time itself, Dr. Barrenetxea states.
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

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.

That’s about the time frame women between the ages of 35 and 40 should give themselves, before discussing fertility concerns with their doctor. For women under 35, experts recommend trying for about a year—really trying, as in unprotected, well-timed intercourse—before having any testing or treatment; women over 40 may want to consult an obstetrician/gynecologist right away. See your doctor sooner than later if you’ve suffered multiple miscarriages, have a history of pelvic inflammatory disease (a serious complication of some STDs), or experience any other symptoms of infertility. Meanwhile, learn these infertility myths you don’t have to worry about.
The second study by Huang et al. demonstrated nearly equivalent pregnancy rates between the three medications. Furthermore, the twin risk was not significantly elevated in any of the three groups. The key difference between these studies is that the dose of gonadotropins was higher in the AMIGOS study (150 units) than the Huang study (75 units). A higher dose often means more eggs ovulated and a greater risk of twins or more.
The diagnosis is one of exclusion — that is, one which is made only after all the existing tests have been performed and their results found to be normal. This is why the frequency of this diagnosis will depend upon how many tests are done by the clinic — the fewer the tests, the more frequent this diagnosis. And the better the tests, the more likely you are getting a diagnosis instead of being told it's "unexplained."

Only 30 percent of patients who receive 100 mg of Clomiphene a day will produce more than three follicles. Patients that produce less than than three follicles have about half the chance of getting pregnant than those that produce greater than three follicles. Patients that receive fertility medications but do not do an insemination have only half the success rates compared to those who do.
The live birth rate is the percentage of all IVF cycles that lead to a live birth. This rate does not include miscarriage or stillbirth; multiple-order births, such as twins and triplets, are counted as one pregnancy. A 2017 summary compiled by the Society for Assisted Reproductive Technology (SART) which reports the average IVF success rates in the United States per age group using non-donor eggs compiled the following data:[10]
Regarding potential spread of HIV/AIDS, Japan's government prohibited the use of IVF procedures for couples in which both partners are infected with HIV. Despite the fact that the ethics committees previously allowed the Ogikubo, Tokyo Hospital, located in Tokyo, to use IVF for couples with HIV, the Ministry of Health, Labour and Welfare of Japan decided to block the practice. Hideji Hanabusa, the vice president of the Ogikubo Hospital, states that together with his colleagues, he managed to develop a method through which scientists are able to remove HIV from sperm.[39]
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]

Undergoing fertility treatment requires precise scheduling of frequent tests and procedures—a tricky proposition when you're a parent. "I've had to go to the doctor early in the morning three times a week for testing," says Bozinovich. "Who can you find to babysit at 7 a.m. on a weekday?" (The answer: a grandparent or, when all else fails, a nurse at the doctor's office.) Your instinct might be to keep your treatment a secret, but it can make your life easier to enlist a friend or relative to help with child care. Also, choose a doctor's office you're comfortable with. You'll be spending a lot of time there; a compassionate staff can make treatment easier.


In the natural process of conception without treatment, a woman’s ovaries produce a mature egg each month, which leaves the ovary and travels along the fallopian tube towards the uterus. Sperm that has been deposited in the vagina through intercourse travels through the cervix through the uterus and up the fallopian tube toward the egg. Millions of sperm are lost in the cervix and do not travel to the fallopian tube. When the two meet, they join to form the early stage of an embryo which then travels down the fallopian tube into the uterus. If all goes well, it will implant in the lining of the womb and pregnancy begins.
Another major cause of infertility in women may be the inability to ovulate. Malformation of the eggs themselves may complicate conception. For example, polycystic ovarian syndrome is when the eggs only partially develop within the ovary and there is an excess of male hormones. Some women are infertile because their ovaries do not mature and release eggs. In this case synthetic FSH by injection or Clomid (Clomiphene citrate) via a pill can be given to stimulate follicles to mature in the ovaries.
In December 2015, the Ontario provincial government enacted the Ontario Fertility Program for patients with medical and non-medical infertility, regardless of sexual orientation, gender or family composition. Eligible patients for IVF treatment must be Ontario residents under the age of 43 and have a valid Ontario Health Insurance Plan card and have not already undergone any IVF cycles. Coverage is extensive, but not universal. Coverage extends to certain blood and urine tests, physician/nurse counselling and consultations, certain ultrasounds, up to two cycle monitorings, embryo thawing, freezing and culture, fertilisation and embryology services, single transfers of all embryos, and one surgical sperm retrieval using certain techniques only if necessary. Drugs and medications are not covered under this Program, along with psychologist or social worker counselling, storage and shipping of eggs, sperm or embryos, and the purchase of donor sperm or eggs.[151]
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]

Although menopause is a natural barrier to further conception, IVF has allowed women to be pregnant in their fifties and sixties. Women whose uteruses have been appropriately prepared receive embryos that originated from an egg of an egg donor. Therefore, although these women do not have a genetic link with the child, they have a physical link through pregnancy and childbirth. In many cases the genetic father of the child is the woman's partner. Even after menopause the uterus is fully capable of carrying out a pregnancy.[109]
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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