While many cases of infertility remain unexplained, there may be answers in the epigenome. Unlike one’s genetic code, the epigenome is dynamic and can be modified by environmental factors and lifestyle choices. Fertility in many cases is a state which changes throughout one’s life. Given the lack of clear genetic or physiological causes of unexplained infertility, the epigenome is thought to be altered in this subset of patients. As a result, looking into the epigenetic basis of infertility can help clinicians inform treatment.
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.
Primary infertility is defined as the absence of a live birth for women who desire a child and have been in a union for at least 12 months, during which they have not used any contraceptives.[14] The World Health Organisation also adds that 'women whose pregnancy spontaneously miscarries, or whose pregnancy results in a still born child, without ever having had a live birth would present with primarily infertility'.[14]
 It is important for couples to maintain open and honest communication with each other, and to recognize that feelings can change over time. For single parents wishing to have additional children, it's also important that they try to develop a strong support system through friends and family. And, because children can pick up on their parents' stress, it is also important to pay attention to how their kids may be feeling. Children might not understand why their parents are feeling a certain way and attribute it to something they've done.  
^ Hozyasz, K (March 2001). "Coeliac disease and problems associated with reproduction". Ginekol Pol. 72 (3): 173–9. PMID 11398587. Coeliac men may have reversible infertility, and as in women, if gastrointestinal symptoms are mild or absent the diagnosis may be missed. It is important to make diagnosis because the giving of gluten free diet may result in conception and favourable outcome of pregnancy.
Those fearful of conceiving with multiples should strongly consider IVF and only transferring one embryo at a time. In these circumstances, just 1% of pregnancies lead to twins, and triplets are even more rare. Alternatively, 8 - 30% of medicated IUI pregnancies lead to twins. Finally, the least preferable circumstance is do to IVF with multiple embryo transfer, where in women under 38 years of age, 30% of pregnancies culminate in a multiple birth.
Nonmedicated cycle with IUI: Also known as natural cycle IUI, a non-medicated cycle with IUI is often used by single women or same-sex female couples who are not directly experiencing infertility, but rather a lack of sperm. This treatment involves tracking the development of the egg that is naturally recruited during a menstrual cycle and then introducing the donated sperm. You will come into the office for two to four monitoring appointments to track egg development and cycle timing.
Previous tests should be carefully reviewed to ensure that the diagnosis is, in fact, "unexplained," and that no test has been omitted or missed. It may sometimes be necessary to repeat certain investigations. For example, if a previous laparoscopy has been done by a single puncture and reported as normal, it may be necessary to repeat the laparoscopy with a double puncture, to look for early endometriosis. 
Spend quality time with your child. In the midst of your infertility problems, you may feel especially upset about shifting your focus from the child you already have to the child you’re longing to have in the future. You may even feel guilty about your inability to give your little one a sibling or about the sadness you are sure is spilling over into her life. The best thing you can do for your child in this situation is to keep life as normal as possible, and ideally, find some quality time to be together. Whether it’s a chat about her day before you tuck her into bed or an afternoon romp in the park, those rituals will go a long way toward keeping your tot’s world stable and happy — even if you sometimes feel your world is spinning out of control. (You might find that focusing on your child lets you live in the moment — at least for a little while — which can help you cope with secondary infertility.) If you’re in a particularly bad place and fear that you may have a hard time handling your true emotions in front of your child (say, your pregnancy test just came up negative for the zillionth time in a row), see if you can arrange to send her to a friend’s house, or enlist your partner or mother-in-law to take over for a bit. Allowing yourself the time to compose yourself can make it much easier to face your little pride and joy with a smile.
Ovarian reserve testing. To determine the quantity and quality of your eggs, your doctor might test the concentration of follicle-stimulating hormone (FSH), estradiol (estrogen) and anti-mullerian hormone in your blood during the first few days of your menstrual cycle. Test results, often used together with an ultrasound of your ovaries, can help predict how your ovaries will respond to fertility medication.
Assisted hatching. About five to six days after fertilization, an embryo "hatches" from its surrounding membrane (zona pellucida), allowing it to implant into the lining of the uterus. If you're an older woman, or if you have had multiple failed IVF attempts, your doctor might recommend assisted hatching — a technique in which a hole is made in the zona pellucida just before transfer to help the embryo hatch and implant. Assisted hatching is also useful for eggs or embryos that have been previously frozen as the process can harden the zona pellucida.
I conceived my first child, a son, with no trouble at all. When he was two, we thought we might have another. A year or so later, when nothing had happened, we saw a fertility specialist, who gave us every test there was. We passed each one, as the consultant put it, "with flying colours". Which left us relieved but also confounded. All I had was a new adjective to add to my diagnosis: Unexplained Secondary Infertility.
IVF success rates are the percentage of all IVF procedures that result in a favourable outcome. Depending on the type of calculation used, this outcome may represent the number of confirmed pregnancies, called the pregnancy rate, or the number of live births, called the live birth rate. The success rate depends on variable factors such as maternal age, cause of infertility, embryo status, reproductive history, and lifestyle factors.
A doctor or WHNP takes a medical history and gives a physical examination. They can also carry out some basic tests on both partners to see if there is an identifiable reason for not having achieved a pregnancy. If necessary, they refer patients to a fertility clinic or local hospital for more specialized tests. The results of these tests help determine the best fertility treatment.
It was an awesome feeling when i found out that i am pregnant, i could not believe myself, after trying for 5 years now, finally i have been able to be called a proud mother of my baby boy. my husband is glad too, by standing by my side all through the struggles of infertility with strong feeling we will achieve this together. i am giving this hint to couples who are struggling with infertility, your time as come as well, with the help of Dr Micheal Casper pregnancy prescription medicine, herbal remedy, which i myself use to get pregnant with few weeks of using it as directed by the doctor. you can also have a child to call your own. this is the doctor contact [email protected]
The first successful birth of a child after IVF treatment, Louise Brown, occurred in 1978. Louise Brown was born as a result of natural cycle IVF where no stimulation was made. The procedure took place at Dr Kershaw's Cottage Hospital (now Dr Kershaw's Hospice) in Royton, Oldham, England. Robert G. Edwards was awarded the Nobel Prize in Physiology or Medicine in 2010, the physiologist who co-developed the treatment together with Patrick Steptoe and embryologist Jean Purdy; Steptoe and Purdy were not eligible for consideration as the Nobel Prize is not awarded posthumously.[1][2]

Dr. Ajay Murdia is a renowned Doctor whose research has been published in a well-known medical journal called "The Lancent" in the UK. With a vision to eradicate infertility from India, Dr. Ajay Murdia established Indira Infertility Clinic in the year 1988. Initially, the main focus of Indira Infertility Clinic was male infertility, although now it aims to provide advanced fertility center across India for both men and women.
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.
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.
Talk it out. Once you realize you’re entitled to your emotions, find an outlet for them. Talking about your feelings and your struggles can be a huge release and allow you to receive the support you need. If your family or friends don’t understand your sadness (or you find it hard to contain your baby envy around friends with more than one child), seek out people in your same situation. Find a support group for people with secondary infertility — online or in your area. And consider joining WTE's Trying to Conceive group to find moms who are also coping with secondary infertility.
An IUI procedure is the process of directly injecting sperm into the top of the uterus. This increases the odds of conception by reducing the distance the sperm must travel to meet the egg. That said, when most people talk about IUIs, they’re referring to the steps leading up to and after the actual procedure. An IUI treatment can be summarized into a few steps:
Secondary infertility is similar to other types of infertility and shares many of the same signs. However, in secondary infertility you’re unable to conceive or carry a baby to full-term after having a previous successful pregnancy. Infertility can be caused by either the man or woman. Treatment options can include medications to induce ovulation, in vitro fertilization (IVF) or surgery.
In the laboratory, for ICSI treatments, the identified eggs are stripped of surrounding cells (also known as cumulus cells) and prepared for fertilisation. An oocyte selection may be performed prior to fertilisation to select eggs that can be fertilized, as it is required they are in metaphase II. There are cases in which if oocytes are in the metaphase I stage, they can be kept being cultured so as to undergo a posterior sperm injection. In the meantime, semen is prepared for fertilisation by removing inactive cells and seminal fluid in a process called sperm washing. If semen is being provided by a sperm donor, it will usually have been prepared for treatment before being frozen and quarantined, and it will be thawed ready for use.
Disclaimer: The information you enter is not stored by CDC and is only used to estimate your chances of success. The IVF success estimator does not provide medical advice, diagnosis, or treatment. These estimates may not reflect your actual rates of success during ART treatment and are only being provided for informational purposes. Estimates are less reliable at certain ranges/values of age, weight, height, and previous pregnancy and ART experiences. Please see your doctor and/or healthcare provider for a personalized treatment plan that is best for you.
A risk of ovarian stimulation is the development of ovarian hyperstimulation syndrome, particularly if hCG is used for inducing final oocyte maturation. This results in swollen, painful ovaries. It occurs in 30% of patients. Mild cases can be treated with over the counter medications and cases can be resolved in the absence of pregnancy. In moderate cases, ovaries swell and fluid accumulated in the abdominal cavities and may have symptoms of heartburn, gas, nausea or loss of appetite. In severe cases patients have sudden excess abdominal pain, nausea, vomiting and will result in hospitalisation.
Endometriosis and infertility are often related, but treating this pelvic inflammatory disorder can improve your chances of pregnancy. Here’s a description of what causes endometriosis, the symptoms of endometriosis, and what to do if you suspect you have this pelvic disorder. According to Harvard Medical School, endometriosis is responsible for many cases of infertility, there… Read More »Endometriosis and Infertility – How a Pelvic Disorder Affects Pregnancy
During the second half of your menstrual cycle, the hormone progesterone kicks in to help prepare the lining of your uterus for a fertilized egg. If the egg isn't fertilized and doesn't implant, it disintegrates, progesterone levels fall, and about 12 to 16 days later, the egg -- along with blood and tissues from the lining of the uterus -- is shed from the body. That process is menstruation. It usually lasts 3 to 7 days.
As a result, most patients need to undergo multiple cycles, and as we pointed out in a another lesson, no cycle is as likely to succeed as the first one. Below is data out of the UK published in the Journal of The American Medical Association that illustrates that after a few cycles most younger patients succeed with IVF but that is not necessarily true for older patients.

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.
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. 

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.
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]
Egg Development – This step is either part of the woman’s natural egg development or stimulated with medications and lasts roughly 5-14 days. Once your follicles are optimal size, a trigger medication may be given to finalize egg maturation and trigger ovulation. This phase of egg development may or may not be accompanied by ultrasound and bloodwork monitoring.
A doctor or WHNP takes a medical history and gives a physical examination. They can also carry out some basic tests on both partners to see if there is an identifiable reason for not having achieved a pregnancy. If necessary, they refer patients to a fertility clinic or local hospital for more specialized tests. The results of these tests help determine the best fertility treatment.
Unlike the simpler process of artificial insemination -- in which sperm is placed in the uterus and conception happens otherwise normally -- IVF involves combining eggs and sperm outside the body in a laboratory. Once an embryo or embryos form, they are then placed in the uterus. IVF is a complex and expensive procedure; only about 5% of couples with infertility seek it out. However, since its introduction in the U.S. in 1981, IVF and other similar techniques have resulted in more than 200,000 babies.
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]
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]
Luteal phase abnormalities: The luteal phase is the part of the cycle that follows the release of the egg from the ovary. It may be inadequate in one way and this is called a luteal phase defect. The corpus luteum produces the hormone progesterone. Progesterone is essential for preparing the endometrium to receive the fertilized egg. Several things can go wrong with progesterone production: the rise in output can be too slow, the level can be too low, or the length of time over which it is produced can be too short. Another possibility is a defective endometrium that does not respond properly to the progesterone. Luteal phase defects can be investigated either by a properly timed endometrial biopsy or by monitoring the progesterone output by taking a number of blood samples on different days after ovulation and measuring the progesterone level. 
West states that the "hardest thing about secondary fertility issues is that you want a sibling for your child." Fiona, who has a son of five and has been trying to conceive a second child for two years, says she can no longer look out of the window at her son playing in the garden. "It breaks my heart. He just looks so alone out there. All I want is a sibling for him but I don't think it's going to happen."
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.

Cancer. Although some early studies suggested there may be a link between certain medications used to stimulate egg growth and the development of a specific type of ovarian tumor, more-recent studies do not support these findings. There does not appear to be a significantly increased risk of breast, endometrial, cervical or ovarian cancer after IVF.
Alcoholism is a disease that includes alcohol craving and continued drinking despite repeated alcohol-related problems, such as losing a job or getting into trouble with the law. It can cause myriad health problems, including cirrhosis of the liver, birth defects, heart disease, stroke, psychological problems, and dementia. Counseling and a few medications can be effective for alcoholism treatment.
The grief and anxiety of SI is, of course, self-perpetuating. You find yourself in a double-bind: you're constantly told that the chances of conceiving are maximised if you can relax and eliminate stress, but it's hard to let go of something so all-consuming, so elemental, as infertility. People were always saying to me: "If you just forgot about it, you'd get pregnant straight away." For the record, this is the most unhelpful thing you can say to someone with fertility problems. West explains that "couples become more and more anxious about the gap [between children]".
One in 8 couples (or 12% of married women) have trouble getting pregnant or sustaining a pregnancy. Infertility is defined as the inability to get pregnant after regular sexual intercourse without the use of any contraceptive methods for 6 months for those 35 years old or over, or 12 months for those under 35.(1)  Under normal circumstances the ability to get pregnant is at the most 25% each month. This number declines over time and starts to decline more rapidly once a women reaches her thirties, so that by age 35, the likelihood of getting pregnant each month is down to about 15%, and by age 40 it’s down to less than 10%.
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.
Around one in 7 couples that require artificial reproductive treatment (ART) have "unexplained" infertility and doctors often first use approaches like ensuring the female partner's ovulation occurs at the same time as natural sex or artificial insemination/intrauterine insemination (IUI). They may then recommend IVF where thousands of the male partner's best sperm are purified and incubated with the egg — this is the preferred initial ART procedure in cases of "unexplained" infertility.
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After a year of trying to conceive, couples should consider infertility as a possible reason and seek professional help. Women actively trying to get pregnant may wish to consult a doctor earlier if they are over the age of 40, have irregular or painful periods, have a history of miscarriages, have been diagnosed with pelvic inflammatory disease or endometriosis, or have been treated for cancer.
Benign uterine growths are tissue enlargements of the female womb (uterus). Three types of benign uterine growths are uterine fibroids, adenomyosis, and uterine polyps. Symptoms include abdominal pressure and pain, pelvic pain, pain during intercourse, and pain during bowel movements. Diagnosis and treatment of benign uterine growths depends upon the type of growth.
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.

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.
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