Fertility expert Zita West has noticed this increase at her London clinic. "The main reason," she explains, "is age. Women are having babies later." Exhaustion also plays a part. "The sleeplessness of life with a small child can't be underestimated," she says. "You might still be breastfeeding, you might be sharing a bed with a toddler, you might be holding down a job at the same time. Basically, there's not a lot of sex happening."

If a man and woman 35 or younger have had unprotected sex for at least 12 months (or six months if older than 35) without getting pregnant, they should suspect secondary infertility. This especially applies to women older than 30 who have experienced pelvic inflammatory disease, painful periods, irregular menstrual cycles or miscarriages, and to men with low sperm counts.


Odds of multiples. Because more than one embryo may be placed in your uterus, your chance of having twins or more is about 20 percent. Though many couples consider this a blessing, multiple fetuses increase your risk of miscarriage and other complications, such as preterm labor. Some doctors will advise you to consider selective reduction if three or more embryos implant successfully. This is a serious decision with major emotional and psychological consequences. IVF researchers are working on techniques to prevent multiple fetuses.
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.
Step on the scale. Have you put on some extra pounds since your last baby was on board? Or maybe you’ve lost a lot of weight (because after all, who has time to eat when you’re running after a little one)? Your weight can impact your fertility, so getting as close as possible to a healthy BMI can also help get you closer to that second pregnancy you’re hoping for.

Cytoplasmic transfer is where the cytoplasm from a donor egg is injected into an egg with compromised mitochondria. The resulting egg is then fertilised with sperm and implanted in a womb, usually that of the woman who provided the recipient egg and nuclear DNA. Cytoplasmic transfer was created to aid women who experience infertility due to deficient or damaged mitochondria, contained within an egg's cytoplasm.
A Cochrane review came to the result that endometrial injury performed in the month prior to ovarian induction appeared to increase both the live birth rate and clinical pregnancy rate in IVF compared with no endometrial injury. There was no evidence of a difference between the groups in miscarriage, multiple pregnancy or bleeding rates. Evidence suggested that endometrial injury on the day of oocyte retrieval was associated with a lower live birth or ongoing pregnancy rate.[30]
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.
By 2017, many centers have adopted embryo cryopreservation as their primary IVF therapy, and perform few or no fresh embryo transfers. The two main reasons for this have been better endometrial receptivity when embryos are transferred in cycles without exposure to ovarian stimulation and also the ability to store the embryos while awaiting the results of pre-implantation genetic testing.
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.
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.
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.

Epigenetic testing may allow patients to forgo the cost of multiple rounds of IVF by predicting whether embryos will fail. Equipped with this information, couples can have their IVF cycles optimized to account for embryonic versus fertilization issues. This represents a significant leap for the medical community given that 36% of couples struggling with unexplained infertility are currently over-treated.
^ Chavez-Badiola, Alejandro; Flores-Saiffe Farias, Adolfo; Mendizabal-Ruiz, Gerardo; Garcia-Sanchez, Rodolfo; Drakeley, Andrew J.; Garcia-Sandoval, Juan Paulo (10 March 2020). "Predicting pregnancy test results after embryo transfer by image feature extraction and analysis using machine learning". Scientific Reports. 10 (1): 4394. Bibcode:2020NatSR..10.4394C. doi:10.1038/s41598-020-61357-9. PMC 7064494. PMID 32157183.

Anger, sadness, and anxiety are common among parents struggling to expand their family. "Having a child already doesn't make going through infertility any easier," says Alice D. Domar, Ph.D., executive director of the Domar Center for Mind/Body Health, in Waltham, Massachusetts, and author of Conquering Infertility. Meeting with a mental-health professional or seeking out blogs and online groups for secondary infertility can help. The website of  the National Infertility Association, resolve.org, is a good place to start.

4. IVF or In-Vitro Fertilization - IVF means eggs are collected and fertilized outside the body, in a laboratory. This is followed by transferring the embryos into the uterus. This advanced technology has resulted in many successful pregnancies in women who had lost hope. During IVF - In-Vitro Fertilization, women can choose to freeze their healthy eggs 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.
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