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.
This tool is also very useful because it also provides you with an indication of the risk/reward of doing two single embryo transfers, vs using multiple embryos in your first transfer. Using only one embryo at a time when doing IVF pretty much eliminates the risk of having twins, however it can be more expensive doing it this way making it a tough decision for many couples. The SART IVF success rate predictor tool can help you quantify these risks for your personal set of circumstances.
By 2012 Costa Rica was the only country in the world with a complete ban on IVF technology, it having been ruled unconstitutional by the nation's Supreme Court because it "violated life."[177] Costa Rica had been the only country in the western hemisphere that forbade IVF. A law project sent reluctantly by the government of President Laura Chinchilla was rejected by parliament. President Chinchilla has not publicly stated her position on the question of IVF. However, given the massive influence of the Catholic Church in her government any change in the status quo seems very unlikely.[178][179] In spite of Costa Rican government and strong religious opposition, the IVF ban has been struck down by the Inter-American Court of Human Rights in a decision of 20 December 2012.[180] The court said that a long-standing Costa Rican guarantee of protection for every human embryo violated the reproductive freedom of infertile couples because it prohibited them from using IVF, which often involves the disposal of embryos not implanted in a patient's uterus.[181] On 10 September 2015, President Luis Guillermo Solís signed a decree legalising in-vitro fertilisation. The decree was added to the country's official gazette on 11 September. Opponents of the practice have since filed a lawsuit before the country's Constitutional Court.[182]
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.

The main durations of embryo culture are until cleavage stage (day two to four after co-incubation) or the blastocyst stage (day five or six after co-incubation).[71] Embryo culture until the blastocyst stage confers a significant increase in live birth rate per embryo transfer, but also confers a decreased number of embryos available for transfer and embryo cryopreservation, so the cumulative clinical pregnancy rates are increased with cleavage stage transfer.[30] Transfer day two instead of day three after fertilisation has no differences in live birth rate.[30] There are significantly higher odds of preterm birth (odds ratio 1.3) and congenital anomalies (odds ratio 1.3) among births having from embryos cultured until the blastocyst stage compared with cleavage stage.[71]


In the UK, previous NICE guidelines defined infertility as failure to conceive after regular unprotected sexual intercourse for two years in the absence of known reproductive pathology.[11] Updated NICE guidelines do not include a specific definition, but recommend that "A woman of reproductive age who has not conceived after 1 year of unprotected vaginal sexual intercourse, in the absence of any known cause of infertility, should be offered further clinical assessment and investigation along with her partner, with earlier referral to a specialist if the woman is over 36 years of age."[12]
The Catholic Church opposes all kinds of assisted reproductive technology and artificial contraception, on the grounds that they separate the procreative goal of marital sex from the goal of uniting married couples. The Catholic Church permits the use of a small number of reproductive technologies and contraceptive methods such as natural family planning, which involves charting ovulation times, and allows other forms of reproductive technologies that allow conception to take place from normative sexual intercourse, such as a fertility lubricant. Pope Benedict XVI had publicly re-emphasised the Catholic Church's opposition to in vitro fertilisation, saying that it replaces love between a husband and wife.[127]

Intrauterine insemination is the process whereby a clinician will place a concentrated specimen of sperm in your uterus. For this procedure, he or she will insert a speculum into your vagina in order to better visualize your cervix. He or she will then pass a soft, thin catheter through the cervix opening and into the uterus. The clinician will introduce the washed sperm into the uterus through this catheter. The procedure is done in our office and takes 1 to 2 minutes. It is not painful and does not require anesthesia. You can return to normal daily activities immediately after an IUI.


DNA damage reduces fertility in male sperm, as caused by oxidative DNA damage,[31] smoking,[28] other xenobiotic DNA damaging agents (such as drugs or chemotherapy)[32] or other DNA damaging agents including reactive oxygen species, fever or high testicular temperature.[33] The damaged DNA related to infertility manifests itself by the increased susceptibility to denaturation inducible by heat or acid [34] or by the presence of double-strand breaks that can be detected by the TUNEL assay.[35]
No matter how many times you've been asked, "When will you have another baby?" the query still stings. Try coming up with a quick comeback—like 'We actually love having an only child'—and commit it to memory, says Dr. Davidson. Another heartbreaker: your child's pleas for a sibling. Try, "You're so wonderful we don't need anyone besides you." Or maybe admit, "We'd like nothing more than to make you a big brother. We hope it'll happen."
3. Painful Periods: We’re not talking about normal cramping here. But, severe pain that stops you in your tracks and even causes nausea or vomiting. Alone this may not be a sign of infertility, but combined with other symptoms like pain during intercourse, blood in the urine or during bowel movements, or irregular periods, can be signs of endometriosis–a condition that accounts for 20-40% of female infertility cases.
•	Male factors causing infertility. Male infertility is due to the reduced number of sperms or low-quality sperms. In such cases, TESE is performed in which by making a small incision single sperm is extracted from the testis and is injected through intracytoplasmic sperm injections (ICSI) directly into a mature egg. This ICSI-IVF enabled method can help you achieve pregnancy.

Bachelor of Arts in Translation and Interpreting (English, Spanish, Catalan, German) from the University of Valencia (UV) and Heriot-Watt University, Riccarton Campus (Edinburgh, UK). Postgraduate Course in Legal Translation from the University of Valencia. Specialist in Medical Translation, with several years of experience in the field of Assisted Reproduction. More information about Sandra Fernández
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.
Sometimes problems getting pregnant for a second or subsequent time are related to a complication that occurred in a prior pregnancy or prior to delivery (damage to the uterus, for instance). But most often, secondary infertility is caused by the same factors that would cause primary infertility — issues like advanced age, obesity, ovulation problems and so on.
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