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One of the biggest challenges is balancing enjoying the child you have with wondering if you'll ever get the larger family you want. "I watched my daughter take her first steps and thought, 'Maybe I'll never have this again,'"‰'' Bozinovich says. (Her problem was never pinpointed, but, happily, she went on to have two more children.) That is tough, the experts agree. "Worrying about what's happening next robs you of the pleasure of the moment," says Dr. Davidson. "It's not easy, but counseling and talking yourself through the rough moments can help you say, 'I'm doing the best I can, and meanwhile I'm living my life.'"‰"
Acknowledge your feelings. When dealing with secondary infertility, it’s very common to feel shock or denial. After all, making one baby might have been a piece of cake for you, so you probably assumed that having a second one would be easy, too. Your friends and even your doctor may also downplay your current infertility problems (telling you not to take it so hard or to “just keep trying”) since you had no trouble before. But secondary infertility is much more common than most people realize. So allow yourself the chance to accept the idea that you may be battling secondary infertility — because once you do, you can tackle the problem head-on.
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:
^ 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.
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.
After your body releases an egg, the hormone progesterone kicks in to build and maintain the lining of the uterus. It makes your body temperature go up slightly. So taking your temperature with a basal thermometer every morning before you get out of bed can help you figure out if you ovulated. You can buy these thermometers at the drugstore. They're inexpensive, but they aren't as accurate as other ways of tracking ovulation.
On or after the day of your retrieval, and before the embryo transfer, you'll start giving yourself progesterone supplements. Usually, the progesterone during IVF treatment is given as an intramuscular self-injection as progesterone in oil. (More shots!) Sometimes, though, progesterone supplementation can be taken as a pill, vaginal gel, or vaginal suppository.
IVF increasingly appears on NHS treatments blacklists.[160] In August 2017 five of the 208 CCGs had stopped funding IVF completely and others were considering doing so.[161] By October 2017 only 25 CCGs were delivering the three recommended NHS IVF cycles to eligible women under 40.[162] Policies could fall foul of discrimination laws if they treat same sex couples differently from heterosexual ones.[163] In July 2019 Jackie Doyle-Price said that women were registering with surgeries further away from their own home in order to get around CCG rationing policies.[164]
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.
Bachelor's Degree in Medicine & Surgery from the University of Navarra, with specialty in Obstetrics and Gynecology from the University of the Basque Country. He has over 30 years of experience in the field and works as a Titular Professor at the University of the Basque Country and the Master's Degree in Human Reproduction of the Complutense University of Madrid. Vice-president of the SEF. More information about Gorka Barrenetxea Ziarrusta

The diagnosis of infertility is often very overwhelming for patients. There is a plethora of information served to them. First is, they can conceive a child only through medical treatment. Second is, the insurmountable amount of information that is hard to comprehend. New medical jargon along with recommendations for treatments and tests that are completely unfamiliar can be very intimidating for the newly diagnosed. Indira IVF's Reproductive Specialists believe in creating a partnership with the patient, and we have found that the most successful partnerships occur when the patient is well-informed and can play an active role in their treatment. We value an open and ethical relationship with each patient in an environment that fosters trust and mutual respect, an environment where questions are welcome and encouraged.
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.

Impaired sperm production or function. Below-average sperm concentration, weak movement of sperm (poor mobility), or abnormalities in sperm size and shape can make it difficult for sperm to fertilize an egg. If semen abnormalities are found, your partner might need to see a specialist to determine if there are correctable problems or underlying health concerns.
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]
Success rates for IVF also vary according to individual circumstances, with the most significant factor again being the age of the woman. At RMA, the likelihood of live birth after transfer of a single, genetically normal blastocyst is 60-65% on average. It is a legal requirement in the US for success rates of fertility clinics to be reported to the CDC. This includes live birth rates and other outcomes. The Society for Assisted Reproductive Technology also reports on these statistics. All of our RMA clinics report their results individually and you can check them in the published data. You should remember that results for different clinics are not always comparable with each other because of differences in the patient base.
Embryo donation is the least expensive of the donor options. It's often cheaper than a regular IVF cycle. An embryo donor cycle costs anywhere between $5,000 and $7,000. This is assuming the embryo has already been created. (As opposed to choosing an egg donor and sperm donor and having the embryo created specifically for your cycle, which would be extremely expensive.)
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.
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:
Treating secondary infertility, like primary infertility, will depend largely on any underlying medical conditions. Through the Couples Clinic at UW Health's Generations Fertility Care, both members of the couple undergo a routine evaluation. Since infertility is not simply a woman's problem, evaluating both members ensures the most effective treatments can be recommended.  
In July 1978, Louise Brown was the first child successfully born after her mother received IVF treatment. 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 co-developed the treatment together with Patrick Steptoe and embryologist Jean Purdy but the latter two were not eligible for consideration as they had died and the Nobel Prize is not awarded posthumously.[1][2]

Psychological factors: Studies on infertile groups of men and women have produced contradictory findings of the importance of psychological factors in causing infertility. Emotional disturbances undoubtedly appear to have some significance. This is only reasonable if you realize that the whole hormonal cycle, with its delicate adjustments, is controlled from the brain. This is an area which needs further investigation.
Intracytoplasmic sperm injection (ICSI) is where a single sperm is injected directly into an egg. Its main usage as an expansion of IVF is to overcome male infertility problems, although it may also be used where eggs cannot easily be penetrated by sperm, and occasionally in conjunction with sperm donation. It can be used in teratozoospermia, since once the egg is fertilised abnormal sperm morphology does not appear to influence blastocyst development or blastocyst morphology.[86]
Sit down with your partner and make a "fertility road map" that outlines what you're willing to try and for approximately how long, suggests Dr. Davidson. "Would you do in vitro fertilization? Would you consider an egg donor? How much money can you spend on treatment? Then build in a timeline," she says. "When you at least loosely define a time frame, dealing with infertility doesn't feel like an endless void."
The penetration of the IVF market in India is quite low at present with only 2,800 cycles/million infertile women in the reproductive age group (20–44 years) as compared to China which has 6,500 cycles. The key challenges are lack of awareness, affordability and accessibility.[152] India in 2018 becomes the destination for Fertility Tourism because of most affordable IVF treatment cost. IVF treatment cost in India varies from $2000 to $4000 (roughly between 150000/- INR to 250000/- INR including all aspects of IVF treatment with medicines which is almost 5 times lower than IVF Cost in Western part of the world.
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.
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.
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.
When weighing the options, the pros and cons of intrauterine insemination (IUI) and in vitro fertilization (IVF) will, of course, be explored fully in discussion with your physician. In general terms, you can expect IUI to be a simpler process, less invasive, and lower cost. Some fertility specialists recommend attempting one or more cycles of artificial insemination before moving to IVF but this does not apply to everyone. For example, for an older woman, to try artificial insemination first may take up valuable time and the recommendation could well be to move straight to IVF. But before you can compare the two treatments, you need to know what exactly you could expect from IVF.
A recent large population-based study collected data from almost 5000 European patients. According to preliminary results presented at the 2019 European Society of Human Reproduction and Embryology, there is no benefit from ICSI in non-male factor cases. Importantly, the study reported no benefit of using ICSI regardless of how many eggs are retrieved after ovarian stimulation. Therefore, having a low oocyte yield should not be a reason for choosing ICSI over IVF.
Certain kinds of IVF, in particular ICSI (first applied in 1991) and blastocyst transfer (first applied in 1984) have been shown to lead to distortions in the sex ratio at birth. ICSI leads to slightly more female births (51.3% female) while blastocyst transfer leads to significantly more boys (56.1% male) being born. Standard IVF done at the second or third day leads to a normal sex ratio.

The Rand Consulting Group has estimated there to be 400,000 frozen embryos in the United States in 2006.[83] The advantage is that patients who fail to conceive may become pregnant using such embryos without having to go through a full IVF cycle. Or, if pregnancy occurred, they could return later for another pregnancy. Spare oocytes or embryos resulting from fertility treatments may be used for oocyte donation or embryo donation to another woman or couple, and embryos may be created, frozen and stored specifically for transfer and donation by using donor eggs and sperm. Also, oocyte cryopreservation can be used for women who are likely to lose their ovarian reserve due to undergoing chemotherapy.[84]


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. 


In some cases, laboratory mix-ups (misidentified gametes, transfer of wrong embryos) have occurred, leading to legal action against the IVF provider and complex paternity suits. An example is the case of a woman in California who received the embryo of another couple and was notified of this mistake after the birth of her son.[94] This has led to many authorities and individual clinics implementing procedures to minimise the risk of such mix-ups. The HFEA, for example, requires clinics to use a double witnessing system, the identity of specimens is checked by two people at each point at which specimens are transferred. Alternatively, technological solutions are gaining favour, to reduce the manpower cost of manual double witnessing, and to further reduce risks with uniquely numbered RFID tags which can be identified by readers connected to a computer. The computer tracks specimens throughout the process and alerts the embryologist if non-matching specimens are identified. Although the use of RFID tracking has expanded in the US,[95] it is still not widely adopted.[96]
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.
Hashimoto's thyroiditis or chronic lymphocytic thyroiditis, is an autoimmune disorder causing inflammation of the thyroid gland. Hashimoto's thyroiditis is a type of hypothyroidism, and is the most common cause of hypothyroidism in the US. Symptoms of Hashimoto's thyroiditis may include dry skin, fatigue, weight gain, feeling cold, excessive sleepiness, dry skin, dry coarse hair, difficulty swallowing, a lump in the front of the throat, muscle cramps, mood changes, vague aches and pains, problems concentrating, leg swelling, constipation, and depression. There is no cure for Hashimoto’s thyroiditis. Diet changes, natural supplements, vitamins, or other natural products will not treat Hashimoto’s thyroiditis. Treatment for the autoimmune disorder is with thyroid hormone replacement therapy, which will be necessary for the rest of the person’s life.
All pregnancies can be risky, but there are greater risk for women who are older and are over the age of 40. The older the women the riskier the pregnancy. As women get older, they are more likely to suffer from conditions such as gestational diabetes and pre-eclampsia. If older women do conceive over the age of 40, their offspring may be of lower birth weight, and more likely to requires intensive care. Because of this, the increased risk is a sufficient cause for concern. The high incidence of caesarean in older mothers is commonly regarded as a risk.
Assess your preconception prep. Have you been on top of the preconception game or are you just too busy for baby-planning activities like charting and timing baby-making sex (or any sex for that matter)? Given that you have a little one underfoot, it's understandable if you're more exhausted than ever. It’s not easy for wannabe second-time parents to devote as much time and energy to TTC as they likely did on the first go-around, but it would be helpful to take a step back (and a hard look) at what's going on. Are your cycles still regular, or have there been any changes that might be hurting your chances for conception success? Have you been able to pinpoint ovulation with accuracy, or are you just having sex whenever (which would make conception less likely)? Getting back on track with tracking your fertility signs may be enough to put you back in the game.
In males with hepatitis B, The Practice Committee of the American Society for Reproductive Medicine advises that sperm washing is not necessary in IVF to prevent transmission, unless the female partner has not been effectively vaccinated.[37][38] In females with hepatitis B, the risk of vertical transmission during IVF is no different from the risk in spontaneous conception.[38] However, there is not enough evidence to say that ICSI procedures are safe in females with hepatitis B in regard to vertical transmission to the offspring.[38]
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]
PCOS: Polycystic ovarian syndrome (PCOS) is an ovarian issue that can cause irregular menstrual cycles and make it difficult for women to ovulate — a crucial part of the conception and pregnancy process. Women with PCOS do not release eggs regularly, and their ovaries often have many small cysts within. IVF is a strong option for women with PCOS, since it can help their bodies ovulate to achieve pregnancy.
Vzhledem k tomu, že vertikální přenos a vliv koronaviru SARS-CoV-2 na graviditu není dostatečně prozkoumán, mezinárodní odborné společnosti doporučují zvážit možná rizika spojená s těhotenstvím v oblastech zasažených onemocněním SARS-CoV-2. Z tohoto důvodu preferuje naše klinika zamražení získaných embryí a odložení transferu. Strategie léčby bude vždy posouzena individuálně ošetřujícím lékařem s ohledem na aktuální situaci v ČR a specifika léčeného páru.
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