• 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.
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]
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.
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 US, up to 20% of infertile couples have unexplained infertility. In these cases abnormalities are likely to be present but not detected by current methods. Possible problems could be that the egg is not released at the optimum time for fertilization, that it may not enter the fallopian tube, sperm may not be able to reach the egg, fertilization may fail to occur, transport of the zygote may be disturbed, or implantation fails. It is increasingly recognized that egg quality is of critical importance and women of advanced maternal age have eggs of reduced capacity for normal and successful fertilization. Also, polymorphisms in folate pathway genes could be one reason for fertility complications in some women with unexplained infertility.[59] However, a growing body of evidence suggests that epigenetic modifications in sperm may be partially responsible.[60][61]
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Once the semen sample is ready, it'll be put through a special washing process, which separates the sperm from the other stuff that is found in semen. The embryologist will choose the “best-looking sperm," placing about 10,000 sperm in each culture dish with an oocyte. The culture dishes are kept in a special incubator, and after 12 to 24 hours, they are inspected for signs of fertilization.
New Brunswick provides partial funding through their Infertility Special Assistance Fund – a one time grant of up to $5,000. Patients may only claim up to 50% of treatment costs or $5,000 (whichever is less) occurred after April 2014. Eligible patients must be a full-time New Brunswick resident with a valid Medicare card and have an official medical infertility diagnosis by a physician.[150]

Preimplantation genetic screening (PGS) or preimplantation genetic diagnosis (PGD) has been suggested to be able to be used in IVF to select an embryo that appears to have the greatest chances for successful pregnancy. However, a systematic review and meta-analysis of existing randomised controlled trials came to the result that there is no evidence of a beneficial effect of PGS with cleavage-stage biopsy as measured by live birth rate.[81] On the contrary, for women of advanced maternal age, PGS with cleavage-stage biopsy significantly lowers the live birth rate.[81] Technical drawbacks, such as the invasiveness of the biopsy, and non-representative samples because of mosaicism are the major underlying factors for inefficacy of PGS.[81]
Pelvic inflammatory disease (PID) is the most common and serious complication of sexually transmitted diseases (STDs), aside from AIDS, among women. The signs and symptoms of pelvic inflammatory disease include: fever, vaginal discharge with a foul odor, abdominal pain, including pain during intercourse, and irregular vaginal bleeding. Pelvic inflammatory disease can scar the Fallopian tubes, ovaries, and related structures and lead to ectopic pregnancies, infertility, chronic pelvic pain, and other serious consequences. Pelvic inflammatory disease treatment includes several types of antibiotics.
At RMA, once the embryos reach the blastocyst stage, they are tested through a process called Preimplantation Genetic Testing for Aneuploidy (PGT-A), which lets doctors know which embryos have a normal number of chromosomes. While genetically normal embryos are much more likely to lead to pregnancy and healthy babies, the transfer of abnormal embryos will either result in no pregnancy, miscarriage, or an affected baby. While testing is occurring on a small part of the embryos, the embryos themselves are frozen, awaiting a receptive uterus. A large, prospective study performed recently at RMA confirmed that performing an embryo biopsy does not harm the embryo and does not decrease the likelihood of implantation.
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This is less extensively studied. It is not yet known whether the ovarian stimulation and the insemination have independent beneficial effects or whether their beneficial effects are only seen when they are used in combination. Most likely they both independently increase fertility potential, with relatively more fertility benefit coming from the IUI component.
Abdominal adhesions (scar tissue) bands of scar tissue that form between abdominal organs and tissues. Symptoms of abdominal adhesions are pelvic or abdominal pain. Abdominal adhesions on the intestines can cause bowel obstruction, which is a medical emergency. Treatment for abdominal adhesions is generally surgery to cut the adhesions away from the internal tissues and organs. There is no way to prevent abdominal adhesions.
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.
Medical treatment of infertility generally involves the use of fertility medication, medical device, surgery, or a combination of the following. If the sperm are of good quality and the mechanics of the woman's reproductive structures are good (patent fallopian tubes, no adhesions or scarring), a course of ovulation induction maybe used. The physician or WHNP may also suggest using a conception cap cervical cap, which the patient uses at home by placing the sperm inside the cap and putting the conception device on the cervix, or intrauterine insemination (IUI), in which the doctor or WHNP introduces sperm into the uterus during ovulation, via a catheter. In these methods, fertilization occurs inside the body.
Infertility can have a profound impact on one’s mental health. When men and women find out that they can’t conceive, they may experience the same painful emotions as anyone coping with grief or profound loss. Common reactions include shock, frustration, grief, anger, decreased self-esteem, anxiety, and depression, but feelings about infertility can vary greatly depending on the source of the problems. Men, in particular, find it far easier to deal with a partner’s infertility than with their own.
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]
Ovarian stem cells: it is thought that women have a finite number of follicles from the very beginning. Nevertheless, scientists have found these stem cells, which may generate new oocytes in postnatal conditions.[67] Apparently there are only 0.014% of them (this could be an explanation of why they were not discovered until now).[citation needed] There is still some controversy about their existence, but if the discoveries are true, this could be a new treatment for infertility.
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 each year that passes, your chances of conceiving decrease significantly, says Julie Tan, M.D., a gynecologist at the Cleveland Clinic Center for Reproductive Medicine, in Ohio. Sometimes even doctors downplay infertility, she notes. Most experts recommend seeing your doc after a year of unsuccessful unprotected sex if you're under age 35 and after six months if you're over 35. But if you're worried sooner, speak up. "If it's been three months and you're concerned, it's not too early to get evaluated, even though it may be premature to treat," explains Dr. Grifo. "Waiting a year to find out there's an issue with sperm count or egg supply can lead to a lot of heartache." You can start with your primary-care doc or ob-gyn but if you're not pregnant after a few months or feel your doctor isn't taking the situation seriously, see a fertility specialist.


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.
Many people of sub-Saharan Africa choose to foster their children to infertile women. IVF enables these infertile women to have their own children, which imposes new ideals to a culture in which fostering children is seen as both natural and culturally important. Many infertile women are able to earn more respect in their society by taking care of the children of other mothers, and this may be lost if they choose to use IVF instead. As IVF is seen as unnatural, it may even hinder their societal position as opposed to making them equal with fertile women. It is also economically advantageous for infertile women to raise foster children as it gives these children greater ability to access resources that are important for their development and also aids the development of their society at large. If IVF becomes more popular without the birth rate decreasing, there could be more large family homes with fewer options to send their newborn children. This could result in an increase of orphaned children and/or a decrease in resources for the children of large families. This would ultimately stifle the children's and the community's growth.[134]
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.
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