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There are several fertility resource organizations and websites that you and your spouse can turn to for support. The American Fertility Association (AFA) / www.theafa.org. The AFA has a free quarterly newsletter full of infertility articles, online educational seminars, and downloadable fact sheets for everyone dealing with reproduction. Resolve / www.resolve.org. The Resolve website contains a large amount of information on infertility, insurance coverage, adoption options, and several bulletin boards along with lists of meetings and events. International Council on Infertility Information Dissemination (INCIID) / www.inciid.org. The INCIID site also contains medical articles, bulletin boards, lists of fertility clinics, current information on fertility treatments and a monthly newsletter.
Some pregnancies may end in miscarriage simply due to ‘older, poorer quality eggs’ that predispose to genetic chromosomal abnormalities. However, there are many other treatable causes of miscarriages. Hormonal abnormalities can easily be diagnosed and treated, and will reduce miscarriage risks. Uterine anatomical defects can be evaluated by an x-ray (HSG-Hysterosalpingogram) or by ultrasound (hysterosonogram). Uterine defects, such as submucous fibroids, polyps, intrauterine adhesions or a congenital uterine abnormality account for 10 – 15% of recurrent miscarriages. These defects can be repaired surgically. Genetic chromosomal unbalanced translocations make up only 1 – 2% of pregnancy losses. This abnormality can be diagnosed by doing a blood test (genetic karyotyping) on you and your partner. Just like miscarriages due to age-related chromosome abnormalities mentioned above (aneuploidy), miscarriages from chromosome translocations can be prevented by doing In-Vitro Fertilization (IVF) and Preimplantation Genetic Diagnosis (PGD).
Traditional Chinese Medicine (TCM), i.e., acupuncture and herbal medicine, when integrated with traditional Western reproductive medicine (fertility medications; inseminations- IUI; in Vitro Fertilization- IVF) may enhance fertility. When couples are trying to conceive, they are often plagued by significant emotional and financial stress. Acupuncture may help alleviate some of this stress. Patients often need to undergo several attempts at IUI and/or IVF in order to get pregnant. Any form of stress reduction (yoga, meditation or acupuncture) can often help the women persist in their fertility treatments, thereby improving their chances for a successful outcome. It is always best to consult an acupuncture specialist who deals specifically with fertility issues and if you are in treatment with a reproductive endocrinologist you should inquire if acupuncture is right for you.
Infertility is defined as the inability to conceive after 1 year of unprotected intercourse in women under 35 or after 6 months of trying for women 35 and older. The basic infertility evaluation can be performed by an ob/gyn. The evaluation may include a Semen analysis to assess male factor problems with sperm and a Hysterosalpingogram (hsg) x-ray to investigate your uterus and fallopian tubes. These tests can often help you and/or your ob/gyn decide when it may be beneficial to be more aggressive with treatment and seek the expertise of a reproductive endocrinologist.
There are several fertility resource organizations and websites that you and your spouse can turn to for support. The American Fertility Association (AFA) / www.theafa.org. The AFA has a free quarterly newsletter full of infertility articles, online educational seminars, and downloadable fact sheets for everyone dealing with reproduction. Resolve / www.resolve.org. The Resolve website contains a large amount of information on infertility, insurance coverage, adoption options, and several bulletin boards along with lists of meetings and events. International Council on Infertility Information Dissemination (INCIID) / www.inciid.org. The INCIID site also contains medical articles, bulletin boards, lists of fertility clinics, current information on fertility treatments and a monthly newsletter.
A simple, inexpensive method includes the use of an Ovulation Predictor kit, which can be purchased over the counter at most pharmacies. This kit will detect a surge of LH hormone in the urine. Ovulation should occur 24-36 hours after the surge is detected.
It is best to contact your insurance carrier directly to ascertain if your treatment, drugs and monitoring will be covered by your insurance. We also have financial counselors on staff who can help you with basic insurance questions and financing options.
There are several fertility resource organizations and websites that you and your spouse can turn to for support. The American Fertility Association (AFA) / www.theafa.org. The AFA has a free quarterly newsletter full of infertility articles, online educational seminars, and downloadable fact sheets for everyone dealing with reproduction. Resolve / www.resolve.org. The Resolve website contains a large amount of information on infertility, insurance coverage, adoption options, and several bulletin boards along with lists of meetings and events. International Council on Infertility Information Dissemination (INCIID) / www.inciid.org. The INCIID site also contains medical articles, bulletin boards, lists of fertility clinics, current information on fertility treatments and a monthly newsletter.
There are many factors to take into account when selecting the right physician and practice. IVF success rates are an important factor to consider when making your decision. Although looking at the statistics can be helpful in assessing the general success of a program, it is also critical to look beyond the numbers. IVF success depends on two factors. The first is the couple’s chance of conception. This will be influenced by many factors including age, diagnosis, years of infertility, ability to produce multiple eggs and the extent of prior testing and treatment. The second factor is the center where you elect to be treated. All practices have their own patient selection criteria, stimulation protocols and laboratory procedures. A comparison of clinical success rates may not be meaningful because patient medical characteristics, treatment approaches, and entrance criteria for SART may vary from clinic to clinic. Ask your physician for an approximate success rate based on all these factors. This can help you make better decisions regarding your family building options.
Intrauterine Insemination (IUI) — a type of artificial insemination — is a procedure for treating infertility. Sperm that have been washed and concentrated are placed directly in your uterus around the time your ovary releases one or more eggs to be fertilized. The hoped-for outcome of intrauterine insemination is for the sperm to swim into the fallopian tube and fertilize a waiting egg, resulting in a normal pregnancy.
Secondary infertility is the inability to get pregnant despite frequent, unprotected sex — for at least a year in women under age 35 or six months in women age 35 and older — by a couple who have previously had a pregnancy. Secondary infertility shares many of the same causes of primary infertility.
Male infertility is defined by low sperm count, abnormal sperm function or blockages that prevent the delivery of sperm. Illness, injury, chronic health problems, lifestyle choices and other factors may also play a role in male factor infertility.
In general, the entire IVF process takes approximately two months once a decision is made to proceed. The first month involves diagnostic tests and evaluations of the couple, consultations, and ‘preparation’ of the ovaries. The second month involves the actual hormone stimulation of the ovaries, monitoring with frequent blood tests and ultrasound exams, retrieval of the eggs, followed 3 – 5 days later by the transfer of embryos into the uterus.
If you are under 35 and have been trying to get pregnant for a year or over the age of 35 and have been trying to get pregnant for over 6 months without success, you should make an appointment with a fertility specialist. A basic blood test can then help you and your doctor decide what treatments may be right for you and outline a plan for moving forward. Women should also see a physician sooner if they have had pelvic inflammatory disease, previous ectopic pregnancy, or pelvic surgery for ruptured appendix or ovarian cysts, since there may be pelvic adhesions (scar tissue) or damage to the fallopian tubes. Painful and heavy periods may indicate fibroids or endometriosis, and may need treatment in order to get pregnant. A man should have a semen analysis early if he has a history of conditions such as testicular trauma, mumps or undescended testicles.
In IVF, a woman is given medication to stimulate her ovaries to mature several eggs at once, rather than the one that the body normally produces at a time. When mature, these eggs are then surgically removed from the ovary using a long needle while the woman is under anesthesia. This is called Egg Retrieval. Once retrieved, these eggs are then mixed with sperm in a Petri dish (”in vitro” is Latin for ”in glass”). After approximately 40 hours, the eggs are checked to see if they fertilized and dividing into cells. If so, they are now called embryos and are then placed inside the woman’s uterus, which is a process called Embryo Transfer.
Placing an egg in a pertri dish with thousands of sperm usually leads to fertilization. However, if it does not occur, we can perform a process called process is called “Intracytoplasmic Sperm Injection” or “ICSI.” This is where a single sperm is injected into the egg. If even this fails, using donor sperm and/or donor eggs is one option that will usually result in fertilization. Your fertility specialist will guide you and recommend which approach is most likely to be successful in your case.
With any stored embryos that you have decided not to transfer into your uterus to attempt pregnancy, you will have four options for their final disposition. You can anonymously donate your embryos so someone else, donate them to someone you know, donate them for lab research, or have them thawed and discarded.
Approximately 1 – 2% of all pregnancies are ectopic (outside the uterus, most commonly in the fallopian tube). The risk of death related to ectopic pregnancy has decreased by almost 90% over the past 20 years. However, ectopic pregnancy is still the leading cause of maternal death during the first trimester of pregnancy due to difficult or delayed diagnosis, tubal rupture and hemorrhage. Risk factors for ectopic pregnancy include: sexually transmitted infections (gonorrhea and Chlamydia primarily), pelvic inflammatory disease, in utero diethylstilbestrol (DES) exposure, infertility and certain infertility treatments, previous tubal sterilization, previous tubal surgery as well as previous ectopic pregnancies. For example, previous tubal surgery increases the risk for ectopic pregnancy at least five-fold. Your previous pelvic infection with its associated tubal pathology increases your risk for ectopic pregnancies at least three-fold. Ectopic pregnancy is associated with various symptoms: early known pregnancy or delayed menses, lower abdominal or pelvic pain, irregular vaginal bleeding or spotting. Ruptured ectopic pregnancies are less commonly seen today, primarily because modern diagnostic tests are more sensitive and allow for an earlier diagnosis. A greater knowledge of early symptoms and awareness of risk factors help to raise clinical suspicion for ectopic pregnancy and allows for earlier diagnosis. For most women, the combination of one or more serum hCG blood tests in conjunction with vaginal ultrasound(s) can often establish the diagnosis of ectopic pregnancy. The early diagnosis of ectopic pregnancy allows for early intervention and treatment options that may help minimize tubal damage.
Several studies have demonstrated a dramatic increase in sperm DNA fragmentation in obese men, and this can lead to a significant reduction in sperm quality. In addition, there may be an increase in the miscarriage rate for men with high-level fragmented DNA damage. Increased sperm DNA fragmentation due to oxidative stress may be due to several factors: men over age 50; possibly cigarette smoke, excessive exposure to heat; obesity and numerous environmental toxins. Some of this sperm DNA fragmentation may be reversed.
Anorexia nervosa can cause long-term or permanent disruption of hypothalamic hormones. This type of hypothalamic anovulation can often be reversed. For example: for underweight women with hypothalamic anovulation, weight gain may allow for resumption of normal menses and even ovulation on occasion. If weight gain does not improve hormone production, the use of injectable medications (gonadotropins) can successfully induce normal ovulation and lead to successful pregnancies. If periods are irregular and sporadic, you are most likely not ovulating or have anovulation. A series of blood tests can easily confirm anovulation and diagnose the causes.
Polycystic ovary syndrome (PCOS) is a common endocrine system disorder among women of reproductive age. Women with PCOS may have enlarged ovaries that contain small collections of fluid — called follicles — located in each ovary as seen during an ultrasound exam. There is no single test to diagnose PCOS. Symptoms may include: Oligo-amenorrhea (irregular or absent periods), Oglio-anovulation (infrequent or no ovulation), Infertility, Hirsutism (excessive hair growth on face, chest or abdomen) and weight gain. Many experts agree that in order to diagnose PCOS, you must first rule out other endocrine conditions, such as thyroid and adrenal disease and the patient must have 2 out of 3 of the following criteria: a history of irregular or absent menstrual cycles and or no ovulation since puberty, hirsutism and/or high blood levels of male hormones – androgens, ultrasound evidence of polycystic ovaries.
It is very important to determine if your tubes are blocked at the ends away from the uterus (referred to as hydrosalpinx). If a woman has hydrosalpinx in her tubes, the fluid that accumulates can be very detrimental to her chances for success, even with IVF. The tubes can be surgically repaired or tied off to improve pregnancy rates before doing further IVF.
The success rate for reversal of tubal ligation depends on your age, your partner, how your tubes were tied and the skill of the reproductive surgeon. The type of tubal ligation is also important. If your tubes were cauterized in several places or large segments were removed the surgery may not be reversible. Depending on your age, In Vitro Fertilization may be a better option. During IVF, the reproductive endocrinologist can stimulate the ovaries, harvest several eggs, fertilize them in the lab, and then select the resulting highest quality embryos to transfer into the uterus.
A decreased thyroid function is known as hypothyroidism, and affects more women than men. Symptoms may include excessive fatigue, cold intolerance, weight gain, dry skin, mental slowing, and constipation. Women may also notice menstrual irregularities, such as menorrhagia (heavy periods) and/or amenorrhea (missed periods), as well as breast discharge (galactorrhea).Lab tests will show increased thyroid stimulating hormone (TSH) and decreased serum levels of thyroid hormone (T4). The increased TSH production by the pituitary adversely affects the pituitary’s production of FSH (follicle-stimulating hormone), which regulates ovarian function. This disruption of FSH may interfere with ovulation as well as ovarian hormone production, thus leading to infertility and/or miscarriages.
Some pregnancies may end in miscarriage simply due to ‘older, poorer quality eggs’ that predispose to genetic chromosomal abnormalities. However, there are many other treatable causes of miscarriages. Hormonal abnormalities can easily be diagnosed and treated, and will reduce miscarriage risks. Uterine anatomical defects can be evaluated by an x-ray (HSG-Hysterosalpingogram) or by ultrasound (hysterosonogram). Uterine defects, such as submucous fibroids, polyps, intrauterine adhesions or a congenital uterine abnormality account for 10 – 15% of recurrent miscarriages. These defects can be repaired surgically. Genetic chromosomal unbalanced translocations make up only 1 – 2% of pregnancy losses. This abnormality can be diagnosed by doing a blood test (genetic karyotyping) on you and your partner. Just like miscarriages due to age-related chromosome abnormalities mentioned above (aneuploidy), miscarriages from chromosome translocations can be prevented by doing In-Vitro Fertilization (IVF) and Preimplantation Genetic Diagnosis (PGD).
Endometriosis is a condition where the endometrial tissue (uterine lining) is found in locations outside the uterus. This most commonly involves the lowest portion of the pelvis, surface of the fallopian tubes, surfaces of the ovaries, bowel or bladder. With more advanced disease, endometriosis can grow deeply within the ovaries, forming cysts called endometriomas (chocolate cysts). Endometriosis is most often associated with dysmenorrhea, chronic pelvic pain, and/or painful intercourse. It also may be completely asymptomatic. The connection between endometriosis and infertility is unclear and may depend on the stage of the disease.
Any anatomical defect within the uterine cavity (polyps, sub mucous fibroids, adhesion’s or septum) may decrease the chance of pregnancy or increase the risk of miscarriage. The uterine cavity can be evaluated by hysterosalpingogram or saline sonogram. An outpatient surgical procedure, hysteroscopy, allows for confirmation of the defect as well as treatment. You should speak with your Ob/Gyn or reproductive endocrinologist for specific recommendations based on your particular condition.
Vitrification is a type of egg freezing. Through vitrification, delicate eggs, once un-freezable without damage, can now be preserved for future use. Vitrification may used as a form of fertility preservation for women who are undergoing chemotherapy due to cancer or by single women who wish to freeze their eggs for future use.
For older women, eggs may be genetically abnormal, causing infertility but also significantly increasing the risks for miscarriages and genetic birth defects. Assessing many of the chromosomes of each normally developing embryo allows the Reproductive Endocrinologist to be even more selective and transfer only embryos with the greatest likelihood of normalcy. PGD or PGS can reduce the risk of miscarriage as well as the risk of many genetic birth defects. The most common situations for recommending PGD or PGS include: Women age 37 or older, severe male factor infertility, a history of miscarriages, previous IVF failures, or previous birth of a child with a single gene disorder (examples such as Cystic Fibrosis, Tay Sachs, Muscular Dystrophy, Hemophilia to name a few) or a Family History of same.
ICSI is a clinical procedure in which a sperm is injected directly into an egg to achieve fertilization. The embryologist selects a single sperm to be injected directly into an egg, instead of fertilization taking place in a dish where many sperm are placed near an egg. Your specialist may recommend ICSI if there is a low sperm count or if sperm issues have been identified (poor morphology, poor motility).
PGD or Preimplantation Genetic Screening (PGS) are procedures used to detect genetic or chromosomal abnormalities in embryos created during an IVF cycle by removing and testing a cell from the embryo on day three of development. Two days later, only a limited number of normal embryos are transferred. The most common reasons to consider doing PGD is if a woman has a strong history of miscarriages, or if she is over 37 years old. A much larger percentage of women over 40 will do PGD compared to younger women. Aneuploidy (an abnormal number of chromosomes) increases significantly with age, thereby increasing conditions such as Down syndrome and miscarriages.
Vitrification is a type of egg freezing. Through vitrification, delicate eggs, once un-freezable without damage, can now be preserved for future use. Vitrification may used as a form of fertility preservation for women who are undergoing chemotherapy due to cancer or by single women who wish to freeze their eggs for future use.
A simple, inexpensive method includes the use of an Ovulation Predictor kit, which can be purchased over the counter at most pharmacies. This kit will detect a surge of LH hormone in the urine. Ovulation should occur 24-36 hours after the surge is detected.
This test is called “strict morphology” or a Kruger test for sperm function. The “strict morphology” of the sperm helps predict a man’s fertility potential even in cases where the man’s sperm count, motility and/or regular morphology on a standard semen analysis are all normal. The strict morphology takes a critical look at many sperm according to a very strict set of criteria. According to the strict criteria, even a minor defect in any category rates the sperm as abnormal. Therefore, relatively few sperm are rated as normal or perfect utilizing the strict morphology test, as compared to the “estimated crude morphology” which is done during a regular semen analysis. The strict morphology score is a result that indicates and predicts the sperm’s potential for fertilization. This evaluation can be very useful in guiding your reproductive endocrinologist with various treatment options including, intrauterine insemination and/or in vitro fertilization IVF.
For older women, eggs may be genetically abnormal, causing infertility but also significantly increasing the risks for miscarriages and genetic birth defects. Assessing many of the chromosomes of each normally developing embryo allows the Reproductive Endocrinologist to be even more selective and transfer only embryos with the greatest likelihood of normalcy. PGD or PGS can reduce the risk of miscarriage as well as the risk of many genetic birth defects. The most common situations for recommending PGD or PGS include: Women age 37 or older, severe male factor infertility, a history of miscarriages, previous IVF failures, or previous birth of a child with a single gene disorder (examples such as Cystic Fibrosis, Tay Sachs, Muscular Dystrophy, Hemophilia to name a few) or a Family History of same.
Traditional Chinese Medicine (TCM), i.e., acupuncture and herbal medicine, when integrated with traditional Western reproductive medicine (fertility medications; inseminations- IUI; in Vitro Fertilization- IVF) may enhance fertility. When couples are trying to conceive, they are often plagued by significant emotional and financial stress. Acupuncture may help alleviate some of this stress. Patients often need to undergo several attempts at IUI and/or IVF in order to get pregnant. Any form of stress reduction (yoga, meditation or acupuncture) can often help the women persist in their fertility treatments, thereby improving their chances for a successful outcome. It is always best to consult an acupuncture specialist who deals specifically with fertility issues and if you are in treatment with a reproductive endocrinologist you should inquire if acupuncture is right for you.
There are considerable benefits to vigorous exercise, which can improve your mental and physical health. However, fertility patients should exercise in moderation. There are some studies which suggest that women exercising vigorously during IVF therapy may have lower pregnancy rates.
Before concluding that you have fertility issues, it is always a good idea to look at how you are leading your life. Make sure you are living a healthy lifestyle which includes a balanced diet and exercise. Obesity, smoking, heavy alcohol and caffeine consumption, drugs and lack of exercise can affect the chances of conceiving.
Several studies have demonstrated a dramatic increase in sperm DNA fragmentation in obese men, and this can lead to a significant reduction in sperm quality. In addition, there may be an increase in the miscarriage rate for men with high-level fragmented DNA damage. Increased sperm DNA fragmentation due to oxidative stress may be due to several factors: men over age 50; possibly cigarette smoke, excessive exposure to heat; obesity and numerous environmental toxins. Some of this sperm DNA fragmentation may be reversed.
Anorexia nervosa can cause long-term or permanent disruption of hypothalamic hormones. This type of hypothalamic anovulation can often be reversed. For example: for underweight women with hypothalamic anovulation, weight gain may allow for resumption of normal menses and even ovulation on occasion. If weight gain does not improve hormone production, the use of injectable medications (gonadotropins) can successfully induce normal ovulation and lead to successful pregnancies. If periods are irregular and sporadic, you are most likely not ovulating or have anovulation. A series of blood tests can easily confirm anovulation and diagnose the causes.
Infertility is generally defined as being unable to get pregnant after one year of unprotected intercourse. Women with irregular menstrual cycles, or who are 35 or older, and have not conceived after six months of intercourse should have a consultation with a reproductive endocrinologist, also know as an infertility specialist. Women who have had two or more spontaneous miscarriages should also make an appointment.
About one-third of infertility cases are due to the man, about one-third are due to the woman, and one-third are caused by a combination of problems in both partners or is simply unexplained. However, it’s important to remember that infertility is a medical problem and it’s not your fault if you are faced with the challenge of it.
Approximately 6% of married American women aged 15-44 are unable to get pregnant after one year of trying to conceive via unprotected sex. Additionally, 12% of women in the same age group have trouble getting or staying pregnant, regardless of marital status.
In most cases, infertility in women is caused by ovulation problems. When ovulation does not occur—or does not occur properly—there are no eggs or only damaged eggs to be fertilized. Irregular or absent menstrual periods are two signs that a woman many have ovulation problems. In other cases, there may be few if any noticeable symptoms. Other problems include blocked fallopian tubes, uterine fibroids, abnormalities of the uterus, or diseases like endometriosis.
A number of factors can contribute to a woman’s struggle with infertility. These include age, stress, being over- or underweight, smoking, bad diet, drinking alcohol, STD’s, and thyroid conditions.
Infertility in men is generally caused by problems producing sperm or problems with the sperm’s ability to travel to or penetrate the egg in order to fertilize it.
A man’s sperm count and quality can be reduced by factors such as age, medications, smoking, drinking alcohol, drugs, exposure to toxins, cancer treatments.
Infertility can be one of the most stressful things you ever have to deal with. Being unable to conceive over a long period of time can trigger genuine feelings of loss, anxiety, depression, isolation of the sense of being out of control. Add that to having to navigate numerous medical decisions and procedures, along with the waiting to find out if a treatment has worked and it’s a lot to cope with. That’s why we offer psychological and emotional support as an integral part of our practice. The fertility journey may not always be easy but we try to make it as calm and stress-free as possible.
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