Infertility

Infertility primarily refers to the biological inability of a person to contribute to

conception. Infertility may also refer to the state of a woman who is unable to carry a

pregnancy to full term. There are many biological causes of infertility, some which may

be bypassed with medical intervention.[1]

Women who are fertile experience a natural period of fertility before and during

ovulation, and they are naturally infertile during the rest of the menstrual cycle. Fertility

awareness methods are used to discern when these changes occur by tracking

changes in cervical mucus or basal body temperature.

Definition

There are strict definitions of infertility used by many doctors. However, there are also

similar terms, e.g. subfertility for a more benign condition and fecundity for the natural

improbability to conceive. Infertility in a couple can be due to either the woman or the

man, not necessarily both.

Infertility

Reproductive endocrinologists, the doctors specializing in infertility, consider a couple to

be infertile if:

the couple has not conceived after 12 months of contraceptive-free intercourse if

the female is under the age of 34.

the couple has not conceived after 6 months of contraceptive-free intercourse if

the female is over the age of 35 (declining egg quality of females over the age of

35 account for the age-based discrepancy as when to seek medical intervention).

the female is incapable of carrying a pregnancy to term.

Subfertility

A couple that has tried unsuccessfully to have a child for a year or more is said to be

subfertile meaning less fertile than a typical couple. The couple's fecundability rate is

approximately 3-5%. Many of its causes are the same as those of infertility. Such

causes could be endometriosis, or polycystic ovarian syndrome.

Primary vs. secondary infertility

Couples with primary infertility have never been able to conceive,[2] while, on the other

hand, secondary infertility is difficulty conceiving after already having conceived (and

either carried the pregnancy to term, or had a miscarriage). Technically, secondary

infertility is not present if there has been a change of partners.

Prevalence

Generally, worldwide it is estimated that one in seven couples have problems

conceiving, with the incidence similar in most countries independent of the level

of the country's development.

Fertility problems affect one in seven couples in the UK. Most couples (about 84

out of every 100) who have regular sexual intercourse (that is, every 2 to 3 days)

and who do not use contraception will get pregnant within a year. About 92 out of

100 couples who are trying to get pregnant do so within 2 years. [3]

Women become less fertile as they get older. For women aged 35, about 94 out

of every 100 who have regular unprotected sexual intercourse will get pregnant

after 3 years of trying. For women aged 38, however, only 77 out of every 100

will do so. The effect of age upon men’s fertility is less clear.[3]

In people going forward for IVF in the UK, roughly half of fertility problems with a

diagnosed cause are due to problems with the man, and about half due to

problems with the woman. However, about one in five cases of infertility have no

clear diagnosed cause [4]

In Britain, male factor infertility accounts for 25% of infertile couples, while 25%

remain unexplained. 50% are female causes with 25% being due to anovulation

and 25% tubal problems/other [5]

In Sweden, approximately 10% of couples are infertile.[6] In approximately one

third of these cases the man is the factor, in one third the woman is the factor

and in the remaining third the infertility is a product of factors on both parts.

Causes

This section deals with unintentional causes of sterility. For more information about

surgical techniques for preventing procreation, see sterilization.

Common causes of infertility:

Ovulation problems

tubal blockage

male associated infertility

age-related factors

uterine problems

previous tubal ligation

previous vasectomy

unexplained infertility

Tuberculosis (TB)

Male Hypospadias

Virus/Mutation

German scientists have reported that a virus called Adeno-associated virus might have

a role in male infertility[7], though it is otherwise not harmful[8]. Mutation that alters human

DNA adversely can cause infertility, the human body thus preventing the tainted DNA

from being passed on. This could explain why some radiation victims from Chernobyl

incident could not produce children.

Causes in either sex

For a woman to conceive, certain things have to happen: intercourse must take place

around the time when an egg is released from her ovary; the systems that produce eggs

and sperm have to be working at optimum levels; and her hormones must be balanced.[9]

There are several possible reasons why it may not be happening naturally. In one-third

of cases, it can be because of male problems such as low sperm count. Some women

are infertile because their ovaries do not mature and release eggs. In this case synthetic

FSH by injection or Clomid (Clomiphene citrate) via a pill can be given to stimulate

follicles to mature in the ovaries.

Problems affecting women include endometriosis or damage to the fallopian tubes

(which may have been caused by infections such as chlamydia).

Other factors that can affect a woman's chances of conceiving include being over- or

underweight for her age - female fertility declines sharply after the age of 35.

Sometimes it can be a combination of factors, and sometimes a clear cause is never

established.

Factors that can cause male as well as female infertility are:

Genetic Factors

o A Robertsonian translocation in either partner may cause recurrent

spontaneous abortions or complete infertility.

General factors

o Diabetes mellitus , thyroid disorders, adrenal disease

Hypothalamic-pituitary factors

o Kallmann syndrome

o Hyperprolactinemia

o Hypopituitarism

Environmental Factors

o Toxins such as glues, volatile organic solvents or silicones, physical

agents, chemical dusts, and pesticides.

Combined infertility

In some cases, both the man and woman may be infertile or sub-fertile, and the couple's

infertility arises from the combination of these conditions. In other cases, the cause is

suspected to be immunological or genetic; it may be that each partner is independently

fertile but the couple cannot conceive together without assistance.

Unexplained infertility

In about 15% of cases the infertility investigation will show no abnormalities. 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.

Assessment

If both partners are young and healthy, and have been trying for a baby for 12 months

to two years without success, a visit to the family doctor could help to highlight potential

medical problems earlier rather than later. The doctor may also be able to suggest

lifestyle changes to increase the chances of conceiving. [12]

Women over the age of 35 should see their family doctor after six months as fertility

tests can take some time to complete, and age may affect the treatment options that are

open in that case.

A family doctor will take a medical history and give a physical examination. They can

also carry out some basic tests on both partners to see if there is an identifiable reason

for not having achieved a pregnancy yet. If necessary, they can refer patients to a

fertility clinic or a local hospital for more specialized tests. The results of these tests will

help determine which is the best fertility treatment.

Treatment

Treatment methods for infertility may be grouped as medical or complementary and

alternative treatments. Some methods may be used in concert with other methods.

At-home conception kit

In 2007 the FDA cleared the first at home tier one medical conception device to aid in

conception. The key to the kit are cervical caps for conception. This at home [cervical

cap] insemination method allows all the semen to be placed up against the cervical os

for six hours allowing all available sperm to be placed directly on the cervical os. For low

sperm count, low sperm motility, or a tilted cervix using a cervical cap will aid in

conception. This is a prescriptive medical device. [13]

At-home assessment

Prior to undergoing expensive fertility procedures, many women and couples will turn to

online sources to determine their estimate chances of success. A take-home baby

assessment can provide a best guess estimate compared with women who have

succeeded with in vitro fertilization, based on variables such as maternal age, duration

of infertility and number of prior pregnancies.[14]

Medical treatments

Medical treatment of infertility generally involves the use of 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) physicians may start by prescribing a course of ovarian

stimulating medication. The physician 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, intrauterine insemination (IUI), in which the doctor

introduces sperm into the uterus during ovulation, via a catheter. In these methods,

fertilization occurs inside the body.

If conservative medical treatments fail to achieve a full term pregnancy, the physician

may suggest the patient undergo in vitro fertilization (IVF). IVF and related techniques

(ICSI, ZIFT, GIFT) are called assisted reproductive technology (ART) techniques.

ART techniques generally start with stimulating the ovaries to increase egg production.

After stimulation, the physician surgically extracts one or more eggs from the ovary, and

unites them with sperm in a laboratory setting, with the intent of producing one or more

embryos. Fertilization takes place outside the body, and the fertilized egg is reinserted

into the woman’s reproductive tract, in a procedure called embryo transfer.

Other medical techniques are e.g. tuboplasty, assisted hatching, and Preimplantation

genetic diagnosis.

Recently, a hormone-antioxidant combination therapy was suggested to improve sperm

count and motility in infertile men, according to an Egyptian study. Ghanem H et al.

Combination clomiphene citrate and antioxidant therapy for idiopathic male infertility: A

randomized controlled trial. Fertil Steril 2009 Mar 5; [e-pub ahead of print]. Published in

Journal Watch General Medicine March 31, 2009 The study included 60 men who were

randomly selected to take either the combination treatment of clomiphene citrate and

vitamin E or a placebo for six months. The pregnancy rate was about 37 percent among

men who had taken the combination therapy, compared with 13 percent for those in the

placebo group. The men in the treatment group also had a greater increase in sperm

concentration and an improvement in sperm progression, the Cairo University

researchers found. Clomiphene citrate is an anti-estrogen drug designed as a fertility

medicine for women but sometimes used to boost sperm production in men with low

sperm counts and poor sperm motility. Vitamin E helps counter oxidative stress, which

is associated with sperm DNA damage and reduced sperm motility. "The results of this

study will be encouraging to male factor patients and their doctors," Dr. R. Dale

McClure, president of the American Society for Reproductive Medicine, said in a society

news release. "However, more research is needed to determine how the components of

the combination therapy affect the different semen parameters observed and the

advantages of using these drugs singly or in combination with other drugs not used in

this study."

Complementary and alternative treatments

Three complementary or alternative female infertility treatments have been scientifically

tested, with results published in peer-reviewed medical journals.

1. Group psychological intervention: A 2000 Harvard Medical School study

examined the effects of group psychological intervention on infertile women

(trying to conceive a duration of one to two years). The two intervention groups—

a support group and a cognitive behavior group—had statistically significant

higher pregnancy rates than the control group. [15]

2. Acupuncture: Acupuncture performed 25 minutes before and after IVF embryo

transfer increased IVF pregnancy rates in a German study published in 2002. [16]

In a 2006 similar study conducted by The University of South Australia, the

acupuncture group’s odds (although not statistically significant) were 1.5 higher

than the control group. [17] Although definitive results of the effects of acupuncture

on embryo transfer remain a topic of discussion, study authors state that it

appears to be a safe adjunct to IVF.[17][18]

3. Manual physical therapy: The Wurn Technique, a manual manipulative physical

therapy treatment, was shown in peer reviewed publications to improve natural

and IVF pregnancy rates in infertile women in a 2004 study, [19] and to open and

return function to blocked fallopian tubes in a 2008 study. [20] The therapy was

designed to address adhesions restricting function and mobility of the

reproductive organs. [19][20]

Tourism

Main article: Fertility tourism

Fertility tourism is the practice of traveling to another country for fertility treatments. [21] It

may be regarded as a form of medical tourism. The main reasons for fertility tourism are

legal regulation of the sought procedure in the home country, or lower price. In-vitro

fertilization and donor insemination are major procedures involved.

Ethics

There are several ethical issues associated with infertility and its treatment.

High-cost treatments are out of financial reach for some couples.

Debate over whether health insurance companies should be forced to cover

infertility treatment.

Allocation of medical resources that could be used elsewhere

The legal status of embryos fertilized in vitro and not transferred in vivo. (See

also Beginning of pregnancy controversy).

Anti-abortion opposition to the destruction of embryos not transferred in vivo.

IVF and other fertility treatments have resulted in an increase in multiple births,

provoking ethical analysis because of the link between multiple pregnancies,

premature birth, and a host of health problems.

Religious leaders' opinions on fertility treatments.

Infertility caused by DNA defects on the Y chromosome is passed on from father

to son. If natural selection is the primary error correction mechanism that

prevents random mutations on the Y chromosome, then fertility treatments for

men with abnormal sperm (in particular ICSI) only defer the underlying problem

to the next male generation.

Many countries have special frameworks for dealing with the ethical and social issues

around fertility treatment.

One of the best known is the HFEA - The UK's regulator for fertility treatment and

embryo research. This was set up on 1 August 1991 following a detailed

commission of enquiry led by Mary Warnock in the 1980s

A similar model to the HFEA has been adopted by the rest of the countries in the

European Union. Each country has its own body or bodies responsible for the

inspection and lisencing of fertility treatment under the EU Tissues and Cells

directive [22]

Regulatory bodies are also found in Canada [23] and in the state of Victoria in

Australia [24]

Psychological impact

Infertility may have profound psychological effects. Partners may become more anxious

to conceive, ironically increasing sexual dysfunction.[25] Marital discord often develops in

infertile couples, especially when they are under pressure to make medical decisions.

Women trying to conceive often have clinical depression rates similar to women who

have heart disease or cancer[26]. Even couples undertaking IVF face considerable

stress.[27]

Emotional stress and marital difficulties are greater in couples where the infertility lies

with the man.[28]

Social impact

In many cultures, inability to conceive bears a stigma. In closed social groups, a degree

of rejection (or a sense of being rejected by the couple) may cause considerable anxiety

and disappointment. Some respond by actively avoiding the issue altogether; middle-

class men are the most likely to respond in this way [29].

There are legal ramifications as well. Infertility has begun to gain more exposure to legal

domains. An estimated 4 million workers in the U.S. used the Family and Medical Leave

Act (FMLA) in 2004 to care for a child, parent or spouse, or because of their own

personal illness. Many treatments for infertility, including diagnostic tests, surgery and

therapy for depression, can qualify one for FMLA leave.

Fictional representation

Perhaps except for infertility in science fiction, films and other fiction depicting emotional

struggles of assisted reproductive technology have had an upswing first in the latter part

of the 2000s decade, although the techniques have been available for decades. [30] Yet,

the amount of people that can relate to it by personal experience in one way or another

is ever growing, and the variety of trials and struggles is huge.[30]

Any individual examples are referred to individual subarticles of assisted reproductive

technology

References

1. ̂ Makar RS, Toth TL (2002). "The evaluation of infertility". Am J Clin Pathol. 117

Suppl: S95–103. PMID 14569805.

2. ̂ MedlinePlus Encyclopedia Infertility

3. ^ a b NICE fertility guidance

4. ̂ HFEA Chart on reasons for infertility

5. ̂ Khan, Khalid; Janesh K. Gupta; Gary Mires (2005). Core clinical cases in

obstetrics and gynaecology: a problem-solving approach. London: Hodder

Arnold. pp. 152. ISBN 0-340-81672-4.

6. ̂ Sahlgrenska University Hospital. (translated from the Swedish sentence: "Cirka

10% av alla par har problem med ofrivillig barnlöshet."

7. ̂ http://www.newscientist.com/article.ns?id=dn1483

8. ̂ http://news.bbc.co.uk/1/hi/health/1620174.stm

9. ̂ About infertility & fertility problems

10. ̂ Mendiola J, Torres-Cantero AM, Moreno-Grau JM, et al. (Jun 2008). "Exposure

to environmental toxins in males seeking infertility treatment: a case-controlled

study". Reprod Biomed Online 16 (6): 842–50. PMID 18549695.

http://openurl.ingenta.com/content/nlm?genre=article&issn=1472-

6483&volume=16&issue=6&spage=842&aulast=Mendiola.

11. ̂ Smith EM, Hammonds-Ehlers M, Clark MK, Kirchner HL, Fuortes L (Feb 1997).

"Occupational exposures and risk of female infertility". J Occup Environ Med. 39

(2): 138–47. doi:10.1097/00043764-199702000-00011. PMID 9048320.

http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/

landingpage.htm?issn=1076-2752&volume=39&issue=2&spage=138.

12. ̂ Infertility Help: When & where to get help for fertility treatment

13. ̂ http://www.newsrx.com/pr_details.php?type=1&id=2904

14. ̂ http://www.formyodds.com

15. ̂ Domar AD, Clapp D, Slawsby EA, Dusek J, Kessel B, Freizinger M (Apr 2000).

"Impact of group psychological interventions on pregnancy rates in infertile

women". Fertil Steril. 73 (4): 805–11. doi:10.1016/S0015-0282(99)00493-8. PMID

10731544. http://linkinghub.elsevier.com/retrieve/pii/S0015-0282(99)00493-8.

16. ̂ Paulus WE, Zhang M, Strehler E, El-Danasouri I, Sterzik K (Apr 2002).

"Influence of acupuncture on the pregnancy rate in patients who undergo

assisted reproduction therapy". Fertil. Steril. 77 (4): 721–4. doi:10.1016/S0015-

0282(01)03273-3. PMID 11937123.

http://linkinghub.elsevier.com/retrieve/pii/S0015028201032733.

17.^ a b Smith C, Coyle M, Norman RJ (May 2006). "Influence of acupuncture

stimulation on pregnancy rates for women undergoing embryo transfer". Fertil

Steril. 85 (5): 1352–8. doi:10.1016/j.fertnstert.2005.12.015. PMID 16600225.

18. ̂ Stener-Victorin E, Humaidan P (Dec 2006). "Use of acupuncture in female

infertility and a summary of recent acupuncture studies related to embryo

transfer" ([dead link]). Acupunct Med 24 (4): 157–63. doi:10.1136/aim.24.4.157. PMID

17264833. http://www.acupunctureinmedicine.org.uk/linkout.php?article=24_157.

19.^ a b Wurn BF, Wurn LJ, King CR, et al. (2004). "Treating female infertility and

improving IVF pregnancy rates with a manual physical therapy technique".

MedGenMed 6 (2): 51. PMID 15266276. PMC 1395760.

http://www.medscape.com/viewarticle/480429.

20.^ a b Wurn BF, Wurn LJ, King CR, et al. (2008). "Treating fallopian tube occlusion

with a manual pelvic physical therapy". Altern Ther Health Med 14 (1): 18–23.

PMID 18251317.

21. ̂ wordspy.com

22. ̂ http://europa.eu/scadplus/leg/en/cha/c11573.htm EU Tissues and Cells

directive

23. ̂ Assisted Human Reproduction Canada

24. ̂ ITA

25. ̂ Donor insemination Edited by C.L.R. Barratt and I.D. Cooke. Cambridge

(England): Cambridge University Press, 1993. 231 pages., page 13, citing Berger

(1980)

26. ̂ Domar AD, Zuttermeister PC, Friedman R (1993). "The psychological impact of

infertility: a comparison with patients with other medical conditions". J

Psychosom Obstet Gynaecol 14 Suppl: 45–52. PMID 8142988.

27. ̂ Beutel M, Kupfer J, Kirchmeyer P, et al. (Jan 1999). "Treatment-related

stresses and depression in couples undergoing assisted reproductive treatment

by IVF or ICSI". Andrologia 31 (1): 27–35. doi:10.1046/j.1439-

0272.1999.00231.x. PMID 9949886. http://www.blackwell-synergy.com/openurl?

genre=article&sid=nlm:pubmed&issn=0303-

4569&date=1999&volume=31&issue=1&spage=27.

28. ̂ Donor insemination Edited by C.L.R. Barratt and I.D. Cooke. Cambridge

(England): Cambridge University Press, 1993. 231 pages., page 13, in turn citing

Connolly, Edelmann & Cooke 1987

29. ̂ Schmidt L, Christensen U, Holstein BE (Apr 2005). "The social epidemiology of

coping with infertility". Hum Reprod. 20 (4): 1044–52.

doi:10.1093/humrep/deh687. PMID 15608029.

30.^ a b chicagotribune.com --> Heartache of infertility shared on stage, screen By

Colleen Mastony, Tribune reporter. June 21, 2009

ds. LH and FSH are critical for the development of eggs in ovaries and

 Possible Causes of infertility

There are numerous causes of infertility. In men, these include environmental and

hormonal factors that affect the production of healthy, motile sperm and normal semen,

as well as blockages that affect the delivery of sperm. In women, the causes are more

varied since she plays a greater role in reproduction. First, one of the organs involved in

reproduction may be absent, mal-formed or non-functional such as damaged fallopian

tubes. Less frequent causes include, for example, endometriosis and

hyperprolactinemia.. Second, the organs may be normal, but the complex hormonal

feedback system that is necessary to support follicular development, ovulation and

implantation of the fertilized egg may be disrupted.

Other causes

Body weight

Women who are significantly overweight or underweight can face difficulties in getting

pregnant. Low weight or excessive weightloss can lead to decrease in important

hormonal "messages" that the brain sends to the ovaries in women and testes in men.

Gonardotropin releasing hormone(GnRH) is produced in the part of the brain called

Hypothalamus. The release of GnRH leads to release of hormonal messangers LH and

FSH by the pitutary glan sperm in the testes.

 

Similarly being overweight or obese can affect the hormonal signals to the ovaries and

testes. Increased weight can also increase insulin levels in women which in turn may

cause the ovaries to overproduce the male hormones and stop releasing eggs. Weight

loss is the best plan of action in such cases supported with clomiphene or

gonadotropins. Body fat plays a critical role in human reproduction. Both excess and

deficiency of body fat lead to reproductive failure. Body weight disorders is one of the

first potential causes of reproductive failure in both men and women. This is a problem

that can be corrected by the affected individual and the infertile couple.

Diet & exercise

Foods rich in manganese (oats, wheat germ, rye bread and peas) promote the action of

oestrogen, and vitamin B's  (wholegrains such as brown rice, wheat germ, pulses oats

and green vegetables), involved in oestrogen metabolism. Their deficiency can hamper

pursuing pregnancy. Soya beans and wholemeal bread will provide magnesium.

Infertility is associated with low vitamin D, and PMS can be completely reversed by

addition of calcium, magnesium and vitamin D. Vitamin D supports production of

estrogen in men and women. PMS has been completely reversed by addition of

calcium, magnesium and vitamin D. Menstrual migraine is associated with low levels of

vitamin D and calcium. Ten minutes of daily exposure of the arms and legs to sunlight

will supply us with all the vitamin D that we need as humans can manufacture vitamin D

from cholesterol by the action of sunlight on the skin.

Proper diet and exercise is essential to maintain a healthy weight. At the same time

extreme exercise can lead to reduced sperm production in men and lack of ovulation in

women by decreasing the brain message to the testes and ovaries. It is impossible to

know how much exercise for a person is too much. Generally running more than 10

miles a week is considered too much when trying to conceive. Try bringing about

modifications in your exercise routine in order to treat reproductive problems.

Smoking

Smoking is a known contributor to infertility problems in women and can lead to an

increased rate of miscarriage. Women who smoke regularly also may enter menopause

at an earlier age because of the damaging effect of tobacco smoke on ovaries. Men

who smoke may have diminished sperm function.

Drugs and Alcohol

Alcohol is known to cause structural and developmental defects in a fetus. This group of

disorders is termed the "Fetal Alcohol Syndrome." It is best to avoid drinking alcohol

during the course of your infertility treatment or during pregnancy. Marijuana use in men

leads to poor sperm counts that take many weeks to recover after exposure. Other

recreational drugs can lead to other significant problems for pregnancy. At the same

time it is desirable to limit the intake of tea, coffee, soft drinks which contains caffeine.

Vitamins

Women who take folic acid before they conceive reduce their risk of neural tube defects

in the fetus by 50%. It is recommended that all women undergoing infertility treatment

take at least 0.4 mg of folic acid (folate) before they conceive and during the course of

their pregnancy. Some high potency vitamins may have a detrimental effect in

pregnancy (i.e. too high level of vitamin A). 

Medication

Regular medications of modern medicine in certain ailments like ulcer, high blood

pressure etc, causes low sperm count & negative side effects that causes infertility

problems in both man & woman.

STDs & PID

Pelvic inflammatory disease (PID) is a major cause of infertility in women. Any sexually

transmitted disease (STD), such as gonorrhea or syphilis, may cause PID, which can

lead to infertility. Prevent STDs by abstaining from sexual intercourse or by using

condoms.

Stress

Does stress cause infertility or does infertility cause stress? Most doctors agree that

reducing stress won't ensure pregnancy, but it may help a couple cope with infertility

and making treatment decisions.

Eating Disorders

The eating disorders anorexia and bulimia can have long lasting impacts (several years)

on fertility. Women with these conditions may not ovulate even if they menstruate. Eggs

may not develop properly. In these cases, treating the disease is essential to restoring

fertility.

 Tests of Infertility in female

There are many potentially useful tests that can be obtained as part of the infertility

evaluation for women. However, therapeutic options largely depend on the results of

three fundamental tests:

Uterine Structural Tests

(i.e. for patency of fallopian tubes and anatomy of uterus)

Hysterosalpingography (HSG)

Office Hysteroscopy

Sonohystogram

Ovarian Reserve Testing

This includes a Cycle Day 3 FSH or preferably, a Clomiphene citrate Challenge

Test.

There are several additional tests that have been used to evaluate infertility.

Tests for Ovulation

Problems of ovulation (egg release from the ovary) account for approximately 25% of

infertility and may be suggested on the basis of the history and physical examination.

If your menstrual periods occur at monthly intervals and you also have breast

tenderness, fluid retention, irritability and menstrual cramps, then your cycles are

usually ovulatory, but not necessarily. Therefore some test of ovulation is necessary:

Urine LH Testing

Blood LH Testing

Basal Body Temperature Graph (BBTG)

Ultrasound Monitoring

MidLuteal Progesterone Testing

Endometrial Biopsy

More Tests in the Female

There are many tests that have been designed to evaluate potential causes of infertility

in women. Very few of these tests, however have been well standardized or even

definitively associated with infertility. Definitive therapy relating to abnormal test results

is also lacking. The following tests although sometimes suggested are generally no

longer recommended as part of the basic infertility evaluation:

Post Coital Test (Sims-Huhner Test, PK)

Cervical Mucus Penetration

Cervical Cultures

Immune Testing

Hormone Testing

Laparoscopy

Diagnostic tests are guided by the history and physical examination and include

simultaneous analysis of both you and your partner. Testing implies that the

knowledge of the result can be used to guide therapy leading to a successful

pregnancy.

There are many tests that have been suggested. However, perhaps the most cost-

effective and arguably the most clinically useful are a semen analysis, an intrauterine

structural study and a test of ovarian age (ovarian reserve) and tubal patency tests.

Infertility testing in women is designed primarily to determine anatomical factors, most

commonly abnormalities within the uterine cavity, and problems with ovarian function

and tubal patency.

 Treatment Options Available

If you think that you are having difficulty becoming pregnant, you should seek the

assistance of your physician. There are several types of treatment. Appropriate

treatment depends on your particular situation or underlying medical or surgical

condition largely depends on the reason thought to be responsible for difficulty in

becoming pregnant.

These treatments may range from the simple like appropriate timing of intercourse to

the complex, high-tech therapies like in vitro fertilization (IVF) in which medications are

given to induce the production of eggs that can be collected and then put together with

sperm in the laboratory so that fertilization occurs. The fertilized eggs can then be

cultured for 3 to 5 days followed by embryo transfer to the uterus.

IVF (In Vitro Fertilization)

IVF has been used safely and effectively for more than two decades. In a typical IVF

procedure, a woman is treated with fertility drugs to regulate her menstrual cycle and

stimulate the development of higher-quality eggs. This process helps to ensure that a

sufficient number of healthy eggs are available for fertilization. Eggs are then "retrieved"

or collected and prepared for insemination using sperm from the male partner or a

donor. Fertilization occurs in a laboratory dish specially prepared with a culture medium

that supports and nourishes the fertilized eggs. Within about 72 hours after fertilization,

embryos are transferred into the woman's uterus.

Since the introduction of IVF, there have been many other important developments that

have made infertility treatment even more effective for both men and women:

In vitro fertilization with endometrial cell co-culture is a special technique for couples

with poor embryo quality where cells from the woman's uterus are used to enhance

development of fertilized eggs. CRMI refined this procedure using the woman's own

endometrial cells rather than cells from animals.

Intracytoplasmic sperm injection (ICSI) is a procedure where a single sperm is selected

and delivered directly into a woman's egg. ICSI is an effective option for men with low

sperm count or sperm that cannot reach the egg successfully.

 

Cryopreservation is the ability to freeze and store embryos that are not transferred right

away. This process can allow couples to achieve a pregnancy later, either after a first

birth or following medical treatments that might affect fertility such as chemotherapy for

cancer treatment.

 

Preimplantation genetic diagnosis (PGD) can be used to identify embryos that do not

carry the gene for certain inherited diseases (such as cystic fibrosis and sickle cell

anemia). This capability greatly reduces the risk that these diseases will be passed on

to children.

For male factor infertility, our comprehensive services include microsurgical repair of

obstructions and vasectomy reversals, surgical repair of varicoceles, and epididymal

and testicular sperm retrieval for use with IVF and ICSI.