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Frequently Asked Questions About Infertility
Find the answers to the most frequently asked questions about infertility
diagnosis and treatment.
Frequently Asked Questions About Infertility
What is infertility?
Infertility is a disease or condition of the reproductive system often
diagnosed after a couple has had one year of unprotected, well-timed
intercourse, or if the woman has suffered from multiple miscarriages.
Who gets it?
Infertility is a medical problem. Approximately 40% of infertility is due
to a female factor and 40% is due to a male factor. In the balance of the
cases, infertility results from problems in both partners or the cause of
the infertility cannot be explained.
What are the risk factors?
Weight
Age
Sexually Transmitted Diseases (STDs)
Tubal Disease
Endometriosis
DES Exposure
Smoking
Alcohol
Can it be prevented?
Infertility is a disease. In some cases, you can take actions to prevent
infertility. However, many causes of infertility cannot be prevented. For
more information about preventing certain types of infertility Risk Factors
What are the signs and symptoms?
Often there are no signs or symptoms associtaed with an infertility problem.
Listening to your body and getting regular checkups will help to detect a
problem. Early detection and treatment of a problem are often critical in
acheiving successful pregnancy outcomes later.
What types of infertility are there?
Infertility is broken down into male factor, female factor, combination of
the two and unexplained infertility. For more information on infertility
diagnosis visit the treatment section of our site.
Infertility Myths and Facts
A great deal of misinformation about infertility exists today. People often
say, "If you just relax, you'll get pregnant." These kind of statements can
be misleading and hurtful for couples experiencing infertility. Click here
for a list of infertility Myths and Facts
What Everyone Should Know About Infertility
Infertility can be a major life crisis. The infertility experience involves
many hidden losses for individuals, their loved ones, and society as a whole.
Treating Infertility
How is infertility treated?
Medical technology now offers more answers and treatment options to men and
women trying to conceive a child. From hormonal treatments, ovulation
indiction and Intrauterine insemination to more advanced technologies like
in vitro fertilization, ICSI to surrogacy, egg/sperm donation and even
embryo donation. For more information on treatment of infertility visit the
treatment section of our site.
What medications are used?
There are a variety of medications used to treat infertility. It is
important to understand the medications and what their purpose is and to
speak with your physician about the medications that will be used in your
specific treatment plan. Fertility Medications
can be overwhelming. Not only are you faced with the shock of not being able
to have a child, but suddenly you are thrust into learning an entirely new
language. This section of our site is intended to provide you with factual
information on the most common fertility drugs. Your physician and medical
team will discuss use of the drugs that are appropriate for you.
Aspirin
Heparin
Clomiphene citrate
Clomid, Serophene
Follicle stimulating hormone (FSH)
Gonal F, Fertinex, Follistim, Bravelle
Human menopausal gonaditropin (hMG)
Pergonal, Repronex
Human chorionic gonadotropin (hCG)
Ovidrel, Novarel, Pregnyl, Profasi
Gonadotropin-releasing hormone agonist (GnRH agonist)
Lupron, Synarel
Gonadotropin-releasing hormone antagonist (GnRH antagonist)
Antagon, Cetrotide
Bromocriptine, Cabergoline
Parlodel, Dostinex
Progesterone
Crinone, Prometrium, Progesterone in oil, vaginal suppositories
Be sure to properly store all medications to ensure their potency.
What is artificial insemination?
Artificial insemination is now more commonly referred to as,IUI, Intrauterine
insemination. It is a procedure used for couples with unexplained infertility,
minimal male factor infertility, and women with cervical mucus problems. It
is a procedure of using the husband's or donor sperm, washing and treating
the sperm and injecting it into the woman during the time of ovulation. IUI
Intrauterine Insemination
IUI is a procedure used for couples with unexplained infertility, minimal
male factor infertility, and women with cervical mucus problems. IUI is often
done in conjunction with ovulation-stimulating drugs. IUI can be performed
using the husband's sperm or donor sperm. Before IUI, the woman should be
evaluated for any hormonal imbalance, infection or any structural problems.
Insemination is performed at the time of ovulation, usually within 24-36 hours
after the LH surge is detected, or after the "trigger" injection of hCG is
administered. Ovulation is predicted by a urine test kit or blood test and
ultrasound.
In the case of husband inseminination, the male partner produces a specimen,
at home or at the clinic or doctors office. The sperm is then prepared for
IUI. Sperm from the male partner or third-party donor are "washed" or
separated. Separation selects out motile sperm from the mans ejaculate and
concentrates them into a small volume. Sperm washing cleanses the sperm of
potentially toxic chemicals which may cause adverse reactions in the uterus.
The doctor uses a soft catheter that is passed through a speculum directly
into the woman's uterus to deposit the semen at the time of ovulation.
IUI may be used in conjunction with ovulatory medications, such as clomophine
citrate, gonadotropins, or urofollitropins. If injectable ovulation
stimulating drugs are used in an IUI cycle, careful monitoring is essential.
Monitoring includes periodic blood tests and ultrasounds beginning around
day 6 of the woman's cycle. Results of these tests will indicate when eggs
are mature, prompting the hCG shot.
IUI is also used with specially prepared donor sperm. The sperm bank sends
the doctor's office sperm that is already prepared for IUI.
IUI is a relatively quick procedure and is performed in the doctor's office
without any anesthesia. It should not be painful, although some women report
mild discomfort.
What is In Vitro or IVF?
In vitro fertilization, IVF, gets its name from the fact that fertilization
occurs outside of the woman's body, in a lab dish instead of a woman's
fallopian tubes. Typically, a woman will use ovulation stimulating drugs to
produce an excess number of eggs. These eggs are surgically removed from the
woman and fertilized in dish with sperm. If fertilization takes place, the
physician transfers the embryo(s) into the women's uterus. ART
Assisted Reproductive Technology (ART)
ART involves several types of medical treatment designed to result in
pregnancy. Types of ART include in vitro fertilization (IVF), gamete
intrafallopian transfer (GIFT), zygote intrafallopian transfer (ZIFT),
embryo cryopreservation, egg or embryo donation, and gestational carriers.
In vitro fertilization is a highly sophisticated, meticulously timed
procedure, which involves removing a ripened egg or eggs from the female's
ovary, fertilizing it with semen, incubating the dividing cells in a
laboratory dish and then replacing the developing embryo in the uterus at the
appropriate time.
The success and availability of IVF has raised the hopes of many infertile
couples who have not been able to conceive because of infertility associated
with not only blocked or absent fallopian tubes but also male infertility
and many other causes.
IVF
Preparing for an IVF Cycle
Before the first cycle a physician will do a semen analysis on the male and
a trial or mock embryo transfer. This involves passing a catheter through
the cervix into the uterus to determine its path through the cervix and to
measure the distance to the top of the uterine cavity.
IVF is generally proceeded by the use of ovulation-stimulating drugs to
increase the number of mature eggs that can be retrieved.
The process of IVF usually includes Ovulation Induction, Egg Retrieval and
Embryo Transfer.
Ovulation Induction
Ovulation can be stimulated by one of several regimens. The drugs used
include: clomiphene citrate (Clomid, Serophene , oral medications), hCG
(Profasi, Pregnyl, Ovidrel , human menopausal gonadotropin, hMG (Pergonal
, Humegon) or FSH (Follistim), Gonal F. These drugs are given by
subcutaneous injection rather than intramuscularly. Clinics often use one or
several of these drugs. A GnRH agonist (Lupron, Synarel) or GnRH
antagonist (Antagon, Cetrotide) can also be prescribed to prevent a
premature surge in the hormone LH. Some clinics start the GnRH agonist in
the luteal phase of the cycle preceding the IVF attempt; others just prior
to ovulation induction. The drug is given by subcutaneous injection or nasal
spray. In contrast, the GnRH antagonists are given once the stimulation
drugs are started
If injectable, ovulatory inducing drugs are being given, frequent blood
samples to check estrogen levels may be drawn. By day 5, estrogen levels
often are over 100 pg/ml. Vaginal ultrasound is used to monitor the growth,
size and number of developing ovarian follicles. Ideally, estradiol levels
should be at least 400 pg/ml. and ultrasound should show at least 2
follicles with a diameter of 16-17 millimeters or greater before hCG is given
. The ripened eggs will be released in 38-40 hours after this injection
Egg Retrieval
Vaginal ultrasound guided aspiration is used to harvest the egg(s).
Intravenous pain medication is often used to make the woman comfortable.
Timing is crucial. If the egg harvest is done too early, the eggs won't
fertilize; if it is done too late the eggs may have been released
spontaneously or may be too mature.
The husband will be asked to provide a fresh semen specimen. After a process
called sperm washing, anywhere from 50,000 to one million sperm are mixed
with the eggs and allowed to incubate for 14-18 hours. The fertilized eggs
(embryos) are then transferred to a new growth medium. The embryologist will
look for embryos that have two pronuclei, indicating normal fertilization
has occurred. 38-40 hours later, the embryos are examined and assessed to
determine how many blastomeres (cells in the developing embryo) are present
and how even the blastomere's walls are.
Embryo Transfer in IVF
If the embryos are developing normally, the woman will return to the clinic
to have the embryos transferred into her uterus. The embryos will usually be
at the two to eight cell stage. Some clinics are now letting embryos grow
for 5 days to the blastocyst stage
The embryos and a small amount of the liquid medium in which they have been
growing are drawn up into a soft rubber tube or catheter which is inserted
into the vagina, through the cervix and into the uterus. The embryos are
flushed gently out of the catheter. Ultrasound may be used to help the
doctor place the embryos in the uterus. The woman may be instructed to stay
in bed for several hours with her head lowered and feet raised. Discharge
from the clinic occurs anywhere from 4-6 hours after embryo transfer.
Progesterone will be given daily to maximize the chances of getting a good
uterine lining for implantation to occur.
Can infertility be surgically treated?
Some types of infertility can be surgically treated in both the male and the
female. The most common type of surgery for the male is to treat vaicocele.
Tubal problems and endometriosis for the female are the most common types
of infertility treated by surgery.
Can my OB/GYN treat me?
In many cases difficulty in becoming pregnant can be resolved by the gynecol
ogist without an extensive fertility evaluation by an infertility specialist.
Often the problem comes down to timing intercourse with ovulation, which
may be assessed using one of the over-the-counter urine LH test kits
(ovulation predictor tests). You OB/GYN can also conduct a basic infertility
evaluation. If a problem is found during your evaluation and for more
complex fertility issues, it is advised to see a specialist. When to See a
Specialist
What questions should I ask my doctor?
It is important to go into the visit with your doctor prepared. RESOLVE has
a "Questions to Ask" series that cover important questions to ask your
physician on a variety of topics.
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