Infertility

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    AHealthwise answered

    Some infertile couples are affected by conditions that prevent the sperm and egg from traveling through a fallopian tube, where fertilization and the first stage of cell division take place. The following are assisted reproductive technology (ART) procedures that are rarely used but may improve the chances of conception in the fallopian tubes. The first step of each of these treatment cycles is superovulation, the stimulation of multiple egg production with a series of hormone injections.

    Gamete intrafallopian transfer (GIFT) uses multiple eggs collected from the ovaries, which are placed into a thin flexible tube (catheter) along with the sperm to be used. The gametes (both eggs and sperm) are then injected into the fallopian tubes using a surgical procedure called laparoscopy under general anesthesia.

    Zygote intrafallopian transfer (ZIFT) combines in vitro fertilization (IVF) and GIFT. Eggs are stimulated and collected using IVF methods, then mixed with sperm in the laboratory. Fertilized eggs (zygotes) are then laparoscopically returned to the fallopian tubes where they will be carried into the uterus. The goal is for the zygote to implant in the uterus and develop into a fetus.

    Pronuclear stage tubal transfer (PROST), similar to ZIFT, uses in vitro fertilization but transfers the fertilized egg to the fallopian tube before cell division occurs.

    Because of the higher costs and risks related to laparoscopy, and the lesser amount of diagnostic information about embryo development compared with IVF, these procedures are rarely used.



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    AMarch of Dimes answered

    You probably already have baby things at home, like clothes, blankets, toys and furniture. Leave them where they are until you're ready to put them away. There's no timeline. You can put them away in a few days, in a few weeks, in a few months -- whenever you’re ready.

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    AJohn K. Jain, MD, Reproductive Endocrinology & Infertility, answered

    Using precise technology, eggs, sperm, and embryos can all be frozen for a patient's later use. An FET, or “frozen embryo transfer,” is the procedure of thawing and implanting a frozen embryo into a patient to hopefully achieve a pregnancy. The embryos being used were retrieved from the patient (or sometimes a donor) during a previous IVF cycle and then vitrified (frozen) for later use. An FET differs slightly from traditional IVF transfer procedures in that when an FET is contemplated a doctor has to prepare the patient’s uterine lining in such a manner that it matches the age of the embryo- which is usually between 3-5 days old at the time it is frozen. When the frozen embryo transfer (FET) cycle is planned, it can be done in a variety of ways including using the patient’s natural cycle. If the natural cycle is used, the woman’s ovulation day must be clearly identified. This is usually done using ovulation detection kits for women who have predictable periods, or by using an injection of human chorionic gonadotropin (HCG) in order to induce ovulation and properly time the embryo transfer period. Alternatively, a patient’s cycle can be coordinated through the use of daily medications, or estrogen replacement. Commonly the patient will begin estrogen replacement in the form of oral pills or patches for approximately 10-14 days, and then add progesterone in the form of vaginal suppositories for the number of days necessary to synchronize the uterine lining with the age of the embryo. In addition to improving the uterine lining thickness, estrogen also typically blocks the natural development of an egg follicle thus preventing the patient from ovulating until the timing is right for the procedure. Were the patient to ovulate prematurely, the cycle would have to be cancelled and rescheduled for a later date.

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    APenn Medicine answered
    Doctors often meet with couples where all of the infertility evaluations are normal and still pregnancy is not occurring. If possible, you should meet with an infertility specialist. A gynecologist with special training and certification in reproductive endocrinology and infertility would be optimal.

    You and your doctor can review all of the evaluation and history and determine a plan. Conception may occur with little or no medical intervention if you are relatively young and your evaluation has been normal so far.

    If conception continues not to occur, stimulation and monitoring of follicular growth and ovulation is recommended, along with regular intercourse as well as timed insemination with a concentrate of your partner's semen. This is called intrauterine insemination.
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    APenn Medicine answered
    The post-coital test is a test that is being used less and less nowadays. However, if the mucus is excellent and the semen analysis is normal, a very poor test (less than five motile sperm per high-power field) may be significant. For example, if the acidity of the mucus is too high (low pH), the sperm die. If a mucus abnormality is found, intrauterine inseminations may be the way to overcome the problem.

    This is the short answer. It gets more complicated if you consider that intrauterine inseminations without superovulation with hormones have fairly limited success, and even with ovarian stimulation, the success is 11% per cycle or 34% over four cycles.

    These are the only reliable statistics published in a paper by Guzick and co-workers in the New England Journal of Medicine several years ago. Quotes of higher pregnancy rates with these treatments have not been confirmed.
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    APenn Medicine answered
    Secondary infertility is when a couple has been successful before but they are now unable to conceive. There are many causes for secondary infertility, affecting the man and/or the woman.

    An evaluation is needed that includes a detailed medical history, usually a physical examination, determination of ovarian reserve (which is usually related to age) and other endocrine blood tests, ovulation, semen analysis, evaluation of the uterine cavity and the fallopian tubes.
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    APenn Medicine answered
    Yours is a common question and challenge. Here you work so hard to be in good shape, but your reproductive system seems to be adversely affected. Almost always this problem eventually reverses itself with time, weight gain, decreased exercise and good calorie and nutritional intake.
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    APenn Medicine answered
    Clinical research has revealed that clomiphene citrate (Clomid) is more effective than metformin in women with polycystic ovarian syndrome (PCOS) who are trying to conceive. If possible, it is best to schedule an appointment with a doctor who specializes in reproductive endocrinology for a complete evaluation. I would not delay the appointment. PCOS is a condition that may cause additional health issues such as type 2 diabetes and coronary artery disease (heart disease) if they are not addressed.
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    APenn Medicine answered
    If you have not ovulated on any fertility medications, then the first goal is to help you to ovulate. Each reproductive endocrinologist has his or her own recipe or plan in this type of situation. If you are overweight, you should work hard to follow a weight-loss diet, similar to that recommended for an overweight adult-onset person with diabetes, and include a daily walk of 30 minutes.

    Some doctors may monitor follicle growth by ultrasound and blood estrogen levels, increasing the dose of clomiphene citrate (even up to five pills a day), and then use human chorionic gonadotropin (HCG) to induce egg release if one or two of the follicles achieve adequate size.
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    APenn Medicine answered
    The hormone human chorionic gonadotropin, or hCG, can be used to help with the actual expulsion of the egg from a mature follicle if your own body does not trigger this process with a hormone called LH. Your fertility doctor should be the one to decide whether you need hCG and/or progesterone based on the monitoring of your cycle.