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Understanding the Causes of Secondary Infertility and Treatment Options

Understanding the Causes of Secondary Infertility and Treatment Options

Secondary infertility affects at least 11% of couples in the United States. Male and or female causative factors are responsible for secondary infertility. Medical conditions or diseases that impair ovulation and fertilization or damage the male or female reproductive tracts can cause secondary infertility. In this article, you will learn more about the male and female causes of secondary infertility and the available treatment options.

Some couples may experience challenges conceiving or giving birth despite previous successful pregnancies. These obstacles typically hinder partners from reaching their family size easily and early. Secondary infertility is the inability to conceive or to deliver a baby where there has been previous successful delivery of at least one child after trying for 12 months before age 35 years and after six months after age 35 years.

Secondary infertility affects at least 11% of couples in the United States. Male and or female causative factors are responsible for secondary infertility. Medical conditions or diseases that impair ovulation and fertilization or damage the male or female reproductive tracts can cause secondary infertility.

In this article, you will learn more about the male and female causes of secondary infertility and the available treatment options.

Causes of Secondary Infertility in Females

Medical disorders and diseases that affect the female reproductive system and hormones are causes of secondary infertility in females. Here are common causes of female secondary infertility.

Ovulation Disorders

woman looking at negative pregnancy test dealing with secondary infertility

Ovulation disorders include anovulation, which is the inability of the ovaries to release a matured egg during the menstrual cycle. Females with anovulation may not get pregnant because fertilization cannot occur without a matured egg. Oligo-ovulation is ovulation at irregular intervals, often unpredictable, resulting in irregular menses.

Ovulatory disorders account for approximately 25% of female infertility cases. Polycystic ovarian syndrome (PCOS) is the most common ovulation disorder and causes 80% of anovulation infertility. PCOS inhibits the normal cyclical hormone regulatory processes that control ovulation, affecting a female’s ability to get pregnant.

Fallopian Tube Blockage

The sperm fertilizes the egg in the ampulla region of the fallopian tubes. Hence, damage or blockage of the tube hinders the sperm from reaching the egg for fertilization. Infections of the fallopian tubes trigger inflammatory reactions that can damage and block the fallopian tube, especially in chronic pelvic inflammatory diseases. Another risk factor for tubal infertility is a history of pelvic surgery, potentially leading to scar tissue.

Uterine Disorders

Chronic infections and procedures such as dilation and curettage predispose the uterine wall to form scars and adhesions that impair the implantation of the fertilized egg. Also, uterine fibroids, especially the submucous types, may impair implantation and lead to secondary infertility.

Genital Tract Infections

The Centers for Disease Control (CDC) reports that approximately 1 out of 8 women with a history of pelvic inflammatory diseases experience difficulties getting pregnant. Chronic or poorly treated Chlamydia or Gonococcal infections of the genital tract are major causes of female secondary infertility.

Endometriosis

Endometriosis is a medical disorder in which the cells lining the uterus, called the endometrium, are found outside the uterine cavity. These external endometrial cells may trigger inflammation that affects the reproductive process in the uterus and fallopian tubes necessary for fertilization and successful implantation.

Causes of Secondary Infertility in Males

Male factors account for approximately 20-30% of infertility cases. Here are common male factor causes of secondary infertility.

Hormonal Disruption

Some medical conditions may alter the blood level of testosterone, the reproductive hormone responsible for sperm production. Also, brain injury or trauma could damage the pituitary gland or hypothalamus in the brain, which may affect the release of regulatory hormones that control testosterone production.

Genital Tract Infections

Chronic genital infections, such as sexually transmitted diseases, cause inflammatory changes that form scars blocking the sperm transport tubules in the male reproductive tract. This blockage halts the transport of sperm from the testis to the vas deferens for storage.

Damage to Sperm Transport Tubules

After sperm production in the testicles, special transport tubules move matured sperm cells to the vas deferens (the tube that connects the testicle to the penis). However, these transport tubules are at risk of damage in males with previous testicular trauma or pelvic surgeries.

Medical Disorders

Some medical disorders interrupt the blood supply to the testis, affecting the quality and quantity of sperm cells the testes produce. Examples of medical conditions that could affect the testicular blood supply include :

•      epididymitis

•      hydrocele

•      testicular torsion

•      varicocele

•      orchitis

Medications

Medications, such as chemotherapy drugs or steroids, affect sperm production and increase the risk of male secondary infertility.

Exposure to Toxic Environmental chemicals

Prolonged exposure to toxic environmental chemicals and radiation damages the testes and affects sperm formation. Examples include some pesticides and heavy metals like lead.

Lifestyle and Unhealthy Habits

An unhealthy lifestyle typically affects the formation and quality of sperm produced in the testes. Hence, males who engage in unhealthy habits such as alcohol and tobacco intake are more prone to secondary infertility than those who avoid these habits.

When to Seek Treatment for Secondary Infertility

couple seeing fertility specialist to treat secondary infertility

If you suspect you or your partner may have secondary infertility, consult a fertility doctor for evaluation.

During your visit to the fertility clinic, the doctor will take your clinical history, conduct a clinical examination, and order tests for diagnostic purposes.

For females, the doctor will take the following clinical history:

•      duration of infertility

•      your last menstrual period

•      menstrual cycle length and frequency

•      past pregnancies and their outcomes

•      history of medical disorders, including STDs and past pelvic surgeries

•      intake of medications such as birth control pills, etc

•      sexual history

Subsequently, your doctor may conduct a pelvic examination and ultrasound to evaluate your reproductive organs.

While for males, your doctor may take the following clinical history:

•      testicular trauma

•      history of infections such as orchitis or mumps

•      use of medications or previous testicular surgeries

•      exposure to toxic chemicals

•      use of tobacco, alcohol, and illicit drugs

Thereafter, your doctor may perform a pelvic exam to examine your male reproductive organs.

Tests for Secondary Infertility

Your doctor will typically order some tests to identify the underlying cause of secondary infertility and to select the most appropriate therapeutic intervention.

For females, here are some of the common fertility tests:

•      hormone profile test

•      pelvic ultrasound

•      specialized X-ray called Hysterosalpingography to outline the uterus and to check for blocked fallopian tubes

For males, semen analysis is the primary fertility test your doctor will order to assess the following:

•      sperm count

•      sperm volume

•      sperm viability

•      sperm morphology to assess any defects in shape

•      chemical properties such as pH, etc

Also, your doctor may request other tests based on the clinical history and examination findings. For example, your doctor may request a scrotal ultrasound scan if the examination reveals a varicocele. Also, serum testosterone level is crucial for suspected cases of hormone imbalance as the cause of secondary infertility.

Treatment and Fertility Options for Secondary Infertility

There are various treatment modalities for secondary infertility, and your fertility doctor has the medical expertise to decide the most suitable intervention. Generally, identifying the underlying cause and administering the specific treatment may help resolve secondary infertility. Here are the major treatment options for secondary infertility.

Medications

Your doctor will use fertility drugs to optimize the sexual hormones and other specific medications depending on the cause. In females, fertility experts use drugs to induce the ovulation of 1 or more eggs.

Clomiphene citrate is common medication doctors use in fertility clinics. It inhibits the negative feedback effect of serum estrogen in the hypothalamus and pituitary gland. This inhibition enables the pituitary gland to continue secreting gonadotropin hormones that aid the ovulation process and eventually release 1 or more matured eggs.

For males, doctors can prescribe hormone replacement medications in cases of low testosterone blood levels.

Also, your doctor may prescribe antibiotics in clinical cases of chronic genital tract infections.

Surgery

Surgical procedures may be the most suitable therapy for specific causes of secondary infertility in males and females. For instance, in females with uterine fibroids or severe endometriosis, surgery may be an effective remedy for these medical disorders.

In some clinical cases, your doctor may perform a minimally invasive surgical procedure using laparoscopic techniques— surgeries are done using a laparoscope which is a special tube with an attached camera.

For males with varicocele, a doctor may recommend surgical intervention to repair the dilated testicular veins.

Assisted Reproductive Technology

ICSI treatment for secondary infertility

Assisted reproduction technology (ART) is a fertility-based treatment that involves the manipulation of eggs or embryos to aid conception. The two most common types of ART are in-vitro fertilization and intracytoplasmic sperm injection (ICSI).

After stimulation of the ovaries with injectable medications, ART involves obtaining eggs from the ovaries through a small outpatient procedure. 

In vitro fertilization involves the exposure of each egg to several sperm in the laboratory, eventually resulting in a fertilized egg, now called an embryo. Intracytoplasmic sperm injection (ICSI) is an alternative method of aiding fertilization, involving the injection of a single sperm directly into each egg in the laboratory resulting in an embryo. After the creation of the embryo through either IVF or ICSI, the embryo grows in the laboratory, and then eventually, the embryo may be transferred to the uterus to achieve pregnancy.

Do you Need Help with Secondary Infertility?

Secondary infertility in males and females is due to various causative factors. Hence, it is essential to seek help from qualified fertility experts to help you identify the specific cause and proffer the appropriate solution.

Our team of experts at Reproductive Gynecology & Infertility are qualified fertility specialists with a track record of helping couples with infertility cases. To expand and reach your family size early, seek help from Reproductive Gynecology & Infertility today.

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New to Fertility Treatment? Here's an Infertility Glossary for You

New to Fertility Treatment? Here's an Infertility Glossary for You

Fertility treatment has its own language, often complicated or highly technical. Acronyms are also a favorite in today's infertility medical lingo. To help decipher the terminology of 21st-century infertility medicine, we've compiled this glossary of common terms and acronyms.

Infertility treatment in modern medicine allows so many individuals and couples to realize their dreams of parenthood. Like most medical fields, fertility treatment has its own language, often complicated or highly technical. Acronyms are also a favorite in today's infertility medical lingo. To help decipher the terminology of 21st-century infertility medicine, we've compiled an "old school" favorite: A glossary of common terms and acronyms.

Glossary of Infertility Terms and Acronyms

We've listed the items here in alphabetical order. Acronyms appear in their commonly used form, followed by the full term the set of letters represents.

Agglutination

Describes an event in which sperm clump together, making it difficult for them to swim easily. Sperm agglutination is a possible indication of immunological infertility, which makes it an important factor to consider in forming an infertility diagnosis.

AI (Artificial Insemination)

A procedure that deposits sperm near the cervix in the vagina or directly into the uterus using a catheter.

Amenorrhea

The complete absence of menstrual periods.

Anovulation

A complete absence of ovulation.

ART (Assisted Reproductive Technologies)

ARTs are various procedures used to combat infertility in which conception occurs without sexual intercourse.

ART Cycle

A process that includes an ART procedure, stimulation of the ovaries, or frozen embryos that are thawed for transfer into a woman. This process starts when a woman begins fertility medications or monitors her ovaries for follicle production.

BBT (Basal Body Temperature)

infertility glossary Basal body temperature tracking

A temperature reading taken every day that can be used to chart ovulation.

Beta HCG Test

This blood test detects very early pregnancies and can help evaluate embryonic development.

Cryopreservation

This freezing process preserves embryos, sperm, and other tissues at very low temperatures. When embryos are not utilized in an ART cycle, they can be cryopreserved for potential use in the future.

DEIVF (Donor Egg In Vitro Fertilization)

An in vitro fertilization procedure in which the egg used is procured from a donor.

Donor Egg

Also known as egg donation, this term describes the donation of an egg from one woman to another. The goal is to become pregnant by in vitro fertilization (IVF).

Donor Embryo

Describes an embryo donated by a couple who previously had ART treatment that resulted in the creation of extra embryos. When donated, all parental rights of the donor couple are relinquished.

Embryologists

Professionals who specialize in advanced laboratory techniques to prepare and provide the conditions necessary for the fertilization of eggs. These specialists facilitate the development, growth, maturation, and preservation of embryos.

Fertility Specialist

A physician who specializes in treating fertility problems. These physicians receive certification in a subspecialty for OB-GYNs from the American Board of Obstetrics after obtaining extra training in reproductive endocrinology and infertility.

Gestation

This term refers to the period of development the fetus undergoes in the uterus from conception to birth, usually 40 weeks' duration.

Gestational Surrogate / Gestational Carrier / Gestational Surrogacy

Arrangement in which a woman agrees to carry a pregnancy on behalf of another individual or couple (the intended parents). In Gestational Surrogacy, embryos are created using the egg of the intended parent (or an egg donor) and the sperm of an intended parent (or a sperm donor). Gestational Carriers (surrogates) do not have any biological relation to the resulting baby.

HCG (Human Chorionic Gonadotropin)

A hormone produced in early pregnancy that's released from the placenta after implantation. It can be employed via injection to trigger ovulation after certain types of fertility treatments. In men, it can stimulate testosterone production.

ICSI (Intracytoplasmic Sperm Injection)

Infertility glossary picture of ICSI

This procedure retrieved eggs and sperm from both partners. In a laboratory, a single sperm is injected directly into the egg, and the fertilized egg is then implanted into the woman's uterus.

Idiopathic Infertility

A term applied when the cause of infertility remains unexplained.

Implantation

This occurs when a fertilized egg embeds itself in the uterus lining.

Infertility

Inability to conceive following a year of unprotected intercourse, or six months in women over age 35.

IUI (Intrauterine Insemination)

Less frequently, it can stand for intra-uterine injection or intra-uterine infection. Intra-uterine insemination is a procedure for treating infertility. The sperm is washed, then concentrated before being placed directly in the uterus when the ovary releases one or more eggs.

IVF (In Vitro Fertilization)

A complex procedure for treating infertility in which mature eggs are retrieved from ovaries and fertilized by sperm in a lab.

Microinsemination

In this laboratory procedure, sperm is injected next to an egg cell surface in a laboratory dish. This is done to increase the chances of fertilization.

PGT (Preimplantation Genetic Testing)

A screening technique used to evaluate the chromosomal makeup of an IVF embryo and whether the embryo contains genetic abnormalities.

Postcoital Test

In this standard fertility test, a sample of cervical mucus is taken from the woman after intercourse to determine the number and behavior of sperm. Cervical mucus is an accurate reflection of the ovarian cycle, the PC test is an invaluable indicator of the endocrine preparation of the female reproductive system.         

Reproductive Endocrinologist

Highly trained Obstetrician-Gynecologist with advanced education, research, and skills in reproductive endocrinology and infertility. 

Secondary Infertility

Infertility lasting six months or more in a couple who previously had a successful pregnancy and birth.

Sperm Bank

A facility that specializes in the collection and freezing of sperm, preserving it to be used later by a couple or donated for use in assisting others with infertility.

Sperm Count

The number of active sperm in an ejaculate sample. Normally, the sperm count ranges from 15 million sperm to more than 200 million sperm.

Sperm Motility

The percentage of sperm in an ejaculate that moves forward.

Surrogacy

Traditional Surrogacy

Traditional surrogacy is sometimes called "straight surrogacy," "partial surrogacy," or "genetic surrogacy." It involves a legal agreement between the intended parents and the surrogate. In this scenario, the surrogate is the biological mother of the baby. The surrogate's own eggs are fertilized using a sperm donor or the intended father. Intended mothers do not have a genetic link to the baby in traditional surrogacy. IHR does not work with traditional surrogates, only gestational surrogates. 

Gestational Surrogacy

A gestational surrogate carries and delivers a baby for another person or couple. Gestational surrogate pregnancies are achieved through IVF. In this procedure, an embryo is created in a lab using the egg and sperm from the intended parents, or donor eggs and sperm may be used. The embryo is then transferred to the uterus of the gestational surrogate. Because the gestational carrier carrying the pregnancy doesn't provide an egg, there is no genetic connection between the child and the surrogate.       

TTC (Trying to Conceive)

Considered slang, this acronym is generally used as a form of shorthand in notes, in online communities, and on social media. Often seen as a hashtag: #TTC.

Ultrasound

Infertility glossary woman looking at ultrasound

A testing procedure that uses high-frequency sound waves to view the ovaries, uterus, and the developing fetus.

Vaginal Ultrasound

This procedure is performed through a probe inserted into the vagina. It allows the viewing of the follicles, fetus, and other soft tissues by using sound waves. Imaging the structures in the pelvis with ultrasound can identify abnormalities and help diagnose conditions.

Make the Call

Are you ready to explore the possibilities for growing your family? Request a consultation with the specialists at Reproductive Gynecology & Fertility, your premiere source for comprehensive, advanced, experienced fertility care. 


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The Pros and Cons of PGT

The Pros and Cons of PGT

PGT is a genetic testing that spot screens for abnormalities in embryos. This guide will walk you through your options to make the best decision for you.

If you are currently planning to start in vitro fertilization (IVF), you may feel overwhelmed by the decisions you have to make. Your physician and you (and perhaps a partner) will discuss IVF protocols, the fertilization method, and what to do with any surplus embryos. Another important decision you’ll need to make is whether to do preimplantation genetic testing (PGT). 

PGT is a procedure that spot screens for abnormalities in embryos to help identify the best embryo to transfer and hopefully decrease the risk of an unsuccessful transfer. In addition, it can be used to screen for genetic diseases in patients who are at risk of transmitting a genetic disease (like BRCA, a breast cancer gene) to a child. 

PGT includes three genetic screening tests for embryos. They are usually referred to by their acronyms. Here’s what you need to know about PGT to decide if it’s the right choice for your fertility journey.

What Is PGT?

PGT is an umbrella term covering three main subsets of genetic testing. They include preimplantation genetic testing for aneuploidy (PGT-A), preimplantation genetic testing for monogenetic/single-gene diseases (PGT-M), and preimplantation genetic testing for structural chromosomal rearrangements (PGT-SR). PGT-A is the most common genetic test for those going through fertility treatments like IVF.

By understanding what each of these tests does, you can speak to your fertility specialist and see if they might be right for you.

PGT-A

PGT-A screens for chromosome abnormalities in embryos. It counts the 46 chromosomes in an embryo and detects whether there is an extra or missing chromosome – this is clinically referred to as aneuploidy. This can reduce the risk of implanting an embryo with a genetic condition such as Down syndrome (where there is an extra chromosome), and it can help predict which embryos will implant most successfully during IVF, resulting in pregnancy.

PGT-M

Formerly known as preimplantation genetic diagnosis (PGD), PGT-M (monogenic/single gene defect) is a screening tool used for couples who may be at an increased risk of having a child with a specific single gene disorder. Those who may benefit from PGT-M include couples who are carriers of the same autosomal recessive condition, such as Cystic fibrosis. 

When patients (and their partners) know this information before IVF, they are encouraged to undergo screening for recessive conditions. For these conditions, if an embryo inherits one mutated gene copy from each parent, the child would be affected by the disease. PGT-M can detect mutations from parents with inherited genetic diseases, such as Huntington’s disease, or a genetic cancer risk like the BRCA gene.

PGT-SR

PGT-SR is performed when a patient (or their partner) is known to have a chromosomal rearrangement – pieces of chromosomes are missing, duplicated, or rearranged. Individuals with chromosomal rearrangements may experience recurrent pregnancy loss or have a child affected by a chromosomal rearrangement. Many times these patients are healthy and would otherwise not show any signs or symptoms. 

Patients with recurrent pregnancy loss (two or more clinical pregnancy losses) should have a karyotype to screen for a chromosomal rearrangement prior to starting IVF. By detecting the chromosomal rearrangement in an embryo, PGT-SR can reduce the risk of having a child affected by a chromosomal abnormality and the risk of another pregnancy loss. 

By working closely with a fertility specialist who understands your fertility process and health history, they’ll be able to confidently recommend whether a specialized test like PGT-SR can help in addition to a more commonly used screening tool like PGT-A.

The Pros and Cons of PGT-A

Here are some factors to remember as you discuss PGT-A with your partner and fertility specialist.

Pro: Optimal Embryo Selection

One of the main goals of PGT-A is to ensure that your IVF is successful. By screening the embryos before implantation, the doctor is able to identify the embryos with a higher chance of a successful pregnancy. Since pregnancy rates are higher with embryos that have undergone PGT-A, only one embryo is transferred. Single embryo transfer is preferred since pregnancy complications increase in pregnant patients with more than one fetus.

Pro: Sex Selection

PGT-A screens all 46 chromosomes, which means information on embryo sex is also available. Some patients prefer not to know the sex of the embryos. Others may be interested for the purpose of family balancing or for rare situations in which a genetic disease is inherited based on embryo sex.

Pro: Reduce Stressful Decisions

The most common cause of pregnancy loss is a chromosomal abnormality in the developing fetus. Some chromosomal abnormalities can increase the risk of stillbirth, shorten lifespan, or cause significant medical problems. By screening embryos for chromosomal abnormalities, some of these tragic situations can be avoided. By screening embryos with PGT-A, hopefully, the risk of miscarriage will decrease, and the number of embryo transfer cycles needed to become pregnant will also decrease.

Con: Extra Cost

IVF is expensive, and additional testing like PGT-A can add cost. Your insurance also may not cover PGT-A with your fertility treatment. However, it’s worth noting that with PGT-A, you may not need multiple embryo transfer cycles to conceive, helping to negate that cost. Together with your fertility specialist, you can discuss the expense of both IVF and PGT-A to your options and how much extra testing may cost.

Con: Embryo Damage

All genetic screening tests require embryologists to remove cells (usually five-seven) from the trophectoderm – which are the cells that become the placenta. This testing is usually performed on a day five embryo (blastocyst) when the embryo is less likely to be impacted by removing a small number of cells. Cells from the inner cell mass are not disturbed as these cells will develop into the fetus. In labs that are routinely performing PGT-A, the risk of damage to the embryo is very low because of the expertise and experience of the embryologists. Your fertility specialist will help you decide if this testing is the best choice for you and will also discuss the genetic screening options that are available after you conceive. 

Con: False Results

Just like with any type of testing, there is a chance that a PGT-A test can deliver a false negative or positive, meaning that healthy embryos may go unused when they could have been transferred, or an embryo with a chromosomal abnormality is transferred based on test results. 

This test is also not a diagnostic test but a screening test. This is because the biopsied cells come from the cells that become the placenta and not the cells that become the fetus. This is not unique to embryo testing as early genetic screening in pregnancy – such as noninvasive pregnancy testing (NIPT), which is offered at 10-12 weeks is also screening the DNA from the placenta. The earliest testing that can be done on the DNA of the fetus is at 15 weeks of pregnancy via an amniocentesis. 

In addition, sometimes embryos contain 2 different cell lines – these are called mosaic embryos. Mosaic embryos can implant and result in a live birth but do so at a lower rate than chromosomally-normal embryos. Mosaic embryo results require individualized counseling between the physician and patient before making the decision to transfer. 

Talk to your fertility specialist about the risk of a false PGT-A result so that you can factor this into your decision-making process.

Is PGT-A the Right Choice for Me?

Many personal factors come into play when deciding to do PGT-A testing on your embryos. This includes:

  • Age: Women who are older who are undergoing IVF to create embryos have an increased risk of chromosomal abnormalities in those embryos. Therefore, women 35 years or older may want to use PGT-A to select the embryo that has the highest chance of pregnancy.
  • Health history: If you’ve had a history of recurrent miscarriages, unsuccessful embryo transfer cycles, or have had abnormal genetic testing results in the past, PGT-A may offer you peace of mind before an IVF transfer.
  • The number of embryos: It is important to note that not every fertilized egg will develop into a blastocyst (day five embryo). There is a risk that no embryos develop to day five or that no embryos are chromosomally normal. Thus, some patients who proceed with PGT-A may not have a viable embryo to transfer.
  • Time: After the embryos are biopsied on day five, the embryos are cryopreserved until embryo transfer. The results from the genetic testing of the embryo may take as long as two weeks. Therefore, patients who test the embryo will usually transfer the embryo the next month. Studies have also shown that for some patients, a frozen embryo transfer has a higher live birth rate than a fresh transfer.

This is just a glimpse of the considerations when thinking about PGT-A testing. To make the best-informed decision, consult with a fertility specialist regarding your situation. They will be able to go over your health history and fertility journey and answer any questions you may have to help you confidently reach your decision.

At RGI, we offer an IVF 100% Success Guarantee Plan to qualifying patients because we’re confident in our experience and technology to help you get the family of your dreams. For some patients, an important part of that will include PGT-A testing. Schedule a consultation with a fertility specialist today and learn more about your fertility and the available treatment options.

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The Basics of Using an Egg Donor: IVF Process, Costs, and Success Rates

The Basics of Using an Egg Donor: IVF Process, Costs, and Success Rates

Fertility treatments such as in-vitro fertilization and egg donation (egg donor IVF or donor egg IVF) allow many individuals and couples to start or expand their family size regardless of their fertility and health status. A 2016 Center for Disease Control and Prevention survey revealed that donor eggs were used in 24,300 Assisted Reproduction Technology (ART) cycles.

Fertility treatments such as in-vitro fertilization and egg donation (egg donor IVF or donor egg IVF) allow many individuals and couples to start or expand their family size regardless of their fertility and health status. A 2016 Center for Disease Control and Prevention survey revealed that donor eggs were used in 24,300 Assisted Reproduction Technology (ART) cycles.

Although the success rate of donor egg IVF procedures varies, the average success rate of live births utilizing this procedure is 49-50%. Your odds of succeeding in using donor eggs are higher when you follow specific steps and consult a fertility specialist. Our team has compiled a few guidelines to help you with the donor egg IVF procedure.

This article will teach you more about egg donor IVF, the process of how donor eggs and IVF work, and the procedure’s benefits and success rates.

What is Egg Donation?

Egg donation is the process in which a donor (female) contributes her eggs to a recipient for conception purposes. At RGI, our egg donors undergo thorough physical and psychological screenings. These screening tests help to ascertain the egg donor’s health status and suitability for the egg donation journey before matching with recipients.

After an egg donor passes the critical screening steps to confirm their eligibility, she will undergo the process to retrieve eggs. First, the donor will take medication to stimulate the ovaries to produce multiple eggs. Egg donors then undergo an egg retrieval to obtain the eggs available for use by another individual or couple.

Eventually, the eggs are fertilized in the lab through in vitro fertilization. In vitro fertilization is the process in which the eggs are exposed to sperm resulting in the development of an embryo in a culture medium in the laboratory. This embryo will then be placed in the recipient’s uterus to result in pregnancy.

Who Benefits From Egg Donation/Donor Egg?

The egg donation process is suitable for individuals and couples who want to start a family but cannot for various reasons.

The egg donation process is recommended in the following clinical cases:

  • older females with infertility
  • single males who have a gestational carrier (surrogate)
  • gay male couples
  • those with a high risk of transmitting a genetic disease
  • females with low ovarian reserves and primary ovarian insufficiency
  • females with damaged ovaries due to cancer treatment
  • unexplained recurrent IVF failure

Apart from these indications, the fertility doctor will evaluate your unique health needs to determine if you will benefit from egg donation.

What Is the Process of Egg Donation?

Pre-donation Screening

Fertility doctors use specific guidelines stipulated by the law to screen egg donors in a fertility clinic. U.S. Food and Drug Administration (FDA) guidelines recommend the following screening procedures for egg donors:

The egg donation process occurs in phases and has both medical and legal procedures to protect the donor and recipient. Here are the typical steps of the egg donation process.

  • formal application
  • in-person or phone interview
  • clinical and psychological history to discover the donor’s medical and family history
  • physical examination
  • blood tests such as HIV, etc, for infectious disease screening
  • drug tests
  • ultrasound scan to examine the female reproductive organs
  • genetic testing to screen for inherited disease

These screening procedures help to confirm the eligibility and health status of the prospective egg donor.

Legal Procedure

The law regulates the egg donation process and helps to protect both parties involved. Generally, the donor and recipient may opt for legal counsel before the egg donation process. Sometimes, a lawyer helps mediate the legal procedures, such as verifying and witnessing contract signing. For instance, some egg donation clinics require all donors to sign a contract. This contract will typically state that the donors do not have any legal rights or responsibilities to a child resulting from the process.

The Treatment Phase

The fertility specialist will use specific fertility drugs to prepare the egg donor. While on these medications, fertility experts monitor the donor closely, stimulating her ovaries to make several eggs in a single cycle. Once the ovaries appear ready, a medication to induce the maturity of the eggs is administered at a precise time relative to the egg retrieval procedure. During this phase, egg donors remain abstinent from sexual intercourse to eliminate pregnancy risk for the egg donor.

Egg Retrieval

On the retrieval day, the donor will receive anesthesia medications, often through the IV. Then the doctor will use ultrasound guidance to insert a needle through the vagina and into the ovary to extract the eggs from the matured follicles. Extracted eggs are cryopreserved until they are used by a recipient for in vitro fertilization.

How Do Donor Eggs and IVF Work?

The in vitro fertilization process takes place after eggs are retrieved from the donor. The sperm donor or intended parent will provide the semen specimen, which will be used to fertilize the mature eggs.

Fertilization can occur in two ways;

  • Conventional insemination: Healthy matured eggs are exposed to sperm cells in the culture medium to allow fertilization.
  • Intracytoplasmic sperm injection (ICSI). In ICSI, a sperm cell is injected directly into each mature egg. ICSI is ideal for clinical cases of low sperm count or repeated history of failed IVF.

After successful fertilization, the embryo grows in the culture medium in the lab. The fertility expert transfers the embryo into the intended parent or gestational carrier’s uterus for implantation.

How Much Do Donor Eggs and IVF Cost?

The cost of egg donation varies depending on the source of the donor eggs. Couples can get egg donors from the following sources:

  • Egg donor agencies: These are specialized commercial egg donation agencies that recruit, screen, and match healthy egg donors with interested couples.
  • Infertility clinics: Some have a bank of frozen eggs harvested from past clients.
  • Specific individuals: A couple can choose a close relative or friend as their egg donor.

The cost of the invitro fertilization process differs for each fertility clinic. The average cost of egg donation will range between $10,000- $15,000. This could be more if it is a fresh egg donation process versus frozen donor eggs, which are typically less expensive.

According to the American Society of Reproductive Medicine, the average cost for one in vitro fertilization (IVF) cycle is more than $12,000. This cost is in addition to the cost of an egg donor.

What Are the Success Rates of Donor Egg + IVF?

mom holds newborn baby after using fertility treatment egg donor IVF

The success rate of egg donation and in vitro fertilization differs from clinic to clinic. The recent Center for Disease Control fertility report states that close to 50% of donor eggs and in vitro fertilization result in a live birth.

The success rate of egg donation and IVF also depends on the following:

  • egg donor’s age
  • extraction process
  • quality of sperm,
  • recipient’s health status

Hence, it is important to consult a fertility expert with a proven track record of successful egg donation and IVF.

Do You Need Help With Egg Donation and IVF?

Egg donation and IVF help couples to start or expand their family size regardless of their health or fertility status. Egg donation and IVF are safe and suitable for LBGTQ+ couples and heterosexual couples struggling with fertility. The egg donation process involves multiple steps and requires expert guidance from an experienced team of fertility experts.

At Reproductive Gynecology and Infertility, we have years of experience helping build families through IVF and donor eggs. Our state-of-the-art IVF technology solution has helped partners achieve their dreams of having a beautiful family.

We have a team of industry-leading fertility physicians and assisted reproductive technology professionals to assist you. Schedule an appointment with us to get started on your family-building journey.

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Getting Pregnant with PCOS

Getting Pregnant with PCOS

Polycystic Ovarian Syndrome, commonly known as PCOS, is one of the leading causes of infertility. As many as five million women in the U.S. are affected by this condition, which may impact ovulation. The condition can make conceiving difficult, but treatments are available and are associated with high success rates.

Polycystic Ovarian Syndrome, commonly known as PCOS, is one of the leading causes of infertility. As many as five million women in the U.S. are affected by this condition, which may impact ovulation. The condition can make conceiving difficult, but treatments are available and are associated with high success rates. Women with PCOS who are interested in conceiving may respond to a combination of lifestyle changes and medical treatment, so it’s important to reach out to a specialist for evaluation. Today we’ll look at what PCOS is, how it affects fertility, and what you can do to increase your odds of getting pregnant if you have PCOS.

What is PCOS?

Polycystic Ovarian Syndrome is a hormonal problem that causes ovulation to be erratic, infrequent, or even entirely absent. Women who do not ovulate regularly will complain of irregular or absent menses.

The name of the condition tells us something about it. “Poly” = “many,” and “cystic” = “having to do with cysts.” PCOS is a condition where there are many small follicles that are arrested in development. Usually, one follicle will develop a mature egg each cycle. In PCOS, the ovarian environment is dominated by androgens like testosterone and insulin resistance. This impairs the development of the follicle and prevents an egg from maturing.

How Does PCOS Affect Fertility?

For conception to take place, your body must produce and release a mature egg. If you don’t ovulate, you cannot get pregnant. Most people ovulate monthly, and the less frequently you ovulate, the fewer opportunities there are to get pregnant. While exact numbers are difficult to pin down due to the variability of severity and symptoms in PCOS, the 2015 Australian Longitudinal Study on Women’s Health found that 72% of participants with PCOS reported fertility problems, compared to 16% in those who did not have PCOS.

Getting Pregnant with PCOS

If you have PCOS, the most important step toward getting pregnant is to induce ovulation. Since ovulation may be irregular in women with PCOS, it can be difficult to identify your fertility window. In women who do not have menses, there is no opportunity to conceive due to a lack of ovulation. Many women with PCOS are prescribed hormonal contraception to help improve their bleeding; therefore, they may be unsure of their cycle regularity once they stop taking hormonal medication. If normal menses does not occur one month after stopping the hormonal medication, this may indicate an ovulation disorder.

In addition, the weight gain often associated with PCOS can make ovulation even less likely. For women with an increased body mass index (BMI), lifestyle approaches such as dietary changes and exercise may result in ovulatory cycles.

Lifestyle Changes that Can Increase Your Chances of Pregnancy

If you have PCOS and you’re overweight, one of the simplest things you can do to increase your chances of getting pregnant is to lose weight. Losing only five to ten percent of your current weight is often enough to restart ovulation. If you’re not overweight, weight loss is unnecessary. However, other non-drug options may be beneficial regardless of your weight.

Here are a few lifestyle changes that could help:

Watch What You Eat

There is no one-size-fits-all option for women with PCOS who are trying to lose weight, but caloric restriction is generally ideal.

  • Decreasing the intake of carbohydrates and foods with high glycemic load is beneficial for women with PCOS because many women with PCOS have insulin resistance.
  • Avoid intake of sugary beverages like soda, and try to buy less packaged food.
  • Include high-fiber foods and lean protein in your daily diet, and pass on red meat.

These dietary changes may help decrease the risk of developing diabetes, which is common among women with PCOS, and promote weight loss — both of which will help to restore ovulation and decrease the risk of complications in pregnancy.

Exercise regularly

For roughly half of those diagnosed with PCOS, exercise can help regularize menstrual cycles and improve ovulation. And, of course, exercise can support weight loss. This doesn’t mean you have to take out a gym membership or invest in expensive equipment; walking and yoga are easy, enjoyable ways to include exercise in your daily routine. There are other benefits of exercise as well, and women with PCOS who exercise regularly report a higher quality of life.

Medications That Can Assist Ovulation

Along with lifestyle modifications, several drugs can help PCOS patients restart or regularize ovulation and get pregnant.

Metformin

Metformin is commonly prescribed to help decrease the development of diabetes in women with PCOS but does induce ovulation. Metformin is commonly used in conjunction with letrozole to help induce ovulation in women with PCOS. It may be started in women with abnormal glucose testing or for women who failed to respond to letrozole or Clomid.

Letrozole and Clomid

These drugs are standard fertility drugs used to increase the regularity of ovulation and stimulate ovulation in people who do not ovulate. While both improve the likelihood of getting pregnant, letrozole appears to be more effective in achieving ovulation for women diagnosed with PCOS.

When to Seek Fertility Treatment

For patients with a diagnosis of PCOS, a pre-conception visit with either an OBGYN or a fertility specialist is important. Women should start incorporating lifestyle modifications (and start a prenatal vitamin) prior to conception.

For women who are not having regular periods, it’s important to seek help immediately so that a proper evaluation can be completed. Male partners should also be evaluated, as many couples have male and female problems.

If pregnancy is not achieved after three to six cycles, it may be time to consider other approaches to fertility treatment, such as IVF. Our fertility specialists can help you explore your options with your unique needs and goals.

Yes, You Can Get Pregnant with PCOS

While PCOS is one of the most common causes of infertility, it’s also one of the most treatable. If you’re ready to take the next step on your fertility journey, contact us today for a consultation.

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Stages of Endometriosis

Stages of Endometriosis

Endometriosis is when endometrial tissue develops outside the uterus, causing inflammation, discomfort, and infertility.

Endometriosis is when endometrial tissue develops outside the uterus, causing inflammation, discomfort, and infertility.

Stages of Endometriosis:

Stage 1 — Minimal

A few superficial lesions, or implants, on the tissue of your pelvis or abdomen with little to no scar tissue.

Stage 2 – Mild

Implants are deeper with some scar tissue.

Stage 3— Moderate

Multiple deep lesions, small cysts on your ovaries, and thick bands of scar tissue.

Stage 4 — Severe

Widespread deep tissue implants, thick scar tissue, and larger cysts on both ovaries

Diagnosing Endometriosis:

Your healthcare provider may perform:

Ultrasound

Imaging of your internal organs using sound waves.

CT Scan

Imaging with computer technology and X-rays to see abnormalities in the body.

MRI

Two-dimensional imaging of your organs.

Laparoscopy

Performed by inserting a tiny tube with a camera into your abdomen to assess endometrial growth.

Endometriosis Treatment:

Pain relief

Over-the-counter pain medicine to relieve discomfort.

Hormone therapy

Hormones to decrease menstrual symptoms and ovulation.

Laparoscopy

A small scope is used to find and remove endometrial growths.

Hysterectomy

Removal of the uterus.

What does endometriosis have to do with infertility?

20-40% of women with infertility have endometriosis.

Endometriosis results in inflammation, affecting the function of your reproductive organs.

It causes scar tissue formation in the pelvic area and adhesion-related distortions of the fallopian tubes, interfering with egg fertilization and implantation.

Contact Reproductive Gynecology and Infertility (RGI) to learn more about endometriosis and infertility treatments.

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10 Things to Know Before and After Your Embryo Transfer

10 Things to Know Before and After Your Embryo Transfer

Going through fertility treatment, you may wonder about the best path to self-care during IVF, especially as embryo transfer day approaches. You may be worried about what effect your actions can have on the process, and you want to make sure you do everything in your power to ensure success. The good news is that caring for yourself before and after your embryo transfer procedure isn’t complicated.

Going through fertility treatment, you may wonder about the best path to self-care during IVF, especially as embryo transfer day approaches. You may be worried about what effect your actions can have on the process, and you want to make sure you do everything in your power to ensure success. The good news is that caring for yourself before and after your embryo transfer procedure isn’t complicated.

Here are ten simple tips for taking care of yourself during this exciting time.

1. Eat a Healthy Diet and Stay Hydrated

If you already eat wholesome meals, keep it up. Now is the time to cut down on sweets, reduce alcohol, and add more fruits, vegetables, and lean protein. There’s no “embryo transfer diet” to follow, but eating as if you’re already pregnant is a good idea. Drinking fluids is also crucial since proper hydration is essential to optimal cell functioning. You want your body to be in optimal condition.

2. Take a Prenatal Vitamin (and Make Sure You Get Enough Folic Acid)

Now is a good time to start taking a prenatal vitamin — following your doctor’s instructions. If you’re taking an over-the-counter prenatal rather than a prescription brand, ensure that it includes DHA omega 3, vitamin D, calcium, and folic acid. While most prenatal vitamins contain adequate amounts of folic acid, your doctor may recommend an additional supplement. Folic acid helps prevent neural tube defects in your baby and may also reduce the risk of heart defects.

3. Avoid Chemical Exposure from Everyday Sources

Modern life is full of products containing endocrine-disrupting chemicals or EDCs. These chemicals may interfere with your hormones, and some can cross the placenta and build up in your unborn baby’s bloodstream, causing developmental issues. Become a label reader and avoid products that contain the following:

  • Bisphenol A (BPA, common in plastics)
  • Phthalates
  • Parabens (common in cleaning and personal care products such as shampoo)
  • Triclosan (found in anti-bacterial products).

Avoid EDCs both before and after embryo transfer or, better yet, cut them out of your life entirely.

4. Take it Easy on Transfer Day and Immediately After

While there’s certainly no need for bed rest (the embryo isn’t going to fall out, after all), relaxing and pampering yourself on embryo transfer day and for a couple of days after is a good idea. This is as much for psychological and emotional reasons as for physical ones; post-transfer days can be an emotional rollercoaster, and rest, relaxation, and pampering can go a long way toward reducing stress.

5. Relax — but Not in the Hot Tub

While pampering yourself in the days after an embryo transfer can be good for your mental and physical health, avoid the sauna or jacuzzi, and pass on a long soak in a hot bath for a few days. Some research suggests that activities that elevate your core temperature might interfere with implantation. Just to be safe, stick to showers or warm baths rather than turning up the heat.

6. Keep Taking Your Medications

Unless your doctor advises you differently, continue taking your prescribed medication. Progesterone is vital as it helps the embryo implant and ensures it stays implanted. Don’t stop any medicines unless your doctor recommends a break.

7. Abstain from Sex Until Your Doctor Okays It

If your doctor has suggested that you refrain from sexual intercourse for a short time after the embryo is transferred, you may wonder why. The answer? Sex can cause uterine contractions. This can affect the embryo’s ability to implant and, in a worst-case scenario, could theoretically lead to a miscarriage. Most experts agree that abstaining from sex for 10 to 14 days is sufficient.

8. Pay Attention to Your Body

You know your body best, so pay close attention to what it’s telling you. If anything feels wrong or “off,” inform your doctor immediately. There’s probably nothing to be concerned about, but a quick consultation can relieve your mind.

If you’ve been taking fertility drugs, keep your eye out for the following symptoms:

  • Sudden weight gain
  • Abdominal pain
  • Bloating
  • Nausea
  • Vomiting
  • Diarrhea

These can be symptoms of ovarian hyperstimulation syndrome or OHSS, and it’s important to let your doctor know immediately.

9. Don’t Rush Out and Buy a Pregnancy Test

Taking a pregnancy test too early isn’t a good idea, no matter how tempting it may be. Pregnancy tests measure the amount of pregnancy hormone in your urine, and it takes some time for this hormone to build up to measurable levels. You might get a false-negative or even a false-positive result if you take a test too soon. So, settle in with a stack of good books, binge-watch Netflix, or find another way to pass the time until your scheduled pregnancy test with your fertility doctor.

10. Use Stress-Reduction Tools to Make the Wait Easier

Finally, do what you can to de-stress while you’re waiting. This is a good time to sign up for meditation, a beginner’s yoga class, or embark on a stress-reduction course.

The Takeaway

The time before and after your embryo transfer can be a template for how you plan to advance during your pregnancy. Forming good habits now and learning to care for yourself with compassion can create a firm foundation to build on in the future. If you’re just starting your fertility journey, if you have questions, or if you simply want to learn more, we can help.

Contact Reproductive Gynecology and Infertility today and speak to one of our fertility experts.

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How to Support Those Struggling With Infertility

How to Support Those Struggling With Infertility

Deciding to start a family can be one of the most exciting life decisions a person can make. However, if a couple or individual has difficulty conceiving, joy and excitement can turn into stress and despair.

Deciding to start a family can be one of the most exciting life decisions a person can make. However, if a couple or individual has difficulty conceiving, joy and excitement can turn into stress and despair.

Unfortunately, infertility is not uncommon. This global issue affects about 48 million couples and 186 million individuals worldwide. So even if you’re not personally struggling with infertility, chances are likely that you know someone who is.

Infertility takes a mental, physical, and emotional toll on those longing to become parents. So how can you best support a friend who’s going through infertility?

What is Infertility?

Infertility is being unable to get pregnant after a year or more (6 months if over the age of 35).

Infertility affects all genders and can be due to several causes. Issues with any of the many steps that lead to conception can cause infertility.

For many people, infertility can occur when there are problems with their reproductive organs — such as the fallopian tubes, uterus, ovaries, testicles, or sperm. Smoking, obesity, alcohol or drug use, radiation exposure, genetic factors, and some medications increase the risk of infertility.

Infertility impacts everyone differently, and people may cope in various ways. It can be heartbreaking when someone wants to become a parent and is met with challenges.

You may be unsure what to do or say if your friend or family member is dealing with infertility. Still, there are several ways to support them.

Talking to Those Struggling With Infertility

When talking to a loved one with infertility, the most important thing is to let them know you’re there for them. Just asking how you can help goes a long way. Infertility comes with many complex emotions, so let your friend know they can talk to you if they feel like discussing it.

What Not to Say to a Friend with Infertility

What NOT to say is just as important as what you say. You may be trying to frame things in a positive light. For instance, saying things like “at least you don’t have cancer” or “at least you have freedom since you don’t have kids” is not helpful. But instead, statements like these minimize the pain of infertility. Just because infertility isn’t life-threatening doesn’t mean it’s not devastating to those trying to conceive.

Don’t Give Advice

Also, avoid advising on what they should do, like telling them to adopt. Adoption is a different journey that comes with its complexities. Your friend may not be ready to think about adoption just yet. On top of that, adoption can be a significant financial strain.

Fertility treatments can also be costly as well as mentally and physically taxing. So it’s best not to push your friend to pursue fertility treatments or tell them what to do about their infertility. In addition, you may not know everything they’ve tried or what it’s like to undergo fertility treatments.

Communicate Openly and Mindfully

Open communication is vital; you shouldn’t hide your pregnancy just because your friend is struggling with infertility. They’re probably very happy for you! But it’s a good idea to drop the news to them in private, so they have time to process it on their own time. You could even give them an individual heads up before posting about your pregnancy on social media.

Supporting a Friend With Infertility

Besides mindful and empathetic communication, there are more concrete ways to support someone struggling with infertility.

Learn About Infertility

Everyone in your friend’s circle may be curious about their infertility and ask them lots of questions about it. Yet, it can be exhausting to constantly rehash all the same information to different people.

You can take some of the burdens off your friend by researching and learning about infertility. Educate yourself about infertility and fertility treatments, like in vitro fertilization or intracytoplasmic sperm injection, so you’ll be on the same page if your friend ever wants to discuss it.

Offer to Help out with Tasks.

Infertility and fertility treatments are mentally and physically exhausting. You can support your friend by helping out with mundane tasks like housework or dropping off a meal. You could offer to attend fertility appointments with your friend or watch their pets so they can have time for self-care.

Ask How They’re Doing and if They Need Anything

The best way to support your friend on the journey to becoming a parent is to ask what they need. For example, some people want a listening ear to talk about it, while others require a mental break.

Remember to check in with your friend and say, “I’m here if you want to talk about it. What do you need from me?”

Don’t Be Afraid to Talk About It

While you want to avoid giving advice, don’t be afraid to talk about infertility. This is where you should let your friend take the lead. They may or may not want to discuss it, but it’s a profound part of their life.

Those struggling with infertility may feel isolated. Many of their friends and family are throwing baby showers and starting families while they fight a silent battle to become a parent. Let your friend know you’re here if they want to talk, and respect their medical decisions surrounding infertility. Don’t try to convince them to do something you may think they should do, and also respect their decision to stop treatments.

Hold Space to Help Your Friend Get Through Their Infertility Struggles

Infertility affects everyone differently, and it’s never an easy journey. The most important thing you can do is lead with love and hold space for whatever your friend is going through. Be a haven for them to laugh, cry, and everything in between. If you communicate with empathy, love, and honesty, you can provide the support your friend needs most.

If you or anyone you know is dealing with infertility, you don’t have to do it alone. At Reproductive Gynecology and Fertility, we provide comprehensive fertility care so those struggling with infertility can successfully become parents. Visit us at Reproductive Gynecology & Infertility to learn more about how we can help.

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Fertility in Your 30’s

Fertility in Your 30’s

In the U.S, the average age that a woman has her first child is 26, up a full five years from the average age of 21 in 1972. A growing percentage of women are choosing to wait to have children until their 30s.

By The Time You’re 30, Here’s What You Should Know About Your Fertility

Many individuals are having their first child later in life than in previous generations. Therefore, it’s important for people to understand the timeline of their fertility.

In the U.S, the average age that a woman has her first child is 26, up a full five years from the average age of 21 in 1972. A growing percentage of women are choosing to wait to have children until their 30s. This is influenced by factors including demanding careers, longer times spent in college or graduate school, or getting married at a later age.

By the time you’re 30 or 35, what do you need to know about your ability to conceive and have a healthy pregnancy?

Below we’ll look at how hormones, egg count and quality, and other factors involved in reproduction change once you’re in your 30s. We’ll also cover fertility treatments most often recommended for those over the age of 35 and cover the basics of freezing your eggs.

Fertility In Your 30’s

If you recall learning about reproduction in high school biology class, you may remember that women are born with all of their eggs. Unlike men who continuously make sperm throughout their lives, women don’t make any new eggs over time. Therefore, the quantity and quality of a person’s eggs start to diminish the older they get, starting from a young age.

According to the American College of Obstetricians and Gynecologists, “Peak reproductive years are between the late teens and late 20s. By age 30, fertility (the ability to get pregnant) starts to decline. This decline becomes more rapid once you reach your mid-30s.”

By the age of 45, the average person’s ability to get pregnant naturally has substantially decreased, to the extent that they’re very unlikely to get pregnant without any intervention.

“Ovarian reserve” refers to the number of healthy, normal eggs that a woman has left inside her two ovaries. This number decreases with age. Having “diminished ovarian reserve” becomes more likely in a person’s 30s, indicating that reproductive potential is lower based on the number and quality of eggs left.

Not only does the quantity of eggs decrease over time, but egg quality also diminishes as a person gets older; remaining eggs in older women are more likely to have abnormal chromosomes compared to eggs in those that are younger.

Changing hormones and pre-existing conditions are two other fertility factors to consider during your 30s. Women in their mid to late 30s have a higher risk of having disorders that can affect a healthy pregnancy, such as uterine fibroids, ovarian cysts, endometriosis, and pelvic inflammatory disease.

Levels of estrogen, the key hormone that controls a menstrual cycle, start to decrease in your mid-30s, resulting in less regular ovulation and irregular periods. Estrogen does not control the menstrual cycle. I would say something like the incidence of ovulation dysfunction increases as we age, resulting in fewer ovulatory cycles per year and irregular periods. Some women enter perimenopause (the stage prior to menopause) as soon as their late 30s, which can make conception less likely.

Finally, although it’s usually only temporary, past birth control use can also impact fertility, especially birth control forms such as injectables/shots. It can sometimes take up to 18 months for ovulation to resume once stopping birth control injections, which is something to take into account if you currently use birth control and wish to get pregnant in the near future.

Success Rates of Getting Pregnant

The average 30-year-old woman without any preexisting reproductive conditions has about a 20% chance of getting pregnant each month. In comparison, someone in their 20s has an even greater chance, about 25% per month.

By the time a woman reaches 40, the success rate of getting pregnant naturally drops to about 5% per month, meaning about one or two out of 10 would be able to get pregnant each month when actively trying to conceive.

Once an individual reaches their mid-30s, the older they get, the higher the risk of having a miscarriage or having a baby with fetal abnormalities. It’s estimated that about 15% of pregnancies in those under 35 result in miscarriage, but this number increases up to 25% to 50% if the person is between 39 and 44 years old.

Other factors to consider are the increased likelihood of chromosomal abnormalities, including Down syndrome, the most common chromosome problem that occurs among women who have children in their 40s. Down syndrome affects about 1 in 85 fetuses if the mom is 40 or about 1 in 35 if the mom is 45.

There are also increased maternal risks involved in having a baby at a later age, including preeclampsia (high blood pressure during pregnancy that can lead to organ injury). Older people pursuing pregnancy also have a higher chance of having twins/multiple pregnancies since the ovaries are more likely to release more than one egg per month.

Fertility Treatments Available

Tracking Your Cycle

If you’re in your 30s and trying to conceive, first start by tracking your menstrual cycles to get an understanding of how regular your periods are and when you’re most likely ovulating.

You can use any number of fertility apps on your phone to help you track your cycles, plus ovulation strips to help you pinpoint which days are best for having sex (a strip will turn positive 24 to 36 hours before ovulation, indicating to have sex at that time).

Additionally, you can monitor changes in your cervical mucus and basal body temperature to determine if and when you ovulated, which is helpful for predicting the following month’s cycle.

Visiting A Reproductive Endocrinologist (REI)

If you haven’t conceived on your own after trying for 6 to 12 months, it’s best to visit a healthcare provider for help with an infertility evaluation.

How long should you wait before seeking professional help?

Once you’re in your mid-30s, it’s recommended that you meet with a Reproductive Endocrinologist (REI) sooner rather than later. The recommended point is after about 6 months of trying on your own. REI fertility specialists can help pinpoint any fertility issues that may make conception more challenging.

REIs perform extensive exams and tests to uncover the full picture of a patient’s reproductive health, including a pelvic ultrasound (which can spot issues such as endometriosis or ovarian cysts), tubal evaluation, ovarian reserve testing, hormonal panel tests, and semen analysis for a partner.

Based on test results, your REI can help you decide which treatment options are most likely to be successful. Treatment for infertility, including if it’s related to advanced age, always depends on the individual case, as there are many potential pathways to having a successful pregnancy.

Potential fertility treatments that may be used to help you get pregnant in your 30s or 40s include IUI (most often for women under 35), IVF, or use of donor eggs, donor sperm, or possibly a gestational carrier (surrogate) if necessary.

Assisted reproductive technologies, including in vitro fertilization (IVF), can help with a variety of infertility causes that come into play in your late 30s or 40s, such as damaged or absent fallopian tubes, genetic abnormalities of embryos, low ovarian count, or a partner with low sperm quantity or quality.

Your REI can also perform prenatal and diagnostic screening tests, both before you become pregnant and once you’re pregnant, to assess the risk of birth defects or genetic disorders, including those that are more common in later-age pregnancies.

Keep in mind that no matter how you plan to become pregnant, and no matter the age, it’s important to take care of your body holistically — by maintaining a healthy weight, eating a nutrient-dense diet, quitting smoking, exercising enough, and managing stress.

Freezing Your Eggs

Egg freezing (fertility preservation) may be a good option for women in their 30s if they want to build their families later in life.

Also called oocyte cryopreservation, egg freezing essentially pauses the progression of chromosomal abnormalities that eggs experience past a certain age. This option allows women to preserve higher-quality eggs that are more likely to be chromosomally normal so that they can get pregnant at a later age through IVF.

Egg freezing can result in a lower risk of miscarriage and a lower risk of Down’s syndrome. One drawback is that it can be expensive and somewhat invasive, considering it involves many of the same medications and steps as IVF; however more employers and insurance companies are beginning to cover some costs of egg freezing.

If egg freezing seems like it may be a good fit for you, speak with your OB-GYN or an REI to discuss your future family building plans and next steps that will help you prepare as best as possible.

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IUI Vs. IVF: Which Treatment Is Right For Me?

IUI Vs. IVF: Which Treatment Is Right For Me?

For those having trouble conceiving, there are various options to seek or utilize that can help you get pregnant, some of which you can even begin to pursue on your own, like making changes to your diet and lifestyle to optimize your body for pregnancy. You can also work with your current OB/GYN or Primary Care Physician (PCP) to start with preliminary testing, such as basic ovarian reserve testing and a referral for a semen analysis.

About 1 in 8 couples in the United States experiences infertility. This number might seem high, but considering how many things need to go perfectly suitable to conceive, it’s not surprising.

There are many reasons why an individual or couple might have a hard time becoming pregnant, including factors related to ovarian health and egg quality, sperm quality (concentration, motility, shape), uterine health, and more.

For those having trouble conceiving, there are various options to seek or utilize that can help you get pregnant, some of which you can even begin to pursue on your own, like making changes to your diet and lifestyle to optimize your body for pregnancy. You can also work with your current OB/GYN or Primary Care Physician (PCP) to start with preliminary testing, such as basic ovarian reserve testing and a referral for a semen analysis.

For many looking into fertility treatments, two options become top choices to consider pursuing: intrauterine insemination (or IUI) and in vitro fertilization (or IVF).

For people struggling to conceive, an initial evaluation with a fertility specialist can help identify the root cause of infertility and factors that may be creating challenges. Reproductive Endocrinologists have extensive training and experience in evaluating problems that can interfere with conception — such as egg, sperm, uterine, or implantation issues — and are therefore best able to guide patients in choosing which treatments are best for them.

IUIs should be performed by a medical professional trained to do them. In most cases, IUIs are used in conjunction with medicated (oral pills) treatment cycles. IVF is a more involved treatment and should only be managed by an experienced reproductive endocrinologist (REI).

Below we’ll look at what IUI and IVF entail, the pros and cons of both treatments, and knowing which one is the right option for you.

What Is IUI?

IUI stands for intrauterine insemination. It involves having sperm injected into the uterus around the time of ovulation. This is done to bypass any potential cervical issues and decrease the sperm’s travel time to the egg and increase the likelihood of fertilization happening.

For whom is IUI a good option? It’s typically one of the first fertility treatments recommended for patients who have not gotten pregnant on their own within about six months to one year of trying depending on age. It’s a great option for those dealing with hormonal and fertility issues such as:

  • Anovulation (lack of ovulation without help from medication)
  • PCOS
  • Cervical mucus problems
  • Sperm quality issues
  • It can also help same-sex couples using donor sperm, single mothers using donor sperm, and sometimes couples with unexplained infertility.

You might also hear IUI referred to as artificial insemination. IUI involves the sperm first being “washed” to increase its potency, then being delivered directly to the uterus.

“Washing” sperm means that a sperm sample is first collected, and then the sperm are separated to sort healthy, motile (swimming) sperm from the less healthy sperm and seminal fluid. Only the best quality sperm is used during an IUI; this way, there’s the greatest chance of the sperm being able to reach and penetrate the egg.

It’s essential that the individual is ovulating or just about to ovulate when IUI is performed because this is the only time that a person can get pregnant. Ovulation is when a mature egg is released from an ovary to begin its journey down the fallopian tubes, at which point it can be fertilized.

Before an IUI is performed, a doctor monitors the individual to track the timing of their cycle and ensure they are ovulating. Monitoring can be done using an ultrasound, which looks at egg follicles within ovaries, and sometimes with bloodwork.

Here are the basic steps involved in an IUI cycle:

  • The IUI cycle begins on the first day of a person’s period and the egg(s) mature inside the ovaries for about the next two weeks leading to ovulation.
  • Some people will take medications to encourage ovulation during this period. For example, medications (such as oral meds like Clomid or Letrozole or injectable hormone medications called gonadotropins) can be used to stimulate more eggs to mature and be released.
  • In most cases, the IUI will take place on the day of ovulation or sometimes the day prior. This is determined using monitoring. A “trigger shot” might also be used to time ovulation since this medication induces ovulation within about 36 hours.
  • A sperm sample from either a partner or a donor will be provided to the doctor’s office, then washed.
  • The doctor/practitioner will insert the washed sperm sample into the uterus using a thin catheter. This is primarily painless and only takes a couple of minutes.
  • After the IUI, the person will lay down and relax for about 10 minutes, and then they are free to leave the doctor’s office and go about their day. Hopefully, at this point, fertilization takes place.

What are the advantages of IUI?

Below are some of the main advantages of IUI:

  • Less invasive and less expensive compared to IVF. A typical IUI cycle can cost about $1000 (depending on your insurance), while IVF can cost $20,000 per cycle.
  • IUI Deposits the best quality sperm possible close to where the egg is waiting, which increases the chances of becoming pregnant in comparison to conceiving through intercourse.
  • Uses monitoring to ensure that insemination happens at the time of ovulation.
  • IUI cycles can either use medications or not, depending on the specific situation. Those who have difficulties ovulating, such as those with irregular periods or PCOS, can use medications to help release more mature eggs.
  • Not using ovulation medication can help lower the cost. This is a good approach for those who ovulate regularly or who are using donor sperm.

Who performs IUIs?

IUIs cannot be performed at home without proper processing and washing of seminal fluid; however, some people may try intravaginal or intracervical inseminations at home, with significantly less success. Most often, people choose to see a medical professional for the procedure. OB/GYNs can perform IUI, which means patients may be able to work with their previous provider if they prefer (only reproductive endocrinologists can perform IVF, however).

That being said, patients often choose to work with a fertility specialist or an REI for an IUI because an REI can perform thorough tests prior to an IUI in order to gain more advanced knowledge of a patient’s fertility status and obstacles.

Specialists typically have cutting-edge technology and equipment and are capable of uncovering a great deal of information about the quality of one’s sperm, eggs, anatomy, menstrual patterns, and so on, which can help increase success with IUI.

How successful is IUI?

IUI is said to have “modest results” in terms of success, meaning it isn’t guaranteed to work and isn’t necessarily more successful than two healthy people having intercourse.

In best-case scenarios, it’s successful about 7% to 20% of the time per IUI cycle, depending on the woman’s age. If a couple tries IUI several times and does not have severe damage to fallopian tubes and has decent quality sperm, they may have a 50% chance of getting pregnant with up to six rounds of IUI.

Overall, success rates depend on the couple’s age, the timing of the procedure, and the health of the eggs and sperm. Individuals younger than 35 tend to have more success with IUI than those over 35 to 40 years old.

Are there any side effects of IUI?

IUI typically doesn’t hurt, although it may feel a bit uncomfortable. Some people experience mild cramping during the procedure. Afterward, it’s okay for the person to resume normal activities, as they’re unlikely to feel any significant side effects.

Side effects can be more noticeable if medications are being taken. For example, ovulation medications can sometimes cause temporary bloating, cramping, water retention, and breast pain.

There’s also a higher likelihood of having multiples (twins or triplets) if using gonadotropin medications with IUI since these drugs can cause multiple eggs to be released and potentially fertilized.

What Is IVF?

IVF stands for in vitro fertilization. It’s a fertility treatment that fertilizes eggs with sperm in a lab (“in vitro” refers to a process performed in a laboratory culture dish instead of inside the body).

IVF is one type of artificial reproductive technology (or ART). IVF aims to stimulate the ovaries to mature as many healthy eggs as possible in a given cycle in order to create embryos. In the majority of cases patients pursuing IVF choose to utilize genetic testing, which entails a few cells being removed from the embryos for testing prior to freezing. Through genetic testing, your REI physician will be able to dramatically increase the likelihood that the embryo being transferred into the uterus is genetically healthy and increase the liklihood of getting pregnant. There are many reasons individuals or couples choose to pursue IVF when growing their family, including various causes of infertility, wanting to utilize genetic testing on embryos, or moving on from other fertility treatments that have been unsuccessful.

The entire IVF process can usually occur within three months. Medications are first used to help eggs inside the ovaries mature, then as many eggs as possible are removed from the body with help from an egg retrieval procedure. The mature eggs are then mixed with a sperm sample in a lab (called insemination), hopefully facilitating fertilization and embryo formation. In frozen embryo cycles, embryos are then frozen to allow for the woman’s body to return to normal after stimulation within a few weeks. The final step is the frozen embryo transfer which occurs after the uterus is primed with estrogen and progesterone for approximately three weeks. In this minor painless procedure, an embryo is released inside the uterus with the aid of ultrasound guidance.

To summarize the steps above, a cycle of IVF includes several steps:

  • Ovarian stimulation using injectable medications.
  • Egg retrieval from the ovaries.
  • Fertilization of retrieved eggs using a semen sample within a laboratory.​​
  • Optional but recommended preimplantation genetic testing of embryos prior to freezing them.
  • Uterine lining preparation.
  • Transfer of the fertilized embryo back into the uterus using a thin tube through the cervix under ultrasound guidance
  • Then hopefully, pregnancy occurs!

There are several additional treatment options available with IVF, including using intracytoplasmic sperm injection (or ICSI), Preimplantation Genetic Testing (PGT), or using donor eggs, donor sperm, or a gestational carrier (surrogate). Including any of these options into your treatment plan will all depend on the couple’s specific needs.

Who is IVF best suited for? Depending on the factors contributing to infertility, IVF may be the best choice and recommended as the primary treatment plan due to its significantly higher success rates than IUI. However, less aggressive initial attempts with IUI cycles would also be appropriate in many situations due to its less invasive and costly nature. In general, IVF would be a good first choice for those with the following conditions:

  • Damaged, blocked, or absent fallopian tubes (the procedure bypasses the fallopian tubes, where ovulation typically takes place).
  • Poor sperm quality (it can be successful even with very little healthy sperm, as explained more below).
  • Prolonged unexplained fertility.
  • Problems with ovulation that are not being solved with other treatments.
  • Severe endometriosis
  • A genetic disorder that can be passed down to offspring.

IVF With ICSI:

ICSI is a procedure only available during IVF and cannot be performed with an IUI. It involves having a single healthy sperm be injected into a mature, retrieved egg. Research shows ICSI typically fertilizes between 50% to 80% of eggs. ICSI is often recommended as a good option when undergoing IVF treatment if:

  • The partner produces too few sperm to do IUI or traditional IVF (in which 50,000 sperm are used to inseminate a retrieved egg).
  • Sperm aren’t motile, or sperm have trouble attaching to or penetrating the thick outer layer of the egg.
  • There’s a blockage in the reproductive tract that is preventing sperm from exiting.
  • Traditional IVF fertilization has not worked for unknown reasons.
  • Eggs that were previously frozen are being used.

What are the advantages of IVF?

Below are some of the main advantages of IVF:

  • Considered the most potent fertility treatment, it can help couples get pregnant when other options cannot.
  • It can help address reproductive issues related to both egg and sperm providers, including egg and sperm health and problems with the cervix and fallopian tubes.
  • It can help treat age-related infertility and prolonged unexplained infertility, which often lead to unsuccessful treatment with  IUI.
  • It offers the option of using ICSI, which IUI does not.
  • It offers the option of using genetic testing, which IUI does not. This reduces concerns regarding certain genetic disorders since embryos can be tested before being implanted to identify genetic disorders or chromosomal abnormalities.
  • It offers the option of storing embryos to be used and transferred at another time.

Preimplantation Genetic Testing:

One of the significant advantages of IVF is that it allows for genetic testing of embryos, including for inherited familial diseases, which IUI and other fertility options do not.

Called Preimplantation Genetic Testing (or PGT), this type of testing is performed to identify if embryos have a specific genetic or chromosomal condition. This way, those embryos are not transferred to the uterus, and the defect is not passed onto the offspring. The goal is to ensure that healthy embryos are transferred to the uterus in order to sustain a pregnancy and result in a healthy baby.

PGT also helps address the fact that one of the most common reasons embryos do not transfer and result in pregnancies is because of abnormal embryo genetic factors.

PGT may be recommended for couples or patients with a history of single-gene disorders, such as cystic fibrosis or sickle cell anemia, or sex-linked disorders, such as Duchenne muscular dystrophy and Fragile X syndrome.

How successful is IVF?

IVF now accounts for up to 4.5% of all live births in the United States and Europe.

The chances of getting pregnant with help from IVF ultimately depend on a number of factors, including age and overall health status, the underlying reason for infertility, and how many healthy embryos were created.

Like with IUI, IVF is most successful when the person providing eggs is younger than 35 to 40 years old and generally healthy. Overall, women between 30 and 40 have about a 40% to 50% chance of IVF working depending on several factors, and however, with the advent of PGT testing, a genetically normal embryo would have an approximately 70% chance of resulting in a healthy pregnancy in a high-quality fertility clinic.

Are there any side effects?

IVF involves using medications that can cause side effects, such as bloating, nausea, water retention, headaches, and mood swings. These are temporary and usually last about one week or so.

The egg retrieval procedure is performed under anesthesia and takes approximately 15-20 minutes. After the process, there may be some mild discomfort, including cramping, swollen ovaries, light bleeding, and tenderness. Following IVF, patients should avoid anything too strenuous, or that involves twisting of the ovaries.

Depending on the medications used in the IVF stimulation, there may also exist a minimal risk of ovarian hyperstimulation, which is a condition that can cause the ovaries to become temporarily swollen and painful, and in very rare circumstances, requires fluid to be removed from the abdomen.

IUI Vs. IVF: Which Is Right For You?

There’s a lot to consider when deciding between IUI and IVF, including the cost, invasiveness, time commitment, use of medications, potential side effects, and success rates.

An IVF cycle is more involved, invasive, and expensive than an IUI cycle; however, it can also be significantly more successful when IUI and medications are not.

If you’re dealing with infertility, your provider will help guide you through the process.

Your fertility provider will run tests to determine things like your egg and sperm quality and then be able to advise you on options that are most likely to be successful. Because every infertility situation is unique and complex, it’s best to listen to your provider’s recommendations regarding your treatment plan.

Is it worth trying IUI before IVF?

You and your doctor together can review your current health status and the specific conditions you’re facing to determine if IUI should be performed first or if it is in your best interest to move directly to IVF as your first-line treatment choice.

In many cases, if appropriate, your physician may recommend trying up to three cycles (sometimes up to six) of medicated IUI before moving onto IVF, assuming there are no significant obstacles that can interfere with IUI being successful. Sometimes certain insurance companies will require this before paying for IVF.

Some doctors may suggest that women in their 40s only try IUI once or twice before going to IVF, or even that they go straight to IVF to not waste time.

How do you know if you should do IUI first or go straight to IVF?

According to fertility experts, here is when to consider IUI before moving on to IVF:

  • Try IUI first if your infertility is mainly related to ovulation issues. This includes individuals with PCOS or other forms of anovulation, plus cervical mucus problems.
  • If the partner providing sperm has moderate sperm health issues but is still producing healthy amounts of sperm, try IUI first.
  • Same-sex couples and single parents trying to conceive with donor sperm can also try IUI first.
  • If the egg provider is under 35 or between 35 and 40 with no significant known fertility issues, IUI is typically done before IVF.

IVF may be a better option if 3-6 IUI cycles have been unsuccessful, or if the individual providing eggs or carrying the pregnancy is in their 40s, there is very little good quality sperm, or if there are known problems with uterine or fallopian tube function.

Family planning is another crucial element to consider when deciding where to start. If more than one child is desired, and advanced female age is one of the issues, IVF may be the best option in order to provide ample opportunity for fertility preservation through embryo creation. This future planning can allow individuals and couples to build the family of their dreams instead of enduring a long fertility journey that results in a significant decrease in the chance of additional successful cycles and future children.

Don’t forget to discuss these issues with your trusted REI so they can guide you appropriately.

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