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Globally, infertility affects approximately 1 in 6 people, according to a 2023 World Health Organization fertility report. The Centers for Disease Control and Prevention (CDC),  reports that 16% of females in the United States experience infertility. 

Though male-factor causes of infertility account for 20-30% of infertility cases, medical experts predict that the male-factor infertility rate may worsen due to increased exposure to environmental toxins. Therefore, it is essential to raise awareness of the prevalence of infertility.

Infertility occurs when couples or individuals are unable to achieve conception after one year of trying if less than age 35 and six months if 35 years or greater. Infertility typically delays or prevents couples from starting or growing their family. However, with the rapid advances in assisted reproductive technologies such as in vitro fertilization (IVF), couples now have an alternative solution. 

This article discusses the rise of infertility, common causes, treatment options, and alternative solutions.

Infertility Statistics

The most current WHO infertility report states that 17.5% of the adult population in the world is infertile. This figure represents approximately 1.36 billion people worldwide. This is in comparison to  a 2004 WHO report which estimated that 60-80 million couples globally struggle with infertility. Personal, lifestyle, and environmental factors play a role in the swift increase in infertility.

Potential Causes and Risk Factors of Infertility

There are various causes and risk factors of infertility in men and women. Your awareness of some of these risk factors may cause you to adopt healthy lifestyle factors and understand if you should seek infertility evaluation early. Here are the common risk factors.

Age and fertility

Everyone  regardless of gender is more fertile when they are young. As an individual's age advances, fertility gradually reduces, which is more dramatic in females. With more couples waiting to build a family later in life, infertility has risen, and fertility treatment is often necessary. 

Race and ethnicity

Your race and ethnicity could also affect your fertility rate. A  report from the CDC noted that Black women are less likely to seek infertility care, take longer to seek care, and have lower success rates with fertility treatment.  Also, a 2021 women's health study found that infertility was more common among female minority groups than non-Hispanic whites.

Lifestyle factors

Unhealthy habits such as tobacco use are associated with infertility, early menopause, and poor pregnancy outcomes. Alcohol should be stopped at pregnancy due to the detrimental effects of fetal development. Marijuana exposure is also associated with infertility. Marijuana use in men is associated with lower sperm counts. Hence, individuals who use these substances are at risk of infertility.

Medical conditions

Medical conditions or treatment procedures that can affect the male and female reproductive tract can also increase the risk of infertility. Examples include untreated pelvic or genital infections, thyroid disease, uterine surgeries or abdominal surgeries, etc.

Infertility in females

The following are common causes of female infertility:

• Ovulation Disorders: In females with ovulation disorders like PCOS, the ovaries do not release an egg for fertilization. This affects a female’s ability to get pregnant.
• Fallopian Tube Blockage: Fertilization occurs in the fallopian tubes, and damage to the tubes hinders the process. ‍
• Uterine Disorders such as adhesions, polyps, and fibroids impair the implantation necessary for conception. ‍
• Prior history of pelvic inflammatory infections (caused commonly by chlamydia) can cause scarring of the fallopian tubes, which can block the female reproductive tract. ‍
• Genetic causes involving chromosomal disorders such as Turner's syndrome. ‍
• Endometriosis: This is a medical disorder in which the cells lining the uterus, called the endometrium, are found outside the uterine cavity. Endometriosis can lower egg reserve, block fallopian tubes, and impair the sperm from finding the released egg.

Male Infertility

Causes of male infertility include:

• Genetic Causes such as chromosomal disorders like Klinefelter syndrome.
• Hormonal disorders affecting the pituitary gland
• Undescended Testis
• Blockage in Sperm Transport Tubules due to physical trauma, prior pelvic surgeries, and infections
• Prior sexually transmitted diseases can cause blockage in sperm transport tubules.  ‍
• Medications such as chemotherapy drugs or steroids like testosterone may affect sperm production and increase the risk of male infertility.  ‍
• Exposure to Environmental Toxins such as heavy metals and industrial chemicals.

It is crucial to seek help from a fertility expert for a thorough clinical evaluation and screening and schedule an appointment early if there are any risk factors for infertility. However, in some cases, the exact cause of infertility in males and females may be unknown.

Available Treatments for Infertility

If you or your partner have risk factors for infertility, consult an experienced fertility doctor for expert clinical care. The fertility specialist will typically combine findings from the clinical and laboratory evaluation to confirm the diagnosis of infertility.

The treatment option depends on the cause of infertility. Here are some treatment methods for infertility.

Medications

Women are commonly prescribed gonadotropins, clomiphene citrate or letrozole to induce ovulation. Men can also be prescribed similar medications in the treatment of male factor infertility.  

Surgery

Surgery is typically the most suitable treatment method for infertility due to structural abnormalities in the female or male reproductive tract. Surgery can help females who have fibroids, uterine polyps, blocked fallopian tubes, or uterine scarring.  

Similarly, in males, surgery may be recommended in certain cases of varicocele, undescended testis, or blockages within the male reproductive tract. 

Assisted Reproductive Technology 

Assisted reproduction technology (ART) is a broad term that covers fertility-based treatments in which the fertility doctor handles eggs or sperm to aid conception. In-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) are the two common types of ART.

With ART, the doctor retrieves eggs from the ovaries during an outpatient procedure and then uses IVF techniques to fertilize the egg in a specialized culture medium in the laboratory. During Intracytoplasmic sperm injection (ICSI), the embryologist injects a single sperm directly into each egg.

After successful fertilization via IVF or ICSI, the fertilized egg develops into an embryo until it reaches the blastocyst stage (usually over a period of five days) until it is either  transferred into the uterus or biopsied for genetic screening.

The success rate of ART differs for each person depending on age, but the average rate for young females is up to 54%.

The Emotional Impact of Infertility and Coping Strategies

Couples experiencing infertility may face emotional distress, such as stress, social stigma, anxiety, and depression. These emotions can be worsened by the family pressure and societal expectations. 

In a study published in Fertility and Sterility reported that women diagnosed with infertility had twice the prevalence of depressive symptoms as women without infertility. s. Research has supported the availability of mental health professions for all individuals seeking infertility evaluation and treatment.    

Couples or individuals can use the following coping strategies to handle the emotional distress from infertility:

• Seek help from a mental health professional: Counseling and psychotherapy sessions from a qualified mental health professional can help resolve negative feelings or moods about infertility.
• Social support: Join support groups filled with individuals with similar interests.
• Engage in relaxation techniques such as meditation and yoga.
• Openly communicate how you feel with your partner or loved one.

Alternative Paths to Parenthood

Couples or individuals may choose other pathways to build their family such as adoption or surrogacy.

Legal Adoption

The process of adoption can be complicated and overwhelming. For individuals who cannot carry a pregnancy or who do not want to pursue fertility treatment, adoption may be the ideal way to expand your family. Gestational Surrogacy

Gestational surrogacy is the process of using a gestational carrier and assisted reproduction techniques to help a couple or an individual to create a family when they cannot do so themselves. 

The gestational carrier is not the biological parent, but her role is to carry pregnancy from an embryo(s) created using the intended parents' or donated sperm and egg.

Gestational surrogacy allows couples or individuals to become parents who are unable to carry a pregnancy themselves. However, the gestational surrogacy process involves many steps and requires a series of legal procedures and ma special contract between the intended parent(s) and the carrier.

Are You Looking for Solutions to Infertility?

Couples or individuals going through infertility face many challenges and emotional distress. However, regardless of the cause of infertility, there is a solution and support for you.

It is essential to consult an experienced fertility expert to evaluate you and recommend a solution that fits your unique health needs. Fertility treatments such as medications, surgery, and assisted reproductive techniques are tailored to each patient who is seen at Reproductive Gynecology & Infertility.

Our team of fertility experts at Reproductive Gynecology & Infertility are board-certified fertility specialists with experience and a proven record of helping couples and individuals with alternative family-building options.

We offer a personalized treatment plan that is specific to your peculiar needs. To get professional help from one of our experts, contact us today.

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Egg freezing is a process in which a woman’s eggs are harvested from her ovaries and frozen (in a process called oocyte vitrification), and stored in a liquid nitrogen chamber until the woman would like to achieve a pregnancy. A woman’s ability to conceive declines with age but egg freezing is an effective method for preserving or extending her reproductive potential.

The process takes about 9-11 days of ovarian stimulation with fertility medications followed by the egg retrieval procedure 2 days later. Patients can go on with their routine schedules over this 11-13 day process and only need to take the day of retrieval off of work.

Should you freeze your eggs?

There are many reasons why women delay childbearing. Women opt to freeze their eggs for several reasons:

• They may not have found their life partner
• To delay starting a family
• To preserve their fertility before beginning cancer surgery, chemotherapy or radiation.
• To avoid the creation and freezing of extra embryos after an IVF cycle.

Life circumstances may also influence your decision to freeze your eggs. For some women, knowing they have preserved eggs brings them peace of mind in a time of life that may not be the ideal time to become pregnant. Many women with demanding careers or the inflexibility of academic calendars may wish to delay family building. Here are a few guidelines to help you determine whether you are an appropriate candidate for egg freezing:

• You are in your 20s to mid-30s. (Women over the age of 37 may consider egg freezing on a case-by-case basis).
• You would like to start a family, but aren’t quite ready and would like to preserve your ability to have children later.

Women may also choose to freeze their eggs if they have a medical condition (malignancy) that could potentially harm their fertility. Here are some reasons in which egg freezing would be a viable option for preserving a woman’s ability to have a baby:

• You are newly diagnosed with a cancer, which may threaten your fertility.
• Your planned medical treatments involve chemicals that have been linked to infertility.
• You’ve been diagnosed with early ovarian insufficiency.

When should you freeze your eggs?

When it comes to your egg supply, age is a factor, since the quality and quantity of eggs rapidly deteriorate after age 35. Egg freezing allows you to preserve the optimal years of your fertility when you’re ready to conceive later in life.

As a woman, you are born with all the eggs you will ever have. With time, your eggs decrease in both numbers and cellular integrity. This decline is in large part why women in their 40s have only about a five percent chance of becoming pregnant each month. So, to answer the question, 'at what age should I freeze my eggs?' the simple answer is: Freeze your eggs in your prime reproductive years of your 20s and early 30s. This allows you to take advantage of premium egg quality and quantity.

If you know you want to start a family someday, but the time isn’t ideal for you right now, contact Reproductive Gynecology & Infertility to explore your options. In addition to providing expert IVF treatments and other solutions for infertility in Columbus, we also offer egg freezing in Columbus, Youngstown, Akron and Canton, Ohio. We will present the facts about egg freezing—how it works, the limitations and the likelihood of a successful outcome.

What You Need To Know About Egg Freezing

In 2018, the New York Times reported more than 20,000 American women elected to freeze their eggs. This number has risen sharply since 2009, when there were only 475 women freezing their eggs. The process of egg freezing involves stimulating the ovaries with hormones to produce multiple eggs. Once the eggs are mature, they are retrieved from the ovaries, taken to the lab and cooled to sub-zero temperatures. Frozen eggs can be stored for over 10 years, until you’re ready to start a family.

What's the process of egg freezing?

If you’re considering cryopreservation, or egg freezing, here are a few things you need to know:

• The timing – Generally, fertility begins to decline in your late 20s or early 30s and falls more rapidly after the age of 35. Consider freezing your eggs sooner rather than later, to ensure you are giving your future self the best chance at having a baby.
• The process – Egg freezing typically involves 8-11 days of hormone injections to stimulate your ovaries, 5-7 doctor appointments, blood draws and transvaginal ultrasound exams.
• The medications – The specialized hormone medications will not be available at your local pharmacy. Instead, your reproductive endocrinologist will recommend a pharmacy that specializes in medications for egg freezing and other fertility treatments.
• The procedure – Once your eggs are mature, you will be placed under mild anesthesia so your physician can retrieve them during a brief 10-15 minute surgical procedure. Using ultrasound guidance, a needle is inserted through the vaginal wall into each ovary. The needle is attached to a catheter that’s connected to a test tube.
• The egg freezing – Once the eggs are successfully retrieved, your physician will hand them over to a skilled embryologist who, using a fast-freezing method called vitrification, will transform the eggs into a glass-like frozen state and store them in a liquid nitrogen storage chamber until they’re needed.

What's the egg freezing timeline?

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The he basic steps and how it works.

• Consultation (~1 hour): Discuss patient's medical history and ask questions.
• Testing (~30 minutes): Undergo ultrasound and lab tests.
• Reviewing Results (~30 minutes): Treatment team goes over the results with you.
• Medication and Monitoring (10-12 days): Receive fertility shots and regular monitoring.
• Egg Retrieval (~1 hour): Anesthesia is administered, and eggs are retrieved for freezing.
• Recovery (4-5 days): Take time to recover from any discomfort or bloating.
• After retrieving the eggs, patients can consult their physician regarding additional egg-freezing cycles. Once the eggs are frozen, patients have the freedom to plan their family according to their own timeline and can return for an IVF cycle when they are ready.

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Start Your Family When You’re Ready With Egg Freezing In Columbus

We are proud to say that Reproductive Gynecology & Infertility has achieved successes where others have not. From egg freezing to IVF and more, we provide individual infertility solutions with the utmost compassion, convenience and commitment.

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If you are interested in egg freezing in Ohio, contact the fertility specialists at Reproductive Gynecology & Infertility. We are ready to help you build your family. Call 866-537-2461 to schedule your appointment today.

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The 'two-week wait' is the time between fertility treatment (IVF or IUI) and either a positive pregnancy test or your period. During this period, you’ll probably feel various emotions, from hope to fear. You may wonder if conception took place and what to do next. It can be a stressful time, but you can take steps to make the wait easier.

During the two-week wait, life can be an emotional rollercoaster. You may find yourself swaying between anticipation and joy, fear, sadness, anger, hope, frustration, or even guilt from one moment to the next. It can be exhausting and mentally draining, and you might find it hard to concentrate on anything else. But focusing on other things is exactly what you should do.

How to Cope with the Two-week Wait: The Dos

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While there’s no magic formula for getting through the two-week wait, being kind to yourself is essential. While you’re waiting, do the following:

• ‍Practice self-care. Get enough rest, eat well, drink water, and avoid alcohol and caffeine. Treat yourself to something relaxing, like a massage, a bath, or a hobby.‍
• Seek support. Reach out to your partner, family, friends, or a support group. Talk to your doctor or a counselor if you have any worries or questions.‍
• Stay busy. Keep yourself occupied with positive activities. Here are some ideas to pass the time:
  - Work on a project (Try these craft ideas)
  - Read a book
  - Go to the theatre and watch a new movie or stay in and watch a classic
  - Play a game
  - Go for a walk
  - Plan something fun after the two-week wait, like a trip you’ve been wanting to go on or a dinner with friends at the new spot in town you’ve wanted to try.‍

• Write down your feelings. Write a journal entry, a letter, or a list of hopes and fears. Expressing your thoughts and emotions on paper can help you release stress and gain perspective.‍
• Maintain healthy habits. Exercise moderately, eat nutritious foods, avoid certain medications, and quit smoking.

Communicate with your doctor and partner. Contact your doctor for guidance if you have any doubts or questions about the treatment or the wait. Keep your partner informed and involved in the process.

Behaviors to Avoid During the Two-Week Wait

Being patient for two weeks is hard, and you may be tempted to overthink things or over-test for pregnancy. These behaviors will make the wait more agonizing, so avoid them if possible: 

• Taking too many pregnancy tests. They’re often wrong 12 days after ovulation or ten days after embryo transfer, and testing too soon can stress or disappoint you with false results.
• Obsessively worrying. Worrying too much can increase stress levels and affect your immune system and hormone balance. Focus on the positive aspects of the treatment and the potential outcomes instead of the negative ones.
• Symptom searching. Many symptoms can be caused by other factors besides pregnancy. Also, some people may not experience symptoms until later in their pregnancy. Symptom searching can increase your anxiety and disappointment if you don't feel anything or your symptoms change.‍
• Drinking and smoking. In the two-week wait, prioritize caution. Steer clear of drinking, smoking, or engaging in any risky activities that could harm a developing pregnancy. If you already exercise regularly, it's okay to continue but hold off on starting any intense new workout routines for now.

Getting Through the Two-Week Wait with Patience and Joy

The best thing you can do during the two-week wait is to let your body do its work. Don’t hurry the process or expect quick results. Trust that your treatment team has done their best to help you and that nature will do its part. Be patient and kind with yourself, find joy in the small things, and celebrate every step you take.

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

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

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

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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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)

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)

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

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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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.

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.

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.

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.

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.