Infertility happens when a couple cannot conceive after having regular unprotected sex. It may be that one partner cannot contribute to conception, or that a woman is unable to carry a pregnancy to full term. It is often defined as not conceiving after 12 months of regular sexual intercourse without the use of birth control.
In the United States, around 10 percent of women aged 15 to 44 years are estimated to have difficulty conceiving or staying pregnant. Worldwide, 8 to 12 percent of couples experience fertility problems. Fertility treatment typically refers to medications that stimulate egg or sperm production or procedures that involve the handling of eggs, sperm, or embryos.
How Can I Check My Fertility?
Male fertility requires that the testicles produce enough healthy sperm and that the sperm is ejaculated effectively into the vagina and travels to the egg. Tests for male infertility attempt to determine whether any of these processes are impaired. You may have a general physical exam, including an examination of your genitals. Specific fertility tests may include:
- Semen analysis: Your doctor may ask for one or more semen specimens. A lab analyzes your semen specimen. In some cases, urine may be tested for the presence of sperm.
- Hormone testing: You may have a blood test to determine your level of testosterone and other male hormones.
- Genetic testing. Genetic testing may be done to determine whether there’s a genetic defect causing infertility.
- Testicular biopsy: In select cases, a testicular biopsy may be performed to identify abnormalities contributing to infertility or to retrieve sperm for assisted reproductive techniques, such as IVF.
- Imaging: In certain situations, imaging studies such as a brain MRI, transrectal or scrotal ultrasound, or a test of the vas deferens (vasography) may be performed.
- Other specialty testing: In rare cases, other tests to evaluate the quality of the sperm may be performed, such as evaluating a semen specimen for DNA abnormalities.
Fertility for women relies on the ovaries releasing healthy eggs. The reproductive tract must allow an egg to pass into the fallopian tubes and join with sperm for fertilization. The fertilized egg must travel to the uterus and implant in the lining. Fertility tests for women try to find out if any of these processes are impaired. You may have a general physical exam, including a regular gynecological exam. Specific fertility tests may include:
- Ovulation testing: A blood test measures hormone levels to determine whether you’re ovulating.
- Hysterosalpingography: It evaluates the condition of your uterus and fallopian tubes and looks for blockages or other problems. X-ray contrast is injected into your uterus, and an X-ray is taken to determine if the cavity is normal and to see if the fluid spills out of your fallopian tubes.
- Ovarian reserve testing: This testing helps determine the number of eggs available for ovulation. This approach often begins with hormone testing early in the menstrual cycle.
- Other hormone testing: Other hormone tests check levels of ovulatory hormones, as well as pituitary hormones that control reproductive processes.
- Imaging tests: A pelvic ultrasound looks for uterine or ovarian disease. Sometimes a sonohysterogram also called a saline infusion sonogram, is used to see details inside the uterus that are not seen on a regular ultrasound.
Depending on your situation, rarely your testing may include:
- Hysteroscopy: Depending on your symptoms, your doctor may request a hysteroscopy to look for uterine disease. During the procedure, your doctor inserts a thin, lighted device through your cervix into your uterus to view any potential abnormalities.
- Laparoscopy: This minimally invasive surgery involves making a small incision beneath your navel and inserting a thin viewing device to examine your fallopian tubes, ovaries, and uterus. A laparoscopy may identify endometriosis, scarring, blockages or irregularities of the fallopian tubes, and problems with the ovaries and uterus.
Not everyone needs to have all, or even many, of these tests before the cause of infertility is found. You and your doctor will decide which tests you will have and when.
What is Basic Fertility Treatment?
Infertility Treatment in men:
- Surgery, if the cause is a varicocele (widening of the veins in the scrotum) or a blockage in the vas deferens, tubes that carry sperm.
- Antibiotics to treat infections in the reproductive organs.
- Medications and counseling to treat problems with erections or ejaculation.
- Hormone treatments if the problem is a low or high level of certain hormones.
Infertility Treatment in women:
- Fertility drugs and hormones to help the woman ovulate or restore levels of hormones
- Surgery to remove tissue that is blocking fertility (such as endometriosis) or to open blocked fallopian tubes
Infertility in men and woman can also be treated with assisted reproductive technology, or ART, which will be further explained in this article.
What are the Different Types of Fertility Treatments?
- Fertility Drugs: They are Injected or taken in pill form, the drugs release hormones that induce ovulation to boost egg production and make the uterus more receptive to embryo implantation. The drugs are typically the first-choice for infertility treatment because of their low cost and relative convenience.
- Artificial Insemination (also known as Intrauterine insemination or IUI): Specially prepared (“washed”) sperm is inserted directly into the uterus through a thin, flexible catheter during IUI, the most common fertility method. If you choose this method, your doctor might recommend that you take fertility drugs as well, to increase the chances of fertilization. It is a simple procedure that can be performed in a doctor’s office.
- Donor Sperm: Sperm from a man other than the intended father is used during IUI or IVF. It is good for couples experiencing male-factor infertility, men carrying genetic disorders they don’t want to pass on to their children, single women, or lesbian couples.
- In Vitro Fertilization (IVF): Multistep process (called a cycle) in which your eggs are extracted and fertilized with sperm in a lab. Once embryos develop, one or two are implanted in your uterus and the rest are stored. Couples with serious fertility problems can become parents with this treatment. Treatments are costly and physically demanding and require a rigorous regimen of fertility drugs before the start of each cycle.
- Intracytoplasmic Sperm Injection (ICSI): An embryologist selects a healthy-looking, single sperm from the male’s semen and injects it directly into the egg with a microscopic needle. Once an embryo develops it’s transferred into the uterus through IVF.
- Donor Eggs: Eggs are obtained from the ovaries of another woman (usually younger) and fertilized by sperm from the recipient’s partner. The resulting embryos are then transferred into the recipient’s uterus. It is best for women whose ovaries are damaged or prematurely failing, or who have undergone chemotherapy and/or radiation; older women with poor egg quality; and women who carry genetic disorders that they don’t want to pass along. The procedure is expensive.
- Surrogacy: The surrogate carries a baby for another woman. The surrogate becomes pregnant by artificial insemination, using the father’s sperm or through IVF with the couple’s embryo. Donor eggs and sperm may also be used.
- Donor Embryos: Embryos are donated by couples undergoing IVF who become pregnant and no longer need unused fertilized eggs. The donated embryo is then transferred to the recipient. It is best for couples in which both woman and man are infertile but want to experience a pregnancy.
- Reproductive Surgery: Surgery–sometimes requiring a hospital stay, sometimes done on an outpatient basis–is used to correct anatomical abnormalities, remove scarring and clear blockages in either the man or the woman.
- Gamete Intrafallopian Transfer (GIFT): Eggs from the woman are collected, mixed with sperm from the man in a petri dish, and then placed directly inside the fallopian tubes, where fertilization can occur. It allows fertilization to occur in a natural environment. It is a more complicated procedure than IVF because a laparoscope is used to insert the egg/sperm mix into the tubes.
- Zygote Intrafallopian Transfer (ZIFT): It is like IVF, but in this case, the embryo is inserted into the fallopian tube, not the uterus.
What are the Advantages of using IVF?
- IVF works where other infertility treatments fail: In some cases, patients move through a range of fertility treatments before arriving at the IVF “station.”
- It can be used by anybody: In-vitro fertilization isn’t restricted to the mother of the baby; it can also be used by surrogate or gestational carriers so a range of people can become parents and participate in the pregnancy and labor experience. This includes same-sex couples, women who are physically unable to carry a baby full-term, or single women, to name a few.
- You can use donated eggs and/or sperm: There are times when a fertility specialist may recommend using donated eggs and/or sperm. In these cases, the egg can be manually fertilized in the clinic and a resulting, viable embryo can be used for IVF, which increases your chances of getting pregnant the first or second time around.
- You have control over timing: Patients who are focused on their careers or who may have a unique life situation that affects exactly when they want their baby to be born will find that IVF benefits them by giving them more overall control. Eggs or embryos can be cryopreserved for future use. You can then choose a window of time when you want to be pregnant – or when you want your baby to be born – counting backward to determine the best time to proceed with IVF. IVF can also help with spacing children in a way that works best for your family.
- Increase your chances of having a healthy baby: Genetic screening is a powerful technology that helps to ensure your baby is born healthy. By utilizing genetic screening – called preimplantation genetic testing (PGT) – you can ensure the fetuses used during IVF are free of known genetic markers.
- Decrease your chances of miscarriage: The most common cause of miscarriage is a genetic abnormality, which causes the body to terminate the pregnancy naturally. By using PGT to determine the genetic viability of an embryo ahead of time, mothers have a better chance of enjoying a healthy pregnancy and carrying the baby full-term.
- Increase your chances of conception: IVF with PGT has the highest success rate of all of the other assisted reproductive options. Multiple cycles can be used if necessary to increase a woman’s chances of fertilization, healthy pregnancy, and live birth.
What are the Disadvantages of Using Fertility Treatment?
Risks of IVF include:
- Multiple births.IVF increases the risk of multiple births if more than one embryo is transferred to your uterus. A pregnancy with multiple fetuses carries a higher risk of early labor and low birth weight than pregnancy with a single fetus
- Premature delivery and low birth weight.Research suggests that IVF slightly increases the risk that the baby will be born early or with low birth weight.
- Ovarian hyperstimulationThe use of injectable fertility drugs, such as human chorionic gonadotropin (HCG), to induce ovulation can cause ovarian hyperstimulation syndrome, in which your ovaries become swollen and painful.
Symptoms typically last a week and include mild abdominal pain, bloating, nausea, vomiting, and diarrhea. If you become pregnant, however, your symptoms might last several weeks. Rarely, it’s possible to develop a more severe form of ovarian hyperstimulation syndrome that can also cause rapid weight gain and shortness of breath.
- The rate of miscarriage for women who conceive using IVF with fresh embryos is similar to that of women who conceive naturally — about 15% to 25% — but the rate increases with maternal age.
- Egg-retrieval procedure complications.The use of an aspirating needle to collect eggs could cause bleeding, infection, or damage to the bowel, bladder, or blood vessel. Risks are also associated with sedation and general anesthesia is used.
- Ectopic pregnancy.About 2% to 5% of women who use IVF will have an ectopic pregnancy — when the fertilized egg implants outside the uterus, usually in a fallopian tube. The fertilized egg can’t survive outside the uterus, and there’s no way to continue the pregnancy.
- Birth defects.The age of the mother is the primary risk factor in the development of birth defects, no matter how the child is conceived. More research is needed to determine whether babies conceived using IVF might be at increased risk of certain birth defects.
- Although some early studies suggested there may be a link between certain medications used to stimulate egg growth and the development of a specific type of ovarian tumor, more recent studies do not support these findings. There does not appear to be a significantly increased risk of breast, endometrial, cervical, or ovarian cancer after IVF.
- The use of IVF can be financially, physically, and emotionally draining. Support from counselors, family, and friends can help you and your partner through the ups and downs of infertility treatment.
Infertility is an issue faced by many individuals today, however with different fertility treatments, solutions are available. Hopefully, this article gave some insight into fertility treatments.
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