INFERTILITY (Male & Female)
Fertility Screening and Drugs
If you are unable to become pregnant after one year of unprotected intercourse, or six months of unprotected intercourse if you are a woman over 35, you and your partner should have a full physical and medical evaluation.
Several blood tests are available to determine if you, your partner, or both of you have a problem that is causing infertility. Some of the tests include,
- Follicle-stimulating hormone (FSH) (For Men and Women)
- Luteinizing Hormone Level (LH)
- Serum Progesterone
Fertility Related Surgery
There are many causes of infertility. Sometimes there’s a structural problem that can be treated surgically to increase the chances of conception. Before undergoing fertility surgery, consult with your board certified Reproductive Endocrinologist to learn everything you can about the procedure, its benefits and risks, and what you can expect. Ask questions and become well informed before making your decision.
Among the surgical options available to women are:
A doctor performs a hysteroscopy to look at the lining of your uterus with a viewing tool called a hysteroscope. The procedure is performed to find the cause of abnormal bleeding, to remove uterine growths like polyps and small fibroids, and to examine the uterus to see if there’s a problem with its shape or size that’s preventing you from becoming pregnant or causing repeated miscarriages. A hysteroscopy is both diagnostic and therapeutic.
Laparoscopic surgery is a minimally invasive diagnostic and therapeutic procedure that uses a telescopic camera system to visualize abdominal and reproductive organs (uterus, fallopian tubes, and ovaries). The surgeon makes tiny incisions (approximately 0.5 to 1 cm) in the abdomen through which a thin, fiber-optic tube fitted with a light and camera is inserted. Suspicious growths can be biopsied and repairs can be made during a laparoscopy, making more invasive surgery unnecessary.
Intrauterine Insemination (IUI)
IUI is a fertility treatment that involves placing sperm inside a woman’s uterus to facilitate fertilization. The goal of IUI is to increase the number of sperm that reach the fallopian tubes and subsequently increase the chance of fertilization.
IUI provides the sperm an advantage by giving it a head start, but still requires a sperm to reach and fertilize the egg on its own. It is a less invasive and less expensive option compared to in vitro fertilization. The most common reasons for IUI are a low sperm count or decreased sperm mobility.
Intracytoplasmic Sperm Injection (ICSI)
Intracytoplasmic sperm injection (ICSI) involves the direct injection of sperm into eggs obtained from in vitro fertilization (IVF). There are basically five simple steps to ICSI which include the following:
The mature egg is held with a specialized pipette.
- A very delicate, sharp, and hollow needle is used to immobilize and pick up a single sperm.
- The needle is then carefully inserted through the shell of the egg and into the cytoplasm of the egg.
- The sperm is injected into the cytoplasm, and the needle is carefully removed.
- The eggs are checked the following day for evidence of normal fertilization.
Once the steps of ICSI are complete and fertilization is successful, the embryo transfer procedure is used to physically place the embryo in the woman’s uterus. Then it is a matter of watching for early pregnancy symptoms. The fertility specialist may use a blood test or ultrasound to determine if implantation and pregnancy has occurred.
In Vitro Fertilization (IVF)
In Vitro Fertilization is an assisted reproductive technology (ART) commonly referred to as IVF. IVF is the process of fertilization by extracting eggs, retrieving a sperm sample, and then manually combining an egg and sperm in a laboratory dish. The embryo(s) is then transferred to the uterus. Other forms of ART include gamete intrafallopian transfer (GIFT) and zygote intrafallopian transfer (ZIFT).
IVF can be used to treat infertility in the following patients:
- Blocked or damaged fallopian tubes
- Male factor infertility including decreased sperm count or sperm motility
- Women with ovulation disorders, premature ovarian failure, uterine fibroids
- Women who have had their fallopian tubes removed
- Individuals with a genetic disorder
- Unexplained infertility
Gamete Intrafallopian Transfer (GIFT)
GIFT is an assisted reproductive procedure which involves removing a woman’s eggs, mixing them with sperm, and immediately placing them into a fallopian tube.
One of the main differences between this procedure and in vitro fertilization (IVF) and zygote intrafallopian transfer (ZIFT) procedures is that with GIFT the fertilization process takes place inside the fallopian tube rather than in a laboratory. However, healthy tubes are necessary for GIFT to work.
GIFT is an assisted reproductive procedure that involves the following:
- Patients must first have an x-ray to determine the presence of at least one healthy fallopian tube. The doctor will also use a laparoscope to ensure that there is not any scar tissue on the outside of the fallopian tube.
- Using a laparoscope, eggs are then retrieved from the ovaries.
- The male provides a sperm sample the same day that the eggs are retrieved.
- The eggs are then mixed with the sperm in a catheter.
- The egg and sperm mixture is inserted into the fallopian tubes with a catheter.
- The woman is then provided with medication to build up the uterine lining to support implantation of a fertilized egg.
If any additional eggs are left over, you may use them for IVF and save any viable embryos to use in the future.
GIFT has been used with the following patients:
- Couples with unexplainable infertility
- Couples who have not had success with IVF
- Couples who have a religious or moral reluctance to use IVF
- Women who have at least one healthy fallopian tube
- Couples in which the husband has a low sperm count or other problems with his sperm
Zygote Intrafallopian Transfer (ZIFT)
ZIFT is an assisted reproductive procedure similar to in vitro fertilization and embryo transfer, the difference being that the fertilized embryo is transferred into the fallopian tube instead of the uterus.
Because the fertilized egg is transferred directly into the tubes, the procedure is also referred to as tubal embryo transfer (TET).
This procedure can be more successful than gamete intrafallopian transfer (GIFT) because your physician has a greater chance of ensuring that the egg is fertilized. The woman must have healthy tubes for ZIFT to work.
The main difference between ZIFT and GIFT is that ZIFT transfers a fertilized egg directly into the fallopian tubes while GIFT utilizes a mixture of sperm and eggs.
ZIFT is an assisted reproductive procedure that involves the following steps:
- A woman’s ovaries are stimulated with medications to increase the probability of producing multiple eggs.
- Eggs are then collected through an aspiration procedure.
- Those eggs are fertilized in a laboratory in a procedure identical to IVF, with the exception of the time frame. During the ZIFT procedure, fertilized eggs are transferred within 24 hours, versus 3-5 days as used in a regular IVF cycle.
- The fertilized eggs are then transferred through a laparoscopic procedure where a catheter is placed deep in the fallopian tube and the fertilized eggs injected.
- The final step is to watch for early pregnancy symptoms. The fertility specialist will probably use a blood test to determine if pregnancy has occurred.
ZIFT is an assisted reproductive procedure which may be the selected form of treatment for any infertility problems except the following:
- Tubal blockage
- Significant tubal damage
- An anatomic problem with the uterus, such as severe intrauterine adhesions
- Sperm that is not able to penetrate an egg
Donor Eggs and Embryos
Egg donation, also referred to as oocyte donation, makes pregnancy possible for women who might not otherwise be able to get pregnant using their own eggs.
The reality is that any woman desiring to become pregnant has the option of pursuing donor eggs. Unfortunately, the majority of women who use donor eggs have significantly diminished egg quality.
Women with the following conditions or situations are typical candidates for donor eggs:
- Early menopause or premature ovarian failure (POF)
- Extremely poor egg quality
- History of genetic disease
- Ovaries do not respond to stimulation
- Hormonal imbalance
- Over the age of 40
Gestational surrogacy is an arrangement in which a woman carries and delivers a baby for someone else. The woman who carries the baby is the gestational surrogate or gestational carrier. The parents-to-be are known as the “intended parents” and are involved in the pregnancy, are present at the birth, and become the child’s parents after the baby is born.
In gestational surrogacy, the baby isn’t genetically related to the gestational surrogate – the egg usually comes from the intended mother and the sperm comes from the intended father (though donor eggs, donor embryos, or donor sperm are sometimes used).
In vitro fertilization (IVF) is a necessary part of this arrangement because eggs from one woman are used to create an embryo implanted in another. In IVF, fertilization occurs after eggs and sperm are combined in a laboratory. The resulting embryo or embryos are then transferred to the gestational surrogate’s uterus.
Less than 1 percent of all assisted reproductive technology procedures involve gestational surrogacy. Cost is likely a major factor that prevents most people from using a gestational surrogate.
An infertility diagnosis is given to a couple who are unable to conceive over the course of one year. When the problem lies with the male partner it is referred to as male infertility. Male infertility factors contribute to approximately 30% of all infertility cases.
There are four main causes of infertility in males:
- A hypothalamic or pituitary disorder (1-2%)
- Gonad disorder (30-40%)
- Sperm transport disorder (10-20%)
- Unknown causes (40-50%)
Much research remains to be performed on the topic of male infertility, as many cases still receive an “unknown cause” diagnosis. Male infertility usually occurs because of sperm that are abnormal, because of inadequate numbers of sperm, or problems with ejaculation.
Sperm can be considered abnormal for two possible reasons: unusually short life span of the sperm and/or low mobility.
Sperm abnormalities may be caused by one or more of the following:
- Inflammation of the testicles
- Swollen veins in the scrotum
- Abnormally developed testicles
Reasons for a low sperm count or lack of sperm include one or more of the following:
- A pre-existing genetic condition
- Use of alcohol, tobacco or other drugs
- Severe mumps infection after puberty
- Hernia repairs
- Hormone disorder
- Exposure to poisonous chemicals
- Exposure to radiation
- Blockage caused from a previous infection
- Wearing restrictive or tight underwear
- Injury to the groin area
- Male infertility can also occur when there are problems with ejaculation.
Ejaculation problems may include any of the following:
- Premature ejaculation
- Retrograde ejaculation, which occurs when the semen is forced back into the bladder
- Erection dysfunctions
- Complications from radiation therapy or surgery
Other causes of male infertility can include:
- History of STD’s
- Urinary tract infections
- Use of certain types of medications
When semen analysis is done, There are some specific markers to access fertility.
Total amount or volume of semen – 2 milliliters is considered normal. A lower amount may indicate an issue with the seminal vesicles, blocked ducts or a prostate gland issue.
- Sperm count – 20 million to 300 million per milliliter is considered in the normal range for sperm counts. Below 10 million is considered “poor.”
- Morphology – the size and shape of the sperm affect the sperms ability to reach and fertilize an egg. 30% is considered a good amount of sperm that are shaped “normal.” And “strict” testing shows an even lower percentage as normal.
- Motility – movement and number of active cells. Movement is rated from 0-4, with score over 3 considered good. The amount of active cells is rated in percentages from 1-100%, with 50% considered the minimum.
Treatment For Male Infertility
Male infertility is most often treated by conventional methods that include one or more of the following:
- Taking medications to help increase sperm production
- Taking antibiotics to heal an infection
- Taking hormones to improve hormone imbalance
- Avoiding taking long hot showers, using hot tubs or saunas
- Wearing looser underwear such as boxer shorts versus jockey shorts
Sperm production may also improve by taking clinically proven supplements. Anything that increases the number of healthy sperm increases the chances of conception. Many health food stores and vitamin shops offer male fertility supplements. Shop for male fertility supplements.
Artificial insemination is an option if the man’s sperm count is low. In this procedure, sperm is collected through multiple ejaculations. They are then manually placed in the female’s uterus or fallopian tubes.
In vitro fertilization is another option that can be used to overcome male infertility factors. In this procedure, the sperm and egg are fertilized in a laboratory after which the fertilized egg is placed in the female’s uterus.
If tests show that there is no sperm production or that other related problems are present, donor sperm can be used to help facilitate conception. In this procedure, donor sperm are obtained from a sperm bank and placed inside the female’s uterus or fallopian tubes through artificial insemination.
A varicocele is an abnormal enlargement of the pampiniform venous plexus in the scrotum. This plexus of veins drains the testicles. The testicular blood vessels originate in the abdomen and course down through the inguinal canal as part of the spermatic cord on their way to the testis. Upward flow of blood in the veins is ensured by small one-way valves that prevent backflow. Defective valves, or compression of the vein by a nearby structure, can cause dilation of the testicular veins near the testis, leading to the formation of a varicocele. This leads to Male infertility.