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Men and women equally cause infertility. 40% of the time the infertility is the result of a male factor and 40% of the time it is the result of a female factor. Because infertility is such a common disease, about 20% of the time, there are both male and female factors to address. It is imperative that you undergo a complete basic infertility evaluation before speculating on the causes and treatments. This information is not a substitute for a physician consultation or infertility evaluation. It just provides some insight into the common diagnoses. Is There A Psychological Impact While Undergoing IVF Treatment? Those couples that do not respond to traditional treatment modalities find themselves confronted with decisions concerning In Vitro Fertilization (IVF). These treatments are highly technological and may cause additional stress for couples that have already endured multiple disappointments. IVF can be difficult, both physically and emotionally. Studies have shown that couples that know what to expect are better able to endure these processes and use their own natural coping skills to their best advantage.
There are several strategies that can assist couples during this time:
Counseling may be of assistance to some couples to help them cope with difficult emotions and stress. Are The Chances Of Birth Defects Higher? There is no reported correlation between babies conceived with medical intervention and birth defects. The risk is no greater than in the normal population. Are My Chances Of Having Multiple Babies Increased? There is a higher rate of multiple births for women treated with fertility drugs than in the general population. The actual rate depends on the type of drugs used and the chosen procedure. There are many strategies to minimize the risk of multiple births, but it is always a risk to some degree. Is There A Higher Miscarriage Rate For ART Patients? The miscarriage rate is about the same for ART as the general population. Many times older females undergo ART and their miscarriage rates are naturally higher. Pregnancy testing is done two weeks after embryo transfer, so we often know about spontaneous miscarriages in the very early stages of pregnancy. These miscarriages would probably go unnoticed in the general population Endometriosis is endometrium in an ectopic location that contains endometrial glands and stroma. In other words, it is uterine-like tissue that is growing outside the uterus causing pain and/or infertility. Its cause is unknown. There are many theories and people who will tell you they know what causes it, but every answer has contradictions. It could be genetics. It could be retrograde menses. It could be congenital. It could be all of the above or none of the above. We simply don't know. Endometriosis is common. The generally accepted percentage of women with Endometriosis is 5% to 15%. However, many women have Endometriosis and don't have the symptoms (usually pain) or the pressing need to be diagnosed (usually infertility). Additionally, Endometriosis can be diagnosed as very mild to severe. There are likely many more people with very mild Endometriosis, which does not cause infertility. The only way to diagnose Endometriosis with complete accuracy is to see it. The only way to see it is through surgery (laparoscopy). There are symptoms and tests that can give a physician clues, but Endometriosis is a very elusive disease. The adage, seeing is believing, is the safest and most effective route to pursue diagnosis and ultimately treatment. What Can Be Done To Improve Sperm Quality? Sperm quality on the day of egg retrieval is often related to what happened in the male's body 3 months ago. This is because sperm development takes almost 3 months. Listed below are guidelines to help insure the semen specimen is of the best possible quality.
A woman is born with a full complement of eggs. There are far more eggs than will ever be used during a normal lifetime and ART has no measurable "lowering" effect. What are the long-term effects of infertility treatments, i.e., ovarian cancer? There is no reliable study to support the claim that infertility treatment causes ovarian cancer. One highly publicized study suggested a link between ovarian cancer in women who had received ovulation induction drugs. These women were also infertile and infertile women are at greater risk for ovarian cancer whether or not they receive ovulation induction drugs. It was not possible to determine if the increased risk was due to the women's infertility or drug treatment. The Center for Disease Control is in the process of conducting a double blind study on this topic and the results should be available within the next 2 years. What restrictions will I have between embryo transfer and the pregnancy test? Patients are asked to avoid strenuous activity that would strain the pelvic area, such as climbing stairs and lifting objects heavier than 15 pounds. Any formal exercise program such as weight lifting aerobics, jogging, etc. should be discussed with the physician. Also, the patient is advised not to take tube baths, douche, insert tampons or have sexual intercourse until the pregnancy test. What happens if I become pregnant? If pregnant, the patient is asked to return to the office for repeat blood tests and ultrasounds to insure an ongoing successful pregnancy. After 8-9 weeks she is referred to an obstetrician for the remainder of the pregnancy. If I am not pregnant, when can we try again? Usually we ask the patient to wait one or two complete menstrual cycles before beginning another ART cycle. Sometimes tests are required that can delay subsequent cycles. Where can I purchase my medications? Medication can be purchased at most pharmacies, however, it is best to choose a store that routinely supplies fertility products. There are wide variations in price and it is best to obtain quotes from several stores in your area. Do not assume that all pharmacies will have the fertility medications you will need. You must also be absolutely sure that the pharmacy will carry a backup supply of all products you are taking. If the doctor decides to increase your dosage it is essential that you obtain the additional medication on the day needed. It is also very important to purchase hCG (human chorionic gonadotropin: Pregnyl, Profasi) well in advance of when you will need it. We recommend that you keep an additional vial on hand in the event you break the first. The injection of hCG must be given at the precise time prescribed or an entire ART cycle could be lost. Again, explain clearly to your pharmacist what your treatment regimen will involve. Many pharmacists are not familiar with infertility treatment protocols. Our nurse will be happy to speak with your pharmacist if necessary. The most important factor is that the medication be available on the day needed in the appropriate quantities. Recently, there has been discussion about purchasing products from outside of the United States. While these products can be less expensive, they are not subject to the same rigorous quality control standards as US product. There is little control over their storage and distribution and quality can vary significantly from vial to vial. Radical changes in temperature can alter the pharmacology of fertility medications rendering them inactive. For these and other reasons, we strongly recommend US approved products. How much does medication cost? The average cost of medication an ART cycle is between $2,000 and $2,500. The majority of this cost is attributable to FSH administered as Follistim, Fertinex, or Gonal-F. Repronex is a generic version of Pergonal currently available in the United States. The cost of Repronex is roughly ½ that of the other preparations. Some patients respond better to pure FSH than Repronex. You and your physician will decide which medication best suits your particular situation.
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