Infertility

Infertility is the inability to conceive after a year of unprotected intercourse in women under 35, or after six months in women over 35, or the inability to carry a pregnancy to term.

Infertility is equally due to male factor as a female factor. Male factor accounts for 40% of infertility, female factor accounts for 40% of infertility, combined female and male problems account for 10% and the remaining 10% are due to unexplained causes. It is essential that both the man and woman be evaluated during an infertility work up.

Most physicians advise you not to be concerned unless you have been trying to conceive for at least one year. If the female partner is over 30 years old, has a history of pelvic inflammatory disease, painful periods, recurrent miscarriage, or irregular periods then it might be prudent to seek help sooner. Waiting only 6 months before having an initial consultation for women 35 years and older is often recommended since if a problem is found there is less time for correction. If the male partner has a known or suspected low sperm count, then it would also be prudent to seek help sooner than waiting a year.

Yes, the child will be biologically yours and have  genes  from both its  parents.

This surgery is usually done under general anesthesia to look for structural abnormalities, endometriosis and adhesions as well as possibly repair any problems found. The abdomen is inflated with carbon dioxide and a scope is inserted through a small incision below the navel. A second incision just above or below the pubic hairline is used to insert a tool to help manipulate the organs for better viewing with the scope.  In case problems are located and it  is required to repair the same, the procedure would be called an Operative Laparoscopy.

This is a procedure in which the cervix is dilated just enough to insert a small scope used for viewing the inside of the uterus. Minor abnormalities can be fixed during this procedure, which can be done under local or general anesthesia. Often done in conjunction with a laparoscopy. .  In case problems are located during the diagnostic procedure and it  is required to repair the same, the procedure would be called an Operative Hysteroscopy.

This is an x-ray of the uterus and fallopian tubes. Doctors inject a special dye into the uterus through the vagina. This dye shows up in the x-ray. Doctors can then watch to see if the dye moves freely through the uterus and fallopian tubes. This can help them find physical blocks that may be causing infertility.

Many things can change a woman's ability to have a baby. These include age ,smoking, excess alcohol use, stress, poor diet, athletic training being overweight or underweight sexually transmitted infections (STIs), health problems that cause hormonal changes, such as polycystic ovarian syndrome and primary ovarian insufficiency.

Yes, these include factors which raise the temperature of the scrotum such as the use of hot tubs or long baths or over tight clothing which can  harm sperm production. A variety of medicines and recreational drugs can also decrease male fertility. These include alcohol, marijuana, cocaine, cigarettes as well as certain medications.  Studies also show that environmental factors have also contributed to decreasing  sperm counts over the years.

It often takes a number of perfectly timed cycles before pregnancy is achieved. The chances of getting pregnant each cycle varies a bit with age. If you are 20-25, your chance per cycle are about 25%. From there they begin to fall off. At 25-30 your chances are about 20%. At 30-35 they are about 15%. After 35 they may be about 10% per ovulatory cycle, and the chances continue the downward trend.  This means that the average woman under 30 will get pregnant within 6 cycles and it would take about nine cycles for an average  women in her early 30s to get pregnant which in the final analysis are better odds  than natural conception. The cumulative chances of success are 39 percent in women under the age of 35, 30 percent in women aged 35-37, 21 percent in women aged 37-40 and 11 percent in women aged 41-42

Common methods of ART include:

• Intra-uterine insemination (IUI): Semen is collected and washed to rid it of impurities. The woman undergoes regular ultrasound scans to determine the time of The sperm is then injected through the cervix, into the uterus using a small catheter.
• In vitro fertilization (IVF) – Embryo Transfer(ET). IVF is an  effective Assisted Reproductive Technique. It is often used when a woman's fallopian tubes are blocked or when a man produces too few sperms. The woman is generally put on certain  drugs that cause the ovaries to produce multiple eggs. Once mature, the eggs are removed from the woman in a procedure known as oocyte retrieval or ovum pick up.. They are put in a dish in the lab along with the man's sperm for fertilization. After 3 to 5 days, healthy embryos are transferred  into  the woman's uterus.

• Gamete intrafallopian transfer (GIFT) involves transferring eggs and sperm into the woman's fallopian tube. So fertilization occurs in the woman's body. These days very few practices offer GIFT as an option.

• Intracytoplasmic sperm injection (ICSI) is generally  used for couples in which the problem is one of male infertility.  Sometimes it is also used for older couples or for those with failed IVF attempts. In ICSI, a single sperm is injected into a mature egg for fertilization. The resultant embryo is transferred into the uterus. ICSI is a good  option for men with very low sperm counts to try to increase the chances of fertilization.
• Assisted hatching:  Assisted hatching is putting a small opening in the embryo's outer layer called the zona pellucida. The embryo which must normally break free of the zona to hatch out prior to implantation in the uterine lining is thus assisted by thecreation of a small opening.  AH is often often used for older women (38 or over), who often have a more  rigid  outer layer for the embryo.