Fertility treatments and diagnosis in review:

IVF in review

    • IVF or Invitro Fertilization is a method of assisted reproductive technology.  Assisted reproductive technology means just what is states; technology used to assist people in reproducing.
      • IVF is a form of ART classified under controlled ovarian stimulation. This is when eggs of a female are surgically removed and joined, in an embryology lab, with a male’s sperm.  Once the egg and sperm meet they should form an embryo.  The embryo is kept safely (and in accordance with strictly regulated policies) in an embryo incubator within an embryology lab.  When ready, am embryo is transferred to the female’s uterus where implantation occurs.
      • IVF is used for many different cases/diagnosis of infertility as a treatment option.  These can include, PCOS, male factor infertility, unexplained, tubal infertility, endometriosis, premature ovarian failure ect.
      • IVF uses special fertility medication in conjunction with in-office and physician monitoring.
    • IUI in review
      • An IUI is an intrauterine insemination.
      • IUI is a fertility treatment that uses a thin catheter to place washed sperm directly into the uterus in order to increase the number that reach the egg in the fallopian tube.
      • IUI can be helpful in cases where sperm motility or count are low by bypassing the cervical mucus.
      • Sometimes ovulation induction with oral or injectable medications are used in conjunction with IUI.

Fertility assessment:

diagnostic tests can help to reveal causes of infertility.  Here are some of the common tests performed:

    • Female:
    • Are you ovulating? This can be confirmed with a urine ovulation predictor kit at home or with a blood test (progesterone).
    • What is your ovarian reserve? This can be performed with a blood test (Antimullerian hormone, or follicle stimulating hormone with estradiol level) or an ultrasound (antral follicle count).
    • Are my Fallopian tubes open?  This can be confirmed by an X-ray exam called a hysterosalpingogram, an outpatient procedure where contrast dye is gently injected into the uterus and through the Fallopian tubes.  As the contrast enters the tube, the length of the tube is outlined and spills out the end if it is open.
    • Is the inside of my uterus normal?  This can be confirmed with a saline ultrasound or with a hysterosalpingogram.
    • Male:
    • Is there sperm and how do the sperm move?  This can be assessed using a semen analysis. 

Fertility Diagnosis’ in review – women

  • PCOS, is short for Polycystic Ovarian Syndrome. This is a hormonal endocrine syndrome.  In order for your healthcare provider to diagnose PCOS, you must meet certain Rotterdam criteria.  There is not one set diagnostic test for PCOS. Many women with PCOS experience these symptoms:
    • Obesity or weight gain
    • Type two diabetes
    • Cystic acne
    • Honeycomb appearing ovaries (lost of follicles, and often high AMH levels due to the high number of follicles)
    • Anovulation  
    • High levels of testosterone that can cause symptoms like hirsutism (aka hair growth) 
  • Endometriosis is a condition where endometrial cells (cells that line the uterus) are found outside of the uterus, including the ovaries, fallopian tubes, pelvis, intestines and bladder.
    • This condition may affect 10% of women and can cause infertility and pelvic pain. 
    • Symptoms may occur during any time during the menstrual cycle and can range from mild to severe. 
    • Some of these symptoms include: pain during intercourse, pelvic pain and cramping, urinary urgency, and constipation.
    • The only definitive way to diagnose endometriosis is with a laparoscopy, a minimally invasive surgery where a small camera is inserted into the abdomen to survey the pelvis. 
  • Fibroids are benign growths of the muscle of the uterus.
    • They can range in size from small to very large.
    • Symptoms of fibroids include heavy bleeding during periods, pelvic pressure, urinary and bowel symptoms.  Some women experience no symptoms while others have very severe symptoms.
    • Fibroids may impact fertility if they are located within the cavity of the uterus and prevent implantation of the embryo from occurring. 
  • There are treatment options available for couples with unexplained infertility including ovulation induction with or without insemination and in-vitro fertilization.
  • Sometimes the cause of infertility cannot be identified, even after extensive testing has been done. 
  • Recurrent pregnancy loss is not the same as infertility.
    • Women with recurrent pregnancy loss are able to get pregnant, however have lost 2 or more pregnancies before 10 weeks’ gestation. 
    • There are many suspected causes of RPL including genetics, uterine abnormalities, autoimmunity, hormonal or metabolic imbalances, and infection. 
    • However, no cause is found in 50-75% of patients.
    • This is a type of female infertility that is caused by damage to the Fallopian tubes, often as a result of pelvic infection, endometriosis or prior pelvic surgery.
  • Tubal factor infertility can prevent fertilization of the oocyte or proper transportation of an embryo into the uterus.
    • An HSG test can be performed to look for tubal factor infertility.
  • The most important predictor of ovarian reserve is age. 
    • As a woman ages, both oocyte quantity and quality decrease. 
    • As age increases, the changes of genetic abnormalities of oocytes increase, leading to difficulties conceiving and the risk of miscarriage.
    • Additionally, women of advanced age may have more complications during pregnancy than women who are younger.
  • Premature ovarian insufficiency is an early loss of ovarian function prior to when a woman would naturally go through menopause.
    • This can lead to infertility and early symptoms of menopause.
    • Women usually have irregular or no periods, can often have menopausal symptoms (hot flashes, vaginal dryness) or have difficulties conceiving.
    • There are several causes of premature ovarian insufficiency including genetic causes, exposure to drugs that are toxic to the ovary (chemotherapy) and autoimmune disease.  Often, the cause is not none.

Fertility Diagnosis’ in review men

    • Sperm abnormalities are an important factor in male infertility.
    • These abnormalities include low sperm count, poor sperm motility and abnormal sperm shape. 
    • Risk factors for male factor infertility include prior history of testicular surgery, certain drugs/medications, varicocele (enlarged varicose vein in the spermatic cord that is connected to the testicle), sexually transmitted infections, environmental exposure to toxins, and lifestyle factors such as smoking.
    • Diagnosis of male infertility is usually made with a semen analysis, physical exam and history, blood tests and sometimes imaging or genetic testing.

 

 

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