One of the important criteria that are assessed during a semen analysis is sperm morphology (the others are count, motility and volume). Sperm morphology is the term used to describe the appearance (size and shape) of sperm. We will often have patients worried because the sperm morphology is “low” (teratospermia). While there are some things that can be done to improve sperm morphology, whether or not they will work depends on the cause of the abnormality and whether it is genetic or environmental.
The American Society for Reproductive Medicine has as part of its practice guidelines that a couple wishing to engage in an egg donor recipient cycle must visit with a mental health professional. Given the road you have already travelled with all the hurdles you have jumped to get this far, why would you be required to see a mental health professional?
While the idea of going to a counselor’s office may be foreign and perhaps concerning to you, the entire experience is constructed to be informative, educational, and emotionally supportive. There is no “pass/fail” pronouncement made and the sole intent is to partner with you to do everything possible to achieve your goal of having a baby.
Studies have shown that approximately 40% of patients will abandon the IVF process after a single cycle. The most common cause of dropout is the physical and psychological burden of the treatment, which accounts for 35% of dropout.
But another common cause is an inadequate response to ovarian stimulation, which is unexpected in most cases, with 10% of couples quitting the IVF process simply because of an inadequate response in the first cycle.
Traditional Chinese Medicine (TCM) can be used to assist couples going through Assisted Reproductive Technology (ART) such as IUI and IVF.
The primary modality used in TCM to treat infertility and/or to enhance fertility is acupuncture. Chinese diet therapy and massage are also integrated into the treatment plan to ensure greater success.
A widely published German study found that using acupuncture with IVF achieved a 42% clinical pregnancy rate compared to only 26% in the control group that did not receive acupuncture.
Maintenance of early pregnancy requires progesterone. Progesterone is a hormone produced by the ovary (corpus luteum) in the second half of the menstrual cycle (after ovulation, also called luteal phase) and for the first few weeks of pregnancy. At around seven weeks of pregnancy, the placenta starts producing progesterone.
There are many issues to think about when you're pregnant or considering becoming pregnant using an egg from an egg donor. Among the health issues to consider is the research associating donor egg pregnancy with an increased risk for preeclampsia or hypertension.
is a test commonly used for testing ovarian reserve. AMH levels reflect the number of eggs (oocyte pool) that remain in the ovary(ies). AMH levels will decline as a woman ages. AMH levels also indicate the number of eggs that will be retrieved and IVF pregnancy rates – a high number is associated with a better outcome. In many IVF clinics, an AMH level > 1.0 ng/mL is considered normal. At InVia we like our anonymous egg donors to have an AMH level > 1.5 ng/mL. Low AMH levels, on the other are associated with a low number of eggs retrieved and a lower pregnancy rate. There are several physicians who will recommend using an egg donor to patients based on low AMH levels alone. If this is a correct policy, it will save a lot of money for the health system. If it is incorrect, then these patients are being treated unfairly. So, it is logical to ask, “What are the pregnancy rates in women with low AMH levels?”
ICSI is an acronym for intra-cytoplasmic sperm injection. In basic terms it means we are injecting a sperm into an egg. ICSI IVF differs from the conventional IVF process in that a single sperm is injected into an egg, instead of fertilization taking place in a dish where millions of sperm are placed near an egg.
People often assume a woman is infertile if she and her partner cannot conceive; however, this is not always the case. Males play a big role in fertility, accounting for at least 35% of infertility cases. Therefore, in order to test a male's fertility, a semen analysis is performed. A semen analysis provides both qualitative and quantitative information.
It is an established fact that risks associated with giving birth to babies conceived through IVF, are increased for both mothers and infants. Most of that increase in risk is related to the higher occurrence of multiple births. Currently, more than 30% of IVF pregnancies are twin or higher-order multiple gestations.
In a previous blog we discussed the expected ultrasound findings in a normal intrauterine pregnancy. Variations from the expected pattern of development are worrisome or, if major, definitive for early pregnancy failure or miscarriage. These were discussed in a recent review article by Doubilet et al. (N Engl J Med 2013;369:1443-51). Here is a summary:
Early miscarriage (early pregnancy loss or spontaneous miscarriage) is defined as a the loss of an intrauterine pregnancy within the first 12 6/7 weeks of pregnancy. It is usually diagnosed with ultrasound (either an empty gestational sac or a gestational sac containing an embryo or fetus without fetal heart activity).
Preimplantation Genetic Diagnosis (PGD) is a procedure used to screen embryos or eggs for genetic or chromosomal abnormalities during a cycle of in vitro fertilization (IVF). There have been several advances with the technique used to biopsy the embryos (e.g. testing embryos at the blastocyst stage 5 or 6 days after egg retrieval) and the technology used. However, what are the success rates for IVF with PGD?
In order to maximize pregnancy rates in an egg donor program, it is very important that a good egg donor is selected. You may already know that it's important that the egg donor be in good health, including being a non-smoker, drug-free, and of a healthy weight. All of these things should be on the list of requirements that your fertility clinic has for being an egg donor.
Polycystic ovary syndrome (PCOS) has become more widely known in recent years as a fairly common hormonal disorder and as a leading cause of infertility. Many doctors prescribe metformin – a drug primarily used to treat type 2 diabetes – to balance the hormones in patients with PCOS. In medical terms, metformin reduces hyperinsulinemia and suppresses the excessive ovarian production of androgens (male hormones) in women with PCOS.
For many decades, we focused mainly on sperm count and motility when doing a semen analysis. For the past 25 years or so, especially with the advent of in-vitro fertilization (IVF), fertility treatment providers have realized the importance of sperm morphology (shape). Sperm morphology reflects the quality of sperm production (spermatogenesis). Abnormal morphology (teratospermia) is associated with male factor infertility with reduced fertilization and pregnancy rates.
For years, we used to use the World Health Organization (WHO) criteria for assessing morphology. These criteria were fairly liberal and a value > 70% oval forms was considered to be normal. However, we at InVia have changed our assessment standards, because we've found that the old WHO criteria have very little value in predicting fertilization in IVF cycles.
Many couples who are trying to get pregnant think that the more sex they have, the better. The truth is that there is only a small window each month during which a woman can become pregnant.
This time is called the "fertile window," and it corresponds to the three days leading up to ovulation. Once an egg is released, it only lives for 12 to 24 hours. But not to worry, as sperm can live for several days. The trick is to have sperm “waiting” for the egg to drop.
A vaginal egg collection is a very routine part of the IVF process. The procedure is over in about 20 minutes, and experienced doctors will usually get one egg from each mature follicle.
During in vitro fertilization (IVF) in order for implantation and pregnancy to occur, the embryos must reach a stage of development known as ‘blastocyst’. Reaching the blastocyst stage is an integral part of the development of an embryo.
The male partner can sometimes be overlooked when couples try to conceive. Approximately 15% of couples pursuing a pregnancy experience infertility. Within these couples, a “male factor” is the sole cause in 30%, and both male and female factor issues are present in another 20% of couples. Collectively, 50% of couples have a male factor involved as a cause of their infertility.
Examining and evaluating the man is often invaluable in helping to optimize not only his reproductive potential, but also the reproductive potential of the couple. Here's what we look for when evaluating a man in a fertility clinic.
When a woman has hypothyroidism and infertility, her fertility specialist has to weigh a number of factors in determining treatment. That decision depends partly on the type of hypothyroidism she has.
New guidelines are leading some fertility specialists to conclude that for subclinical hypothyroidism, infertility treatment might not include a thyroid pill.
Tubal pregnancy is possible regardless of how you get pregnant. But there are some unique aspects to tubal pregnancy that pertain to cases in which IVF is used. Here are ten interesting facts about IVF and tubal pregnancy:
1) A tubal pregnancy (also called an ectopic pregnancy) is a pregnancy that is implanted outside the uterus. During in vitro fertilization (IVF) embryo(s) are transferred into the uterus. However, subsequent uterine contractions can squeeze the embryo(s) into the tube where they can implant and result in a tubal pregnancy.
Many times women are concerned after experiencing failed IVF with a fresh embryo transfer if it is best to move right along into another cycle for a frozen embryo transfer. They wonder if there are any carryover effects from the ovarian stimulation and if they should wait to cycle to minimize any residual effects that could potentially impact endometrial receptivity. So, the question is, “Will waiting before performing my frozen embryo transfer cycle increase my chances to become pregnant?”
Here are just a few examples of what patients on Ideal Protein learn about weight loss from our Health and Wellness Coach Lauren Wismer.
Couples who experience recurrent pregnancy loss (RPL) characterized by multiple miscarriages may benefit from a medical evaluation and psychological support. A detailed history and physical examination is the initial step in the evaluation. Important points in the history include:
Anti-mullerian hormone (AMH) levels are now routinely used clinically to assess ovarian reserve. AMH levels are believed to reflect the pool of oocytes (eggs) that remain in the ovary (ies). Low AMH level are associated with a reduced number of eggs that are available and will often predict low ovarian response during IVF. AMH levels are therefore believed to reflect the quantity of eggs that remain. The question is, do AMH levels also reflect egg quality and therefore pregnancy rates with IVF?
Now it is fairly common for women to achieve their educational goals and establish a career path before they consider having children. It often takes years to obtain these goals and this occurs during the most fertile period: ages 15 - 30. Often women will consider having a child between the ages of 35 – 45 and by then, her fertility has already starting to decline. In previous blogs, I have discussed the fact that after age 40, fertility declines precipitously, and have described treatment options for this age group. But what about women seeking pregnancy after 45? What are the treatment options available? How risky are these pregnancies?
In vitro fertilization (IVF) is now a fairly commonly used procedure and has resulted in the birth of tens of thousands of babies every year. According to the latest statistics available (2015, www.sart.org) there were 209,336 IVF cycles performed in the U.S. alone. This is an increase from 154,412 IVF cycles being performed in 2011.
In addition, the success rates with IVF have been steadily increasing with fewer embryos being transferred (details once again at www.sart.org). Initially, IVF was devised as a treatment for patients with diseased fallopian tubes (tubal factor). There have since been several other indications for IVF and a couple of brand new ones, which will be discussed in this blog.
So you're in the IVF process, and now you’ve waited the long 10-16 days for your first pregnancy test. Your hCG level comes back positive. Congratulations!
Then the panic sets in. Is my number too low? Is it too high? Does this mean I'm having twins? Triplets? At InVia Fertility, we often have patients ask us to interpret their hCG level from that first positive test—and the truth is, most of the time that's not possible.
The technologies for successfully freezing embryos have now been available for more than twenty-five years.
With improved freezing techniques, the success rates with frozen embryo transfer (FET) are now equal to or even better than those achieved with the transfer of fresh embryos. The pregnancy outcomes with frozen embryos also seem to be better than their fresh counterparts.
I am frequently asked by patients whether to get vaccinated for the flu. The answer is an unequivocal yes! Whether a woman is trying to conceive, just found out she is pregnant, or is well into her pregnancy, she should be vaccinated against the flu.
If you're undergoing or researching IVF, you may have learned that not all embryos are able to implant, and therefore sometimes the decision is made not to transfer an embryo to the patient after an analysis is performed. The analysis used to make that determination is called blastocyst grading. What exactly is the embryology lab looking for when they perform blastocyst grading?
Letrozole is an oral non-steroidal aromatase inhibitor approved for the treatment of hormonally responsive breast cancer after surgery. It has been used (off-label) for ovulation induction as part of the IVF process since 2001.
Given a choice, a majority of patients would prefer to take medications orally. So when it comes to progesterone, why do we prefer the intramuscular or the vaginal route? It's simple: the oral route doesn't work as well. Here’s why:
Age-related infertility is something fertility clinics are seeing increasingly, as more couples work on getting pregnant after 40. It is a fact that one cannot change one's biological age. The question is, can anything be done to at least partly reverse the reproductive aging process, and reduce the chances of IVF failure?
Exciting new research has suggested simple changes in diet and lifestyle may improve fertility and increase your chance of conception. Namely, adding more antioxidants to your fertility diet can reduce oxidative stress (OS) and its negative affects on fertility for both men and women, write Dr. David Meldrum and his colleagues in their article in Fertility and Sterility.
Egg donation is generally very safe with no long-term risks. Society would not permit a young, healthy woman to donate her eggs if the procedure was always dangerous.
However, there are some short-term risks associated with egg donation, and some egg donors will experience complications. Knowing the warning signs and being educated about these complications will help reduce their impact drastically.
Here are some of the most common complications you should be aware of when making the decision to donate your eggs.
Letrozole (marketed as Femara in the U.S.) is a drug that is approved for the treatment of breast cancer after surgery. It is also used (“off label”) for ovulation induction. I have discussed its mechanism of action and success rates in a previous blog, as well as use of Letrozole versus Clomid for patients with PCOS. Despite its obvious advantages, Letrozole is used infrequently by fertility specialists in the U.S. A major reason for this is a controversy about the use of Letrozole and birth defects in the resultant children.