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 May 11, 2005
Female Infertility
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Infertility in a couple that relates to factors associated with the woman rather than the man.


Many women trying to conceive for the first time panic if their periods continue for even three or four months. But the standard definition of infertility is unsuccessful conception after an entire year of unprotected intercourse. At that point, a couple should seek a comprehensive examination that includes menstrual and pregnancy history, semen analysis, ovulation tests, and sometimes a laparoscopy to detect endometriosis or pelvic adhesions. Such testing determines the causes of infertility in 70 to 85 percent of all couples.


Many factors may account for infertility: abnormalities of the uterus (such as fibroids); ovarian dysfunction; endometriosis; scar tissue from previous surgery; thyroid problems or other hormonal imbalances; sexually transmitted diseases or other infections in the man or woman; and a low sperm count. Female reproductive problems account for 40 percent of all infertility cases; male reproductive problems account for another 40 percent; and 20 percent of the time physicians cannot determine precisely what is wrong.


The treatment of infertility has made enormous progress in the last decade as a result of advances in assisted reproductive technology, or ART. This technology combines the use of fertility drugs - hormonal therapy - with artificial insemination using any of a group of techniques: intrauterine insemination (IUI), in vitro fertilization (IVF), gamete intrafallopian transfer (GIFT), zygote intrafallopian transfer (ZIFT), or oocyte (egg) donation. Fertility Drugs: fertility drugs, forms of hormone therapy, are designed to trick the ovaries into producing eggs, sometimes many eggs in a single cycle, by stimulating the woman's hormones to do their assigned jobs more efficiently or by replacing them with "outside" hormones. Clomiphene, marketed under the brand names of Clomid and Serophene and used for the treatment of infertility problems for more than twenty-five years, is an agent that increases the hormone production. Taken by tablet, clomiphene works by making the pituitary gland produce large quantities of FSH (follicle-stimulating hormone). The FSH in turn stimulates ovulation - in fact, sometimes accomplishing its purpose so well that it results in the release of two or more eggs, giving a woman on clomiphene a 10 percent chance of carrying twins. Pergonal and Metrodin are powdered forms of FSH and are mixed with sterile water and taken by intramuscular injections. Intrauterine insemination (IUI): In this procedure, a small amount of concentrated sperm, first "washed" to remove most of the seminal plasma that surrounds it, is placed in the uterus through a thin plastic catheter that is passed through the vagina and cervix. Usually painless, the IUI procedure takes only a few minutes to accomplish. IUI is almost always used in combination with a fertility drug - clomiphene or Pergonal - to stimulate ovulation followed by an HCG injection to trigger the release of an egg. The timing of the IUI is determined with the help of vaginal ultrasound, previous cycle lengths, BBT temperature graphs, or urinary LH correlation kits. In Vitro Fertilization: This is designed to make it easier for the sperm and the egg to meet successfully by taking essential reproductive events out of the body and performing them in vitro (in glass). Mature eggs are removed from the ovaries, fertilized with sperm in a laboratory dish, and then the resulting embryo is implanted into the uterus. IVF, first used to treat women with absent or damaged fallopian tubes, is used today for any kind of infertility. Although here are many IVF programs is use throughout the U.S., each differing in minor ways, all use four basic steps: ovarian stimulation; egg retrieval; fertilization; and embryo transfer. Ovarian Stimulation using either Pergonal or Metrodin or both: The development of the follicles is closely followed by observing their growth with transvaginal ultrasound and measuring their ability to produce estrogen. When the eggs are big enough, they are ready for egg retrieval. Egg Retrieval: During IVF, the eggs are removed just before ovulation. A thin needle is passed through the back wall of the vagina up to the ovaries, all accomplished with the guidance of transvaginal ultrasound. As the doctor watches the procedure on the screen of the ultrasound machine, the needle punctures the follicle and, with gentle suction, carefully removes the egg along with the follicular fluid. The eggs are placed in a sterile container and are examined by a cell biologist or embryologist. If they are judged to be normal in shape and development, they are ready for fertilization. Fertilization: Now the eggs and fresh "washed" sperm are mixed together for fertilization. When fertilization has indeed occurred and the eggs, now called embryos, are beginning to undergo cell division, they are graded and prepared for transfer to the uterus. Embryo Transfer: One to three days after the eggs are retrieved, up to four healthy embryos are inserted into the uterus with a thin plastic tube that is passed through the cervix. Gamete Intrafallopian Transfer (GIFT) is a more sophisticated variation of the basic IVF procedure and usually produces a slightly higher pregnancy rate. Zygote Intrafallopian Transfer (ZIFT) is the latest variation on the IVF-GIFT technique. The freshly fertilized eggs (zygotes) are placed into the fallopian tubes during a laparoscopy after they have reached the embryo stage.


Is it a hormonal problem? Is the ovulation process abnormal? Is there another problem present such as endometriosis? What are treatment options? What are the benefits and risks of fertility drugs? Do you recommend IVF? What type of IVF would be most beneficial? What is your success rate for procedures to restore fertility?

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