Infertility 101

Dana Ambler, DO

Director, Donor Egg Program

Associate Physician

Conceptions Reproductive Associates

Myths Facts

You’ll get pregnant if. . .

you just relax

you go on vacation

you stop thinking about it

you stand on your head after intercourse

Stress– Little effect if regular

menses & ovulate– Moderate stress has

some effect on fertility– Severe stress-

problems with ovulation and fertility

Intercourse– Having it will help you

conceive

Myths Facts

Most people who get pregnant at fertility clinics, have “mutiples” (twins, triplets and more)

~ 80% patients who conceive have a singleton pregnancy

10 - 20% will have twins

<1% of all patients have triplets

Myths Facts

Most people need to have multiple tests done to first diagnose the problem even before starting treatment

Most couples need very few tests to determine the cause of the infertility– Semen analysis– Test for ovulation

(Blood tests)– Test to check fallopian

tubes

Myths Facts

Insurance never covers the cost of infertility treatment

Up to 30% of insurances cover some of the costs

15 states already have laws mandating fertility coverage

It is critical to write your legislator if you think this is important

Myths Facts

Miscarriages are caused by – Stress– Picking up something

heavy– Having intercourse

Miscarriages are usually the result of an abnormal egg and/or sperm resulting in an embryo with abnormal DNA

This cannot be prevented once the embryo has formed

Myths Facts

Egg quality decreases at the age of 32

Up to 10% chance of pregnancy per month if 35 and older

Approximately 20% chance that pregnancy will result in miscarriage

Infertility

Twelve consecutive months of unprotected intercourse without conception– >35 years old → six months– >40 years old → immediate evaluation

Worldwide, 1 in 7 couples have problems conceiving

85-90% conceive in one year

Primary Infertility and Secondary Infertility

Female30%

Male30%

Unexplained10%

Combination20%

Infertility Causes

Typical EvaluationHistory and Physical Exam (Female)– Duration of infertility? Previous treatment?– Regular menstrual cycles? Abnormal

bleeding?– Severe pain with menses or intercourse?– Sexual history? Timing? Contraception?

Lubricants?– Previous surgeries, hospitalizations,

infections?– Medical conditions?– Occupation? Tobacco, alcohol, drug use?

Typical Evaluation

Tests for Ovarian Reserve– Follicle Stimulating Hormone– Luteinizing Hormone– Estradiol– Anti-Mullerian Hormone– Ultrasound

Typical Evaluation (Female)

Tests for Ovulation (if uncertain)– 21 day progesterone– Ovulation predictor kit– Thyroid, Prolactin, vit D– Polycystic Ovarian

Syndrome

Typical Evaluation

Test of Anatomy:– Hysterosalpingogram

(HSG)– Laparoscopy (if

suspect endometriosis or pelvic abnormality)

Typical Evaluation

History and Physical Exam (Male)– Sexual history? Timing? Contraception?

Lubricants?– Prior genital injury? Surgery?– Infections?– Drug/Medication Use?– History of fathering children?– Medical conditions?– Occupation? Tobacco, alcohol, drug use?

Typical Evaluation (Male)

Tests for husband– Semen Analysis (SA)– Physical exam if SA is abnormal

Varicocele?

Normal testicular development?

Laboratory evaluation

Infertility Statistics

Age of female

Infertility TreatmentsSurgery

Superovulation or Ovulation Induction

Intra-uterine Insemination (IUI)

In vitro Fertilization– Intracytoplasmic Sperm

Injection (ICSI)– Complete

Chromosomal Screening (CCS)

Treatment of Infertility

Ovulation defect – Fertility medications– Other options

Metformin (PCOS)

Bromocriptine

Dexamethasone

Aspirin

Progesterone

DEPENDS ON AGE OF FEMALE

Intrauterine Insemination

In Vitro FertilizationFallopian Tube diseaseEndometriosisMale Factor InfertilityMultifactor or Unexplained InfertilityAdvanced Reproductive AgePremature Ovarian FailureMullerian anomaliesMedical DiseaseGenetic DisordersPrevious treatment failures

Treatment of InfertilityMale Factor– Referral to Urology– Antibiotics– Very little success with any treatment except

IUI and IVF (medications seldom helpful)– High dose antioxidants and multivitamins– Surgery– Boxers not briefs – No hot tubs – No smoking/drugs

Treatment of Infertility

“If every test is normal, why can’t we get pregnant?”

Unexplained Infertility– Wait and see– Clomiphene + IUI (Inseminations)– Gonadotropins + IUI– In Vitro Fertilization (IVF)