What are some new advances in the field of infertility treatment?Within the last several years, a few infertility centers have started to culture embryos in the laboratory for five days until they reach the blastocyst stage of development before transferring the embryo to the uterus. An embryo at this stage is much more likely to implant (attach) to the uterus and result in conception. Although his technique is more demanding of the embryology laboratory, it is helpful in the selection of quality embryos resulting in a higher conception rate. A secondary benefit is that fewer embryos can be transferred, helping to reduce the incidence of multiples.Here at the Rocky Mountain Center for Reproductive Medicine® in Fort Collins, Colorado, we began doing blastocyst transfers in April of 1998 with very good success. It has been vital in achieving our goal of a maximum pregnancy rate with a minimal risk of multiple pregnancies. Is there help for the couple with a male infertility factor?Yes. Sometimes low sperm counts or poor sperm motility (movement) requires extra help to fertilize the oocyte (egg). A procedure called ICSI (Intracytoplasmic Sperm Injection - pronounced ICK-SEE) overcomes these severe male infertility factors. In our Fort Collins, Colorado lab, our embryologist, Shari Olson, Ph.D., performs this procedure by capturing an individual sperm cell and injecting it into the mature egg by means of a small pipette. This process is repeated for each individual egg.
We are encouraged with the results that we have had using this procedure at the Rocky Mountain Center for Reproductive Medicine®. For some couples, ICSI has overcome severe male infertility when only a few sperm were available for fertilization. This procedure gives new meaning to the phrase, "Sometimes it only takes one!" Is it possible to get pregnant if I’ve had a tubal sterilization?Many individuals eventually regret the decision to have a tubal ligation. While this is considered a "permanent" form of contraception, patients do have the option of surgically reuniting the fallopian tubes through a process called a microscopic tubal reanastomosis. This can commonly be done as an outpatient with excellent results. Depending on other infertility factors, most couples are able to conceive in a short interval of time. An alternative to this procedure would be in vitro fertilization (IVF), where the eggs are fertilized outside the body with the resulting conception placed into the uterus. The best choice for an individual would require a consultation to consider all other fertility factors.How can I determine the cause of our infertility?Determining the cause of infertility can be accomplished by several easy tests. Initially, the husband has a semen analysis, while the wife documents ovulation by a simple blood test. Provided both of these are normal, the next test involves an x-ray to see if the fallopian tubes are open and to make sure the uterine lining is compatible for embryo attachment. Depending on a couple's individual circumstances, an outpatient surgery (laparoscopy) may be the next "test" to look for endometriosis or scar tissue. All of these tests can be accomplished within 1-2 months if desired.How Long Should a Couple Attempt to Conceive Before Seeking Advice from an Infertility Specialist?For couples who have recently discontinued contraception, the average monthly pregnancy rate approximates 20%. For a typical couple, this means that 50% conceive within 6 months and another 30-40% conceive in the subsequent 6 months. It becomes increasingly difficult to conceive spontaneously after 12 months of unsuccessful attempts. Therefore, infertility specialists recommend evaluation after 12 months of attempted conception. We also recommend evaluation after 6 months in patients over 35 due to concerns related to an age-related decline in fertility.What is the Role of a Laparoscopy in Infertility?A laparoscopy is particularly helpful in diagnosing and effectively treating endometriosis or pelvic adhesions (scar tissue). Both of these conditions can cause pelvic pain and/or infertility. The incisions for this outpatient surgical procedure are small (1/4-1/2") and full recovery is often achieved within several days. Most importantly, in individuals with either of these conditions, a laparoscopy can dramatically improve the chances of conception.Are Miscarriages Common Following Infertility Treatment?No. Infertile women who conceive after fertility treatment have a similar risk of miscarriage when compared to fertile couples. The overall risk of miscarriage is approximately 20% among the general population.Women who experience bleeding in the first three months of pregnancy, however, may be at increased risk of miscarriage. Despite this, at least two-thirds of patients with bleeding will deliver normally. What are the Causes for Repeated Miscarriages?An evaluation for repetitive miscarriages is ordinarily confined to three major causes. The first, and the easiest to correct, is an anatomical abnormality of the uterus. Scar tissue, or tumor, can create a poor environment for the embryo to attach. Most of the time, however, it can be corrected by outpatient surgery. The second major cause is immune-mediated and can be detected by a simple blood test. Similarly, genetic reasons underlie some miscarriages and can easily be assessed. Fortunately, most individuals with this problem have a good prognosis.Does Smoking Affect my Fertility?British researchers recently concluded that smoking can significantly delay the time to conception. This is true for males and females alike. Even exposure to passive (second-hand) smoke resulted in more problems with infertility. Clearly, anyone interested in conceiving should not smoke or be exposed to smoke.Who needs to consider using an egg donor? Women who experience problems that lend to depletion of quality oocytes (eggs) may need to consider using an egg donor to assist in getting pregnant. Premature menopause, surgical removal of both ovaries, or individuals over 40 who have failed to conceive despite appropriate fertility treatments are the most common individuals seeking an egg donor. Usually this is an anonymous process where the eggs are removed from the donor, fertilization is allowed to occur and the resulting embryos are then transferred into the recipient's uterus. Success rates are extremely high with this process.What is In Vitro Fertilization (IVF)?For patients with irreparably damaged fallopian tubes, profound oligospermia (low sperm counts), or failure to conceive after adequate attempts of intrauterine inseminations, in vitro fertilization (IVF) has become the treatment of choice. The technology involves incubating the oocytes (eggs) and sperm in the laboratory and allowing the resulting embryo(s) to develop for a number of days prior to transferring them into the endometrial cavity.In the 1980's, pregnancy rates for IVF were relatively low, at approximately 15 percent. As the nutritional requirements for the embryo growth within the laboratory became better understood, conception rates began to increase. As we head into the new millennium, anticipated pregnancy rates for many patients may exceed 50 percent. How can I tell if I am infertile?By definition, infertility is the inability to conceive after 12 months of unprotected intercourse. The first step is to diagnose the problem that is causing the lack of conception. Primarily, there are three tests necessary to determine the cause.The first test is to document that ovulation is occurring in the woman. Having a hormone test, called progesterone, done one week prior to the next anticipated menses can accomplish this. The second test is a semen analysis to make certain that there is an adequate number of sperm. Lastly, a Hysterosalpingogram (HSG) is performed to document that the fallopian tubes are not blocked and that the lining of the uterus appears normal. Dye is injected through the cervix into the uterine cavity in this x-ray test. Eventually the dye goes into the fallopian tubes and should flow out through the end of the tubes. This documents that the sperm are able to get to the fallopian tubes where fertilization normally occurs, and that the egg can be captured by the fallopian tube. These three tests are the cornerstones to infertility evaluation. Can caffeine consumption affect my pregnancy?If you experience nausea during the first trimester of your pregnancy, consuming caffeine has a dose-related association with miscarriage. Researchers at Vanderbilt University found that caffeine consumption of at least 300 mg/day increased the risk of miscarriage by 5 times. This amount compared to a typical 7-ounce cup of brewed coffee, which contains 80 - 135 mg. of caffeine. Caffeine consumption in pregnant women without nausea, or caffeine consumption prior to pregnancy did not increase the risk of miscarriage.Can I choose the sex of my child prior to infertility treatment?There are methods for determining the sex of a child; one involves the removal of a few cells from an in vitro fertilized embryo and the other involves sperm-sorting prior to egg fertilization. Sperm-sorting can be done with either artificial insemination or in vitro fertilization and can increase the odds of a specific gender.Neither of these methods is guaranteed and the American Society for  Reproductive Medicine discourages them for any reason other than screening for genetic defects. Although these methods are performed in a couple of other states, they are not currently offered at our clinic.
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