Transcript Infertility 101 - Conceptions Repro

Infertility 101
Dana Ambler, DO
Director, Donor Egg Program
Associate Physician
Conceptions Reproductive Associates
Myths
Facts
You’ll get pregnant if. . .
Stress
you just relax
you go on vacation
you stop thinking
about it
you stand on your
head after intercourse
– Little effect if regular
menses & ovulate
– Moderate stress has
some effect on fertility
– Severe stressproblems with
ovulation and fertility
Intercourse
– Having it will help you
conceive
Myths
Most people who get
pregnant at fertility
clinics, have
“mutiples” (twins,
triplets and more)
Facts
~ 80% patients who
conceive have a
singleton pregnancy
10 - 20% will have
twins
<1% of all patients
have triplets
Myths
Most people need to
have multiple tests
done to first diagnose
the problem even
before starting
treatment
Facts
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
Insurance never
covers the cost of
infertility treatment
Facts
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
Miscarriages are
caused by
– Stress
– Picking up something
heavy
– Having intercourse
Facts
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
Infertility Causes
Combination
20%
Unexplained
10%
Male
30%
Female
30%
Typical Evaluation
History 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 Treatments
Surgery
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 Fertilization
Fallopian Tube disease
Endometriosis
Male Factor Infertility
Multifactor or
Unexplained Infertility
Advanced Reproductive
Age
Premature Ovarian
Failure
Mullerian anomalies
Medical Disease
Genetic Disorders
Previous treatment
failures
Treatment of Infertility
Male 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)