Infertility is a symptom, not a diagnosis. There are many conditions that can cause infertility. Timely diagnosis is critical because almost all effective treatments loose their efficiency with advancing maternal age. Causes of infertility in couples sort out to approximately 1/3 female, 1/3 male, and 1/3 combined medical issues. Diagnosis is not always precise. It is, however, focused toward selecting effective treatment options. Good information is critical to the selection of optimal therapy that gives balance to risk and benefit.
In-vitro fertilization, or IVF, is the treatment of choice for a woman with blocked, severely damaged, or absent fallopian tubes. It is also used in cases of endometriosis or male factor infertility. Couples with unexplained infertility over a long period of time may also find success with IVF. While IVF may be the preferred method of achieving pregnancy in these cases, our specialists consider all options for their patients before recommending this complicated, highly technical, and invasive procedure. After all, the objective is having a baby, not having IVF.
In-vitro fertilization, or IVF, is the treatment of choice for a woman with blocked, severely damaged, or absent fallopian tubes. It is also used in cases of endometriosis or male factor infertility. Couples with unexplained infertility over a long period of time may also find success with IVF. While IVF may be the preferred method of achieving pregnancy in these cases, our specialists consider all options for their patients before recommending this complicated, highly technical, and invasive procedure. After all, the objective is having a baby, not having IVF.
First used in the United States in 1981, IVF is a delicate medical procedure performed by highly trained professionals using sophisticated laboratories and equipment. According to the latest statistics from the Centers for Disease Control (CDC), IVF pregnancy rates per treatment cycle have increased steadily since 1984 when the CDC first began reporting national statistics (www.cdc.gov/ART/ART2005/index.htm).
More recently IVF pregnancy rates per cycle have peaked and become comparable among the United States' best clinics where different pregnancy rates between are now heavily dependent on patient selection, clinic policies related to the number of embryos transferred, and policies related to numbers of embryos selected for preservation. National concern surrounding costs and morbidity in cases of multiple embryo pregnancies has resulted in fewer embryos being transferred. This shift has resulted in higher percentages of single, but healthier, pregnancies. In New England where patients benefit from insurance mandates, multiple rates tend to be lower than in other parts of the nation. Consequently, overall pregnancy rates per cycle are lower in the New England region.
Most important for individual patients, IVF pregnancy rates are profoundly affected by maternal age and diagnosis. Each patient is unique, so the overall pregnancy rates of a particular clinic may not be a helpful index of expectation for an individual patient with her unique set of circumstances.
In selected cases, the Tufts Medical Center team may use additional techniques to increase the chance of pregnancy through IVF, including:
- Micromanipulation of oocytes, sperm and embryos, including assisted hatching, which involves making a hole in the embryo's covering to aid in sperm penetration.
- Fertilization and implantation of donor oocytes to help older women and women who have undergone premature menopause.
- Intracytoplasmic sperm injection (ICSI), where a single sperm is injected into the oocyte. This may be combined with surgical sperm recovery procedure from a male partner who has no ejaculated sperm by removing it from the male ducts (microsurgical epididymal sperm recovery or MESA) or from the testicle directly (TESE).
Sometimes multiple cycles of IVF are required, so embryo cryopreservation or vitrification (drying) is used to store embryos for possible transfer at a later date. And for those couples or individuals with serious inherited disorders, the Tufts Medical Center team can perform preimplantation genetic diagnosis, or PGD, to test embryos for genetic disorders prior to their transfer to the uterus.
Failure to ovulate regularly is a common cause of infertility in women. Three of the most common causes are polycystic ovarian disease, hyperprolatinemia, and hypogonadotropism.
Failure to ovulate regularly is a common cause of infertility in women. Three of the most common causes are polycystic ovarian disease, hyperprolatinemia, and hypogonadotropism. In many of these cases, particularly with younger women whose partners are not infertile, careful ovulation induction with production of a single monthly oocyte can be accomplished with restoration of reproductive efficiency at close to normal levels. Our approach to these patients is somewhat holistic: we find that weight reduction, dietary measures, and the relatively simple use of ovulation-inducing agents is very effective, as well as less subject to complications. We try to avoid using IVF in these patients and are very frequently successful.
COH with IUI involves deliberate induction of multiple ovulations, combined with injection of washed sperm cells directly into the uterus where fertilization occurs in vivo. This approach is very effective in younger women with normal pelvic anatomy and fertile husbands.
COH with IUI involves deliberate induction of multiple ovulations, combined with injection of washed sperm cells directly into the uterus where fertilization occurs in vivo. This approach is very effective in younger women with normal pelvic anatomy and fertile husbands. In appropriate patients, this treatment can be very effective; however, it can be most ineffective and result in the loss of valuable time in older women, patients with tubal disease or in association with significant male infertility. Its principal virtue is simplicity and effectiveness in well-selected cases.
Male factors can include low sperm production, commonly related to genetic mutation afflicting many men. They include blockages in the sperm conducting system, antibodies against sperm, injury to the testes, hormonal problems, poor descent of the testes and varicoceles.
Male factors can include low sperm production, commonly related to genetic mutation afflicting many men. They include blockages in the sperm conducting system, antibodies against sperm, injury to the testes, hormonal problems, poor descent of the testes and varicoceles. Choice of therapies commonly involves consultation with our andrology consultant, Robert Oates, M.D., Boston University. Dr. Oates is located a short distance from our facility and collaborates in the care of our patients on a regular basis. Comprehensive evaluation will include a through history and exam, followed by highly specialized laboratory testing to asses as precisely as possible the cause and a course of treatment to improve the
male factor.
Microsurgical epididymal sperm aspiration (MESA), testicular sperm extraction (TESE), electro ejaculation, variocele repair and vasectomy reversal are techniques commonly used to correct or enhance sperm quality prior performance of ICSI in the treatment of some of the more severe male factor cases.
Donor insemination is an approach commonly used when the male factor is severe beyond reasonable treatment. Donor insemination can be a very satisfying approach when standard treatments prove repeatedly ineffective.
