Infertility in Women
Female infertility can result from a range of factors. Dr. Aimee will work with you to determine the cause of your infertility and the best treatment options. Common causes of female infertility include:
Problems with fertility may arise if a woman’s fallopian tubes have been damaged by pelvic infection, previous tubal pregnancy or ruptured appendix. Most women with tubal problems benefit from in vitro fertilization (IVF).
Most women ovulate every 21 to 35 days. Women with cycles greater than 35 days are considered to have oligo-ovulation. Those who do not ovulate at all have anovulation. Medical therapy is often successful in these cases.
Age and Infertility
Advanced age is now the leading cause of infertility in the United States. For women, age-related infertility results from a decrease in the number and quality of her eggs over time.
Endometriosis is a condition where normal uterine tissue grows outside the uterus. Laparoscopy, a minor outpatient surgical procedure, is the most common treatment for endometriosis.
Abnormalities of the cervix affect fertility. One of the most common causes is prior surgery on the cervix (such as a cone biopsy or laser therapy to treat cervical cancer). Treatment includes intrauterine insemination and IVF.
Abnormalities to the shape of the uterus can also impact fertility. Some of these include scar tissue, polyps or fibroids. Hysteroscopy or a laparoscopy can be used to treat many uterine abnormalities.
When a couple has fertility concerns, Boston IVF recommends that both the male and female partner have full consultations in order to determine the most effective treatment approach.
A common misconception is that infertility is primarily a woman’s “problem”. In fact, male factor infertility affects the same number of couples as female factor infertility. An additional 25% of couples who seek treatment have more than one factor or condition affecting their ability to reproduce.
To identify male infertility, we analyze a semen sample for the volume of semen, the concentration of sperm, the percent of actively moving sperm and number of normal shaped sperm.
Even if one or more of these measurements is lower than normal, a man may have normal fertility. A semen analysis alone cannot fully predict a couple’s fertility. When male infertility is identified, Boston IVF recommends an infertility evaluation of the female.
Infertility in Men
A common misconception is that infertility is only a female problem. In fact, for almost 50% of infertile couples, the cause is related to the male partner (either alone or in addition to a female factor).
Some of the causes of male infertility include:
- A problem with testicular production of sperm
- No sperm (azoospermia)
- A blockage or absence of the duct for sperm (vas deferens) from the testicles
- A dilated vein in the scrotum (varicocele)
- A hormonal imbalance
- Lack of sperm mobility or function
- Previous injuries or health factors
- Ejaculation disorders
Treating Male Infertility
If male factor infertility has been diagnosed through a semen analysis, there are several approaches for treatment including drug therapy, surgical therapy, ART, ICSI and donor sperm.
Hormonal imbalances affecting the development of sperm can usually be successfully treated with drug therapy.
When there is a physical barrier preventing sperm production and maturation or ejaculation, a surgical procedure may be the most effective means of retrieving the sperm for insemination. These surgical procedures involve retrieval of the spermatozoa using a thin needle.
ART – Assisted Reproductive Technology
The female partner will often undergo intrauterine insemination (IUI) or in vitro fertilization (IVF) to treat certain types of male infertility. In cases where IVF is involved, it is often performed using ICSI.
ICSI – Intracytoplasmic Sperm Injection
Intracytoplasmic sperm injection, or ICSI, is used in cases where sperm are insufficient, do not swim properly, or have an abnormal shape that prevents them from penetrating the egg. An embryologist uses a microscope to carefully select, immobilize and draw a single healthy sperm into a pipette. After stabilizing the mature egg of the female partner, the embryologist carefully injects the sperm into the egg. This process takes less than ten minutes and does not damage either the egg or the sperm.
An alternative approach to male factor infertility is using a donor from one of several national sperm banks. Boston IVF can provide information to aid your search for a donor. Once a donor is identified and the sperm is available, the female would most likely go through an IVF cycle in combination with ICSI.
A vasectomy can often be reversed through surgery. A vasectomy reversal rejoins the vas deferens. It is performed under a light sedation with the aid of a microscope. Pregnancy rates following a vasectomy reversal are generally over 50%.
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