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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

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Infertility 101

Infertility 101

Dana Ambler, DO

Director, Donor Egg Program

Associate Physician

Conceptions Reproductive Associates


Myths facts
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 facts1
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 facts2
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 facts3
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 facts4
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 facts5
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
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


Typical evaluation
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 evaluation1
Typical Evaluation

  • Tests for Ovarian Reserve

    • Follicle Stimulating Hormone

    • Luteinizing Hormone

    • Estradiol

    • Anti-Mullerian Hormone

    • Ultrasound


Typical evaluation female
Typical Evaluation (Female)

  • Tests for Ovulation (if uncertain)

    • 21 day progesterone

    • Ovulation predictor kit

    • Thyroid, Prolactin, vit D

    • Polycystic Ovarian

      Syndrome


Typical evaluation2
Typical Evaluation

  • Test of Anatomy:

    • Hysterosalpingogram (HSG)

    • Laparoscopy (if suspect endometriosis or pelvic abnormality)


Typical evaluation3
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
Typical Evaluation (Male)

  • Tests for husband

    • Semen Analysis (SA)

    • Physical exam if SA is abnormal

      • Varicocele?

      • Normal testicular development?

      • Laboratory evaluation


Infertility statistics
Infertility Statistics

Age of female


Infertility treatments
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
Treatment of Infertility

  • Ovulation defect

    • Fertility medications

    • Other options

      • Metformin (PCOS)

      • Bromocriptine

      • Dexamethasone

      • Aspirin

      • Progesterone

DEPENDS ON AGE OF FEMALE



In vitro fertilization
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 infertility1
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 infertility2
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)


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