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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 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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