Fertility Services

What are fertility services?

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Fertility services are a generalized medicine practice that aid in conception. These services assist both couples and individuals who want to become pregnant but have not been able to. In most cases, these patients have restricted fertility for a variety of medical reasons, like a lack of regular ovulation, damaged fallopian tubes, unhealthy sperm, or conditions like cystic fibrosis. Fertility services involve treatment regimens designed to induce pregnancy. Some services, like genetic counselling, are provided to folks with certain conditions who are unsure if they can carry a viable pregnancy.

There is a broad range of fertility services available. In most cases, these treatments are available to people who have female reproductive organs. Common treatments include In Vitro Fertilization (IVF), intrauterine insemination, ovulation induction, and embryo transfer, among more. If you are interested in learning about how you may benefit from fertility services, talk to your OB/GYN about options.

What is in vitro fertilization?

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In Vitro Fertilization (IVF) is an assistive reproductive technology. A reproductive endocrinologist retrieves mature eggs from the ovaries and sperm is used to fertilize the eggs in a lab. IVF can help people with the following infertility struggles conceive a child:

  • Reduced ovarian function
  • Damaged or blocked fallopian tubes
  • Uterine fibroids
  • Endometriosis
  • Fertility difficulty in people over 40
  • Abnormalities in sperm shape or low sperm count
  • Unexplained fertility

Prior to receiving IVF, ovarian reserve testing will provide information about the quality and size of the eggs. A doctor will also perform a uterus examination to test for uterine health and the best method for implanting embryos. A sperm test will determine the shape, size, and number of sperm.

When you visit a fertility specialist or OB/GYN, you will undergo five steps in the IVF process.

  1. Stimulation. Fertility drugs increase the number of eggs produced to make sure the IVF procedure has several potential eggs.
  2. Egg collection. Also known as follicular aspiration, this is a surgical procedure that allows the doctor to suction eggs and fluid out of egg-containing follicles in the ovaries.
  3. Insemination. After the lab receives the sperm sample, the two are mixed in a petri dish with the hope of producing embryos.
  4. Embryo culture. A doctor will observe the fertilized eggs to make sure they are developing and dividing.
  5. Transfer. Once the embryos reach the appropriate size, they can be implanted into the uterus. This process usually takes three to five days. When the embryo implants into the uterine wall, usually after 6 to 10 days, the person becomes pregnant.

As with all fertility services, there are some complications associated with IVF. The most immediate and concerning is an ectopic pregnancy, where the fetus becomes unviable and can endanger the life of the birth parent. Some patients also experience multiple pregnancies, ovarian hyperstimulation syndrome (OHSS), miscarriage, and damage, infection, or bleeding in the bladder or bowels.

Not all IVF attempts are successful. The American Pregnancy Association reports that the live birth rate for people under 35 is 41-43%. The live birth rate for people over 40 is 13-18%.

What is intrauterine insemination?

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Intrauterine Insemination (IUI) is a fertility treatment. This procedure makes it easier for sperm to reach the egg. A doctor puts the sperm directly into the uterus, bringing them closer to the egg. IUI can help people with the following infertility struggles conceive a child:

  • Cervix issues or cervical mucus
  • Mild endometriosis
  • Decreased sperm motility
  • Low sperm count
  • Unexplained fertility
  • Ejaculation or erection issues

If you and your doctor agree to try IUI, you will receive a variety of tests, including ultrasounds and bloodwork. You will then receive medication instructions. A week into taking the prescribed medication, a doctor will perform another ultrasound. Once the ovulation schedule is determined, the procedure can begin.

IUI is typically painless and quick. A doctor will gather the sperm sample on the day of the procedure or thaw the already-gathered sperm sample. The sperm will travel on a long, thin tube through the cervix and into the uterus.

There are some complications associated with IUI. Some patients experience multiple pregnancies or infection. More common are vomiting or nausea, a sudden increase in abdominal size, pelvic or abdominal pain, and sudden weight gain. Others may experience ovarian hyperstimulation syndrome (OHSS) and shortness of breath.

IUI success rate depends on whether fertility drugs are used, any known fertility diagnoses, age, and other fertility concerns. Success rates are lower for people over 40, or people who have completed three cycles of IUI without getting pregnant.

What is ovulation induction?

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Ovulation induction is a foundational part of fertility treatments. The process includes using hormone-based fertility medications to prompt the development and release of eggs. A doctor can use ovulation induction as standalone practice or in tandem with other assistive reproductive technologies, like IVF, IUI, and others. Ovulation induction can help people with the following infertility struggles conceive a child:

  • Hypothalamic issues (brain does not signal ovulation)
  • Hyperprolactinemia (elevated prolactin serum)
  • Lack of or irregular periods as a result of PCOS or abnormal pituitary hormone glands
  • Infrequent or irregular ovulation
  • Anovulation (no ovulation)
  • Endometriosis
  • Thyroid disease
  • Stress
  • Eating disorders

In ovulation induction, a fertility specialist will analyze the ovulation cycle. An ultrasound will show the follicles’ development in the ovaries, and the uterus lining’s appearance and thickness. Once the doctor determines viability, the patient will undergo a three-step process.

  1. Stimulation. Fertility medication stimulates the ovaries to increase the growth of egg-containing follicles.
  2. Monitoring. A doctor monitors the ovulation cycle to analyze the size and number of developing follicles.
  3. Artificial insemination or timed intercourse. A doctor determines which day of the ovulation cycle provides the best chance of pregnancy, so an artificial insemination or timed intercourse can take place on that day.

Ovulation induction comes with several common but manageable side effects. Most people will experience headaches, hot flashes, nausea, and bloating, as well as inflammation at the injection sites. Others may develop ovarian hyperstimulation syndrome (OHSS), experience blurry vision, or produce multiple pregnancies.

The success rate for ovulation induction depends on age and other fertility diagnoses. Yale Medicine reports a 20-25% success rate of pregnancy per cycle.

What is egg freezing and frozen embryo transfer?

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Egg freezing/frozen embryo transfer (FET) is the process of freezing eggs for the possibility of pregnancy later in life. Egg freezing/EFT can help people with the following infertility struggles conceive a child:

  • Chemotherapy patients and people who have had cancer
  • Infections
  • Organ failure
  • Endometriosis
  • Personal circumstances regarding partnership, career, educational, or value-driven plans

For patients who are interested in egg freezing and frozen embryo transfer, the doctor will gather medical history. This will help them determine menstrual cycle regularity. They will also take several blood tests to analyze hormone levels. Hormone treatment will stimulate more egg production. Birth control pills, taken a month before the hormone treatment, increases its effectiveness.

There are two types of egg retrieval:

  • Non-surgical. Using ultrasound imaging, a doctor uses a needle to retrieve eggs from the ovarian follicles.
  • Surgical. If a doctor cannot locate the eggs using ultrasound imaging, they will make an incision in the abdomen and use a needle to retrieve eggs from the ovarian follicles.

After retrieval, the eggs are frozen until the patient is ready to use them. As with all fertility services, there are certain side effects for patients who elect for egg freezing and frozen embryo transfer. In most cases, side effects are mild. They include mood swings, headaches, bloating, and weight gain. However, some may experience ovarian hyperstimulation syndrome (OHSS) and/or develop an increased risk of ovarian cancer.

A frozen egg leads to live birth 2-12% of the time. Older people have a lower success rate for egg freezing/FET.

What is genetic testing?

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Genetic testing reveals changes or mutations present in the DNA that can cause disease or illness. It is not a perfect process. A positive result does not guarantee the presence of a condition, and a negative result does not guarantee the absence of a condition. People who want to have children, but who are unsure whether they will pass on certain genetic conditions, often undergo some form of genetic testing.

Genetic testing requires a rigorous analysis of family medical history. A genetic counselor can help assess risk for different genetic conditions. Once you determine that you are interested in this type of testing, you and your doctor will discuss the four types of genetic screening:

  1. Blood sample
  2. Cheek swab
  3. Amniocentesis
  4. Chorionic villus sampling

A positive result indicates that the test detected whichever genetic change was being tested. This result can help form a diagnosis, find out if a gene will be passed to a child, or determine whether the test recipient will develop a certain disease.

A negative result indicates that the test did not detect whichever genetic change was being tested. This result does not necessarily guarantee the condition will never present. An inconclusive result usually requires follow-up testing or periodic reviews of the gene.