What is Infertility?

Approximately 85% of women will become pregnant within one year of trying. Only an additional 7% of couples will conceive in the second year. Based on these results, infertility is defined as the inability to conceive within 12 months.

The most common causes of Infertility are:

● Advancing Maternal Age: As women age, the number of eggs they produce and the egg quality decreases at a rapid rate.

● Ovulation disorders: Normal and regular ovulation (the release of a mature egg) is essential for women to conceive naturally. There are many disorders that may impact the ability for a woman to ovulate normally. The most common disorders impacting ovulation include PCOS (link to past written PCOS article). Ovulation can be detected by keeping a menstrual calendar or using an ovulation predictor kit.

● Uterine Fibroids: There are three types of fibroids and 40% of women have them. However, only submucosal fibroids reduce a woman's pregnancy rate. Submucosal fibroids can cause heavy periods, or bleeding between periods LINK TO PAST FIBROID ARTICLE

● Endometriosis: It causes infertility by producing inflammation and scarring in the uterine cavity. This can result in pelvic pain and affect eggs, sperm or developing embryos.

● Unknown: About 15% of couples can never pinpoint the cause of their infertility.

Luckily there are fertility treatments to help overcome Infertility:

1) Clomid, Tamoxifen, Letrozole (pill form) or Gonadotropins (Injectable): These medications help induce egg development and ovulation

2) Insemination: Intrauterine Insemination (IUI) is the process where sperm is washed and prepared for placement into the uterine cavity, bypassing the cervix and bringing the sperm closer to the tubes and ovulated egg

3) In Vitro Fertilization (IVF): IVF is the process where the woman's eggs are collected and then fertilized by sperm outside the body in a laboratory

When a couple decides to seek the help of a fertility specialist they will have a fertility evaluation. 

During this process the following will be conducted:

● Medical and Fertility History

● Transvaginal Ultrasound: An ultrasound is an important tool in evaluating the structure of the uterus, tubes, and ovaries. It can also detect any abnormalities like fibroids or ovarian cysts. Additionally, transvaginal ultrasound offers the opportunity for your doctor to assess the estimated number of available eggs (i.e your ovarian reserve).

● Laboratory testing: Blood work is conducted to measure blood levels of hormones like Estradiol, FSH and AMH (anti-Mullerian hormone), (related to ovarian function and overall egg numbers), TSH (assesses thyroid function) and Prolactin (hormone that can affect menstrual function if elevated), and Vitamin D.

● Hysterosalpingogram (HSG): This test is important in evaluating fallopian tubal patency, uterine filling defects such as fibroids and polyps, and scarring of the uterine cavity (Asherman syndrome). Many uterine and tubal abnormalities detected by the HSG can be surgically corrected. We have been performing HSG at our facility since 2009, and Dr Sharara has performed over 1000 HSGs.

● Semen analysis: The semen analysis is the main test to evaluate the male partner fertility concerns. There are many factors analyzed including:

1) semen volume

2) sperm concentration

3) sperm motility (movement)

4) morphology (shape)

5) WBC count

6) viscosity

If you are having trouble conceiving or have already been diagnosed with infertility and are in the process of selecting a fertility clinic, we invite you to visit read this article for an overview of options and factors to consider. Visit: http://vcrmed.blogspot.com/2015/04/how-to-choose-fertility-center.html

Should I do genetic testing?

There are a lot of factors to consider when deciding to conceive a child. Genetic testing can be a sensitive issue for some. It is important to talk openly with your doctor about any possible genetic risks and then consider your options.

Factors For Genetic Testing Consideration

A thorough health history can help decide if genetic testing should be considered. Factors include:

1. You and your spouses age
2. Ethnic background*
3. Family History
4. Medical History

*Common Genetic diseases related to your ethnicity include:

• Sickle cell anemia (most common in people of African heritage)
• Thalassemia (occurs most frequently in people of Italian, Greek, Middle Eastern, Asian and African ancestry)
• Tay-Sachs disease (most common among Ashkenazi Jews)
• Cystic fibrosis (most likely to occur if there’s a family history of cystic fibrosis — people with Caucasian background are more likely be affected than other ethnicity)
• Fragile X Syndrome
• Duchenne Muscular Dystrophy

If a thorough medical history suggests the possibility of a genetic disease, your doctor will probably recommend that you and your partner be screened to see if either (or both) of you carry a gene. The test can be done through blood testing.

Ultimately, the decision should be made by you and your partner. We recommend to speak to a genetic counselor (it is a free phone call) before scheduling the test so that all your questions/concerns are addressed. All genetic companies (such as Natera, Good Start Genetics, Recombine, etc) offer a free phone consult before doing the test, and if any of the screens come back positive for one of the common genetic diseases noted above. There’s no right answer, only the answer that’s right for you and your family.

If you are in the process of trying to conceive and are experiencing fertility issues, we welcome you to learn more about Virginia Center for Reproductive Health at: http://www.vcrmed.com/

FAQ about IUI-Intrauterine Insemination

Virginia Center for Reproductive Medicine prides itself on providing each patient with the utmost personal care and attention. We are happy to answer any questions you may have about fertility treatments and the procedures involved. Below, we have composed a list of most frequently asked questions about the Intrauterine Insemination (IUI) process and associated responses.

Who should consider IUI?

Patients suffering with low sperm count, decreased sperm mobility, unexplained fertility, hostile cervical condition or ejaculation dysfunction can all benefit from an IUI procedure.

How is IUI done?

IUI with washed semen is a technique that places prepared sperm directly into the uterus using a catheter. IUI bypasses the vagina and cervix where many sperm are otherwise lost, thus the number of motile sperm available to fertilize an egg is increased.

When should the IUI procedure occur?

An IUI procedure is performed around the time of ovulation.

Does the procedure hurt?

Most women consider IUI to be fairly painless, similar to having a pap smear. There can be some minimal cramping afterwards, but often what is felt is ovulation-related rather than from the IUI.

Can sperm fall out?

Once sperm is injected into the uterus it doesn’t fall out. Occasionally there is wetness after the IUI procedure but this is related to the catheter loosening the cervical mucus.

How long after IUI should implantation occur?

Implantation generally takes place 7 days days after ovulation/your IUI procedure.

How soon can I take a pregnancy test?

It is highly recommend that the patient wait two weeks before taking a pregnancy test to prevent a false positive due to hormones and injectibles.

What is the success rate for IUI?

Success rates will vary with the couple’s original diagnosis and the number of cycles of IUI.  The pregnancy rate per cycle of insemination is 15-20%.  The pregnancy rate may be as high as 30-50% in couples undergoing three cycles of IUI. 

The use of fertility medication, such as Clomid, Tamoxifen, or injectable Gonadotropins, increases the chance of pregnancy. The pregnancy rate using Clomid/Tamoxifen is about 15-%, and that of injectables/IUI is about 20-25%, but these rates are age-dependent and are significantly lower in women > 35. The multiple pregnancy rate is about 5% with Clomid or Tamoxifen (mostly twins), but increases to about 20-25% with injectable gonadotropins (some may be higher-order multiples, i.e triplets or more).

How many IUIs should I try before moving on to IVF?

It depends on what you can afford and what medication you are taking. If a couple doesn't have success after four ovulatory cycles on injectables with well-timed IUI, it would be time to consider IVF.

If you are considering IUI or other fertility treatments, we invite you to Contact Us

The patients at VCRMED are taken care of by a single physician who knows everything about their specific case. We believe this care results in faster success. We would love to assist you in making your dreams come true.

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