|SECTION 1 - DISCLAIMER|
This FAQ is intended to provide some basic information about the alt.infertility and misc.health.infertility newsgroups as well as a very
|SECTION 2 - TABLE OF CONTENTS|
|SECTION 3 - DEFINING INFERTILITY|
Infertility is a disease or condition of the reproductive system resulting in the inability to conceive after one year of unprotected well-timed intercourse. Infertility also includes the inability to carry a pregnancy to the delivery of a live baby.
Infertility is a medical condition, not a sexual disorder.
Sperm can be inseminated for 12 well-timed cycles as a measure of infertility for women with no male partner or for couples unable to have normal intercourse for medical reasons. There are some cases of inability to conceive due to failure to achieve intercourse for medical reasons, such as spinal injury in the male partner.
One in every six couples of childbearing age have a problem conceiving. Over 80% of all infertile couples can be helped to achieve pregnancy with proper medical treatment.
Infertility is a female problem in 35% of the cases, a male problem in 35% of the cases, a combined problem of the couple in 20% of cases, and unexplained in 10% of cases. It is essential that both the man and the woman be evaluated during an infertility work-up.
Most physicians advise you not to be concerned unless you have been trying to conceive for at least one year. If the female partner is over 30 years old, has a history of pelvic inflammatory disease, painful periods, recurrent miscarriage, or irregular periods then it might be prudent to seek help sooner. Waiting only 6 months before having an initial consultation for women 35 years and older is often recommended since if a problem is found there is less time for correction. If the male partner has a known or suspected low sperm count, then it would also be prudent to seek help sooner than waiting a year.
RESOLVE Inc. is a support group with information about infertility. Resolve is online at http://www.resolve.org.
|SECTION 4 - INFERTILITY AND RELATED NEWGROUPS|
Some discussions might include:
This group addresses the unique emotional aspects of pregnancy after the struggles of infertility. The group is in addition to an on-going email list of over 100 members called 'Panfert'.
The pregnancy group is for special emotional support for those who have achieved pregnancy after enduring infertility. The group is for the special support of those who will understand the conflicting feelings of finally achieving pregnancy with the normal need to discuss the discomforts and changes that occur during pregnancy. The group provides a forum for those who will also understand the fear and uncertainty often felt by women who are pregnant after infertility. The main pregnancy group news:misc.kids.pregnancy can be full of difficult posts for women finally pregnant after infertility.
Secondary infertility is the inability to conceive again after one or more successful pregnancies.
This group is open to all who wish to discuss infertility, but be aware that most in the group have already successfully birthed and are raising at least one child. Some in the group have multiple children in their home. Children are discussed in many posts. The group hopes to have an open forum for anyone wishing to discuss infertility issues along with discussion of children. The group primarily encompasses emotional issues related to secondary infertility. Parenting after infertility is also discussed.
The group includes those who had no prior infertility with having a child/children, but are now experiencing trouble achieving another pregnancy. The group also includes those who have had prior infertility perhaps of long duration involving extensive treatment to have a child/children and are now trying to achieve another pregnancy.
Cross posting to other infertility groups should be avoided to prevent inadvertent upset by the mentioning of children to those who may be feeling sensitive.
Some discussions might include:
Newsgroup FAQ written by founders posted at: http://www.fertilityplus.org/faq/primaryfaq.html
Primary infertility is infertility without ever conceiving or successfully carrying a pregnancy to a live birth.
The group also welcomes anyone without any living biological children after suffering infertility. Those who have biological children, even after infertility, should be prepared for not being welcome on this group. The group is for the emotional issues related to primary infertility (those with no living biological children as defined in the FAQ for the primary sub-group).
Cross posting to or from other infertility groups should be avoided!! Posting by any other than primary infertiles as defined for this group should be avoided. Anyone with biological children, even if after enduring infertility, should probably avoid posting or making comments on this group to prevent possible hurt feelings. This group is a sanctuary for the special and sometimes strong feelings for those who do not and may NEVER have biological children after infertility.
Some discussions might include:
The newsgroup alt.infertility.parenting is set up to be a natural progression from alt.infertility and alt.infertility.pregnancy. It is for the discussion of all emotional and practical aspects of parenting after conceiving as a result of infertility treatments or parenting after adoption. This could include discussions about how people are coping with parenthood and discussions about the emotional aspects of undergoing treatment again for another child. Another topic for discussion would be practical suggestions for those having difficulty dealing with their new family.
"Alt.infertility.alternatives will be a place to explore the alternatives to a medical resolution to infertility. Among these are adoption, foster parenting, and child free living. It will be a place for the discussion of these subjects as well as moving on from treatment. It will be a place to learn from each other the processes we are going through and sharing the pitfalls and the joys." - from FAQ
This newsgroup is for discussing all aspects of pregnancy loss. "Its objective is to provide support and information for everyone experiencing or concerned about the trauma of miscarriage (including blighted ovum), ectopic pregnancy, therapeutic terminations, still birth or neo-natal death. Postings should be supportive and non-judgmental." - from Charter
news:alt.support.endometriosis and news:alt.med.endometriosis
Information on endometriosis is available at: http://www.bioscience.org/books/endomet/babaknia.htm
|SECTION 5 - NETIQUETTE FOR ALT.INFERTILITY & MISC.HEALTH.INFERTILITY|
Electronic communication is a relatively new phenomena when compared to the age-old standards of proper behavior (e.g., what Mom told us to do, and what Miss Manners continues to tell us to do). Fortunately, the standards of polite society work just fine within electronic communities and USENET communication. Occasionally, due to the impersonal nature of USENET communication, conflicts and arguments can arise. The purpose of this netiquette section is to assist new USENET users in general, and users of the infertility-related USENET newsgroups in particular, in avoiding improper behavior on the Internet.
Persons who are new to USENET newsgroup participation may benefit from reviewing general netiquette standards. World Wide Web copies of these standards is available here:
A more global overview of Internet communications can be found here:
Additional insights into the Internet culture can be found here:
In general, the rules of USENET netiquette can be summarized briefly:
1. Do not type messages in all uppercase letters; this is considered as shouting and is most appropriate only in USENET headers that are of interest to a wide audience, and as emphasis within a message.
2. Avoid unnecessary and prolonged debates on controversial issues. These debates can deteriorate into flaming which is not needed in the a.i./m.h.i. newsgroups.
3. When involved in a debate, consider moving the discussion from the USENET newsgroup to private e-mail.
4. Do not post back to the newsgroup any information that was received through private e-mail. This is considered very bad netiquette.
5. Do not cross-post messages to inappropriate newsgroups.
This last general rule has specific importance for the specialized infertility newsgroups such as alt.infertility.primary, alt.infertility.secondary. In general, pregnancy announcements that are posted to a.i/m.h.i should not be cross-posted to a.i.p and a.i.s. because a.i./m.h.i. are open forums for all infertility-related issues whereas a.i.p., for example, focuses on issues that are specific to those dealing with primary infertility. Discussions of how to deal with a child who wants a sibling should be kept to a.i and a.i.s. Posts about how it feels to not have children should be kept to a.i and a.i.p. Please note that subgroups are primarily for discussion of emotional aspects of infertility and medical/treatment questions should be posted to a.i/m.h.i.
6. Do not post graphics (photos, drawings, etc.) as attachments or part of your signature file. It is considered rude as it takes longer to download and costs some people more money. If you want to share a picture, post a link.
In addition to these general USENET netiquette rules, there are some specific a.i./m.h.i. netiquette procedures. For example, it has become common practice to add a "sensitivity tag" and give people a little warning in the subject header for certain kinds of posts:
(pg) in pregnancy posts
(child) for child mentioned
(vent) for emotional vent
The pregnancy and child tags should be used whenever either topic is mentioned, even if only in one's signature.
These "sensitivity tags" or "warning tags" can be modified and used whenever a USENET participant is posting information that may not be of interest to all newsgroup participants, such as:
(miscarriage mentioned) or (mc)
Because the a.i./m.h.i. newsgroups have specific protocols for announcing pregnancies, births, etc., there is always the opportunity for a well-meaning new participant to violate netiquette standards of the group. In those situations, it is best to unobtrusively message the new participant through e-mail, encourage them to read the FAQ section on netiquette, and assure the new participant that violations of netiquette standards by "newbies" are quickly forgotten. Also, the fact that a warning tag did not appear does not mean that netiquette was violated. Each participant in the a.i./m.h.i. newsgroups has the ability to stop reading a post or a thread of posts whenever he/she becomes uncomfortable with or offended by the material. In other words, the conclusion that "netiquette was violated" cannot be logically drawn from the premise of "your post made me feel uncomfortable".
Finally, all a.i./m.h.i. participants should realize that not everyone views infertility in the same way that we, the conceptionally challenged, do. Infertility is one of many interrelated issues (including abortion, adoption and related moral and religious beliefs) that are seen as controversial by many people. Because infertility and infertility treatments are sometimes seen by others as a controversial issue, there is an increased likelihood that flame-trollers with less-than-helpful motives may lurk the groups, looking for opportunities to stir dissension.
For clarification, a flame-troller is an individual who participates in a newsgroup for the primary reason of stirring up controversy. This can be distinguished from a well-meaning participant who creates or contributes to a controversial discussion. Flame-trollers can be particularly disruptive for newsgroup participants because of the ability of a flame-troller to post information anonymously and forge e-mail addresses to essentially create conflicts among newsgroup participants. Flame-trollers can often be recognized by the inflammatory statements within their posts, the level of controversy associated with their posts, and, most importantly, a reader's strong negative reaction to these posts.
It is best to avoid labeling anyone a flame-troller and try to ignore posts by not responding either through the newsgroup or privately through e-mail. Flame-trollers quickly disappear when they are ignored, but they will remain so long as attention is paid to them. If a controversial post originated from a well-meaning participant, this will usually become apparent through the way that the person responds within the current discussion thread or in subsequent threads.
In general, it is better to ignore those things that offend you than to draw more attention to those things through follow-up posts.
Commercial posts, for the most part, are not welcome on a.i/m.h.i. Anything that does not have to do with infertility is inappropriate, as is anything that provides no real information and just tries to sell a product.
|SECTION 6 - GETTING READY TO SEEK MEDICAL HELP|
The first thing you need to do is decide how you want to start. For couples who haven't been trying for 6-12 months, it may be worth working on timing intercourse and gathering information for a few months before seeking medical help -- for example, taking basal body temperature and using ovulation predictor kits. If you suspect ovulation problems -- having long cycles, discomfort, any recent change in cycling, etc. -- or suspect a problem with sperm production, seeking medical help as early as possible makes sense.
There are three specialists infertile couples are referred to: a gynecologist (OBGYN), a reproductive endocrinologist (RE), and a urologist for male factor. An OBGYN will be able to help women with simple fertility problems, but even one that claims a specialty in infertility probably has fewer credentials than an RE. The advantage to seeing an RE is that getting people pregnant is all they really do, and they tend to be more aggressive in looking for the problem as well as in treating infertility. Most likely one would get more thorough monitoring with an RE as well.
It's a good idea to have both the man and woman checked at the same time. Having a semen analysis before the woman goes through any invasive tests makes a lot of sense in order to prevent any unnecessary discomfort. A general practitioner, OBGYN, RE or urologist can order this test.
Often couples need to see their primary care physician in order to get a referral. You may wish to do a bit of homework to find out about good doctors in your area -- a good place to check in the U.S. is RESOLVE, http://www.resolve.org -- and also find out what your insurance will cover costs if you don't have ample funds to cover treatment.
Once you have a referral, make sure all relevant medical records are forwarded to the doctor and also send any of the information you've been gathering ahead of time. Make a list of questions you want to ask at your first appointment and bring paper and a pen so you can take some notes. Ask questions about anything you don't understand and try to participate in your treatment and in the development of a plan.
|SECTION 7 - INFERTILITY TESTS|
Information and brief description of the more common tests used to diagnose infertility.
Discussion of medical and surgical history. This includes a history of systemic diseases, such as viral infections (particularly postpubertal mumps and venereal disease), fevers, and diabetes mellitus, previous surgery, especially in the genitourinary area, duration of infertility, previous pregnancies, and sexual history. Many men had a hernia repair as babies and this occasionally causes a blockage of the vas due to scar tissue or to just bad surgical practices.
Physical exam: This includes an examination of testicle position in the scrotum (if the testicles haven't descended properly, the sperm will not be cool enough), an examination of the scrotum for varicoceles (varicose veins of the testicles), and an examination of the prostate and prostatic fluid for signs of infection. Also, fat and hair distribution is examined, for signs of hormone imbalance.
Urinalysis: Looks for signs of a urinary tract infection, presence of sperm in the urine (which, in conjunction with a low sperm count, may indicate retrograde ejaculation), and signs of systemic disorders such as kidney problems or diabetes mellitus.
Semen analysis: This is done at least three times, since sperm count varies, and a 2-3 day abstinence is required before each analysis. Normal values follow:
ejaculatory volume: 1.5-5.0 cc
For more information check http://matweb.hcuge.ch/matweb/endo/PGC_network/Semen_analysis_rrumbullaku.htm.
Endocrine tests: Blood tests to check levels of testosterone, FSH (follicle stimulating hormone), LH (luteinizing hormone), prolactin, estradiol, and the thyroid hormones T-4 and T-3. Usually FSH levels are measured first for men with low sperm counts, and others are measured as indicated. Some patterns of hormone abnormalities are more amenable to treatment than others. An elevated FSH is an indicator of testicular failure or the beginnings of testicular failure. If this is the case, there is little that can make a large difference in the count. Low normal or low levels of testosterone often indicate testicular atrophy (usually due to varicoceles). There is also little that can be done to change the sperm count if the levels of testosterone are low. Thyroid is an often overlooked or forgotten cause of sperm problems and is easy to check and easy to remedy. A link to general thyroid disease info is http://thyroid.miningco.com/.
Postcoital: Checks cervical mucus for presence of sperm after coitus. If a sperm count is low, generally it is just as easy to move on to intra-uterine insemination (IUI)rather than waste a cycle or more trying to do a postcoital. The sperm of men with low counts are more delicate and have more trouble surviving in mucus than do normal men's sperm.
Sperm Penetration Assay (SPA), or Hamster test (HEPA): This tests the ability of the sperm to penetrate a specially prepared hamster egg. This test is controversial and there is no clear evidence that the results are worthwhile. (FWIW, a little hamster has to die to donate the egg.)
Testicular biopsy: Takes a small piece of testicular tissue, and checks sperm-producing tubules and cells between the tubules. Possible patterns include: Normal (the tubules and the sperm in them are normal, so the problem is likely a blockage elsewhere), maturation arrest patterns, hypospermatogenesis (elements are there, but sperm isn't), and germinal cell aplasia (there just isn't any sperm there, and the only options for parenthood are donor insemination or adoption). This test is usually done as a last resort. It is often done in conjunction with an IVF cycle where donor sperm are ready as a backup in case there are no sperm in the biopsy.
Ultrasound of seminal vesicles to show their size, development, and whether they are emptying and storing sperm properly.
Vasogram: An x-ray using a dye to outline the ducts and look for obstructions.
Hormone tests: These are simple blood tests to check if there is a hormonal imbalance. These tests may include any or all of the following:
luteinizing hormone (LH)
A chart of hormone levels is posted at http://www.fertilityplus.org/faq/hormonelevels.html.
Insulin resistance (IR) testing: Insulin resistance is precursor to diabetes that can cause weight gain and is often seen in those with PCOS. Testing should be done on overweight infertility patients and anyone suspected of having PCOS, What happens is that the body starts producing excess insulin (hyperinsulinemia) in order to keep glucose levels normal. Testing glucose levels alone won't indicate insulin resistance until it is fairly advanced -- what's needed is fasting glucose and insulin levels, or a glucose tolerance test (preferrably also checking insulin). More info is at http://www.inciid.org/faq/pcos.html.
Pelvic exam: A physical exam to check for signs of infection as well as obvious physical abnormalities. Pretty much the standard feet-in-stirrups event.
Abdominal ultrasound: A transducer is passed over the bare skin of the abdomen in order to view the uterus and ovaries. Cysts, fibroids and uterine abnormalities may be visible.
Trans-vaginal ultrasound: A transducer wand is inserted into the vagina to view the cervix, uterus and ovaries. Provides greater detail than abdominal ultrasound.
Post-coital test (PCT): A sample of cervical fluid is obtained by gently scraping the cervix within a few hours of intercourse. The fluid is checked under a microscope to see if motile sperm are present. Must be done with fertile mucus at ovulation time.
Endometrial biopsy (EMB): Used to "date" the lining in relation to ovulation and to test for infection or pre-cancerous cells. To date the lining, the test is generally performed a few days prior to expected menses. A thin catheter is inserted through the cervix and a small sample of the uterine lining is removed.
Hysterosalpingogram (HSG): People often call this the dye test. A catheter is inserted through the cervix and a small amount of dye is pushed into the uterus while x-rays are being taken (usually continuous motion as well as a few stills). The shape of the uterus is observed, as well as how the dye flows through the fallopian tubes.
Laparoscopy: This surgery is usually done under general anesthesia to look for structural abnormalities, endometriosis and adhesions as well as possibly repair any problems found. The abdomen is inflated with carbon dioxide and a scope is inserted through a small incision below the navel. A second incision just above or below the pubic hairline is used to insert a tool to help manipulate the organs for better viewing with the scope. Patients may be able to get a videotape of the surgery.
Hysteroscopy: The cervix is dilated just enough to insert a small scope used for viewing the inside of the uterus. Minor abnormalities can be fixed during this procedure, which can be done under local or general anesthesia. Often done in conjunction with a laparoscopy.
Personal experiences with EMBs, HSGs, laparoscopies and hysteroscopies are posted in the Invasive Infertility Tests FAQ at http://www.fertilityplus.org/faq/itests.html.
Infectious disease testing: Some physicians will test for a variety of sexually transmitted and other infectious diseases including ureaplasma, mycoplasma, gonorrhea, chlamydia, syphilis, toxoplasmosis, rubella (German measles), cytomegalovirus virus, Hepatitis b&c and HIV I & II.
Immune testing: Some of the tests mentioned below are still controversial, but more and more doctors are seeing the benefits of checking into and treating immune disorders which affect fertility.
Lupus (SLE) tests (includes commonly tested for lupus anti-coagulant):
Anti-phospholipid antibodies (APA) tests (includes IgM, IgG and IgA markers):
Anti-nuclear antibodies (ANA) tests:
Anti-thyroid antibodies (ATA):
Anti-sperm antibodies (ASA): These can be either autoimmune or alloimmune. They are a blood test, usually indicated by a specimen at IUI-time behaving abnormally. If it's Autoimmune (the male has them) then the sperm are healthy looking, but they clump together and make knots that don't make satisfactory progression in great looking mucus. If it is alloimmune (the woman has them) then they are usually healthy looking but mostly dead on arrival or all of the live ones are incredibly slow. It's at IUI time that most of us get sent for the full range of tests, but many of us are treated without testing (testing cost is high, treatment cost is low). Treatment is usually prednisone for the party doing the antibodies. Dose is dependent on severity. Prednisone is very inexpensive -- about $5.00/month each.
Leukocyte Antibody Detection (LAD or HLA sharing)
The full Immunophenotype costs around $500 each and several may be necessary to gauge success of treatment. It is similar to testing that cancer, AIDS and transplant patients have. It measures all kinds of things about our immune systems in general and then our Reproductive Immunologists make some interpretations to apply our results to reproductive problems.
MRI or CT scan: One of these might be done if elevated prolactin is found. This is to look for a pituitary tumor.
|SECTION 8 - COMMON CAUSES OF INFERTILITY|
Unexplained: One of the most common forms of infertility is unexplained. This is when no physical, hormonal or immunological cause for infertility is found in either partner. Recent studies indicate that some unexplained infertility may be related to the use of non-steroidal anti-inflammatory drugs (NSAIDs), which impede ovulation. Check http://www.fertilityplus.org/faq/nsaids.html for more information.
Cancer treatment: Chemotherapy and radiation can cause abnormal sperm or sterility.
DES (diethylstilbestrol) exposure: Synthetic estrogen used in the 50s and 60s used by women to prevent miscarriage. Can cause low sperm counts, decreased sperm motility, and abnormal sperm forms, small penises, undescended testicles (risk factor for testicular cancer), abnormal testicles.
Hormonal imbalances: Hormone problems affecting sperm count include thyroid problems, low testosterone levels, elevated FSH, and excess prolactin (see next entry).
Hyperprolactinemia (excess prolactin): can inhibit GnRH, resulting in lower LH and testosterone. Also low FSH.
Idiopathic oligospermia: A fancy way of saying, "You don't have much sperm, and we have no idea why."
Immune problems: Both men and women can have immune reactions to sperm. There is a lot of controversy about how prevalent this is. Immune reactions to sperm in the man (autoimmune) can be a problem post-vasectomy, but may also have other causes. Anti-sperm antibodies in the male are often indicated by hyperviscosity which may inhibit forward progression. In mild cases, anti-sperm antibodies in the male or female (alloimmune) may be overcome by IUIs, for which the man will be asked to ejaculate into a cup with a special preparation in it. If IUI does not work, or if the problem is considered too severe, IVF may be necessary, with ICSI likely for male anti-sperm antibodies. Predisone, a steroid, may be given to the party producing the antibodies.
Impotence: One of the less common causes. Note: impotence is a *medical* problem. There are a variety of medical causes that can contribute, including diabetes mellitus, certain required medications such as antidepressants, etc. Sexual advice from friends is generally *not* welcome. Some useful advice on impotence can be found at http://www.impotence.org. he drug Viagra, according to the manufacturer, does not appear to have any negative impact on sperm. See http://www.viagra.com/hcp/pro_pack_insert.htm.
Infection: Postpubertal mumps, and, occasionally, venereal diseases such as gonorrhea and chlamydia can harm male fertility. Also, recurrent infections such as prostatitis can lower sperm count and motility.
Klinefelter's Syndrome: Men with Klinefelter's syndrome have two X chromosomes and one Y chromosome, rather than the normal one X and one Y. They are generally tall and thin, with small testicles. More information can be found at http://www.globalwebsol.com/vv/ and http://www.genetic.org. Both sites include listserv and support group addresses.
Lifestyle factors: These include factors which raise the temperature of the scrotum (such as the use of hot tubs or long baths), or harm sperm production. A variety of medicines and recreational drugs can decrease male fertility. These include alcohol, marijuana, cocaine, cigarettes, anabolic steroids, sulfasalazine, cimetidine (Tagamet, used for ulcers), nitrofurantoin (used for UTIs), anti-hypertensive drugs (specifically calcium channel blockers), aspirin, Dilantin (for epilepsy), colchicine, and antidepressants (note that some of these drugs should *not* be simply discontinued, because they may be required for other serious medical problems). Exposure to certain chemicals, such as lead and arsenic, and many types of paints or varnishes, can also adversely affect male fertility.
Obstruction: Can occur at various points, blocking sperm from getting out. Treated surgically. Often may be easier to work around obstruction by doing MESA or TESA instead of trying to repair surgically.
Prior surgery: The vas may be damaged during surgery fo hernia repair, orchiopexy, and even during varicocelectomy.
Retrograde ejaculation: Can be caused by certain medications, surgeries, and nerve damage (for example, from diabetes mellitus). Sperm goes in the wrong direction and can be found in the urine.
Sexual Dysfunction: Reported in up to 20% of infertile men. May include decreased sexual desire, inability to maintain an erection, and premature ejaculation. This could result from low testosterone or performance anxiety.
Trauma to testicles: Injury to testicles, such as from being hit, followed by atrophy. May also be the result of having the mumps and develop bi-lateral orchitis.
Undescended testicle: If the testicles do not descend during puberty, their body temperature may be too high, reducing quality and quantity of sperm production. Rare.
Varicocele: An enlarged vein in the scrotum, which causes pooling of blood and an elevated temperature. This one is controversial. According to some, it is one of the most common and readily treatable causes of male infertility. Others say that varicocele is also common among fertile men, and question the connection with infertility and the need for treatment. Large varicoceles that go untreated can cause permanent damage to the testicles. This can lead to testicular failure or atrophy. Testicular failure is indicated by an elevated FSH and means that the testicles are starting to stop producing sperm. Testicular atrophy is indicated by small testicle size and often leads to lower testosterone levels. This affects sperm counts and can also lead to the need for testosterone replacement therapy as the man ages. Note: Testosterone replacement _should not_ be used while pursuing fertility treatments as it will make the brain think it doesn't need to make testosterone and sperm counts will diminish even further. Description of surgery with graphics is available at http://www.maleinfertility.org/new-varicocelectomy.html
Vasectomy reversal: Though vasectomies are meant as a permanent means of birth control, it turns out that they can often be reversed. However, it is easier to reverse them if not too much time has passed since the vasectomy. The more time has passed, the more likely it is that the man will have an immune reaction to his own sperm.
Adhesions and scarring: Can be caused by sexually transmitted diseases left untreated, Chlamydia being the most common. Scarring can lead to blockage of the fallopian tubes, or damage to the delicate membranes within the tubes. It can also be formed by endometriosis and prior surgeries in the abdominal area.
Age: A woman's fertility begins falling off after the age of 25, though pregnancy can be achieved and maintained for most women into their early 40s. The rate of miscarriage and birth defects increases after 35. See http://noah.cuny.edu/pregnancy/march_of_dimes/pre_preg.plan/after30.html
Asherman's Syndrome: This is a condition where the walls of the uterus adhered to each other. Usually caused by uterine inflammation.
Cancer treatment: Chemotherapy and radiation can cause early menopause. Information on how cancer treatment affects fertility is posted at http://oncolink.upenn.edu/specialty/med_onc/bmt/bmt_11.html
DES (diethylstilbestrol) exposure: Synthetic estrogen used in the 50s and 60s to prevent miscarriage. Can cause abnormalities in the reproductive organs such as shortened cervix, deformities of the vagina or cervix, T-shaped uterus, abnormal fallopian tubes, ovulation problems, increased risks of ectopic pregnancy, repeated miscarriage, and premature delivery. See hhttp://www.teleport.com/~skeely/
Endometriosis: Growth of endometrial tissue outside the uterus. Can cause blockage of the fallopian tubes and adhesions. May not cause any symptoms beyond infertility, but could cause crampy periods and painful intercourse. FAQ posted at http://www.bioscience.org/books/endomet/babaknia.htm.
Environmental hazards: Pesticides may damage a woman's eggs leading to early menopause. Some materials are linked to early miscarriage. Ethylene oxide, used in chemical sterilization of surgical instruments. Exposure by healthcare professionals (including veterinary) to nitrous oxide. Vinyl chloride, used in plastics, and metallic compounds including manganese, arsenic, and nickel.
Hyperprolactinemia (elevated levels of the hormone prolactin): Can be caused by pituitary tumors, and breast milk production after giving birth. May lead to weak or skipped ovulation. Lowering prolactin levels can be achieved with Bromocriptine (Parlodel).
Hypothyroid: Underactivity of the thyroid gland. Symptoms include low basal body temperature and unexplained weight gain. Can throw off the endocrine system leading to ovulation problems and to miscarriage. An article about thyroid disease and pregnancy, fertility and pregnancy loss is posted in two parts at http://thyroid.miningco.com/library/weekly/aa063097.htm (part 1) and http://thyroid.miningco.com/library/weekly/aa070797.htm (part 2).
Immunological problems: The most common immune problems, testing positive for anti-phospholipid antibodies or the lupus anticoagulant, can lead to blood clots in the placenta that prevent nourishment from reaching a fetus. There are other more controversial causes of immunological fertility problems -- please check http://www.inciid.org for more information.
Luteal phase defect (LPD): There are two types of luteal phase problems that fall under the category of LPD. One is a short luteal phase -- 10 days or less. The second is when the length of the phase is not necessarily shorter than the standard 12-16 days, but it is out of phase and progesterone production is low. Typical treatment is to enhance ovulation and/or to use hCG or progesterone support after ovulation.
Luteinized unruptured follicle syndrome (LUFS): Failure of the follicle to release an egg even though it has reached maturity. Commonly seen when an LH surge is not followed by ovulation. Can be confirmed with ultrasound. May account for 5-30% of women with unexplained infertility.
Medication: Non-steroidal anti-inflammatory drugs (NSAIDs -- see http://www.fertilityplus.org/faq/nsaids.html), radiation and chemotherapy for cancer treatment, antihistamine and decongestants may lead to fertility problems. Vitamin C in large doses is also considered an antihistamine - which can lead to cervical mucus drying out.
Menopause: When a woman stops having regular ovulation and menses. Pregnancy may still be achieved through drug therapy and perhaps IVF with donor egg.
Obesity: Excess weight can lead to elevated estrogen levels which act as birth control and prevent a woman from ovulating. Drugs to induce ovulation can bypass this problem. For more information on weight and infertility, please check http://www.fertilityplus.org/faq/bbwfaq.html.
Polycystic ovaries (PCO): This condition often leads to ovulation problems. It can be diagnosed through ultrasound to show cysts in the ovaries or through blood tests of hormone levels. PCO patients often have elevated LH (LH:FSH greater than 3:1) and excess androgens. Insulin resistance is also common. Check http://www.pcosupport.org for lots of information and support services.
Polycystic Ovary Syndrome (PCOS): Symptoms include infertility, irregular cycles, obesity, acne, excess facial and body hair, obesity, skin tags, dark skin patches (back of neck, under arms, under breasts, groin), cystic ovaries, excess male hormones, insulin resistance, and dyslipidemia. It should be diagnosed through a combination of a physcial exam, ultrasound evaluation to look for possible cysts in the ovaries or ovarian enlargment, and blood tests to check LH and FSH (check ratio as well as levels on these two as LH higher than FSH is indicative of PCOS, especially when 2:1 or 3:1), testosterone, DHEAS, SHBG, androstenedione, prolactin, TSH, fasting glucose and insulin testing. Check http://www.inciid.org/faq/pcos.html and http://www.pcosupport.org for lots of information and support options.
Premature ovarian failure (POF): Characterized by high FSH in a younger woman (usually in her 30s). Cancer treatment and environmental hazards may play a role in the development of POF.
Recurrent miscarriage/pregnancy loss (RPL): When a woman miscarries more than one pregnancy. Testing can be done to try to determine the cause of such losses. If an underlying condition is found, the woman may need to be treated for the problem before a pregnancy can be carried to term. Testing information can be found at http://www.fertilityplus.org/faq/miscarriage/rpl.html.
Smoking: Associated with an approximately 5% increase in miscarriage rate. Smoking also doubles the chances of an ectopic pregnancy by damaging the cilia in the tubes. Studies have shown a marked decrease in effectiveness of IVF and GIFT. More information on smoking and GIFT can be found in the April 2, 1997 section of "What's up Doc?" at http://www.ivf-et.com/ (direct to the information is http://www.ivf-et.com/wud970407.html)
Tubal ligation (and failed surgery to reverse): Surgical sterilization of a woman by obstructing or tying of the fallopian tubes. May be reversed surgically with varying degrees of success.
Turner's Syndrome: Women should have cells that are 46XX, but Turner's women are missing an X -- hence a karyotype of 45XO or a mosaicism of 46XX and 45XO. Turner's women with a 45XO karyotype are sterile while those with a mosaicism may be able to get pregnant and carry to term. Women tend to be ultra-feminine and small in stature. Check http://www.onr.com/ts-texas.
Uterine abnormalities: Include problems from DES exposure, septums, T-and heart-shaped uterus.
Vegetarian lifestyle: Vegetarians may experience irregular ovulation that reduces the chances of conception.
|SECTION 9 - TREATING INFERTILITY|
Please note, information on drugs mentioned appears after the male and female sections, as does methods of impregnation (IUI, IVF).
Varicocele: The options are either surgery to close it off, or balloon insertion to block the blood flow.
ICSI: Done in conjunction with IVF. After the eggs are retrieved, a single sperm is injected into each mature egg. Stats on ICSI vary _widely_ from clinic to clinic. It is a good idea to check out the clinic and the embryologist for their ICSI statistics before doing ICSI. A fertilization rate of at least 50-60% should be expected with a good clinic and currently the better clinics have a 35-45% ongoing pregnancy rate. (needle aspiration of sperm, inject in egg, implant egg again, supposed to work even with quite low sperm counts).
For retrograde ejaculation: antihistamines and alpha-sympathomimetics.
For idiopathic oligospermia: Antiestrogens, such as clomiphene citrate (Clomid and Serophene) and tamoxifen can increase sperm density and motility. Sporadic success has been reported with testoractone. hCG has had some positive results, but they aren't solidly reproducible. GnRH (in early stages of investigation).
Of questionable benefit or outmoded: testosterone, arginine, bromocryptine (other than for hyperprolactemia), corticosteroids, thyroxin, oxytocin. (This list from "Male Infertility," by Larry Lipshultz, MD, and Serono Syposium. There seems to be a lot of controversy about which infertility treatments are worthwhile, so some of these may still be being debated.) Note: Larry Lipshultz is a highly regarded urologist who specializes in male infertility. He is located at the Baylor College of Medicine in Houston, Texas.
Coffee and vitamin C are claimed to improve sperm motility. There is conflicting evidence on whether caffeine is good or bad for sperm counts. Caffeine added to washed sperm does help motility, but whether caffeine taken internally will help is questionable. Vitamin C does have a tendency to help other vitamins absorb.
Vitamin E: May help sperm attach better to the egg. Recommended dose is 600 mg per day. An improvement was shown in sperm function on the zona binding test, which may help increases chances of pregnancy.
Vitamins and herbs: Rachel Browne has suggested the following formula which seems to have helped her husband: multi vitamin (without iron but with zinc), 1 mg C, 1000 mg l-arginine, 200 IU E, Bee Pollen and Siberian Ginseng in 500 mg pills, 100 mcg selenium, high potency B-complex, and 250 mg l-carnitine. His multi vitamins have: 10000IU beta carotene, 400 IU D, 150 mg C, 100 IU E, 25 mg B1, 25 mg B2, 25 mg B6, 100 mcg B12, 100 mcg niacinamide, 50 mg pantothenic acid, 300 mcg biotin, 400 mcg folic acid, 25 mg PABA, 25 mg choline bitartate, 25 mg inositol, 25 mg calcium, 7.2 mg magnesium, 5 mg potassium, and 15 mg zinc.
Microsurgical epididymal sperm aspiration (MESA), testicular sperm aspiration or extraction (TESA, TESE) and percutaneous epididymal sperm aspiration (PESA): MESA, TESA,PESA and other forms of retrieving sperm are used when there is no sperm in the ejaculate are used in conjunction with IVF and often with ICSI. Depending on where this is done, it can be done with a needle, a microscopic needle, or surgery. See http://www.ihr.com/bafertil/articles/azoosper.htm or http://www.maleinfertility.org/new-retrieval2.html
Other treatments include surgery to remove blockage, vasectomy reversal (of course), and some kind of gadget which men wear to cool the scrotum area.
Anovulation, irregular ovulation, and weak ovulation: All are treated with clomiphene citrate, menotropins (Pergonal, Humegon), and urofollitropins (Metrodin, Fertinex) to enhance follicle production. Some women also treat this problem with accupuncture or herbs. Check http://www.healthy.net/clinic/therapy/chinmed/specifics/fertility.htm for more information.
Endometriosis: Some can be removed with laser during laparoscopy. Also treated with Danazol, Lupron or birth control pills.
Polycystic ovaries (PCO): Can be treated by using superovulation drugs, steroids, and ovarian surgeries mentioned below. Current studies are looking into the use of GnRH.
Immune problems: Some autoimmune problems are treated with low-dose aspirin and Heparin. Alloimmune problems are treated with paternal white blood cell immunization and IVIg. See http://www.inciid.org for more information.
Adhesions and scarring: Treated with laparoscopy and hysteroscopy for laser removal of scar tissue.
Infectious: STDs and PID are treated with antibiotics when possible. May also require surgery for adhesions and scarring.
Recurrent miscarriage/pregnancy loss: If a cause can be found, it usually lies within one of the above-mentioned fertility problems, such as an immune problem or infectious disease. See http://www.fertilityplus.org/faq/miscarriage/rpl.html for testing information.
Laparoscopy: Often used to laser out endometriosis. Brief description and personal experiences are posted at http://www.fertilityplus.org/faq/itests.html#lap1
Hysteroscopy: used to remove fibroids and correct septums. Brief description and personal experiences are posted at http://www.fertilityplus.org/faq/itests.html#hyst1
Tuboplasty: Plastic or reconstructive surgery to correct abnormalities in the fallopian tube.
Fimbrioplasty: Plastic surgery on the fimbria, finger-like projections at the end of the fallopian tube that capture the egg from the ovary and deliver it into the tube.
Ovarian drilling: Process of putting several holes in polycystic ovaries to increase chances of ovulation.
Ovarian wedge resection: surgical removal of a portion of a polycystic ovary to increase the chance of ovulation.
Aspirin (low-dose or "baby" -- usually 81-82 mg): Used in treatment of immune problems such as presence of anti-phospholipid antibodies or the lupus anticoagulant -- mostly in conjunction with Heparin. Also used by some to increase thickness of the uterine lining. Basically to prevent clotting in the lining. Very few side effects are observed with low-dose aspirin. Full-strength aspirin and NSAIDs such as Advil and Aleve should not be used as they may interfere with ovulation and reduce the chance or pregnancy. Check http://www.ivf.com/immune.html for information on aspirin therapy in pregnancy. Check http://www.fertilityplus.org/faq/nsaids.html for more information on ovulatory problems related to these drugs.
Birth control pills: Commonly used for suppression of the ovaries prior to a stimulated cycles. Common side effects include headaches, weight gain, light periods, mid-cycle spotting, and elevated blood pressure.
Bromocriptine, brand Parlodel: Used for reduction of prolactin levels in both men and women. Side effects include dizziness and drowsiness, as well as more serious ones such as convulsions, black stool, nervousness, shortness of breath, and more.
Clomiphene citrate, brands Clomid and Serophene: Used to induce or enhance ovulation in women by stimulating the hypothalamus to release more GnRH and the pituitary to produce more LH and FSH. Common side effects include drying of cervical mucus, headaches, dizziness, cramping, hot flashes, moodiness, sore breasts, stomach upset, bloating, vision problems, skin rash thinning of uterine lining and formation of cysts. For men, it is used to lower estrogen and to increase LH and FSH to increase sperm counts. See http://www.fertilitext.org/clomid.htm and http://www.serono-usa.com/fertility/serophene.html.
Conjugated estrogens, brands, Premarin, Premaril and many others: Given mostly as hormone replacement. Side effects for men include muscle spasms, weakness, numbness, shortness of breath, change in vision, and headache. In women it can cause profuse bleeding. In both sexes it may cause increased chance of yeast infection, hair loss, acne or rashes, gastrointestinal problems, nausea and vomiting. Premarin info http://www.premarin.com/.
Danazol, brand Danocrine: Synthetic androgen used to treat endometriosis. Side effects include acne and oily skin, muscle cramps, weight gain, swelling of feet or lower legs, tiredness and weakness.
Estradiol: Given often after IVF to keep E2 levels up. Side effects include nausea and bloating.
Follitropins, alpha and beta,(recominant FSH, R-FSH, R-hFSH) brands Follistim, Gonal-F, Puregon: Recombinant FSH (lab made, rather than made from urine of post menopausal women), most often used for superovulation. Received through subcutaneous injection, though Follistim is approved for intramuscular injection in obese women. Side effects include hyperstimulation, abdominal or pelvic pain, bloating, and body rashes. Follistim info http://www.organoninc.com/products/consumer/follistim/follistim_c.html, Gonal-F info http://www.serono-usa.com/fertility/gonal_f.html.
Glitazones, brands Actos (pioglitzone) and Avandia (rosiglitazone): These are insulin-sensitizing meds used primarily for diabetics, but gaining popularity in the treatment of insulin resistance in women with PCOS. These medications are usually tolerated better than metformin, and may be more effective in improving glucose tolerance. The downside is that they are less likely to assist weight reduction (if desired) and they are both Pregnancy Category C medications and most doctors will want to take patients off the medication once a pregnancy is achieved. Liver function should be monitored quarterly while on these meds, and patients should be aware of signs of liver troubles such as jaundice, dark urine, vomiting and stomach pain. The most common side effect is headaches. Check http://www.actos.com, http://www.avandia.com and http://www.inciid.org/faq/pcos.html for more information.
GnRH-antagonist, ganirelix acetate, brand Antagon: Used to inhibit premature luteinizing horomone (LH) surges in women undergoing controlled ovarian hyperstimulation (COH). It's use is similar to Lupron, but it is newer on the market and has the added benefit of shortening up the IVF cycle. Side effects include abdominal pain, headache, ovarian hyperstimulation, vaginal bleeding, injection site reaction, nausea, and gastrointestinal discomfort. More info: http://www.organoninc.com/pi/antagon/antagon.html.
Gonadotropin releasing hormone (GnRH): Used in treating PCO and low sperm count.
Guaifenesin, brand Robitussin (many generics available): Used to thin cervical mucus. Recommended dose is 2 teaspoons three times per day with a full glass of water. Should be taken starting 5 days prior to ovulation and continued until ovulation has occurred. Side effects include nausea and gastrointestinal problems. Check http://www.fertilityplus.org/faq/cm.html.
Heparin: Used in treatment of immune problems -- to prevent blood clotting in the uterine lining. This is an anticoagulant which may have side effects such as nosebleeds, blood in urine or stool, and bruising. Recommended that you take calcium supplements in addition to pre-natal vitamins since Heparin depletes the supply.
Human chorionic gonadotropin (hCG), brands A.P.L, Profasi, Pregnyl, Chorigon, Novarel, and recombinant brand Ovidrel: For women hCG is used to induce ovulation, usually after taking clomiphene citrate, menotropins or urofollitropins. Also used to support the corpus luteum and keep progesterone levels elevated. Side effects include pregnancy symptoms such as nausea and breast swelling. Interferes with the ability to take a pregnancy test. Used to help a man's sperm count if the FSH, LH, and testosterone levels are low. Sometimes used in conjunction with menotropins. Only for men with the rare condition of hypogonadotropic hypogonadism. Side effects include moodiness and tiredness. The new recominant hCG, Ovidrel, is supposed to cause less localized reaction, and may help with empty follicle syndrome. Profasi info http://www.serono-usa.com/fertility/profasi.html, Pregnyl info http://www.organoninc.com/products/consumer/pregnyl/pregnyl_c.html.
Intravenous immunoglobulin (IVIg): Treatment for immune disorders. Side effects are fast or pounding heart and trouble breathing.
Leuprolide acetate, brands Lupron and Decapeptil: used to treat Endometriosis, uterine fibroid tumors, and to suppress women prior to IVF. Side effects include moodiness, hot flashes, and irregular vaginal bleeding. Lupron info http://www.lupron.com/.
LHRH antagonist, cetrorelix, brand Cetrotide: used to block LH surge/premature ovulation. It blocks the effects of gonadotropin-releasing hormone (GnRH). The GnRH controls the secretion of LH, the hormone that triggers ovulation. Like Antagon, it allows for a shorter stimulation cycle for IVF or IUI. Side effects include, reddening, itching, or swelling at injection site, nausea, and headache.
Menotropins, brands Pergonal, Humegon, Repronex, Menogon: FSH and LH, commonly used for superovulation. Side effects in women may include hyperstimulation, soreness around ovaries, bloating and rash. For men, side effects include dizziness, loss of appetite, headache, irregular heartbeat, nosebleeds, and shortness of breath. Pergonal info http://www.serono-usa.com/fertility/pergonal.html, Humegon info http://www.organoninc.com/products/consumer/humegon/humegon_c.html, Repronex/Menogon info http://www.ferringusa.com/rephome.htm.
Metformin, brands Glucophage and Glucophage XR: Metformin is a diabetes medication used to to improve insulin utilization. For several years it has also been used to treat insulin resistance that often accompanies PCOS. For some women it will restore ovulation or improve response to ovulation stimulation medications. Side effects are mostly gastroinstestinal and usually lessen with continued use.It is a Pregnancy Category B medication that is sometimes continued in all or part of pregnancy. For more info, check http://www.glucophage.com, http://www.inciid.org/faq/pcos.html and http://www.fertilityplus.org/faq/metformin.html.
Paternal white blood cell immunization: White blood cells from the father are injected into the mother as a way of fighting certain immune problems. Commonly given when partners are very similar genetically because the woman's body may fail to recognize the pregnancy and fight it.
Progestins, brand Provera: Used to induce a period when there is no natural cycle. Side effects, bloating, headaches, mood swings, swelling of face and extremities, increased blood pressure, and weight gain.
Progesterone, brands Crinone, Prometrium, or compounded at pharmacy: Can be given as suppositories, vaginal capsules, oral capsules/pills, lozenges/troches, Crinone gel applicator, and injections. Used to keep progesterone levels elevated in the luteal phase. Side effects include bloating, cramps, constipation or diarrhea, dizziness, drowsiness, headache, nausea, breast pain or swelling, and pain during intercourse. Serious side effects that warrant doctor consultation include pain, swelling or redness of an arm or leg, one-sided muscle weakness, vision problems, trouble breathing, fainting, itching, or skin rash. Crinone info http://www.serono-usa.com/fertility/crinone.html.
Progynon C (Ethinylestradiol 0.02mg): used to increase thin uterine lining.
Steroids such as dexamethasone and prednisone: used to suppress androgens in women with PCO and for certain immune problems. Side effects include weight gain, blurred vision, and increased thirst. May increase insulin resistance.
Tamoxifen citrate, brand Nolvadex: Used to treat men with elevated estrogen levels. It is also used for women who fail to ovulate. The typical starting dose is 20mg on days 2-5 of the cycle. Women with irregular cycles can start it any time, and the dose may be increased as needed. It is used in a similar manner as clomiphene citrate, but may have less damaging effect on cervical mucus and uterine lining. Side effects include nausea, hot flashes, weight gain, and headache. Any vision changes, vomiting or skin rash require doctor consultation. This medication is used primarily for breast cancer. Nolvadex info http://www.nolvadex.com/.
Urofollitropins, brands Metrodin and Fertinorm (discontinued): Pure FSH, most often used for superovulation. Received through intra-muscular injection. Side effects include hyperstimulation, abdominal and pelvic pain and bloating.
Urofollitropins, highly purified, brands Fertinex, Fertinorm HP and Metrodin HP: Pure FSH, most often used for superovulation. Received through subcutaneous injection. Side effects include hyperstimulation, abdominal and pelvic pain and bloating. May not be as effective in those with a body mass index over 26 (meaning higher dose may be needed). Fertinex info http://www.serono-usa.com/fertility/fertinex.html.
Timed intercourse: As the name implies, this involves timing intercourse for ovulation. The use of ovulation predictor kits may make this more exact. The greatest pregnancy rate is achieved in those who have sex the 5 days leading up to ovulation and perhaps ovulation day (though some feel that is too late). Couples with low sperm counts should have sex every other day, while daily intercourse should be fine for those with normal and high counts.
Artificial insemination (AI): The insertion of sperm into the female reproductive tract. Includes insemination at the cervix and intra-uterine insemination (IUI).
At-home insemination (AHI): This can be done with donated sperm (though proper testing is suggested before doing this) or with the husband/significant other's sperm. Rather than using a turkey-baster, as some jokingly suggest, this is best done with an oral medicine syringe. Semen is collected in a cup (or thawed from donor), sucked into the syringe, and slowly injected into the woman's vagina as close to the cervix as possible. For more information, check http://www.fertilityplus.org/faq/homeinsem.html.
Intra-uterine insemination (IUI): Semen is collected and "washed" or "spun." The sperm is then injected through the cervix, into the uterus using a small catheter. Check the IUI FAQ at http://www.fertilityplus.org/faq/iui.html.
Intra-tubal insemination (ITI): This is similar to IUI, but the catheter goes beyond the cervical opening and deposits sperm in the fallopian tube. This is a more uncomfortable procedure and may not greatly improve chances of success.
In vitro fertilization (IVF): Eggs and sperm are combined in a lab to fertilize eggs outside the body. Embryos are transferred back 2-3 days after egg retrieval.
Intra-cytoplasmic sperm injection (ICSI): Basically one sperm injected into one egg. Used for men with very low sperm counts to try to increase the chance of fertilization.
Assisted hatching (AH, AZH): Assisted hatching is putting a small opening in the embryo's outer layer called the zona pellucida. The embryo must break free of the zona to hatch out prior to implantation in the uterine lining. AH is often used for older women (38 or over), who often have more rigid zonas.
Non-surgical embryonic selective thinning (NEST): Similar to assisted hatching, only the embryo is slightly shaved prior to implantation to thin the zona pellucida rather than put a hole in it.
Gamete intra-fallopian transfer (GIFT): Combining eggs and sperm outside of the body and immediately placing them into the fallopian tubes to achieve fertilization.
Immature oocyte retrieval: Immature eggs are collected and grown in the lab using fertility drugs. When mature, they are fertilized and replaced in the same manner as IVF.
Zygote intra-fallopian transfer (ZIFT): IVF with the transfer of the zygote into the fallopian tube -- a combination of IVF and GIFT.
Stimulated cycle oocyte retrieval in (office) fertilization (SCORIF): This is a stimulated cycle, like IVF, where the eggs are retrieved and placed in a capsule with sperm. The capsule is then inserted into the vaginal so that fertilization takes place within the woman's body. After fertilization (2-3 days), the embryos are transferred into the woman's uterus.
Non-stimulated (cycle) oocyte retrieval in (office) fertilization (NORIF): Natural cycle where eggs are retrieved, placed in a capsule with sperm, and the capsule is inserted into the woman's vagina for fertilization. In 2-3 days the embryos are transferred in the uterus.
Donor egg: Use of another woman's egg to achieve pregnancy through IVF.
Donor sperm: Use of donated sperm for artificial insemination or IVF. List of online cryobanks can be found at http://www.fertilityplus.org/faq/donor.html.
|SECTION 10 - INFERTILITY INSURANCE|
The best way to determine what kind of infertility insurance you have is to check the details of your policy and/or call the company (and get any details in writing if necessary). One often sees questions on the infertility newsgroups about whether or not this or that insurance company covers infertility treatment -- it isn't that easy a question to answer because the same company in the same state can sell different policies to employers.
If you have coverage for prescriptions, you may need to check separately to see what is covered. When calling about drugs, use specific names. Drugs that have multiple purposes are usually covered (such as progesterone and estrogen). There are cases where treatment is not covered, but medications are -- and vice versa. There are also policies that cover testing but not treatment, and many cover treatment at a different percentage than other services.
These are just some common sense suggestions . . . you can check the following sites for more information: State Infertility Insurance Laws at http://www.asrm.org/patient/insur.html ; Infertility Insurance FAQ at http://www.fertilethoughts.net/infertility/faq.html; and Insurance Coverage for Infertility article at http://www.inciid.org/legal.html. The latter two sites also have bulletin boards for discussion of insurance issues.
|SECTION 11 - RECOMMENDED READING|
The Ache for a Child
And Hannah Wept: Infertility, Adoption, and the Jewish Couple
The Couples Guide to Fertility: Techniques to Help You Have a Baby
Getting Pregnant and Staying Pregnant: Overcoming Infertility and Managing Your High-Risk Pregnancy
Getting Pregnant When You Thought You Couldn't: The Interactive Guide That Helps You Up the Odds
Having Your Baby by Donor Insemination: A Complete Resource Guide
Healing Mind, Healthy Woman: Using the Mind-Body Connection to Manage Stress and Take Control of Your Life
How to Be a Successful Fertility Patient: Your Guide to Getting the Best Possible Medical Help to Have a Baby
How to Get Pregnant with the New Technology
Infertility: Your Questions Answered
In Pursuit of Fertility: A Fertility Expert Tells You How to Get Pregnant
Listen to Your Body
Longing for a Child: Coping with Infertility
Miscarriage: A Man's Book
Miscarriage: Women Sharing from the Heart
Overcoming Infertility Naturally
Preventing Miscarriage: The Good News
A Silent Sorrow: Pregnancy Loss Guidance and Support for You and Your Family
Sweet Grapes: How to Stop Being Infertile and Start Living Again
Taking Charge of Infertility
Taking Charge of Your Fertility: The Definitive Guide to Natural Birth Control and Pregnancy Achievement
Wanting Another Child: Coping With Secondary Infertility
There is also a book section in the Fertility Information Resource List at http://www.vais.net/~travis/firl.html.
More recommended reading regarding miscarriage is posted at http://www.fertilityplus.org/faq/miscarriage/resources.html.
Perspectives Press is a publisher specializing only in adoption and infertility titles, for adults and children. Go to http://www.perspectivespress.com/ourbooks.html for a listing of titles. Purchasing information is included as well as an online order form for direct sales. There is also a discount book page where you can get some deals.
Amazon books at http://www.amazon.com has a huge selection of infertility and miscarriage books available for mail order at a small discount. It takes 2-3 days for most titles to be sent out, then add transport time. This resource also allows you to sign up for notification whenever new books in your selected subject area become available. Most books sold at a 20-30% discount off the cover price, some at 40%.
Tapestry books at http://www.tapestrybooks.com has a large selection of infertility and adoption titles. Amazon may have more available, but tapestry offers a printed catalog of titles as well as its web site.
Barnes & Noble is now online at http://www.BarnesandNoble.com. In-stock titles are sold at 20-30% discount off the cover price.
Used with permission of Travis Low, Fertility Information Resource List (FIRL), http://www.vais.net/~travis/firl.html
FerreFax, by the Ferre Institute, Inc.
Fertility and Sterility
Hannah to Hannah
The Infertility Experience (T.I.E.)
The Infertility Experience (T.I.E.)
Newsletter of Resolve National
Roots & Wings Adoption Magazine
|SECTION 12 - LINKS TO MORE FAQS AND INTERNET RESOURCES|
FIRL -- Fertility Information Resource List
INCIID -- International Council on Infertility Information Dissemination
Atlanta Reproductive Health Centre
IHR Infertility Resources
DES Information Page
Home Pregnancy Test HCG Levels & Mini-FAQ
Infertility FAQ for Women of Size
Invasive Infertility Tests FAQ
Low-Tech Ways to Help You Conceive FAQ
Male Infertility Assessment, Diagnosis, and Treatment
Misc.Kids Miscarriage FAQ
Miscarriage Support and Information Resources
Ovulation Predictor Kit FAQ
Recurrent Pregnancy Loss Testing
Turner's Syndrome FAQ
|SECTION 13 - STATISTICS|
Please note that statistics are in no way individual, so our real odds of success may be much different from what is listed below.
It often takes a number of perfectly timed cycles before pregnancy is achieved. The chances of getting pregnant each cycle varies a bit with age. If you are 20-25, your chance per cycle are about 25%. From there they begin to fall off. At 25-30 your chances are about 20%. At 30-35 they are about 15%. After 35 they may be about 10% per ovulatory cycle, and the chances continue the downward trend.
This means that the average woman under 30 will get pregnant within 6 cycles. Women in their early 30s get pregnant on average by the end of 9 cycles. Mid-30s would be a year. At any age you are considered infertile if you have been having regular unprotected intercourse for a year without conception; however, women over 35 should seek treatment after 6 months.
Intra-cervical insemination (ICI): "Success rates with intracervical insemination have varied widely, but unfortunately, only 10 to 15% of couples will obtain a pregnancy following 4 to 6 well timed cycles of insemination." From http://www.ivf.com//insem.html
Intra-uterine insemination (IUI): Searching through about a dozen medical journal articles and a number of web sites resulted in a rather wide-range of statistics. Basically the odds of success are reported to be just under 8% and as high as 26% per cycle. The low statistics are with one follicle, while multiple follicles resulted in as high 26% success. Another influencing factor is sperm count. Higher sperm counts increase the odds of success, however, there was little difference between success with good-average counts and those with high counts. The overall success rate seems to be between 15-20% per cycle, judging from the articles which will be abstracted as part of the IUI FAQ at http://www.fertilityplus.org/faq/iui.html. The rate of multiple gestation pregnancies was 23-30%.
Intra-tubal insemination (ITI): Similar to IUI only the sperm is deposited in the fallopian tube. Atlanta Reproductive Health Centre reports only a slightly higher success rate with ITI over IUI, and a great deal more discomfort to the patient. One journal article was found, calling this fallopian tube sperm perfusion, suggesting that this procedure doubles the chances of success. The citation is:
Fanchin R, Olivennes F, Righini C, Hazout A, Schwab B, Frydman R, A new system for fallopian tube sperm perfusion leads to pregnancy rates twice as high as standard intrauterine insemination., Fertil Steril 64: 3, 505-10, Sep, 1995.
According to the Center for Disease Control and Prevention, the 1996 live births rate per retrieval on fresh cycles for IVF was 25.9%, GIFT was 28.7%, and ZIFT was 30.3%. Check http://www.cdc.gov/nccdphp/drh/art96/sec2_q5.htm for more details and a graph. You can find clinic specific success rates at http://www.cdc.gov/nccdphp/drh/art96/index.htm
Sort of a roll of the dice. If your doctor says you have about a 20% chance of success, look across the table to see how many cycles it might reasonably take to get pregnant.
Vertical axis is the percentage odds per cycle
|SECTION 14 - ACRONYMS AND ABBREVIATIONS|
2WW = 2-Week Wait
ACA = Anti-cardiolipin Antibodies
B2 = Baby Two (mailing list)
C# = Cycle Number
D&C = Dilation & Curettage
E2 = Estradiol
FBG = Fasting Blood Glucose
GD = Gestational Diabetes
HbA1c = Glycosylated Hemoglobin (also called Glycohemoglobin)
IBT = Immunobead Binding Test
LAD = Leukocyte Antibody Detection Assay
MAI = Miscarriage After Infertility (mail list)
NEST = Non-surgical Embryonic Selective Thinning
O, OV = Ovulation
P4 = Progesterone
RE = Reproductive Endocrinologist
SA = Semen Analysis
T4 = Thyroxine
TEBG = Testosterone-Estradiol Binding Globulin
UR = Urologist
V = Vasectomy
WBC = White Blood Cells
ZIFT = Zygote Intra-fallopian Transfer
AMAP = As Much As Possible
Also check glossary at:
This section Copyright © 1996-2001 by Rebecca Smith Waddell. All rights reserved.
|SECTION 15 - APPENDIX|
This group would discuss all matters related to infertility (inability to become pregnant or the inability to sustain a pregnancy) from emotional support to medical problems and treatments.
Original discussion and votes can be found at: