ARC^® Fertility Articles

By Susan Conway M.D., M.P.H., M.M.Sc.^©

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Sterilization is the most common contraceptive method utilized by couples in the United States. Approximately 27% of fertile women choose tubal sterilization as their method of contraception. About half of these surgeries are performed within 48 hours post-partum and the other half as interval procedures remote from a pregnancy. The procedures are meant to be permanent and most women enter into the decision with a sincere intention to prevent additional pregnancies.

As embryologists, one of the most common questions that we get from patients is “What do the grades of my embryos tell us about my chances of becoming pregnant?” The answer to this question is not a simple one. The objective of this article is to explain how we grade embryos and what those grades mean as far as an embryo’s potential for development.

Endometriosis

Definition: A condition in which tissue that resembles the lining of the uterus (endometrium) is found outside the uterus. While the most common locations for the lesions are behind the uterus (cul-de-sac), on the ovaries, or on the bladder surface, lesions have also been found in the bowel, appendix, c-section scars, lungs, and even the eye.

A Journey through an In Vitro Fertilization (IVF) Cycle

Cameron John Mullinder’s birth in late 2006 was a milestone. His mother, Louise Brown, was the first in vitro fertilization (IVF) baby in the world, born in England in 1978. Her birth generated a firestorm of criticism. His birth was a mere curiosity. Louise Brown’s conception by combining sperm and egg in the laboratory caused great fear that science had outpaced morality, that humankind had exceeded forbidden boundaries. Yet now, 30 years later, IVF is part of the treatment options offered by most full-service infertility programs.

Many centers have come to rely on ovarian reserve testing in order to identify those patients unlikely to become pregnant prior to initiation of a first IVF treatment cycle. In theory, women unlikely to conceive can be given the opportunity to avoid the financial disappointment associated with an IVF failure.

Center for Fertility and Reproductive Endocrinology
Magee Women’s Hospital
300 Halket Street, Suite 5150
Pittsburgh, PA 15213
Ph: (412) 641-1600

In life, there are a great number of things that are intended to be permanent and cannot be undone. Fortunately for women, this is not always the case in regards to tubal sterilization. While tubal ligation is considered a form of permanent sterilization, sometimes circumstances change.

It is now possible to test embryos created by In Vitro Fertilization (IVF) for genetic diseases by utilizing Preimplantation Genetic Testing (PGT). The primary goal of PGT is to identify genetic defects in embryos created through IVF before transferring them to the uterus, thus decreasing pregnancy terminations and births with genetic abnormalities.

30 to 40% of infertile women have problems with ovulation. An egg has to be released from the ovary each month in the middle of the cycle to have the opportunity to be fertilized in the tube and subsequently implant in the uterus to develop into a pregnancy. Ovulation can be induced by a variety of different medications. Your physician will discuss which treatment regime is right for you.

Intrauterine insemination (IUI) is a procedure in which a washed semen sample is directly placed into the top of the uterine cavity with a very soft catheter at or near the time of ovulation. This procedure is indicated when there are problems with the sperm, such as a low count or low motility, or an incompatibility between the sperm and the cervical mucus.

Infertility Evaluation Definition

The textbook definition of infertility is when a couple has difficulty achieving pregnancy after trying for one year. However, the work-up can be started earlier even if a couple has attempted pregnancy for a shorter period, especially if the female partner is older than 35. Some women have a known condition that will not allow a chance of conception without help and should get help without delay. In the female partner some of these conditions include blocked fallopian tubes from infections or tubal ligations, ovulation defects, and/or moderate to severe endometriosis. Very low sperm counts or no sperm in the male partner can also warrant immediate intervention or treatment.

Prior to conception, any patient desiring fertility has an opportunity to insure her health is optimal for a pregnancy. Her health care provider is in a unique position to offer counseling on medical care and behavior modification, if applicable. This article will address appropriate preconception screening.

Over the last several years, the field of Assisted Reproductive Technology (ART) has advanced rapidly in providing assistance to couples with male factor infertility. In couples that are having difficulty trying to conceive a child, approximately 40% will be diagnosed with a male problem. A routine semen analysis is used to determine the adequate number and quality of sperm to predict the fertilization potential.

1. What is the definition of infertility?

An accepted definition of infertility is the inability of a couple to conceive after 12 months of unprotected intercourse appropriately timed with ovulation. The estimated incidence of infertility is 10-15% of the general population. Interestingly, the monthly rate of conception for couples without fertility problems is only 20-25% and after one year approximately 85% of these couples will have conceived.

Approximately 50 percent of fertilized oocytes end in spontaneous abortion, most occurring before or at the time of the next expected menses. Of clinically recognized pregnancies, 15 percent result in miscarriage.  Recurrent pregnancy loss (RPL) has been defined as three or more spontaneous losses, usually in the first trimester.  However, evaluation after two losses (up to 5% of couples) has been recommended due to the similar diagnostic yield following the work-up for two vs. three losses.  Etiologies of RPL consist of genetic, anatomic, endocrinologic, immunologic and unexplained.  Advanced maternal age, cigarette smoking, alcohol and heavy coffee use have all been associated with RPL.  Recently, cocaine and tobacco use have been implicated.  No study has established a definite role for infections in RPL.