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Infertility 101

Infertility 101. Dana Ambler, DO Director, Donor Egg Program Associate Physician Conceptions Reproductive Associates. Myths Facts. You’ll get pregnant if. . . you just relax you go on vacation you stop thinking about it you stand on your head after intercourse. Stress

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Infertility 101

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  1. Infertility 101 Dana Ambler, DO Director, Donor Egg Program Associate Physician Conceptions Reproductive Associates

  2. Myths Facts You’ll get pregnant if. . . • you just relax • you go on vacation • you stop thinking about it • you stand on your head after intercourse • Stress • Little effect if regular menses & ovulate • Moderate stress has some effect on fertility • Severe stress-problems with ovulation and fertility • Intercourse • Having it will help you conceive

  3. Myths Facts • Most people who get pregnant at fertility clinics, have “mutiples” (twins, triplets and more) • ~ 80% patients who conceive have a singleton pregnancy • 10 - 20% will have twins • <1% of all patients have triplets

  4. Myths Facts • Most people need to have multiple tests done to first diagnose the problem even before starting treatment • Most couples need very few tests to determine the cause of the infertility • Semen analysis • Test for ovulation (Blood tests) • Test to check fallopian tubes

  5. Myths Facts • Insurance never covers the cost of infertility treatment • Up to 30% of insurances cover some of the costs • 15 states already have laws mandating fertility coverage • It is critical to write your legislator if you think this is important

  6. Myths Facts • Miscarriages are caused by • Stress • Picking up something heavy • Having intercourse • Miscarriages are usually the result of an abnormal egg and/or sperm resulting in an embryo with abnormal DNA • This cannot be prevented once the embryo has formed

  7. Myths Facts Egg quality decreases at the age of 32 Up to 10% chance of pregnancy per month if 35 and older Approximately 20% chance that pregnancy will result in miscarriage

  8. Infertility • Twelve consecutive months of unprotected intercourse without conception • >35 years old → six months • >40 years old → immediate evaluation • Worldwide, 1 in 7 couples have problems conceiving • 85-90% conceive in one year • Primary Infertility and Secondary Infertility

  9. Typical Evaluation • History and Physical Exam (Female) • Duration of infertility? Previous treatment? • Regular menstrual cycles? Abnormal bleeding? • Severe pain with menses or intercourse? • Sexual history? Timing? Contraception? Lubricants? • Previous surgeries, hospitalizations, infections? • Medical conditions? • Occupation? Tobacco, alcohol, drug use?

  10. Typical Evaluation • Tests for Ovarian Reserve • Follicle Stimulating Hormone • Luteinizing Hormone • Estradiol • Anti-Mullerian Hormone • Ultrasound

  11. Typical Evaluation (Female) • Tests for Ovulation (if uncertain) • 21 day progesterone • Ovulation predictor kit • Thyroid, Prolactin, vit D • Polycystic Ovarian Syndrome

  12. Typical Evaluation • Test of Anatomy: • Hysterosalpingogram (HSG) • Laparoscopy (if suspect endometriosis or pelvic abnormality)

  13. Typical Evaluation • History and Physical Exam (Male) • Sexual history? Timing? Contraception? Lubricants? • Prior genital injury? Surgery? • Infections? • Drug/Medication Use? • History of fathering children? • Medical conditions? • Occupation? Tobacco, alcohol, drug use?

  14. Typical Evaluation (Male) • Tests for husband • Semen Analysis (SA) • Physical exam if SA is abnormal • Varicocele? • Normal testicular development? • Laboratory evaluation

  15. Infertility Statistics Age of female

  16. Infertility Treatments • Surgery • Superovulation or Ovulation Induction • Intra-uterine Insemination (IUI) • In vitro Fertilization • Intracytoplasmic Sperm Injection (ICSI) • Complete Chromosomal Screening (CCS)

  17. Treatment of Infertility • Ovulation defect • Fertility medications • Other options • Metformin (PCOS) • Bromocriptine • Dexamethasone • Aspirin • Progesterone DEPENDS ON AGE OF FEMALE

  18. Intrauterine Insemination

  19. In Vitro Fertilization • Fallopian Tube disease • Endometriosis • Male Factor Infertility • Multifactor or Unexplained Infertility • Advanced Reproductive Age • Premature Ovarian Failure • Mullerian anomalies • Medical Disease • Genetic Disorders • Previous treatment failures

  20. Treatment of Infertility • Male Factor • Referral to Urology • Antibiotics • Very little success with any treatment except IUI and IVF (medications seldom helpful) • High dose antioxidants and multivitamins • Surgery • Boxers not briefs • No hot tubs • No smoking/drugs

  21. Treatment of Infertility “If every test is normal, why can’t we get pregnant?” • Unexplained Infertility • Wait and see • Clomiphene + IUI (Inseminations) • Gonadotropins + IUI • In Vitro Fertilization (IVF)

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