What is infertility?

Infertility is the inability to conceive during a period of 1 year in a woman younger than 35 years of age and six months in a woman older than 35 years despite regular, unprotected sexual intercourse.

 

How common is infertility?

According to the Centers for Disease Control and Prevention (CDC), approximately 12% of women between the ages of 15 and 44 in the United States struggle to get pregnant or carry a pregnancy to term. After one year of trying, 6% of married women in the same age range in the US are unable to get pregnant.

 

What causes infertility in women?

Conditions impacting the ovaries, fallopian tubes, or uterus, can play a part in female infertility. These conditions include:

• Polycystic ovary syndrome (PCOS)
• Functional hypothalamic amenorrhea (FHA)
• Improper function of the hypothalamus and pituitary glands
• Diminished ovarian reserve (DOR)  
• Premature ovarian insufficiency (POI)
• Endometriosis
• Fallopian tube obstruction
• Uterine factor, including congenital or post-procedural abnormalities of the uterus

 

What causes infertility in men?

Male infertility can occur due to a variety of reasons including genetic conditions, hormonal disorders, or interruption of testicular or ejaculatory function. Infertility in men is assessed by semen analysis. This analysis evaluates the concentration (number), motility (movement), and morphology (shape) of the sperm.  More advanced sperm testing may reveal additional functional abnormalities, such as the inability of sperm to properly fertilize an egg.

At Sound Fertility Care, both male and female infertility can be assessed in conjunction due to the dual training of our physician.  This helps to facilitate treatment when both male and female factors coexist. For example, in the case of men who have had vasectomies, sperm retrieval can be done by the same physician who leads the overall fertility treatment plan, thus unifying a couple’s care.

 

Are there factors that increase the risk of male infertility?

In addition to age, there are a number of lifestyle and medical factors that can impact infertility in men including:

• Repeated exposure of the testes to high temperatures
• Exposure to certain medications, exogenous testosterone, radiation, or environmental toxins
• Tobacco or marijuana consumption
• Excessive alcohol use
• Being overweight or obese

Are there factors that increase the risk of female infertility?

Fertility in women has been shown to decrease with the following:

• Tobacco smoking – up to 13% of infertility in women is caused by cigarette smoking
• Excessive alcohol consumption
• Severe weight loss or gain
• Amenorrhea (absent periods) due to physical or emotional stress
• Age – around 1/3 of couples where the woman is older than 35 have fertility difficulties

 

Can psychological treatment help patients deal with infertility?

Coping with infertility can cause anxiety, depression, feelings of isolation and other feelings of emotional turmoil. These can be helped by seeing a mental health professional who is familiar with infertility treatment. A therapist will be able to help patients learn coping skills, and work through their feelings of fear, grief, and stress.

 

What is Intrauterine Insemination (IUI)?

Also known as “artificial insemination”, intrauterine insemination (IUI) is the procedure in which prepared sperm is placed in the uterus during a woman’s fertile window.  Fertility medications may be used to “superovulate” or increase the number of mature eggs ovulated within that fertile window, as well as to increase precision of timing for IUI.

What is In Vitro Fertilization (IVF)?

In Vitro Fertilization (IVF) is the process of combining sperm with surgically retrieved eggs in a laboratory with the aim of achieving fertilization. After fertilization occurs, the resulting embryos are cultured through the first 3-5 days of development and are either “frozen” for later use or transferred into the uterus.

 

What is egg freezing (oocyte cryopreservation)?

This process involves using hormone treatments to stimulate the ovaries to cultivate more than one egg in a menstrual cycle. These eggs are available at baseline and through hormonal stimulation will be cultivated for retrieval, as opposed to undergoing “apoptosis” or the body’s natural means of programmed cell death.  When the timing is right, the patient is anesthetized and the eggs are retrieved using a long needle. After retrieval, the eggs are then frozen using cryo-protectants and liquid nitrogen. Unlike IVF, the eggs are not fertilized before being stored for future use.

 

What is blastocyst biopsy?

When an embryo is around five days old, cell differentiation begins to occur. This stage of development is referred to as blastocyst. During this time, the embryo displays an inner cell mass that will become the fetus and outer cells, called a trophectoderm, which will develop into the placenta.

Blastocyst biopsy is directed microsurgery on a blastocyst where 4-7 cells are removed from the trophectoderm, or placental precursor cells, for genetic testing (PGS).   Blastocyst biopsy is highly technical and performed only by senior embryologists with deep experience in embryo care and manipulation. The biopsied cells are placed in separate transport vials, so that embryo identity can be maintained, and are shipped to specialized labs for genetic analysis.  The remaining blastocyst is frozen and maintained in liquid nitrogen until the PGS results are available.

 

What is PGS?

Preimplantation Genetic Screening (PGS) is a genetic test performed on embryos during the IVF process. The purpose of PGS is to guide in selecting an embryo for transfer that has the highest probability of establishing an ongoing pregnancy and a healthy liveborn. A small number of cells is taken from the trophectoderm (placental precursor) of a day 5 embryo (blastocyst). PGS examines this genetic material looking for chromosomal abnormalities. The test gives information about genetic health enabling the care team to select the best embryo for transfer. Aneuploid embryos, or embryos with the incorrect number of chromosomes, frequently result in an unsuccessful pregnancy or the birth of a child with a genetic condition. PGS determines which embryos are most likely to have the correct number of chromosomes and the best likelihood of IVF success.

While the potential for chromosomally abnormal embryos increases as a woman ages, PGS is appropriate for the majority of people of all ages undergoing IVF. Although PGS, or any other genetic test, cannot be 100% accurate due to a combination of technical and biological factors, incorporating PGS into the IVF process results in higher pregnancy rates and fewer miscarriages due to the identification of chromosomally abnormal embryos that otherwise would have been transferred.

 

What is Frozen Embryo Transfer (FET)?

Embryo freezing is a standard procedure for all quality embryology laboratories worldwide.  Specialized methods for embryo freezing, such as “vitrification,” enable high survival rates, >95%.  Being able to rely on high embryo survival rates after freezing is key to the PGS process, as well as treatment cycles mandating a “freeze all” strategy.  Following ovarian stimulation for IVF, it may be beneficial to freeze all embryos to allow a woman’s body to return to baseline before embryo transfer to attempt pregnancy.  Newer studies also demonstrate a higher pregnancy rate and better outcomes in scenarios for frozen embryo transfers.

To accomplish a frozen embryo transfer cycle, a woman’s uterus becomes the focus.  Hormones are used to prepare the lining of the uterus to facilitate a “receptive” state for the transferred embryo.  The embryo(s) is/are thawed and transferred to the uterus through a specialized catheter by the physician using ultrasound guidance.  Programming the uterine lining and the thaw time for the embryo hopefully optimize implantation and a successful ongoing pregnancy.

 

What will happen to stored embryos that are not used?

Frozen embryos can be stored indefinitely, with reports of healthy children born after the thawing and transfer of embryos that have been frozen for long periods (>15-20 years).  Once a patient or couple has completed their family building with their available embryos, they can then select from the following options for their “supernumerary” or extra embryos:

1. Anonymous embryo donation
2. Embryo donation to someone they know, also known as “directed embryo donation”
3. Donation of embryos for laboratory research
4. Disposal