Infertility Classroom For Patients
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Financial Services
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Like success rates, the cost for infertility treatment varies widely between clinics. The best way to assess your ultimate cost is to ask for a copy of each clinic’s itemized charges by procedure. It is important to determine if there are any additional charges not included in the fee schedule, such as hospital charges, drug costs, and testing. Although the cost of treatment is important, the outcome is more important. A good formula to use is the cost versus take-home baby rate for your recommended procedure.
Many centers offer the service of investigating insurance benefits for you, or you can check with your employer’s human resources department. Keep this in mind when your employer offers a choice of health care plans during enrollment.
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PGD
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Preimplantation genetic diagnosis (PGD) is a diagnostic test used in conjunction with in vitro fertilization (IVF) performed on embryos to assist detection of known genetic diseases or chromosomal abnormalities. Since it was first performed in 1989, PGD has become the most important advance in genetic testing to determine whether genetic abnormalities are possible with a given pregnancy. Couples known to have serious genetic disorders or who carry a genetic disease have successfully decreased the likelihood of having a child with these life-threatening afflictions.
A single cell is removed from an embryo and analyzed for a specific abnormality. PGD allows the professional embryology team at the Reproductive Science Center of New England to identify embryos with irregularities. By transferring only non-affected embryos to the mother’s uterus, the probability that couples will have a healthy child increases.
Prior to the use of PGD, genetic disease diagnosis was limited to testing a fetus through amniocentesis or chorionic villus sampling. PGD provides a couple with more conclusive information about the health of the fetus. Knowing the genetic health of the fetus provides a couple with the tools to make informed decisions about the path a pregnancy may take. -
Treatment
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Infertility is on the rise, affecting approximately 1 in 7 couples. However, the fact that infertility is a treatable condition is not common knowledge. Major advances in the diagnosis and treatment of infertility have been made in recent years.
However modern medicine can sometimes be confusing. Today's rapid healthcare advancements can often give infertile couples a perplexing range of treatment options. In addition, couples often feel overwhelmed by time commitment, costs, insurance coverage, job and career goals, religious beliefs, cooperation between partners, medical diagnosis and emotional energy.
Our staff is here to help you sort through these issues. It is best to start by making an appointment with a fertility specialist at the Reproductive Science Center of New England to discuss the appropriate diagnostic testing and range of treatment options. After a diagnosis of infertility, the RSC specialist can assist you to decide upon the best treatment plan based on your specific situation. -
Diagnosis
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Treating infertility takes teamwork. We encourage both male and female partners to participate in an infertility evaluation, a step-by-step process that typically takes one to two months. A thorough evaluation of you and your partner may determine the cause of your infertility and help our specialists recommend the most appropriate treatment. Sometimes the causes are readily detectable. Other cases require more in-depth testing.
This testing may begin with your medical history, a review of records of previous treatment and testing, and in-depth questions. These questions may include the following topics: previous infertility experience, previous surgical procedures, any infertility tests already performed, occupational risks, history of sexual development, use of birth control, previous pregnancies, sexual practices, and any current complaints, such as weight gain. Alcohol and/or tobacco use and history is also thoroughly explored.
For the female partner, this would include the regularity of your menstrual periods, cramping, pelvic pain, bleeding, discharge or genital infection. For the male partner, this will include genital injury and/or infection, surgery, past history of infertility (if any), and medication or drug usage.
The female partner’s physical exam may include a pap smear, pelvic exam, cervical cultures, urine analysis, blood tests, and pelvic imaging. The male partner will undergo a semen analysis and a general physical exam if indicated.
Diagnostic tests will help to determine the cause of infertility in the reproductive process. The major components of the reproductive process include production and delivery of sperm, the ovulatory cycle, fertilization and implantation. After a history and physical exam have been performed, the physician will order the appropriate blood tests. These may include:Reproductive Hormone Tests
Any or all of the following blood tests may reveal clues to infertility: FSH, LH, prolactin, progesterone, estradiol, thyroid function tests, testosterone, and androstenedione. After basic hormonal tests are performed, the physician will review the results and order other diagnostic tests, if appropriate.
Basal Body Temperature (BBT)
The BBT is a measure of the female’s body temperature. In most women, body temperature prior to ovulation is low (97.2 to 97.4 degrees) and it rises to more than 98 degrees just after ovulation. This temperature rise is due to the production of the hormone progesterone following ovulation.
Beginning with the first day of menstruation, the woman should take her temperature immediately upon awakening each morning. Special thermometers that show a range of just a few degrees are more accurate. The woman should record the daily temperature, along with other events such as intercourse, bleeding, sleepless nights, or an illness. A slight temperature rise (more than half a degree) at approximately mid-cycle indicates that ovulation could have occurred. Due to advances in technology, this test is rarely requested by physicians.Luteinizing Hormone (LH) Monitoring
LH testing may be used in addition to BBT charting. Measurement of daily blood LH levels is the most reliable predictor of an LH surge. This surge is an important event, since ovulation normally occurs about 12-36 hours after detection. While daily blood testing to determine serum LH levels is both inconvenient and costly, simple, inexpensive urinary LH ovulation kits for home use have become readily available and are generally reliable.
Post-Coital Test:
The post-coital (after intercourse) test determines whether sperm are able to progress through the woman’s cervical mucus. The test is timed close to the time of ovulation. After the couple has intercourse, a physician exams the woman eight to 12 hours later in the clinic. A sample of cervical mucus is examined for the quality and quantity of mucus and for the presence of active sperm.
Endometrial Biopsy:
This test requires the removal of a small sample of tissue from the lining of the uterus. The test determines if the uterine lining is properly developed to allow implantation of a fertilized egg or may be used to rule out inflammation of the lining leading to infertility or miscarriage.
Semen Analysis:
For semen analysis, the male produces a semen sample through masturbation or through intercourse using a special condom which does not have spermicidal chemicals. A lab specialist examines the semen sample for volume of the ejaculate, concentration of sperm, motility and morphology (size and shape) of the sperm cells, and survival ability.
Cultures for Chlamydia and Mycoplasma:
A swab of the cervix yields a culture for detecting these infectious agents, which are associated with infertility in both men and women. Research has shown chlamydia to be a cause of tubal infection in women. Mycoplasmas are associated with decreased sperm motility, antisperm antibodies, and abnormal egg penetration.
Immunologic Testing
Immunologic factors may play a role in infertility, suggesting a need for testing. This type of testing is not routinely performed as part of infertility evaluation.
Hysterosalpingogram
This test determines if the uterine cavity is normal in size and shape and if the fallopian tubes are open or blocked. A physician introduces dye into the uterus through the cervix, and X-rays are taken to determine if the tubes are open. The female undergoes this test after a menstrual period but before anticipated ovulation, usually between days 5-12 of a menstrual cycle.
Over the course of an infertility evaluation, diagnostic clues appear. By the conclusion of the investigation, a physician has a better idea of the possible causes of infertility in the majority of couples.
In some couples, infertility is due to one specific factor such as low sperm count, fallopian tube damage, ovulatory dysfunction or endometriosis. In other couples, a variety of factors may be present. Other diagnoses that may cause infertility include improper sexual technique, smoking, alcohol or drug use. In a small percentage of couples, there is no apparent cause for infertility.
Once the evaluation process is complete, the physician meets with the patients to discuss the diagnosis and the appropriate treatment options. In addition, at RSC, our nurses, counselors and financial staff are available to provide patients support and guidance in making decisions. - Surgical Options ( 2 items )
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Assisted Reproductive Technology
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Assisted Reproductive Technology
Assisted Reproductive Technology (ART) refers to any infertility treatment that uses advanced technology to combine sperm and eggs outside the body in a laboratory. Most couples go through extensive infertility evaluation before considering ART. Some infertile couples will choose to use lower-technology treatments, such as intrauterine insemination (IUI), before turning to ART. Others find that their chances at getting pregnant are optimal with ART. It's estimated that about one-third of infertile couples in the United States are good candidates for infertility treatment using ART.
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Male Overview
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For a man to be fertile, his sperm cells must be healthy and be transported to their destination – the egg. Most cases of male infertility are due to sperm abnormalities, yet any of the following can play a role:
- Low sperm count [link to oligospermia/azoospermia]
- Abnormally shaped sperm cells [link to motility-morphology]
- Sperm that are immobile or have impaired movement [link to motility-morphology]
- Impaired delivery of sperm [link to structural]
Sperm basics
Fertilization depends on sperm that are properly shaped (morphology) and able to move (motility) rapidly and accurately toward the egg. Impaired motility and morphology can result in sperm not reaching the egg.
Sperm count or concentration refers to the number of sperm cells per milliliter of semen. Men with 10 million or fewer sperm per milliliter are considered subfertile. Approximately 20 million or higher is considered average; 40 million sperm or higher per milliliter indicates increased fertility.
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Female Overview
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Hydrosalpinx
A hydrosalpinx is a fallopian tube that is filled with fluid. Injury to the end of the fallopian tube (the ampulla) and its delicate fingers (the fimbria) -- whether from infection or trauma, such as with contraceptive tubal ligation -- causes the end of the tube to close. Glands within the tube produce a watery fluid that collects within the tube, producing a sausage shaped swelling. The fluid is somewhat toxic to early embryo development.
Presence of hydrosalpinx creates or makes worse a number of situations. It prevents ovulated eggs from meeting with sperm. When conception does occur within the tube, hydrosalpinx can prevent embryos from reaching the uterus. The commonly performed diagnostic hysterosalpingogram (HSG) can inadvertently introduce bacteria into the tubes, possibly resulting in serious infection if hydrosalpinx exists. Hydrosalpinx interfere with fertility treatment and decreases chances for successful in vitro fertilization. Use of fertility drugs can unwittingly increase the fluid build-up within undetected hydrosalpinx.
The most common causes of hydrosalpinx are undiagnosed or untreated chlamydia and gonorrhea. Other possible causes are use of IUDs, endometriosis, and abdominal surgery.Blocked Fallopian Tubes
Hydrosalpinx is one specific form of fallopian tube blockage, but there are others. Previously undetected or untreated infection of the tubes (salpingitis), including sexually transmitted infections, can cause adhesions and scarring within the tubes. Endometriosis lesions can also block tubes. Pelvic inflammatory disease (PID) is sometimes to blame.
When blockage exists within one or both fallopian tubes, the egg cell and sperm cells are prevented from meeting, thereby preventing natural conception. In addition to barring conception, blocked fallopian tubes can also be the cause of ectopic pregnancy, a dangerous condition in which a pregnancy, unable to move to the uterus for implantation, starts to grow within the tiny fallopian tube itself.Ovarian Cysts
Women of any age can have cysts on one or both ovaries. A cyst is a fluid-filled sac. Most ovarian cysts are benign, meaning they are not cancerous. The normal ovary can have small cysts leftover from ruptured egg follicles. On ultrasound, these simple cysts appear as bubble-like structures, filled with fluid. They usually disappear on their own and produce no symptoms.
Some ovarian cysts are associated with problems such as abdominal or pelvic pain, spotting in between menstrual periods, and/or infertility.
hemorrhagic cyst -- occurs when bleeding is also present
dermoid cyst -- comprised of the same tissue as skin, fat, bone, hair, or cartilage; may become inflamed or cause ovarian torsion (twisting)
endometrioid cyst -- caused by endometriosis, a common cause of female infertility
polycystic ovary -- usually twice its normal size with many small cysts on the outside; seen in women with and those without polycystic ovary syndromeFibroid Tumors
Many women have benign (non-cancerous) tumors in their uterus called myomata uteri or fibroids. These myoma may be silently present and cause no problems. In some women, however, fibroids can cause excessive and frequent menstrual periods, pelvic pain, infertility, and recurrent pregnancy loss.
Severe anemia can result from excessive uterine bleeding. Other symptoms can include pelvic pressure on the woman's bladder or rectum which may result in frequent urination or constipation. Some women will experience pain during sexual intercourse (due to an enlarged uterus).
Benign fibroids can be removed surgically through procedures known as laparoscopic or hysteroscopic myomectomy. - Common Causes ( 1 items )
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About Infertility
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