What is azoospermia

 Azoospermia means there’s no sperm in a man’s ejaculate. Its causes include a blockage along the reproductive tract, hormonal problems, ejaculation problems, or issues with testicular structure or function. Many causes are treatable and fertility can be restored. For other cases, it may be possible to retrieve live sperm to be used in assisted reproductive techniques.

What is azoospermia?

Azoospermia is a condition in which there’s no measurable sperm in a man’s ejaculate (semen). Azoospermia leads to male infertility.

Are there different types of azoospermia?

There are two main types of azoospermia:

Obstructive azoospermia: This type of azoospermia means that there is a blockage or missing connection in the epididymis, vas deferens, or elsewhere along your reproductive tract. You are producing sperm but it’s getting blocked from the exit so there’s no measurable amount of sperm in your semen.

Nonobstructive azoospermia: This type of azoospermia means you have poor or no sperm production due to defects in the structure or function of the testicles or other causes.

What are the causes of azoospermia?

The causes of azoospermia relate directly to the types of azoospermia. In other words, causes can be due to an obstruction or nonobstructive sources.

Obstructions that result in azoospermia most commonly occur in the vas deferens, the epididymis, or ejaculatory ducts. Problems that can cause blockages in these areas to include:

• Trauma or injury to these areas.
• Infections.
• Inflammation.
• Previous surgeries in the pelvic area.
• Development of a cyst.
• Vasectomy (planned permanent contraceptive procedure in which the vas deferens are cut or clamped to prevent the flow of sperm).
• Cystic fibrosis gene mutation, causes either the vas deferens not to form or causes abnormal development such that semen gets blocked by a buildup of thick secretions in the vas deferens.

Nonobstructive causes of azoospermia include:

• Genetic causes. Certain genetic mutations can result in infertility, including:
  • Kallmann syndrome: A genetic (inherited) disorder carried on the X chromosome that if left untreated can result in infertility.
  • Klinefelter’s syndrome: A male carries an extra X chromosome (making his chromosomal makeup XXY instead of XY). The result is often infertility, along with a lack of sexual or physical maturity, and learning difficulties.
  • Y chromosome deletion: Critical sections of genes on the Y chromosome (the male chromosome) that are responsible for sperm production are missing, resulting in infertility.
• Hormone imbalances/endocrine disorders, including hypogonadotropic hypogonadism. hyperprolactinemia and androgen resistance.
• Ejaculation problems such as retrograde ejaculation where the semen goes into the bladder
• Testicular causes include:
  • Anorchia (absence of the testicles).
  • Cryptorchidism (testicles have not dropped into the scrotum).
  • Sertoli cell-only syndrome (testicles fail to produce living sperm cells).
  • Spermatogenic arrest (testicles fail to produce fully mature sperm cells).
  • Mumps orchitis (inflamed testicles caused by mumps in late puberty).
  • Testicular torsion.
  • Tumors.
  • Reactions to certain medications that harm sperm production.
  • Radiation treatments.
  • Diseases such as diabetes, cirrhosis, or kidney failure.
  • Varicocele (veins coming from the testicle are dilated or widened impeding sperm production).

How is azoospermia diagnosed?

Azoospermia is diagnosed when, on two separate occasions, your sperm sample reveals no sperm when examined under a high-powered microscope following a spin in a centrifuge. A centrifuge is a laboratory instrument that spins a test sample at a high speed to separate it into its various parts. In the case of centrifuged seminal fluid, if sperm cells are present, they separate from the fluid around them and can be viewed under a microscope.

As part of the diagnosis, your healthcare provider will take your medical history, including asking you about the following:

• Fertility success or failure in the past (your ability to have children).
• Childhood illnesses.
• Injuries or surgeries in the pelvic area (these could cause duct blockage or poor blood supply to the testicles).
• Urinary or reproductive tract infections.
• History of sexually transmitted diseases.
• Exposure to radiation or chemotherapy.
• Your current and past medications.
• Any abuse of alcohol, marijuana, or other drugs.
• Recent fevers or exposure to heat, including frequent saunas or steam baths (heat kills sperm cells).
• Family history of birth defects, learning disabilities, reproductive failure, or cystic fibrosis.

Your healthcare provider will also conduct a physical examination, and will check:

• Your entire body in terms of signs of/lack of maturation of your body and reproductive organs.
• Your penis and scrotum, checking for the presence of your vas deferens, tenderness or swelling of your epididymis, size of the testicles, the presence or absence of a varicocele, and any blockage of the ejaculatory duct (via exam through the rectum) as evidenced by enlarged seminal vesicles.
• Your healthcare provider may also order the following tests:
• Measurement of testosterone and follicle-stimulating hormone (FSH) levels.
• Genetic testing.
• X-rays or ultrasound of the reproductive organs to see if there are any problems with the shape and size, and to see if there are tumors, blockages, or an inadequate blood supply.
• Imaging of the brain to identify disorders of the hypothalamus or pituitary gland.
• Biopsy (tissue sampling) of the testes. A normal biopsy would mean a blockage is probable at some point in the sperm transport system. Sometimes, any sperm found in the testes is frozen for future analysis or can be used in assisted pregnancy.

How is azoospermia treated?

Treatment of azoospermia depends on the cause. Genetic testing and counseling are often an important part of understanding and treating azoospermia. Treatment approaches include:

• If a blockage is the cause of your azoospermia, surgery can unblock tubes or reconstruct and connect abnormal or never developed tubes.
• If low hormone production is the main cause, you may be given hormone treatments. Hormones include follicle-stimulating hormone (FSH), human chorionic gonadotropin (HCG), clomiphene, anastrozole, and letrozole.
• If a varicocele is the cause of poor sperm production, the problem veins can be tied off in a surgical procedure, keeping surrounding structures preserved.
• Sperm can be retrieved directly from the testicle with an extensive biopsy in some men
• If living sperm are present, they can be retrieved from the testes, epididymis, or vas deferens for assisted pregnancy procedures such as in vitro fertilization or intracytoplasmic sperm injection (the injection of one sperm into one egg). If the cause of azoospermia is thought to be something that could be passed on to children, your healthcare provider may recommend genetic analysis of your sperm before assisted fertilization procedures are considered.

Azoospermia 

Infertility Treatment Methods

Infertility Treatment Methods (IVF | ICSI | EGG

 Donation)

Tehran (ISNA) - Normal pregnancy depends on various factors and conditions, in case of any disorder in any of them, the chance of fertility is decreased or even may go to zero. Infertility is one of the unwanted life phenomena that have been recently increased. A couple who couldn’t have a baby after a year of having sex without contraception, they are considered as infertile. All things needed couples know about fertility treatment is described in this post.

Infertility and its affecting factors

A couple is considered infertile if they cannot become pregnant after 12 months of unprotected intercourse. For women over the age of 35, infertility means not having fertility after 6 months of unprotected sex. Various causes can lead to infertility in couples. In general, these factors can be summarized in female and male factors.

Female-infertility factors include abnormalities in the female reproductive system or poor egg quality that impairs fertility.

Male-Infertility Cause is one-third of couples’ infertility causes. These types of infertility indicate the presence of dysfunction in sperm production or ejaculation in the male.

Research shows that in a third of cases, a combination of female and male factors causes infertility in couples. About 10% of couples also suffer from unknown causes of infertility.

Different methods of fertility treatment

There are different methods of infertility treatment like IVF, ICSI, IUI, and Egg Donation which can help infertile couples and give them a chance to have a baby. Iran is one of the leading countries in the region and in the world in the field of infertility treatment, therefore many couples choose fertility treatment in Iran for infertility treatment.

Several advanced research institutes and hospitals, provide infertility treatment services like IVF in Iran to both local and international patients. Moreover, other fertility services such as Gender Selection are offered in these centers as well for people who choose fertility treatment in Iran.

In the following, some of the most important methods of infertility treatment are introduced.

 What is IVF?

In Vitro Fertilization (IVF) is one of the assisted reproductive techniques (ART) in which a man’s sperm and the woman’s egg are combined in a laboratory dish, where fertilization occurs. When the egg is fertilized, the primary cell begins to divide and form the embryo. The resulting embryo or embryos is/are then transferred to the woman’s uterus to implant and develop naturally.

How is IVF done?

IVF is a common procedure, used to overcome a range of fertility issues. It is a multi-step process involving ovulation induction, egg retrieval, Collection and preparation of sperm, fertilization, culture, and embryo transfer. The IVF process can be explained in these five steps:

•           Ovulation induction

The greater the number of oocytes prepared during a treatment cycle, the greater the chance of a healthy fetus forming and subsequently the chance of pregnancy. A doctor prescribes ovulation induction drugs to stimulate the growth of several oocytes in a woman’s cycle.

•           Ovum Pick up:

During a minor surgery, the infertile doctor picks up the mature oocytes using a special needle. This is done under conditions of local or general anesthesia. The procedure usually takes less than 30 minutes.

•           Collection and preparation of sperm

In vitro fertilization of the oocyte with sperm requires the collection of semen. If the male is unable to produce semen, TESE or PESA methods are used to collect sperm.

The collected sperms are washed by a specific method and examined for motility and shape. Finally, high-quality sperms are selected to fertilize the oocytes.

•           Fertilization and embryo culture:

After the ovum picks up, the embryologist examines the obtained egg to select mature eggs that are suitable for fertilization.

The mature eggs are placed in a culture medium and the sperm is transferred to an incubator for fertilization. In IVF, high-motility sperms move to the eggs and fertilize them. Once this occurs, the fertilized eggs are considered embryos.

In conditions with a low number and low quality of sperm, the specialist uses intracytoplasmic sperm injection (ICSI). It is an additional part of an IVF treatment cycle in which a single sperm is injected into each egg to assist fertilization.

•           Embryo Transfer

Finally, the selected embryos are prepared for transfer to the uterus. A specialist physician inserts the embryo into the mother’s uterus during a minor surgery without the need for anesthesia.

What is the difference between ICSI and IVF?

The difference between IVF and ICSI is in how the oocyte is fertilized. In IVF, the oocyte is exposed to sperm in an in -vitro container until the highly motile sperm enters the oocyte and fertilizes it. But in the ICSI technique, a selected sperm is injected directly into the oocyte through a special needle. In this method, high-quality and motile sperm are separated and ready for injection in a laboratory using a special method. The ICSI method is mostly used in cases where the quality of male sperm is low.

Egg donation

Infertility is not always cured by prescribing medication or using advanced methods of infertility treatment. In cases where a woman’s ovarian reserves are low or the quality of eggs is low, but the uterus and other reproductive organs are healthy, the only fertility way is to receive an egg donated by a volunteer. For a consult of our doctors and specialists and to use the service of Egg Donation in Iran, you can contact us through the HayatMedTour website.

Fertility treatment in Iran

With over 30 years of experience in infertility research and treatment, Iran is one of the world’s pioneers in effective infertility treatment.  There are more than 80 specialized fertility treatment centers in Tehran, Urmia, Yazd, Isfahan, and other cities of Iran. These clinics with the up-date of knowledge and equipment in the world; offer various methods for infertility treatments with the best quality and reasonable prices.

The high quality and affordable cost of fertility treatments in Iran have led many medical tourists to choose this destination for the treatment of their infertility problems.

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How to Improve Sperm Quality

 If you and your partner are planning a pregnancy, you might be wondering about the health of your sperm. Understand the factors that can affect male fertility — then consider steps to help your sperm achieve your goal.

What determines sperm health?

Male reproductive system

Sperm health depends on various factors, including quantity, movement, and structure:

• Quantity. You're most likely to be fertile if your ejaculate — the semen discharged in a single ejaculation — contains at least 15 million sperm per milliliter. Too little sperm in an ejaculation might make it more difficult to get pregnant because there are fewer candidates available to fertilize the egg.
• Movement. To reach and fertilize an egg, sperm must move — wriggling and swimming through a woman's cervix, uterus, and fallopian tubes. This is known as motility. You're most likely to be fertile if at least 40% of your sperm are moving.
• Structure (morphology). Normal sperm have oval heads and long tails, which work together to propel them. While not as important a factor as sperm quantity or movement, the more sperm you have with a normal shape and structure, the more likely you are to be fertile.

What causes male fertility problems?

Various medical issues can contribute to male fertility problems, including:

• A problem in the hypothalamus or the pituitary gland — parts of the brain that signal the testicles to produce testosterone and sperm (secondary hypogonadism)
• Testicular disease
• Sperm transport disorders

Age can also play a role. The ability of sperm to move and the proportion of normal sperm tend to decrease with age, affecting fertility, especially after age 50.

What's the best way to produce healthy sperm?

You can take simple steps to increase your chances of producing healthy sperm. For example:

• Maintain a healthy weight. Some research suggests that increasing body mass index (BMI) is linked with decreasing sperm count and sperm movement.
• Eat a healthy diet. Choose plenty of fruits and vegetables, which are rich in antioxidants — and might help improve sperm health.
• Prevent sexually transmitted infections (STIs). Sexually transmitted infections — such as chlamydia and gonorrhea — can cause infertility in men. To protect yourself, limit your number of sexual partners and use a condom each time you have sex — or stay in a mutually monogamous relationship with a partner who isn't infected.
• Manage stress. Stress can decrease sexual function and interfere with the hormones needed to produce sperm.
• Get moving. Moderate physical activity can increase levels of powerful antioxidant enzymes, which can help protect sperm.

What's off-limits?

Sperm can be especially vulnerable to environmental factors, such as exposure to excessive heat or toxic chemicals. To protect your fertility:

• Don't smoke. Men who smoke cigarettes are more likely to have low sperm counts. If you smoke, ask your doctor to help you quit.
• Limit alcohol. Heavy drinking can lead to reduced testosterone production, impotence, and decreased sperm production. If you drink alcohol, do so in moderation.
• Avoid lubricants during sex. While further research is needed on the effects of lubricants on fertility, consider avoiding lubricants during intercourse. If necessary, consider using baby oil, canola oil, egg white, or a fertility-friendly lubricant, such as Pre-Seed.
• Talk to your doctor about medications. Calcium channel blockers, tricyclic antidepressants, anti-androgens, and other medications can contribute to fertility issues. Anabolic steroids can have the same effect.
• Watch out for toxins. Exposure to pesticides, lead and other toxins can affect sperm quantity and quality. If you must work with toxins, do so safely. For example, wear protective clothing and equipment, and avoid skin contact with chemicals.
• Stay cool. Increased scrotal temperature can hamper sperm production. Although the benefits have not been fully proved, wearing loose-fitting underwear, reducing sitting, avoiding saunas and hot tubs, and limiting scrotum exposure to warm objects, such as a laptop, might enhance sperm quality.

Chemotherapy and radiation therapy for cancer can impair sperm production and cause infertility that might be permanent. Ask your doctor about the possibility of retrieving and storing sperm before treatment.

When is it time to seek help?

Adopting healthy lifestyle practices to promote your fertility — and avoiding things that can damage it — can improve your chances of conceiving. If you and your partner haven't gotten pregnant after a year of unprotected sex, however, you might consider being evaluated for infertility. A fertility specialist also might be able to identify the cause of the problem and provide treatments that place you and your partner on the road to parenthood.

How to Improve SPERM Quality

How to improve egg quality for pregnancy

How to Improve Egg Quality

Having healthy eggs is one of the most important and influential factors on a woman's fertility. Therefore, ensuring the health and quality of eggs before pregnancy is very important. Most women who have weak oocytes are unable to conceive normally and will inevitably have to use infertility treatments such as IVF. In some cases, the quality of the eggs is so low that the only way to get pregnant is to use Egg Donation. Therefore, strengthening the eggs and finding ways to increase their quality is one of the most important concerns before attempting to conceive.

The effect of age on the egg quality

In the past, it was believed that every woman was born with all her ovarian reserves and could not produce more eggs after birth. Therefore, age was the most important factor affecting the health and quality of eggs and with increasing age, the quality and quantity of eggs decreases. But new scientific findings show that stem cells in the ovaries can produce new eggs during the reproductive years. However, it should be noted that age still has an important effect on the process of ovulation and the production of new egg cells, because the production of new oocytes is possible only at the reproductive age, and with increasing age, the possibility of embryo implantation in the uterus decreases.

Although it is not possible to prevent a decrease in fertility and ovulation with aging, there are ways to improve the egg quality and increase the chances of pregnancy at an older age. Factors such as a healthy diet, regular exercise, lifestyle changes and the use of supplements, etc. can have a positive effect on the quality of eggs. Therefore, observing these items is very important to increase the quality of eggs before attempting to conceive, especially at the age of over 40 years.

Factors affecting the quality of egg

The quality of the eggs largely depends on the environment in which the ovary grows. Oocytes usually go through a 90-day period from the beginning of development until they reach puberty and are released from the ovaries. . Therefore, the ovarian environment during these 90 days has a great impact on the quality of the released eggs. In general, women over the age of 40 have a poor ovarian environment to grow quality oocytes. However, following some tips for 3 to 4 months before getting pregnant can help them to increase the quality of eggs and pregnancy health. The most important factors affecting the health and quality of eggs are:

• Proper diet

We know that proper diet and nutrition have a direct impact on our health. So it is not surprising that diet may affect the reproductive health and quality of eggs. Women who are planning to become pregnant should eat foods that are high in vitamin A, such as liver, fish, and a variety of high-fat dairy products, to improve the quality of their eggs. Adequate intake of vitamin A by the body contributes to the proper response of the ovaries, increasing the quality of eggs and fetal growth. In addition, research shows that eating omega-3 foods such as fish and flaxseed is effective in maintaining fertility and improving egg quality.

Doctors recommend a low-carb, high-fat diet (unsaturated fat) before pregnancy. This diet helps to improve the quality of eggs in two ways, one is to reduce inflammation and the other is to balance reproductive hormones. Inflammation can cause tissue damage, reduce blood flow to the ovaries, and interfere with the ovaries' ability to receive nutrients. However, adequate ovarian nutrition and adequate blood flow are essential to ensure the growth of eggs and the production of quality eggs. Therefore, to reduce inflammation, it is recommended to limit carbohydrate intake because the breakdown of carbohydrates in the body causes the production of glucose, fructose, and other sugars that cause inflammation.

The balanced production of reproductive hormones is another factor affecting the quality of eggs. When hormones become unbalanced in the body (a common symptom of polycystic ovary syndrome; PCOS), the ovaries do not function properly and the eggs mature at low speed and quality.

Therefore, to increase the quality of eggs, it is recommended to increase the consumption of unsaturated fats because fat gives energy to the body and helps in the production of hormones and the growth of egg cells. In addition, it is recommended to avoid excessive caffeine consumption because the caffeine in various ways impairs women's reproductive function.

• Lifestyle

Some simple lifestyle changes can improve egg quality and increase your chances of getting pregnant. Some of these changes are:

No.1  Having enough sleep

Adequate and quality sleep is an important part of a healthy lifestyle. During sleep, the body repairs cells and recovers lost energy. In addition, during sleep, the hormones needed for reproduction are released. Therefore, adequate sleep contributes greatly to the growth and health of the eggs. The brain secretes the hormone melatonin to improve sleep. In addition to improving sleep quality, this hormone also increases egg quality and facilitates ovulation and fetal growth. With age, the level of the hormone melatonin decreases, so in women over 40, it is important to choose methods to improve sleep. Eating a healthy diet, managing stress, and reducing cell phone and TV use can help improve sleep patterns.

No.2  Avoiding alcohol and smoking

Research shows that alcohol consumption and smoking reduce the quality of eggs and increase the number of abnormal eggs. The chemicals in cigarettes cause the DNA of the egg to mutate, which is usually not suitable for fertility. Therefore, avoiding alcohol and smoking has a significant effect on egg health and quality.

No.3  Stress management

Stress causes imbalance and causes many problems in the body. When we are stressed, the body begins to produce the hormones cortisol and prolactin. These hormones can disrupt the ovulation process and prevent the production of quality eggs. The importance of stress management in the infertility treatment process is twofold. Because fertility treatment itself is a stressful process and if this stress is managed properly, it will have a great impact on the success of treatment.

No.4  Exercising

Light exercise such as walking and yoga are great ways to reduce stress, increase blood flow to the genitals and strengthen the immune system. As mentioned earlier, the ovaries need enough blood flow to provide nutrients and oxygen in order to be a good environment for quality eggs to grow. Therefore, exercising helps a lot to increase blood flow and increase the quality of eggs. In addition, drinking at least 8 glasses of water a day and doing abdominal massages increase blood circulation in the ovaries and uterus and improve the quality of eggs.

• Use of supplements

Using supplements is one of the best options to complete a healthy diet and ensure the health of the body and reproductive health. Supplements can help improve egg quality in women of childbearing age and over 40 years. Research shows that the nutrients and vitamins in supplements increase the ability of the egg to divide and improve the quality of the formed fetus. In addition, the antioxidants in supplements prepare the ovarian environment to improve egg quality.

The most important supplements recommended to improve egg quality in women over 40 are:

Omega-3: Omega-3 helps maintain fertility in women and improves egg quality by delaying ovarian aging. Getting enough omega-3 through your diet is difficult, so it is recommended to take a fish oil supplement that contains adequate amounts of omega-3.

 Coenzyme Q10: Coenzyme Q10 (Co Q10) is an antioxidant that enhances the ability of an egg to divide. The level of this enzyme in the body decreases with age. Therefore, supplementation of this enzyme is recommended to improve the quality of eggs and provide the energy needed for egg DNA amplification in women over 40 years of age.

Vitamin A: Vitamin A plays an important role in improving egg quality and fetal growth. Vitamin A supplementation helps women over the age of 40 to ensure proper egg growth.

Other Supplements: Supplements containing vitamin E, zinc, folate, and some B vitamins can also help increase egg quality.

The effect of increasing egg quality on the success of fertility treatments

Paying attention to strategies to improve egg quality is important not only for women who are planning to become pregnant at an older age, but also helps women who intend to use fertility treatments such as IUI, IVF, and ICSI and increases the chances of successful treatment.

Infertility treatments using high-quality eggs increase the likelihood of embryo formation. In addition, embryos formed with quality eggs have a better chance of implanting in the uterus and will continue to have more successful cell division.

 

Fertility Treatment

 There are 3 main types of fertility treatment:

• medicines
• surgical procedures
• assisted conception – including intrauterine insemination (IUI) and in vitro fertilizations (IVF)

Medicines

Common fertility medicines include:

• clomiphene – encourages the monthly release of an egg (ovulation) in women who do not ovulate regularly or cannot ovulate at all
• tamoxifen – an alternative to clomiphene that may be offered if you have ovulation problems
• metformin – is particularly beneficial for women who have polycystic ovary syndrome (PCOS)
• gonadotrophins – can help stimulate ovulation in women, and may also improve fertility in men
• gonadotrophin-releasing hormone and dopamine agonists – other types of medicine prescribed to encourage ovulation in women

Some of these medicines may cause side effects, such as nausea, vomiting, headaches and hot flushes.

Speak to your doctor for more information about the possible side effects of specific medicines.

Medicine that stimulates the ovaries is not recommended for women with unexplained infertility because it has not been found to increase their chances of getting pregnant.

Surgical procedures

There are several types of surgical procedures that may be used to investigate fertility problems and help with fertility.

Fallopian tube surgery

If your fallopian tubes have become blocked or scarred, you may need surgery to repair them.

Surgery can be used to break up the scar tissue in your fallopian tubes, making it easier for eggs to pass through them.

The success of surgery will depend on the extent of the damage to your fallopian tubes.

Possible complications from tubal surgery include an ectopic pregnancy, which is when the fertilised egg implants outside the womb.

Endometriosis, fibroids and PCOS

Endometriosis is when parts of the womb lining start growing outside the womb.

Laparoscopic surgery is often used to treat endometriosis by destroying or removing fluid-filled sacs called cysts.

It may also be used to remove submucosal fibroids, which are small growths in the womb.

If you have polycystic ovary syndrome (PCOS), a minor surgical procedure called laparoscopic ovarian drilling can be used if ovulation medicine has not worked.

This involves using either heat or a laser to destroy part of the ovary.

Read more about laparoscopy.

Correcting an epidydimal blockage and surgery to retrieve sperm

The epididymis is a coil-like structure in the testicles that helps store and transport sperm.

Sometimes the epididymis becomes blocked, preventing sperm from being ejaculated normally. If this is causing infertility, surgery can be used to correct the blockage.

Surgical extraction of sperm may be an option if you:

• have an obstruction that prevents the release of sperm
• were born without the tube that drains the sperm from the testicle (vas deferens)
• have had a vasectomy or a failed vasectomy reversal

Both operations take a few hours and are done under local anesthetic as outpatient procedures.

You'll be advised on the same day about the quality of the tissue or sperm collected.

Any sperm will be frozen and placed in storage for use at a later stage.

Assisted conception

Intrauterine insemination (IUI)

Intrauterine insemination (IUI), also known as artificial insemination, involves inserting sperm into the womb via a thin plastic tube passed through the cervix.

Sperm is first collected and washed in a fluid. The best quality specimens (the fastest moving) are selected.

Read more about IUI.

In vitro fertilizations (IVF)

In vitro fertilizations (IVF), is when an egg is fertilized outside the body. Fertility medicine is taken to encourage the ovaries to produce more eggs than usual.

Eggs are removed from the ovaries and fertilized with sperm in a laboratory. A fertilized egg (embryo) is then returned to the womb to grow and develop.

Egg and sperm donation

If you or your partner has an infertility problem, you may be able to receive eggs or sperm from a donor to help you conceive. Treatment with donor eggs is usually done using IVF.

Fertility Treatment Methods

A guide about the IVF process

 

what is IVF?

Thinking about overcoming infertility with in vitro fertilization (IVF)? Here’s how it works, plus everything you need to know about the IFV timeline, injections, side effects, and more.

About one in eight American couples struggle with infertility, or the inability to conceive despite having regular unprotected sex. As a solution, increasing numbers of people are turning to in vitro fertilization (IVF), a procedure in which surgically removed eggs are fertilized with sperm in a laboratory, then inserted directly into the uterus.

About 5% of all children born in the United States were conceived through IVF, says Amy Schutt, M.D., a reproductive endocrinologist at the Family Fertility Center at Texas Children’s Pavilion for Women. That equates to more than one million total babies. If you’re seeking to get pregnant through IVF, it’s important to understand the success rates, method, and possible side effects. Here’s all you need to know about IVF before signing up for the procedure.

• Who Gets IVF Procedure?

Infertility has a wide range of causes in both women and men. Treatment usually involves correcting the underlying problem with medication or surgery. But sometimes conventional treatment proves difficult, and couples turn to assisted contraception methods like IVF instead. For example, women with fallopian tube blockage often opt for IVF; since the fertilized egg is inserted directly into the uterus during the procedure, the tubes aren’t necessary for conception. Similarly, IVF procedure is common if the man has a low sperm count (oligospermia) or a lack of sperm in the ejaculate (azoospermia).

• Not every woman suffering from infertility is a candidate for IVF. According to Dr. Schutt, patients should think twice about IVF if they have a premature ovarian failure or a serious medical problem that precludes pregnancy. Religious beliefs and financial constraints may also deter women from undergoing the procedure (the average cost of IVF is $12,000, plus an additional $3,000-5,000 for necessary medications). What’s more, women who don’t produce eggs – whether because of menopause or another condition – can’t undergo IVF unless they use a donor or frozen eggs, according to Dr. Timothy Hickman, the medical director of CCRM Houston and director of the Division of Reproductive Endocrinology and Infertility at Houston Methodist Hospital.

IVF Process: How is IVF done?

“IVF involves handling of both eggs and sperm within the laboratory to allow for the fertilization of eggs and early development of embryos,” says Dr. Schutt. To prepare for IVF, a woman takes injectable fertility medications for approximately 10 days, during which the growth of her eggs is closely monitored. “When the eggs are ready to be collected (about 14 days later), the woman takes one final HCG injection that assists in the maturation of the eggs – and 36 hours afterward, the eggs are collected from the ovary,” says Dr. Schutt. Doctors use a narrow needle, suction device, and ultrasound imaging to retrieve the eggs. This IVF process usually involves anesthesia or sedation to relieve pain.

Next, the embryologist places the collected eggs on a Petri dish. She combines the eggs with sperm taken from the male in a process called insemination. If the sperm has low motility (impaired movement) the embryologist may insert sperm directly into the eggs (ICSI). The fertilized eggs, or embryos, are stored for three to seven days. "If genetic testing (chromosomal defect screening that lets you see the sex of the embryo) is to be performed, then the embryo is biopsied between the fifth and seventh day of development," adds Dr. Schutt. Note that some clinics allow you to choose the sex during genetic testing, while others do not. 

Finally, doctors transplant one or more embryos into the uterus with a catheter. Implantation – and subsequent pregnancy – usually takes place one or two weeks later.

IVF Success Rate

According to Dr. Schutt, the success rate of IVF depends largely on egg quality and quantity. “Egg quality is primarily a reflection of the age of the woman from which the eggs are obtained. The younger a woman is when she goes through IVF, the greater chance her eggs will potentially result in a healthy pregnancy,” she says. “Egg quantity is more variable, and it’s measured via ultrasound (to count the number of antral follicles) and lab work,” including blood tests. Other factors that affect IVF success include weight, alcohol intake, and tobacco use. 

IVF Side Effects

Most women who undergo IVF don’t have any symptoms, but possible IVF side effects include:

• Cramping
• Bloating
• Breast tenderness
• Clear or bloody fluid, which comes from the vagina in small amounts
• Mood swings
• Constipation

Some women also experience side effects from the hormonal injections they take before IVF. These include headaches, abdominal pain, mood swings, bloating, hot flashes, and ovarian hyperstimulation syndrome (OHSS) – a rare condition that occurs from excess egg production. Symptoms are weight gain, abdominal pain and swelling, nausea, shortness of breath, and dizziness. Consult your doctor if you think you developed OHSS – or if you experience other worrisome side effects of IVF like heavy vaginal bleeding or excessive pain.

A Guide to the IVF Process

what is IVF treatment

 IVF is a common treatment for people who are unable to conceive naturally

Usually, in IVF, the woman has medicines (fertility hormones) to stimulate the ovaries to produce several eggs. The eggs are then collected and mixed with sperm in a laboratory.

IVF is carried out when the sperm quality is considered to be ‘normal’ If there are issues with the sperm quality such as low motility or numbers, a procedure called intracytoplasmic sperm injection (ICSI) may instead be used – this is where a single sperm is injected into the egg by an embryologist

If fertilization is successful, the embryos are allowed to develop for between two and six days. This helps the embryologist to select the strongest embryo, which is then transferred back to the woman’s womb to hopefully continue to a successful birth.

Often several good-quality embryos will be created. In these cases, it's normally best practice to freeze the remaining embryos because putting two embryos back in the womb increases your chance of having twins or triplets, which carries health risks. You can use your frozen embryos later on if your first cycle is unsuccessful or you want to try for another baby.

What does IVF involve?

This process outlines a single cycle of IVF following the most commonly used procedure. You may find that your treatment is slightly different depending on your history and what your clinic thinks is best for you.

• Usually, the first step is to use medication to stimulate the ovaries to produce eggs. There are different ways this can be done. One way is to suppress natural hormones before taking hormone medication to stimulate the ovaries. This treatment often called a long protocol, involves taking a daily injection or nasal spray to suppress hormone production. A scan checks the woman’s natural cycle is fully suppressed. If it is, hormone treatment (usually gonadotrophin) is started to boost the number of eggs the body produces.
• Some clinics may use the ‘antagonist protocol’. This involves taking medication (an antagonist) to suppress your hormones for a few days after you have taken the hormone medication (usually gonadotrophin) to boost the number of eggs the body produces.
• Whichever way the ovaries are stimulated to produce eggs, you will be closely monitored for a few days by the clinic. This may involve having blood tests or ultrasound scans.
• The eggs will be collected whilst under sedation or general anesthetic. The procedure takes around half an hour and you may feel a little sore or bruised.
• Whilst the eggs are being collected, the man will be asked to come to the clinic to produce a sperm sample, or your donor sperm will be taken from the freezer, for mixing with your eggs.
• Medication will help to prepare the lining of the womb. This is usually taken as a pessary or gel which you can insert yourself into the vagina/rectum.
• The eggs will be mixed with the sperm in a laboratory. The aim is for the eggs and sperm to fertilize to create an embryo.
• If fertilization happens, the resulting embryo(s), will be monitored to check how it’s/they’re developing.
• Two to five days after fertilization, the embryo(s) will be transferred to the womb. You won’t need any kind of anesthetic for this unless you have a condition that would make the procedure painful. You’ll be given a date to do a pregnancy test. Although you’ll understandably be excited at this stage, try not to do this early as you may get a false result.

Tips for a Successful IVF and Pregnancy

 Read an article on “tips for increasing fertility” and you’re bound to see something about the importance of lifestyle – typically diet and exercise. A wide range of studies shows a correlation between women with healthy weights and increased IVF success rates.

Exercise and IVF, however, is a trickier business. Too much exercise – particularly cardiovascular activity – seems to have an effect on reproductive hormone production, and that affects your ability to conceive.

Another challenge in determining “how much is too much” is that “exercise” for one woman is very different from exercise for another. The frequent low-impact walker exercises, as does the regular triathlete, as does the lifelong equestrian rider or rock climber. However, the intensity levels and risks associated with these various exercises are very different, and some are more conducive to a successful IVF cycle and a healthy pregnancy than others.

Take it Easy and Other Exercise Tips for IVF Success

After reviewing studies regarding exercise, pregnancy, and IVF success, we’ve found these 6 tips will help you achieve the healthy pregnancy and live birth you so anxiously desire.

1. Take it easy. That’s the most important and more general advice we can give to women who are pursuing IVF. We realize that taking it easy is a major challenge for women who are used to vigorous exercise. However, the more studies you review, the more you will see a correlation between increased physical activity and decreased rates of conception. If you are a regular runner, biker, marathon runner, or participate in workout regimens designed for moderate/advanced athletes, your doctor is probably going to tell you to take it easy while pursuing your fertility treatments.

2. Four hours or less. What does “take it easy mean?” Well, good question. A study, published in Obstetrics and Gynecology, reviewed IVF results for more than 2200 women over a nine-year period. Their conclusion was, “Women who reported exercising 4 hours or more per week for 1-9 years were 40% less likely to have a live birth and were almost three times more likely to experience cycle cancellation and twice as likely to have an implantation failure or pregnancy loss than women who did not report exercise.” These findings may inspire you to pare your routine down a bit during the months preceding, during, and after your IVF cycle to give you and your baby the best chance for success. Keep your cardio workouts to no more than 4 hours per week and fill in the gaps with lower-intensity options that still increase strength and flexibility, like yoga, water exercise, or tai chi.
3. Ditch high-impact anything. If your exercise of choice is high-impact, it’s time to put it on the backburner for a while. Any serious falls, injuries or impact to the abdominal wall can seriously compromise your reproductive health, especially if there is a freshly implanted baby in there, or if you are prone to miscarriages.
4. Prepare for “no exercise” during the week of egg retrieval. This isn’t because you shouldn’t (although you will want to take it easy), but more because you probably won’t feel like it. The fertility medications you’ll take, combined with some of their potential physical side effects – like bloating, fatigue, and mild discomfort – will make you feel more like lying down and taking a nap than going outside to run a few miles. This is A-OK, and we always recommend you listen to your body and not push anything. You are embarking on a very intricate and delicate process, so you don’t want to do anything that could compromise it.
5. Start finding other modes of stress release. For many women, regular exercise is as much about the stress relief and endorphin rush as it is about weight loss or overall health. If this is the case for you, start learning new ways to reduce or eliminate stress. What are some of the things you’ve always wanted to try but haven’t? Yoga, meditation, more outdoor time, a hobby or craft class, all those books you’ve meant to read but haven’t had time to? Now is the time to start fostering a relationship with other modes of stress release and “escape” so you won’t be so shell-shocked when you have to back off from exercising.
6. Take the long view. Perhaps one of the best pieces of advice for any situation in life is to “take the long view.” Your months, or even a couple years, of lower-impact exercise may seem like forever to you, but they’re really not. You are making a tremendous commitment – mind, body, soul, and wallet – to bring a baby into your life. The months you spend cutting back on excessive exercise now will be well worth the final results. Once you have your beautiful baby in your arms, you’ll enjoy nothing more than loading him or her up in your jogging stroller and getting back in shape. For now, just enjoy the miraculous process of transforming two single cells into a healthy, happy, miniature human being!

IVF and Exercise: 6 Tips for a Successful and Healthy Pregnancy

Everything about Egg Donation

Why Use an Egg Donor?

The most common reason why single women and couples turn to egg donation is poor egg quality due to advanced maternal age. A woman’s egg quality lessens as she ages and significantly declines after age 37.

Who Uses Egg Donation?

• Couples in which the woman has poor-quality or no eggs, but who want a biological child using the male’s sperm
• Women with no ovaries but an intact uterus
• Women with genetic factors that they do not want to pass on to their children
• Women over the age of 42

There are many things to consider when thinking about using an egg donor. If you have a partner, start by exploring these questions.

Fact: The first known pregnancy achieved with a donated egg occurred in 1984. In 2016, the CDC reported approximately 9,000 births resulting from donor eggs.

Egg Donation Requirements

Egg donors undergo psychological and medical screening, which includes a thorough medical history, physical exam, and ovarian reserve assessment to determine if she is likely to be a good donor candidate. Egg donors are healthy young women, usually between ages 21 and 30.

Egg Donation Process

1. The egg donor gets hormone injections to induce ovulation of multiple eggs. Women naturally release one egg a month and the injections allow a large number of eggs to mature at the same time. Once her eggs are mature and ready for retrieval, her fertility doctor schedules the procedure.
2. The egg donor is put under sedation and her doctor uses an ultrasound-guided needle inserted into each mature follicle to retrieve each egg. The lab will attempt to fertilize several eggs in a laboratory using the recipient’s partner’s sperm or selected donor sperm. This process is in vitro fertilization (IVF).
3. An embryo (fertilized egg) is then transferred into the recipient’s uterus.

In a fresh transfer cycle, the donor and the recipient’s cycles are synchronized using medication.

In a frozen transfer, the embryos are frozen and typically transferred at a later time. Frozen transfers are sometimes utilized to perform preimplantation genetic screening for aneuploidy (an abnormal number of chromosomes).

If successful, the embryo will implant into the uterine lining and develop into a healthy baby.

Egg Donor Cost and Sources

Commercial egg donor agencies recruit, screen, and match healthy donors with couples and individuals. Many infertility clinics also offer donated eggs from couples who have produced excess eggs.

In some cases, the recipient may ask a close friend or relative to donate her eggs. Recipients may choose a fresh egg donation cycle or a frozen egg donation cycle (from a frozen egg bank).

Egg Donation Success Factors

Success depends on many factors, including the egg donor's age, retrieval process, quality of sperm, and the recipient’s overall health.

As with all third-party reproduction processes, recipients should seek counseling to explore emotional concerns and an experienced attorney to protect their, and their potential children’s, rights

everything about egg donation

make ivf successful

 In vitro fertilization or IVF, effectively treats many causes of male and female infertility. IVF can be an excellent option for many patients who have struggled to get pregnant with other fertility treatments. It is an especially successful treatment for women with tubal issues, endometriosis, or polycystic ovarian syndrome. For women of advancing maternal age, IVF is also very successful with the use of donor eggs. Men with low sperm counts and couples with inherited diseases also benefit from IVF.

IVF has been around since the mid-1980s to treat couples experiencing infertility. Back then, the chances of bringing home a baby after IVF was a dismal 10%, less than what you would expect from Mother Nature at about 20%. Today, over 190,000 IVF cycles are conducted in the U.S., with average live birth rates of over 32% for women of all ages. Younger women with younger eggs have even better success, with live birth rates approaching 50%.

What has accounted for this incredible increase in success with IVF? Most notably are the new techniques that have arisen over the last several years that offer the possibility of improving a patient’s odds of having a baby through IVF. Let’s take a look at some of these success-boosting techniques.

Assisted Hatching

Sometimes viable embryos do not implant in the uterine wall simply because they are unable to break free from their surrounding “jelly coat,” called the zona pellucida. We perform assisted hatching in the lab right before embryo transfer using a laser to create a hole in the zona. This allows the embryo to “hatch” and make contact with the lining of the uterus and implant.

Intracytoplasmic Sperm Injection

We first used ICSI, or intracytoplasmic sperm injection, to treat cases of severe male factor infertility. In this technique, a single sperm is injected into the cytoplasm (interior) of the egg. Today, the use of ICSI is now routinely applied to a wide range of clinical situations whenever there is a possibility that fertilization may not occur. Such situations may include unexplained infertility or when frozen sperm samples survive their thaw poorly. Further, ICSI is used in any case where there is an extreme need to maximize normal fertilization, such as when a woman has only a few eggs retrieved.

“Freeze All Embryos” IVF Cycle

In the past, we preferred to perform fresh embryo transfers for most patients because the embryos had a better chance of implanting and developing into a baby than frozen embryos did. However, over the past several years, vitrification techniques for freezing and thawing embryos have improved so much that frozen embryos now have an equal or perhaps better chance of implanting than fresh embryos.

When there is a planned “freeze all embryos” IVF cycle, the developing embryos are frozen via vitrification and stored until they are transferred at a later time. This technique is especially beneficial for women at risk of hyper ovarian stimulation caused by the medications used to produce multiple eggs during the cycle. We have found that high hormone levels associated with ovarian stimulation might affect the lining of the uterus, making it less likely for the transferred embryos to implant. We see this particularly in patients who develop higher progesterone levels earlier in the ovarian stimulation cycle.

Preimplantation Genetic Screening (PGS)

PGS helps us answer the question of which embryos have the greatest potential to become a healthy pregnancy and baby. Humans have 23 pairs of chromosomes, inheriting one copy of each chromosome from either parent. When sperm fertilizes an egg, it creates an embryo which should consist of 23 chromosomes from the mother and 23 chromosomes from the father. But often, embryos are created with too many or too few chromosomes. This is a major cause of miscarriage and increases dramatically with maternal age. One of the most common examples is Down Syndrome, or Trisomy 21, which is caused by the presence of a third copy of chromosome 21.

PGS gives the patient two advantages. First, it allows us to be 99% certain the embryo has the correct number of chromosomes thereby increasing the chance for a healthy pregnancy. Second, it allows the patient to transfer only ONE embryo thereby decreasing the chance of twins (which have a much higher rate of complications). The pregnancy rate of transferring just one embryo that has undergone PGS and is deemed chromosomally normal is the same as transferring two embryos that are not tested.

how to make IVF successful