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All about infertility causes of male infertility causes of female infertility causes of infertility infertility tests female fertility tests male fertility tests infertility treatment assisted reproductive technology (ART) treatments for female infertility female infertility drugs treatments for male infertility infertility prevention in vitro fertilization (IVF) intrauterine insemination (IUI) gamete intrafallopian transfer (GIFT) intracytoplasmic sperm injection (ICSI) zygote intrafallopian transfer (ZIFT)

What is in vitro fertilization (IVF)?

In vitro fertilization (IVF) is the process used to conceive a child outside the body. A woman's eggs and a man's sperm are placed together in a plastic dish for fertilization. Once fertilized, the resulting embryos are placed back in the woman's uterus in the hope that a successful pregnancy will follow.

Ovulation induction agents, such as Pergonal are usually given to the mother 8-10 days before treatment, as they allow larger numbers of eggs to be recovered, improving the chances of a successful fertilization. Before the development of such drugs few eggs would be retrieved because it required careful monitoring of the mother's 'LH surge' in order to recover eggs at the right time. This also often resulted in the performing of egg retrievals in the early morning or night time because of the unpredictability of such an occurrence. As well as 'superovulation' inducing drugs, gonadotropin releasing hormone agonists carefully control the timing of retrieval by preventing any unexpected LH surges.

The eggs can be retrieved from the mother using the more common sonographic technique involving an ultra-sound guided needle piercing the vagina. The follicles of the woman are punctured and the woman's follicular fluid is removed and placed in an incubator. Laproscopic egg recovery involves retrieval through an incision in the abdomen. This is used in women who also require a simultaneous assessment of their pelvic anatomy through a diagnostic laparoscopy.

Semen is also taken from the husband. It can be analysed using 'sperm penetration assays', where some sperm is checked to see whether it can puncture a zone-stripped hamster egg. The sperm can also be cultured to detect bacteria which can reduce the chances of pregnancy.

The sperm and the egg are incubated together (at a ratio of about 75,000:1) in the culture media for about 18 hours. The eggs and sperm should fertilise in the usual way in this media, but if this is not possible, assisted fertilisation techniques -- such as injecting the sperm directly into the egg using intracytoplasmic sperm injection (ICSI) techniques -- may be used. They are then passed to a special growth medium and left for 40 hours until the eggs have become pre-embryos.

The fertilized eggs are transferred to the woman's uterus through a thin, plastic catheter, which passes through her vagina and cervical canal. Often, multiple embryos are passed in to the uterus to improve chances of successful pregnancy. If this procedure is unsuccessful, the mother has to be given one month for recovery before the IVF egg-extraction procedure is repeated. This may be avoided by freezing embryos in liquid nitrogen when they are fertilised, and transferring them during the natural ovulation cycle again.

The mother has to wait two weeks before she returns to the clinic for the pregnancy test. During this time she can boost the chances of pregnancy by continuing to take progesterone - which keeps the uterus lining thickened and suitable for implantation to occur. The chances of a successful pregnancy is approximately 20 per cent for each IVF cycle.

There is no clear evidence that infertility medicines, if properly used, increase the risk of birth defects or cancer. The increase in the hormone oestrogen can cause breast tenderness, slight nausea, dizziness and slight abdominal swelling. Occasionally, too many follicles develop and a condition called ovarian hyperstimulation syndrome (OHSS) may occur. This is an unpleasant experience, which may include marked abdominal swelling, nausea, vomiting and diarrhoea, lower abdominal pain and shortness of breath. There is also a theoretical risk (very rare) of damaging organs, or causing infection or bleeding, with the collection needle.

More information on infertility

What is infertility? - Infertility is the inability to achieve and/or maintain pregnancy. Infertility may due to a variety of causes, including abnormal hormonal levels, low sperm production and scarring of the fallopian tubes.
What causes infertility in men? - The most common male infertility factors include azoospermia and oligospermia. In rare cases, infertility in men is caused by a genetic disease such as cystic fibrosis or a chromosomal abnormality.
What causes infertility in women? - The most common female infertility factor is an ovulation disorder. Other causes of female infertility include blocked fallopian tubes. Inability of the fertilized egg to implant in the uterus will lead to female infertility.
What causes infertility? - Causes of infertility include a wide range of physical as well as emotional factors. Infertility can be caused by any interruption in the usual process of fertilization, pregnancy, and birth.
How is infertility diagnosed? - In the male, sperm examination and sperm count is commonly done. In females, the basal body temperature is recorded each morning over several months to find any ovulatory disorders.
What female fertility tests are available? - Blood tests that measure the levels of various hormones. The doctor may want to measure the man's testosterone levels to see if they are high enough. Basal body temperature (BBT) can be measured at home using a special thermometer to help predict the most fertile days.
What male tertility tests are available? - A semen analysis is the most common testing procedure for determining if there is a male infertility factor. Semen analysis is the mainstay of male testing.
What treatments are available to cure infertility? - The ultimate goal of infertility treatment is a healthy pregnancy and the birth of one healthy infant. There are various treatments for infertility, depending what the problem is.
What is assisted reproductive technology (ART)? - Assisted reproductive technologies are medical treatments to overcome infertility. The most common type of ART is in vitro fertilization.
What are the treatments for female infertility? - Assisted reproductive technology (ART) combines the use of fertility drugs - hormonal therapy with artificial insemination using any of a group of techniques. Acupuncture may also be helpful.
What medicines treat female infertility? - Clomiphene triggers the release of FSH and LH, boosting egg growth and helping the ovaries release a monthly egg. Bromocriptine suppresses a hormone called prolactin. LH-RH drugs are used when the pituitary or hypothalamus gland is not producing hormones.
What are the treatments for male infertility? - Low sperm counts can be treated by collecting and concentrating healthy sperm for insemination or assisted reproductive technology (ART) treatment.
How to prevent infertility? - Most types of infertility cannot be prevented. Smoking has been linked to low sperm counts. Alcohol affects the fertility of both men and women. Excessive exercise can lead to menstrual disorders in women and affect sperm production in men.
What is in vitro fertilization (IVF)? - In vitro fertilization (IVF) is the process used to conceive a child outside the body. In vitro fertilization is a method of assisted reproduction that involves removing eggs from a woman's ovary, combining the egg with sperm in a dish and replacing the resulting embryos in the woman's uterus.
What is intrauterine insemination (IUI)? - Intrauterine insemination is a procedure in which a fine catheter is inserted through the cervix into the uterus to deposit a sperm sample directly into the uterus.
What is gamete intrafallopian transfer (GIFT)? - Gamete intrafallopian transfer (GIFT) is an infertility treatment in which eggs are removed from a woman's ovaries, and placed in one of the fallopian tubes, along with the man's sperm.
What is intracytoplasmic sperm injection (ICSI)? - Intracytoplasmic sperm injection (ICSI) is an in vitro fertilisation procedure in which a single sperm is injected directly into an egg.
What is zygote intrafallopian transfer (ZIFT)? - Zygote intrafallopian transfer (ZIFT) is technique in which a woman's egg is fertilized outside the body, then implanted in one of her fallopian tubes.
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