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Path To Fertility Blogger Lisa Rosenthal  

Lisa Rosenthal has over twenty-five years of experience in the fertility field, including her current roles as Coordinator of Professional and Patient Communications for RMACT and teacher and founder of Fertile Yoga, a class designed to support, comfort and enhance men and women's sense of self. Her experience also includes working with RESOLVE: The National Infertility Association and The American Fertility Association, where she was Educational Coordinator, Conference Director and Assistant Executive Director

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What Is IUI? Hint - Intrauterine Insemination | Infertility Basics

  
  
  

Infertility Basics: Answering What Is IUI

couple speaking with fertility specialistInfertility is not all high technology.

 

Not for everyone.

 

Many of us are able to be treated without IVF (In Vitro Fertilization).

 

An IUI or Intrauterine Insemination is a fertility treatment that is highly effective, depending on your diagnosis.

 

It is also included as part of the Connecticut State Mandate.

 

Three IUI cycles are included for those who qualify for that mandate.

 

Below, IUI is explained in a step by step process. Still have questions whether it's right for you?

 

If you have been trying to conceive for a year and you are under 35, call a board-certified reproductive endocrinologist. If you are over 35, only wait for six months to call.

About IUI (Intrauterine Insemination): A Form of Artificial Insemination

Intrauterine insemination involves placing a concentrated semen sample in the uterine cavity to improve the chances of conception. IUI is a form of artificial insemination.

 

Intrauterine insemination serves three basic purposes:


  • It gets a high concentration of sperm into the female reproductive tract, increasing the chance of sperm reaching the egg to achieve fertilization.

  • It helps to get higher number of sperm high into the female reproductive tract, which helps overcome mild to moderate male fertility problems. With the help of our office and the use of an ovulation predictor kit, your fertility specialist is able to synchronize timing to optimize your chances of becoming pregnant.

  • Additionally, when combined with ovulation induction or superovulation, IUI can treat many causes of infertility. Among them:

  • Ovarian dysfunction (inability to ovulate normally on your own)
  • Infertility associated with endometriosis (a painful inflammatory condition of the female pelvis)
  • Cervical factor infertility (related to prior surgery)
  • Unexplained infertility (infertility in which the exact cause cannot be identified).
  • Polycystic ovarian syndrome (a common female endocrine disorder)

 

Intrauterine insemination offers a multi-faceted approach to augmenting a couple’s fertility.

 

The Role of IUI in Male Infertility

 

For example, male infertility is a factor in about a third of all infertile couples, usually attributable to low sperm count, abnormal sperm or motility problems. By concentrating more sperm in the female reproductive tract, the odds of achieving a pregnancy increase.

 

The sperm are concentrated using a multi-step process called sperm washing. The technique removes excess seminal fluid that can cause cramping or pain if it is not washed away at the time of intrauterine insemination.

 

In other cases, inadequate cervical secretions and antibodies may act as barriers to sperm entering the female reproductive tract and penetrating the egg. IUI places the sperm beyond those barriers, again increasing the chances of fertilization and pregnancy.

 

IUI is an effective treatment for both male fertility problems and couples with unexplained infertility. In couples with unexplained infertility where all other testing is normal, intrauterine insemination (IUI) combined with ovulation induction/superovulation can double a couple’s chance for pregnancy.

 

Most physicians recommend three to six IUI attempts before moving on to more aggressive treatment.

 

As always, contact us for more information about Intrauterine Insemination (IUI).

 

Lisa Rosenthal's Google+

 

 

Stuck in One Place with Infertility? I Did 9 IUI's. Yes, 9

  
  
  

Infertility Decisions: A Story of Nine IUI's

IUI Treatment and Infertility Support

"Stuck in irons, straight into the wind."

 

I like that phrase. 

 

Particularly when it comes to fertility treatment.

 

Sometimes we just get to a place where making a decision feels impossible. 

 

For example, I did 9 IUI's (intrauterine insemination, sometimes referred to as artificial insemination).

 

If you're an experienced fertility treatment patient, if you've looked infertility right in the eye, you know that sounds excessive.

 

It is excessive. Not just because it was 9 IUI's. But also because my fertility doctors and medical team were suggesting other options. I wasn't willing to hear them. 

 

I was stuck.

 

I was young. I was kind of dumb. I'm not connecting those two things and insinuating that you are dumb, if you are young. I am not insinuating that young is dumb. I'm strictly talking about myself here!

 

I was young. I was kind of dumb. And I was scared.

 

Not a winning combination. A truthful analysis however. Definitely a combination that would create the feeling of being stuck. 

 

I like the phrase, "stuck in irons, straight into the wind".

 

It's a sailing term. Roughly, it means that the bow (front) of your boat is headed directly into the wind, making it impossible for the sails to fill with wind. So you just sit there, with wind all around, unable to make use of it. 

Fertility Treatment Options: When to Look Around

That was me. There were lots of fertility treatment options all around, I had great doctors who tried to lead me into different treatment protocols and I sat there, stuck.

 

When in a sailboat, stuck in the wind, one needs to gently move in almost any direction to fill the sails. The rudder turns the boat one way or another, and fills the sails, if there is wind. 

 

Maybe I'm being unduly harsh about my younger self. If I add a little compassion then perhaps it's true that what I needed to do was sit there as long as I did to find the course of treatment that I was comfortable with. 

 

I don't know anymore. 

 

I do know that sitting quietly and considering has a lot of value. And that action is necessary. We all have our ways of finding balance between those two and we all come to different conclusions.

 

Sometimes it's moving ahead, despite feeling scared about our choice; trusting ourselves and our doctors that it's time.

 

Sometimes it's sitting quietly. Longer than it makes sense to other people because it makes sense to us.

 

Check in with other people that you trust and respect. Let them reflect back to you how you're feeling and what you're thinking.

 

Decide whether it's time to move around and catch the wind.

 

 

Male Infertility 101- Possible Causes and Treatments

  
  
  

It's Wednesday, so it's time for medical information about infertility, fertility and treatment that you can trust. So much of the focus is on women when it comes to infertility, when it's just about as likely that the problem lies with the male partner. Please read what the board certified reproductive endocrinologists at Reproductive Medicine Associates of CT have to say about male factor infertility.

Male Infertility 101- Causes and Treatments

Although infertility research and medical services have traditionally focused on women, fertility issues crop up just as often in men. In fact, it’s estimated that up to 40% of infertile couples are unable to conceive because the man’s sperm production is less than optimal.

The first and most obvious sign of male infertility is the inability for couples to get pregnant. There may be no other symptoms unless the infertility is caused by a hormonal problem, in which case reduced facial and body hair growth or low sex drive may be the tip off.

Male infertility may be due to:

  • Genetic abnormalities
  • Hormone deficiency or surplus
  • Impotence
  • Infections of the prostate, testes or epididymis (tubes that store and carry sperm)
  • Older age
  • Previous chemotherapy
  • Previous scarring due to infection (including sexually transmitted diseases), trauma or surgery
  • Radiation exposure
  • Environmental pollutants
  • Exposure to high heat for prolonged periods
  • Retrograde ejaculation (dry orgasm)
  • Smoking
  • Heavy use of alcohol, marijuana or cocaine
  • Use of certain prescription drugs
  • Poor nutrition
  • Being overweight or too thin
Causes of Male Infertility

Male infertility can also be caused by low sperm count (subfertility), reduced sperm movement (motility), or abnormally-shaped sperm (also known as abnormal sperm morphology.)

If indicated, men are referred for evaluation to a urologist who specializes in diagnosing and treating infertile men. This evaluation includes a medical history, physical examination, complete semen analysis and, if appropriate, sperm function tests.

Once we determine the most appropriate course of treatment for each couple, alternatives may include:

At Reproductive Medicine Associates of Connecticut, we focus on establishing the correct diagnosis and using advanced treatment techniques to make it possible for many men who are diagnosed with male infertility to become fathers. Contact us for more information.

Simple Infertility Treatments When You're Trying to Conceive

  
  
  

Infertility blog- PathtoFertility

Infertility treatment can be very simple or very complicated. Here's the run down on simple.


Intrauterine insemination and artificial insemination are the same thing. Both infertility treatment procedures place the sperm where it can meet the egg.
Sometimes these treatments are done with medications that cause you to produce more than one egg, sometimes they are done with no medications at all. The insemination is done using a catheter, with sperm that have been cleaned in a lab, placing the sperm through the cervix into the uterus.

 

Sometimes that's all it takes.

 

Sometimes it's even simpler. Sometimes it's properly timed sexual relations (intercourse) and understanding when you are ovulating. Knowing that day one of your cycle is the first day of menstruation and that ovulation will take place, in a cycle of 28 days on about day 14. That having sexual relations on day 12, 14 and 16 will work best for trying to conceive.

 

Sometimes conceiving is something right inbetween. There's medication that brings on ovulation so that an egg can become large and mature enough to be fertilized after it's been released and travelled down the fallopian tube. Then, instead of any type of insemination, you have sexual relations and allow sperm to travel up to the uterus through the vaginal canal.

 

There are simple solutions sometimes to infertility.

 

Infertility does not always mean that you will need IVF (Invitro Fertilization) or donor egg or other third party reproductive help.

 

Often, understanding your own reproductive health can make a difference. Keeping track of how often you get your period and how long it lasts is not only helpful to you, but also helpful if you should need help from a fertility specialist.

 

Do you know your family history can help too?

 

Did your mother have trouble becoming pregnant? Were her periods regular? When did she start menopause? Were her periods regular?

 

Knowing these simple things can make a difference in getting pregnant.

 

Moral of the story, don't assume that if you are having trouble getting pregnant, that your path to fertility will be long, expensive and overly involved.

 

It can be much shorter and easier than you ever thought possible.

 

 

 


Fertility Testing on Day 21

  
  
  

Wednesday text
Good morning. Today is Wednesday, our day to focus on the medical aspects of fertility and treatment. Fertility treatment often has a language all it's own. Here's another term that is significant in testing and treatment that you may not understand as thoroughly as you might like, Day 21.

 

On Day 21 of your cycle, your fertility specialist will want to check the levels of progesterone and estradiol (E2) in your system and the thickness of your endometrium (uterine lining).

 

Day 21 testing checks a woman’s progesterone level to confirm that ovulation has occurred. It is done on the 21st day of the menstrual cycle (Day 1 is the first day of flow, not including any spotting). A low Day 21 progesterone level suggests the cycle was anovulatory (no egg was produced). If no egg is produced, pregnancy cannot be achieved.

 

The timing of ovulation, and the associated peak in progesterone, is related to the subsequent menstrual period, not the preceding one. In an average cycle of 28 days, the time between ovulation and the next period is about two weeks, so progesterone is measured about seven days before the expected period, or on Day 21. However, if a woman’s cycle is longer or shorter than 28 days, the testing day will be adjusted accordingly. For example, a woman with a 35-day cycle would be tested for progesterone on Day 28.

 

Serial estradiol (E2) levels are often measured for monitoring superovulation in intrauterine insemination (IUI) and in vitro fertilization (IVF) treatment cycles.

 

If you are not ovulating, there are steps that can be taken to help release the eggs, including drugs. Your fertility specialist will discuss these options with you.

 

An ultrasound exam is also used to measure your uterine lining to determine if it is thick enough for a fertilized egg to implant.

 

Day 21, explained. If there are other phrases that you hear and would like to understand, try our glossary. Our doctors at RMACT, along with our excellent nursing staff, have written it, for you.

What to Do to Ensure that You Have the Infertility Medications that You Need

  
  
  

Wednesday text
If you have begun most types of infertility treatment at a fertility program then most likely you will need to be taking some type of medication. Whether you are doing an IUI cycle (Intrauterine insemination- a technique that transfers sperm directly in to the uterus. It bypasses the vaginal and cervical defense mechanisms of the female reproductive tract and allows better sperm delivery to the fallopian tubes. This allows the sperm and egg to interact in close proximity. It is a very common treatment for mild and moderate deficits in the semen analysis. IUI is typically used in conjunction with medications that increase the number of eggs per cycle and triggering of ovulation. The goal is to have more “targets” for the sperm (eggs), perfect timing and better sperm delivery) or IVF (In Vitro Fertilization-A powerful procedure to help patients conceive pregnancies. IVF entails stimulating your ovaries to develop multiple follicles. This is achieved with injectable medications. The goal of IVF is to produce a large number of growing follicles, then harvest the eggs inside the follicles through a short surgical procedure performed in our office. The eggs are then inseminated with sperm in the laboratory, sometimes using ICSI, in order to create embryos that can then be transferred back to the endometrial cavity (the womb) of the patient. The name in vitro fertilization refers to the fact that the oocyte is fertilized by the sperm in the laboratory, rather than inside the female reproductive tract), keeping track of your medications will be of primary importance.

Read below for information about what to do if you do not have the infertility medications that you need.  

 What do I do if I don't have my meds?
The medications used for an IVF cycle are highly specialized and often not available at local pharmacies. It is extremely important that you check your inventory of medications prior to starting your IVF cycle to assure that you have the correct dosage of medications. If you are unsure of this, please contact your nurse during normal business hours to review.

  • Many Mail order pharmacies can ship your medications the next day. If you run out of medications, your prescription can be called into one of these pharmacies.
  • If your insurance does not participate with this pharmacy, you may have to pay for the medication out of pocket and submit to your insurance to be reimbursed.
  • If you don’t have medications for the same day, you may have to skip that day’s meds and receive your medications the following day. This could negatively affect your cycle, so keeping track of your inventory is very important.
  • Also please note that you have refills on most of your medications. You can call your pharmacy to receive these refills once you realize you are running low.
  • It is extremely important that you stay on top of your medications before, during, and after your cycle

Please don’t panic if you realize that you either don’t have a medication that you will need to use or you have less than you need. Call us, we will figure out a solution so that you can start on time, with the medications necessary for your cycle. That’s our job.

Infertility treatment does not always mean IVF

  
  
  

Wednesday image
Going to a Reproductive Endocrinologist can be daunting enough, coming to terms with not getting pregnant on your own, recognizing that something is not working the way that it is supposed to. Those things can be hard enough to face, then there's the "specialist". There are all these rumors and myths flying around about treatment, cost, procedures; rumors that range from not scary to very scary. One truth around infertility treatment is that IVF (in vitro fertilization) is not always the first course of treatment. There are other, less invasive, less expensive methods of treatment that are highly effective depending on your individual diagnosis. Ovulation induction is one such treatment. Read below for detailed information about how ovulation induction works. As always, call us with any questions.

Some causes of infertility can be effectively treated with ovulation medicine known as ovulation induction - or superovulation therapy combined with timed relations or artificial insemination.

Ovulation induction therapy is focused on achieving a healthy ovulation and depending on the diagnosis, the ovulation of multiple eggs. Inducing the release of more than one egg can dramatically increase a woman's per cycle chance of pregnancy. Ovulation medicine is used to induce ovulation; increasing the number of eggs a woman produces each month (normally it is one). At the appropriate time, sperm are introduced into the vagina/cervix through timed relations or into the uterine cavity by a process called intrauterine insemination or IUI also known as artificial insemination).

How Ovulation Induction Therapy Works

  1. The first step in superovulation therapy is to administer medications which should enhance the development of a mature egg(s) produced by the ovaries.
  1.  
    • During the normal reproductive cycle, two hormones - follicle stimulating hormone (FSH) and luteinizing hormone (LH) - are required to initiate and complete the process of egg maturation. Medications are administered to women either orally or by injection to increase levels of both LH and FSH.
  2. Fertility is then further enhanced by monitoring the development of eggs in the ovary using an ultrasound. These ultrasounds are most commonly performed transvaginally and allows the doctor to monitor the development of follicles. Follicles are fluid filled sacs within which an egg develops.
  3. Once the follicle or follicles have reached the appropriate size to contain a mature egg a single injection is given to trigger ovulation. This helps us provide optimal timing for fertilization and hopefully a pregnancy.
  4. The patients are then instructed to have timed relations over the next two days to coincide with the superovulation. If the patient's treatment plan requires intrauterine insemination and not timed relations, the intrauterine insemination is then performed within the next two days. With intrauterine insemination, the semen sample is prepared in a way that allows us to place an enriched, highly motile concentrate of sperm directly into your uterus through the cervix. This procedure involves the use of a very small tube to pass the sperm beyond the cervix to optimize sperm delivery. By performing a well timed intrauterine insemination (IUI) with prepared concentrated semen from your partner or a donor we have optimized timing and sperm delivery to give the best sperm concentration around the egg and the best chance for success.
  5. Following two days of insemination we will confirm adequate hormone concentration to support implantation using a simple blood test 5-7 days later. If these levels are low your Doctor will recommend hormonal supplementation.

As a result of this treatment path there is an increased likelihood that ovulation will occur at the right time and that sperm willRMACT logo reach the egg(s) to complete fertilization and hopefully a pregnancy. For many couples the chances of pregnancy approaches 20% with a single month of therapy.

Medicine used for Ovulation Induction and Superovulation Therapy

  • Clomiphene citrate - (Clomid® or Serophene®) is a pill which can be taken orally to induce ovulation and the process of egg maturation. We monitor the effect of this medication on the ovaries using an ultrasound.
  • Gonadotropins - are injectable medications which are taken using a very small needle for injection beneath the skin. These ovulation medications are known by the following trade names:
    • Gonal-F®
    • Follistim®
    • Bravelle®
    • Menopur®

These superovulation medications are all different forms of Follicle Stimulating Hormone - the most important hormone for the development of healthy eggs. Follicle Stimulating Hormone (FSH) is naturally made by your body in the pituitary gland and by giving yourself additional FSH you can help your own body improve egg production.

Injectable medicines are more powerful than the oral medication and tend to produce a larger number of eggs. To assess the process of egg maturation while you are being treated with these medications, several (2-3) ultrasounds and blood samples are needed to monitor the safety and likelihood of success of these ovulation medications.

Medications Used to Induce Ovulation (Egg Release)

Your body naturally releases another hormone call Luteinizing hormone to trigger egg release. There are two additional medications we use to do this at the best time in your ovulation induction cycle:

  • hCG (human chorionic gonadotropin) This is an ovulation medicine given via injection which can be used to trigger egg release. Commercial brands are known as:
    • Pregnyl®
    • Novarel®
  • Ovidrel® -this is a synthetic human pregnancy hormone which can be used to trigger egg release. It is available as a pre-filled injection on a very small needle.

Medications used to support implantation and an early pregnancy

Your body naturally releases two additional hormones which support implantation and an early pregnancy known as estrogen and progesterone. Some women do not produce enough of these hormones and we recommend supplementation to optimize the chances for a pregnancy. These medications are called:

  • Estrace® This is a form of estrogen which can be taken orally to support implantation and early pregnancy
  • FemTrace® This is another preparation of estrogen which can be taken orally to support implantation and early pregnancy
  • Prometrium® This is a form of progesterone which can be taken orally to support implantation and early pregnancy
  • Endometrin® This is a form of progesterone which can be taken orally to support implantation and early pregnancy

Infertility Treatment is Not Always Expensive or High Technology

  
  
  


Today's medical infertility day! Friday, we will continue the dialogue on egg donation with Evelina W. Sterling PhD and Sharon LaMothe. For today, for those of you who are new to this, or just suspecting that you may be experiencing a fertility  problem or for those of you who have tried to get pregnant a few months or more and are starting to wondering, we don't want you to think that fertility treatment  automatically means high technology and IVF (In Vitro Fertilization). Often top fertility specialists, (board certified reproductive endocrinologists) will start with protocols that are much less invasive and much less expensive. Read what Reproductive Medicine Associates of Connecticut (RMACT) has to say about IUI (Intrauterine Insemination) also known as Artificial Insemination.

Intrauterine Insemination (IUI)

Intrauterine insemination is also known as IUI and Artificial Insemination. This is a procedure that involves concentrating the semen sample into a small volume and then placing it into the uterine cavity. Sometimes you may hear this referred to as artificial insemination. The correct terminology is intrauterine insemination (IUI) because in the vast majority of cases the semen is placed into the uterus. In rare instances the semen is placed in the cervix or vagina.

Intrauterine inseminations with ovulation induction/superovulation can treat many causes of infertility including:

  • Ovarian dysfunction (inability to ovulate normally on your own)
  • Infertility associated with endometriosis (a painful inflammatory condition of the female pelvis)
  • Cervical factor infertility (related to prior surgery)
  • Unexplained infertility (infertility in which the exact cause cannot be identified).
  • Polycystic ovarian syndrome (a common female endocrine disorder)

What is Intrauterine Insemination?

Intrauterine insemination serves several purposes in order to augment a couple's fertility. 30% of all infertile couples have a degree of male factor infertility. The sperm count may be low or may have low motility, or there may be many abnormal sperm. In these situations, by getting more sperm into the female reproductive tract, we can achieve better pregnancy rates.

Intrauterine insemination also serves to bypass the normal barriers of entry of the sperm into the female reproductive tract. The cervix secretes mucus and antibodies, which can serve to prevent sperm from entering the female reproductive tract. You may be aware of the thin cervical mucus that is secreted around the time of ovulation. This is what allows sperm to enter the uterine cavity. In some women this cervical mucus is inadequate or contains antibodies, which can damage sperm and thereby prevent sperm from reaching the egg.

Intrauterine insemination therefore serves 3 purposes:

  • It gets a high concentration of sperm into the female reproductive tract into the uterus thereby increasing the chance of sperm reaching the egg to achieve fertilization.
  • It helps to get higher number of sperm high into the female reproductive tract thereby helping to overcome mild to moderate male fertility problems.
  • Additionally with the help of our office and the use of an ovulation predictor kit we are able to synchronize timing to optimize a woman's chance of becoming pregnant

Therefore artificial insemination is an effective treatment for both male fertility problems and couples with unexplained infertility. In couples with unexplained infertility where all other testing is normal, intrauterine insemination (IUI) combined with ovulation induction/superovulation can double a couple's chance for pregnancy.

Most physicians recommend 3-6 attempts (depending on age of patient at time of treatment) at IUI prior to moving on to more aggressive treatment.

As always, we are available to answer questions or help you in any other way that you need it.

Infertility treatment does not always mean IVF

  
  
  
  Going to a Reproductive Endocrinologist can be daunting enough, coming to terms with not getting pregnant on your own, recognizing that something is not working the way that it is supposed to. Those things can be hard enough to face, then there's the "specialist". There are all these rumors and myths flying around about treatment, cost, procedures; rumors that range from not scary to very scary. One truth around infertility treatment is that IVF (in vitro fertilization) is not always the first course of treatment. There are other, less invasive, less expensive methods of treatment that are highly effective depending on your individual diagnosis. Ovulation induction is one such treatment. Read below for detailed information about how ovulation induction works. As always, call us with any questions.

Some causes of infertility can be effectively treated with ovulation medicine known as ovulation induction - or superovulation therapy combined with timed relations or artificial insemination.

Ovulation induction therapy is focused on achieving a healthy ovulation and depending on the diagnosis, the ovulation of multiple eggs. Inducing the release of more than one egg can dramatically increase a woman's per cycle chance of pregnancy. Ovulation medicine is used to induce ovulation; increasing the number of eggs a woman produces each month (normally it is one). At the appropriate time, sperm are introduced into the vagina/cervix through timed relations or into the uterine cavity by a process called intrauterine insemination or IUI also known as artificial insemination).

How Ovulation Induction Therapy Works

  1. The first step in superovulation therapy is to administer medications which should enhance the development of a mature egg(s) produced by the ovaries.
  1.  
    • During the normal reproductive cycle, two hormones - follicle stimulating hormone (FSH) and luteinizing hormone (LH) - are required to initiate and complete the process of egg maturation. Medications are administered to women either orally or by injection to increase levels of both LH and FSH.
  2. Fertility is then further enhanced by monitoring the development of eggs in the ovary using an ultrasound. These ultrasounds are most commonly performed transvaginally and allows the doctor to monitor the development of follicles. Follicles are fluid filled sacs within which an egg develops.
  3. Once the follicle or follicles have reached the appropriate size to contain a mature egg a single injection is given to trigger ovulation. This helps us provide optimal timing for fertilization and hopefully a pregnancy.
  4. The patients are then instructed to have timed relations over the next two days to coincide with the superovulation. If the patient's treatment plan requires intrauterine insemination and not timed relations, the intrauterine insemination is then performed within the next two days. With intrauterine insemination, the semen sample is prepared in a way that allows us to place an enriched, highly motile concentrate of sperm directly into your uterus through the cervix. This procedure involves the use of a very small tube to pass the sperm beyond the cervix to optimize sperm delivery. By performing a well timed intrauterine insemination (IUI) with prepared concentrated semen from your partner or a donor we have optimized timing and sperm delivery to give the best sperm concentration around the egg and the best chance for success.
  5. Following two days of insemination we will confirm adequate hormone concentration to support implantation using a simple blood test 5-7 days later. If these levels are low your Doctor will recommend hormonal supplementation.

As a result of this treatment path there is an increased likelihood that ovulation will occur at the right time and that sperm will reach the egg(s) to complete fertilization and hopefully a pregnancy. For many couples the chances of pregnancy approaches 20% with a single month of therapy.

Medicine used for Ovulation Induction and Superovulation Therapy

  • Clomiphene citrate - (Clomid® or Serophene®) is a pill which can be taken orally to induce ovulation and the process of egg maturation. We monitor the effect of this medication on the ovaries using an ultrasound.
  • Gonadotropins - are injectable medications which are taken using a very small needle for injection beneath the skin. These ovulation medications are known by the following trade names:
    • Gonal-F®
    • Follistim®
    • Bravelle®
    • Menopur®

These superovulation medications are all different forms of Follicle Stimulating Hormone - the most important hormone for the development of healthy eggs. Follicle Stimulating Hormone (FSH) is naturally made by your body in the pituitary gland and by giving yourself additional FSH you can help your own body improve egg production.

Injectable medicines are more powerful than the oral medication and tend to produce a larger number of eggs. To assess the process of egg maturation while you are being treated with these medications, several (2-3) ultrasounds and blood samples are needed to monitor the safety and likelihood of success of these ovulation medications.

Medications Used to Induce Ovulation (Egg Release)

Your body naturally releases another hormone call Luteinizing hormone to trigger egg release. There are two additional medications we use to do this at the best time in your ovulation induction cycle:

  • hCG (human chorionic gonadotropin) This is an ovulation medicine given via injection which can be used to trigger egg release. Commercial brands are known as:
    • Pregnyl®
    • Novarel®
  • Ovidrel® -this is a synthetic human pregnancy hormone which can be used to trigger egg release. It is available as a pre-filled injection on a very small needle.

Medications used to support implantation and an early pregnancy

Your body naturally releases two additional hormones which support implantation and an early pregnancy known as estrogen and progesterone. Some women do not produce enough of these hormones and we recommend supplementation to optimize the chances for a pregnancy. These medications are called:

  • Estrace® This is a form of estrogen which can be taken orally to support implantation and early pregnancy
  • FemTrace® This is another preparation of estrogen which can be taken orally to support implantation and early pregnancy
  • Prometrium® This is a form of progesterone which can be taken orally to support implantation and early pregnancy
  • Endometrin® This is a form of progesterone which can be taken orally to support implantation and early pregnancy

I hope that the information above de-mystified some of the aspects of infertility treatment. Understanding the process of ovulation induction, often a first treatment at an infertility clinic, can be comforting. Here is what it is. Here is what it is not.

Often, understanding the process allows you to breathe a sigh of relief. Keeping in mind that there are people who will walk you through it one step at time.

 

Infertility specialists answer most frequently asked questions

  
  
  

Fertility Specialists Answer Most Common Infertility Questions

Norwalk, CT (March 30, 2010) - The fertility doctors of Reproductive Medicine Associates of Connecticut (RMACT) - Fairfield county's largest fertility clinic - have compiled the most common questions they receive about fertility, as well as answers. 

"Infertility can be confusing, and people frequently ask questions because they want to know if they should seek help from a fertility specialist," says Dr. Mark Leondires, Medical Director.  "The questions and answers below are intended to give some basic knowledge.  Many couples put off seeing a fertility specialist when they are having trouble getting pregnant, but they are typically reassured after being diagnosed and starting a treatment plan."

What is infertility?

Infertility is a disease or condition of the reproductive system often diagnosed after a couple has had one year of unprotected, well-timed intercourse, or if the woman has been unable to carry a pregnancy that results in a live birth.

Is infertility a "women's problem"?

Infertility is a medical problem. Approximately 35% of infertility is due to a female factor and 35% is due to a male factor. In the balance of cases, infertility results from problems in both partners or the cause of the infertility cannot be explained.

How long should we try before we see a doctor?

In general, if you are less than 35 years old and have been trying for more than one year you should schedule an appointment with a fertility specialist. If you are greater than 35 years old we would like to see you after at least six months of timed, unprotected intercourse. However, if you have a reason to suspect you may have a problem getting pregnant such as a history of pelvic inflammatory disease, painful periods, miscarriage, irregular menstrual cycles, or if your partner has a low sperm count, you should seek help sooner. Many couples have a hard time admitting that there may be an infertility problem, but be reassured there are often many things we can do to help.

What is a Fertility Specialist?

A fertility specialist, or Reproductive Endocrinologist, is a medical doctor who has been specially trained in the complex issues that can contribute to infertility. In addition to being trained as an Obstetrician/Gynecologist which requires a four-year residency a fertility specialist must complete an additional two to three year fellowship in reproductive endocrinology.  This fellowship training is highly specialized to focus on the diagnosis and treatment of infertility and  female endocrinology.. A physician can become Board Certified in Reproductive Endocrinology by successfully completing the fellowship as well as written and oral examinations. 

Currently in the Unites States, there are only about 1,000 Board Certified Reproductive Endocrinologists. Specifically for infertility related to males, Urologists with a sub-specialty in Andrology are the most qualified experts as they have often completed two-year fellowships and passed exams to become Board Certified in Andrology.

At what time of the month is a woman fertile?

The most fertile time of a woman's cycle is just before or the of day ovulation. Ovulation usually occurs two weeks before a period starts, so it is necessary to count backwards from the anticipated start of the next period in order to find the most fertile time. Take the number of days in the usual cycle (from the beginning of one period to the beginning of the next) and subtract 14. For example, a woman with a 32-day period would likely ovulate around day 18 (32-14=18), while a woman with a 28-day cycle would ovulate around day 14 (28-14=14). We recommend every other day intercourse around the day of ovulation. That would mean days 12, 14 and 16 for women with 28 days cycles.

It is best to have intercourse before ovulation rather than afterwards, so a woman who ovulates on day 14 would have a good chance of conceiving if she has intercourse on either day 13 or 14. For women with irregular cycles you can extend the period of having sexual relations to every other day from day 11 to 18 ( 11-13-15-17).  In order to better understand what day you ovulate take your average menstrual cycle length (for example 32 days) and subtract 14 and that will give you that day you ovulate around (that would be about day 18).  Therefore you would have relations days 15-17&19 to cover all your bases.

Alternatively, women with irregular cycles may want to use an ovulation predictor kit, which can be purchased over the counter at most local pharmacies. This involves testing your urine around the time of ovulation using a detector stick, which give you a visual reading. Additionally, there are electronic monitors which detect ovulation by tracking two hormones (estrogen and luteinizing hormone) starting with urine testing on day one of your menstrual cycle. The methods that utilize urine predictor sticks or urine ovulation detector machines are usually highly sensitive, accurate, and reliable.

How can a woman tell if she ovulates?

The simple, inexpensive way of finding out the approximate time of your ovulation is to take your basal temperature (that is, your body temperature at rest) every morning and record it on a chart. You can buy a Basal Body Thermometer at your local drug store. Save all your charts so you can review them with your doctor. Three or four months of charting should be adequate. If your temperature goes up after the middle of your menstrual month you likely do ovulate. In general you ovulate about two days prior to the temperature rise.

How often should we have intercourse?

It is a good idea to have intercourse every other day around the time you ovulate. Remember, every woman is different, and may not ovulate exactly on "Day 14." And, just because you ovulated on "Day 14" this month, doesn't mean you will next month. It is preferable to have intercourse every other day rather than every day so that sufficient sperm will be available. To increase your chances of the egg becoming fertilized, do not douche or use lubricants immediately before having intercourse.

What fertility testing should our fertility doctor perform?

Your doctor will likely do the following:

  • Blood tests to check reproductive hormone levels in the woman; estradiol (E2), progesterone, follicle stimulating hormone (FSH), luteinizing hormone (LH), thyroid hormone, prolactin, and possibly male hormone levels.
  • Complete semen analysis on the male partner
  • Hysterosalpingogram (HSG), an x-ray exam to evaluate if the woman's fallopian tubes are open
  • Ultrasound to confirm the normal appearance of your uterus and ovaries in the woman

What about smoking and drinking alcohol and caffeine?

There is evidence linking reproductive impairment with exposure to alcohol, tobacco, and caffeine.

Alcohol and tobacco use have been demonstrated to affect the reproductive capacities of both men and women, and tobacco is an especially potent reproductive toxin that negatively effects female fertility by damaging eggs. In men there is a direct effect on sperm quantity, quality, and reproductive function. In general we ask that women consume less than 150 mg of caffeine per day which is equivalent to two small 8 oz cups per day. Remember sodas and tea also contain caffeine. In addition, it is wise to be in the best physical shape possible while you attempt to conceive and, of course, to ensure a healthy pregnancy and baby.

Are hot tubs really bad for a man?

Yes. High temperatures can damage sperm. That is why the scrotum is located outside the body - to act as a kind of "refrigerator" to keep the sperm cool. So, it is a good idea to avoid hot tubs, saunas, and steam rooms when men are trying to help in the pregnancy pathway.

What else can we do?

Learn as much as you can about infertility.

  • Get and read good, reliable information (not just from popular magazines) from your doctor, library, or trusted friends or family.
  • RESOLVE (http://www.resolve.org/) and the American Fertility Association (AFA - www.theafa.org) has over 60 fact sheets on different topics related to infertility, and support groups in many areas.
  • Also visit the ASRM (http://www.asrm.com/), SART (http://www.sart.org/), ACOG (www.acog.org) and CDC (http://www.cdc.gov/) web sites for more information.

 

About RMACT

Reproductive Medicine Associates of Connecticut (RMACT) specializes in the treatment of infertility.  With Connecticut fertility clinics and egg donation offices in Norwalk, Danbury and Greenwich, and affiliate New York fertility clinics serving Westchester, Putnam and Dutchess counties, our team of Board-Certified Reproductive Endocrinologists offer a wide range of infertility treatments from ovulation induction and intrauterine insemination (IUI) to the most advanced assisted reproductive technologies including in-vitro fertilization (IVF), egg donation and preimplantation genetic diagnosis (PGD). The RMACT team of fertility doctors includes Drs. Mark P. Leondires, Spencer S. Richlin, Joshua M. Hurwitz and Cynthia M. Murdock. All physicians are members of the American Society for Reproductive Medicine (ASRM), the Society for Assisted Reproductive Technology (SART) and the Fairfield County and Connecticut Medical Societies. RMACT's IVF laboratory is accredited by the College of American Pathologists (CAP), and CLIA; other accreditations include the Accreditation Association for Ambulatory Health Care (AAAHC) and the American Institute for Ultrasound in Medicine (AIUM). RMACT offers individualized infertility treatment plans in a patient-focused and supportive environment. Support services, such as, infertility treatment financing, psychological counseling, acupuncture and yoga are also available. For more information visit, http://http://www.rmact.com/.

  

 

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