infertility

August 15, 2013 by Aaron Leave a Comment

IUI Discount Programs

saving on IUI treatment — IUI Discount programs give patients more options. Image credit

Hi! First off I want to apologize for taking some time off from writing for this blog. Life had gotten a little hectic and I couldn’t find enough time to sit down and work on this site. I am happy to say that things have calmed down a bit, and I have started working on a series of new posts! It’s super exciting to be getting some momentum going again on this project :)

Today I wanted to talk a little about IUI, or intra-uterine insemination, treatments. IUI is a great first treatment option for many couples. It is relatively non invasive and much cheaper than IVF. It is often recommended for women or couples who have:

ovulation issues
are unable to properly time intercourse, / sexual dysfunction
mild male factor
unexplained fertility
or for women using donor sperm

An IUI is a type of artificial insemination. Basically, instead of having the male inseminate the female naturally via sexual intercourse, a medical professional uses a tiny catheter to inject a small amount of prepared sperm directly into the woman’s uterus. This procedure is timed to occur right around when ovulation (when a female is most fertile) occurs, and can be done either naturally or accompanied by fertility drugs. The idea is to coordinate the whole operation so that the sperm and the egg can meet in a favorable environment at the proper time for fertilization to occur.

iui explained — Prepared sperm is injected directly into the uterus during an IUI procedure. Image source

The IUI process can increase a woman’s chances of becoming pregnant over practicing timed intercourse and can be a successful treatment for many of the disorders listed above. The procedure is relatively simple, and, as such, does not cost much compared to an IVF cycle. The cost can vary depending on the complexity of the monitoring and if fertility medications are used. I will list out the main varieties in order of ascending costs.

The cheapest, and often least successful are natural IUI cycles where ovulation is determined through the use a combination of a best guess based on cycle lengths, temperature readings, and maybe ovulation kits to confirm ovulation. No fertility medications are used. These are less successful then the more monitored counterparts, as more is being left unknown throughout the process.

Next up would be natural cycles with monitoring. These are IUI cycles without any medication but with a clinic monitoring the woman’s cycle to more accurately determine the optimum time for the insemination to occur. The amount and type of monitoring can vary depending on the fertility clinic. Clinic monitoring can be very important as proper timing is very important to IUI success.

Medicated cycles with or without monitoring are the most expensive variant, but also the most successful. These cycles use fertility drugs to increase the chances that a healthy egg will be ovulated. The amount of monitoring can vary depending on the clinic you go to, but most often they will have you come in for one or more blood draws and ultrasounds to precisely determine when ovulation occurs. Sometimes ovulation is even triggered through the use of other medications.

Regardless of the type of IUI cycle that is recommended by your doctor it is probable that you will need more than one cycle to be successful. If you are looking into, or about to start an IUI treatment cycle I sincerely hope you will get pregnant on the first round, but the odds are against you. It has been said that the odds of any given IUI cycle to succeed are around 20-30% for a young healthy couple. Depending on the severity of the issues affecting you or your partner those odds will be go down.

Since the cost disparity between a round of IUI and an IVF cycle is so pronounced many couples will want to pursue a couple IUI cycles before moving on to IVF. Sometimes against the recommendations of their physicians who understand that the chances for success with IUIs will be very low for that patient. I certainly can’t blame a patient for trying an IUI or two even when the odds are stacked against them. However, that money is more often than not just thrown away with unsuccessful cycles before the patient ultimately ends up pursuing IVF.

That doesn’t have to happen! The other day I came across a fertility clinic in Seattle that addresses this issue with two separate programs designed to make the whole decision process much easier for patients. One program is for patients who have a good chance succeeding though IUI treatment, but will likely need more than one cycle to achieve a healthy pregnancy. They call the program an IUI Discount Program, and it basically allow a patient to get a third IUI cycle free, if they prepay for the first two. The best part is that they will refund the patient the second cycle if the first one is successful. They also give an option for patients to go through the program again at a slightly higher rate.

Their next program is called an IUI Credit Program. This one is my favorite of the two as it allows patients to first try a couple IUI cycles, and if those are not successful, apply the money they have already spent against the cost of an IVF cycle. This gives patients the ability to first try the low cost option, before having to commit to an IVF cycle.

Both these programs are innovative and among some of the best I have seen. They give patients the ability to reduce their financial burden as they pursue lower cost fertility treatments before jumping into the much more expensive options. I just wish more fertility clinics would offer programs such as these as they have the potential to really benefit the patient.

Cheers!

February 11, 2013 by Aaron Leave a Comment

How to deal with infertility on Valentines Day

This sappy image could be your wallpaper, all you have to do is click on the picture..

Infertility has a way of taking the romance, and fun out your most intimate moments. Sex can quickly become just a means to an end, and if you have been trying for while, a forced reminder of your difficulties or even your perceived failings. Things like tracking ovulation cycles, or, if you have been seeing a specialist, injections, blood draws and lot of poking and prodding just doesn’t do much in the romance aspect for most people. Don’t even get me started on the stress of infertility… Let’s be frank, fertility woes can add bucket loads of tension to the healthiest of relationships.

When you are dealing with infertility it is easy to lose your perspective. You can get so caught up in the process of timed intercourse, medications, and treatments that you can forget the most important thing. Your relationship with your partner. Whatever happens with your fertility journey it is important that you don’t forget to put the time and energy in to keeping your loving relationship going. With Valentines Day just around the corner, this makes it a perfect time to strengthen your relationship.

Love it or hate it, Valentines Day is coming up once again (hint.. it is this Thursday). I know it has become hyper-commercialized with sappy cards, jewelry adverts.. the list goes on. Many of us (myself included) would rather ignore the hype. No matter what your thoughts are, the core idea of Vday is a great one. It is supposed to be a day where you make that extra effort to make sure your partner, boyfriend/girlfriend, etc, feel special and loved. An idea anyone can get behind.

Regardless of your thoughts about Valentines Day, you should take the time this year to make your partner feel loved. If you are fighting with infertility, my advice is to take the day off (or maybe a day this weekend) from all the infertility stuff and focus on each other. No matter what you consider a good time, be it a nice walk together, a movie, or maybe a nice dinner out, make sure you do something together. Just spend time with your partner and reconnect. Whatever you do, make sure you finish the day in bed… without any thoughts of conception!

January 25, 2013 by Aaron Leave a Comment

Polycystic Ovary Disease (PCOS) and Fertility

PCOS is one of the primary causes of infertility in the USA

As part of an ongoing series to provide information on the various facets of infertility and related conditions I want to talk a little about PCOS or polycystic ovary syndrome. Awareness of PCOS is increasing with the obesity prevalence among women of childbearing age in the United States. Since a link exists between obesity and PCOS, a corresponding increase in fertility problems and inability to conceive a pregnancy may occur. According to data from the National Health and Nutrition Examination Surveys of 2009-2010 presented by the Centers for Disease Control, 39.1% of women between 20-39 years old in the United States were obese. PCOS occurs in women on normal weight, as well. It is an endocrine abnormality that causes cysts to form in the ovaries and produce abnormally high levels of androgens, along with irregular periods and systemic hormonal imbalances.

Long considered as a hereditary condition, there is still no known cure. The website of the National Women’s Health Network includes an article in the Women’s Health Activist Newsletter (November/December 2007) by Kiesha McCurtis that describes the broad range of problems associated with PCOS.

The symptoms of PCOS will vary from woman to woman and include:

Infertility (not able to get pregnant) In fact, PCOS is the most common cause of female infertility.
Infrequent, absent, and/or irregular menstrual periods (root cause of infertility)
Hirsutism (HER-suh-tiz-um) — increased hair growth on the face, chest, stomach, back, thumbs, or toes
Pelvic pain
Cysts on the ovaries
Acne, oily skin, or dandruff
Weight gain or obesity, usually with extra weight around the waist
Thick patches of dark brown or black skin on the neck, arms, breasts, or thighs
Skin tags — excess flaps of skin in the armpits or neck area
Male-pattern baldness or thinning hair
Anxiety or depression
Sleep apnea — when breathing stops for short periods of time while asleep

How common is PCOS

In 2005, Azziz stated in the Journal of Clinical Endocrinology and Metabolism that approximately 6.6% of women in the United States have PCOS. It is estimated that as many as 5 million woman in the US may suffer from PCOS. Due to the strong correlation between obesity and the incidence of PCOS and the rising prevalence of obesity in the US I would expect that percentage to be even higher now.

Health insurance companies that cover in vitro fertilization may not cover it for women with PCOS due to the possible health risks. In that case, women with PCOS who choose IVF may need to bear the entire cost themselves. For a woman with PCOS who wants a baby, adoption—even international adoption—may be a preferable option.

Treatment of PCOS

The primary means of treating PCOS will vary depending if you are trying to concieve or not. If you are not trying for a baby then the most common recommendations are lifesytle modifications, including: exercise, healthy eating, and weight loss (if overweight); or birth control pills to help regulate your hormonal levels.

For women with PCOS seeking to become pregnant, Clomiphene Citrate is the fertility drug frequently prescribed. While in vitro fertilization has been performed on young women with polycystic ovary syndrome, the risks may outweigh the benefits. Pregnant women with PCOS are at increased risk of gestational diabetes (which is a predisposing factor for later development of Type 2 Diabetes), as well as miscarriage and pre-eclampsia.

Another pregnancy risk for a women with PCOS is the higher association of premature birth. Additionally, because of the hormonal imbalances associated with PCOS, lactation may also be a problem.

Preventing PCOS

Although, we do not yet have a clear picture of how to prevent PCOS, weight loss in young women of childbearing age needs to be emphasized as a way to prevent potential development of PCOS. Since PCOS has been linked to insulin resistance, avoiding overly sugary foods and regular exercise (both of which are proven to help with insulin resistance) may be beneficial.For those obese women who want to have children, prevention of PCOS may provide a better goal for them to reduce their body mass index (BMI) than other health-related reasons. Because of the array of health risks associated with PCOS—including infertility—addressing the increase in prevalence of obesity in adolescents in the United States is important in reducing the overall incidence of PCOS. (sidebar: I have found a paleo-based diet, comprised of mostly whole foods with lots of meat and vegetables, to be quite effective in regulating my weight and would be happy to discuss that with anyone if they were interested.

The relationship of obesity to PCOS is yet another reason for obesity to be a primary public health focus. Infertility prevention is less costly to the health system as a whole than infertility treatment.

References
U.S. Centers for Disease Control. NCHS Data Brief 82; January 2012.

McCurtis K. Women’s Health Activist Newsletter (November/December 2007). National Women’s Health Network.

Azziz R, Marin C, Hoq L, et al. (2005). Health care-related economic burden of the polycystic ovary syndrome during the reproductive life span. J Clin Endocrinol Metab 90(8): 4650-4658.

January 24, 2013 by Aaron Leave a Comment

What are some common causes of infertility?

Infertility can be cased by many things — Knowing the cause of your infertility can help reduce the stress and empower you to solve/treat the problem

Infertility refers to an inability to conceive a child despite unprotected intercourse for a period of at least 12 months. Infertility is a frequently reported issue that may be associated with trivial lifestyle or dietary irregularities requiring modifications or it may also be associated with strong medical, hormonal or surgical abnormalities that require treatment. It is very important to understand the primary cause of infertility in order to know the proper way to treat the root cause. Infertility can expensive enough without wasting time and money on improper treatments.

Why is it important to know the cause(s) of infertility?

It is very important to know the nature and severity of defect that is interfering with conception in order to manage or treat infertility effectively. Moreover, your choices of fertility treatment depend on the cause of infertility. With advancing age, hormonal and structural changes in the female body affect the ability of a woman to become pregnant. However, having difficulty in conception is different from being infertile. Similarly, as opposed to popular misconception, men can also be the cause of infertility. According to research statistics, men are responsible for almost 40% cases of infertility.

Some of the main causes of infertility in women include:

Hormonal irregularities: In order to get pregnant, it is very important to have normal concentration of all the hormones in the body. Abnormalities of hormones like thyroid hormone, prolactin hormone, estrogen or progesterone defects, Cushing syndrome, uncontrolled diabetes and systemic medical problems like kidney and liver may affect the ability of women to become pregnant
Long standing pelvic infections: Egg is released into fallopian tubes each month on 14th day of ovarian cycle and if intercourse is performed while egg is still in fallopian tubes, the chances of conception are very high; however, in cases of long standing pelvic infections, pelvic surgeries and untreated sexually transmitted infections, the chances of tubal scarring is very high that prolong the conduit of sperm for fertilization. Other conditions include abdominal surgery or pelvic surgery.
Structural abnormalities of female genital tract: In some cases, genetical or acquired abnormalities of female genital tract like bicornuate uterus, bifid uterus, history of uterine fibroids, cystic ovarian masses and other abnormalities can also lead to infertility.
Nutritional defects: Dietary irregularities deficiencies or nutritional is one of the most popular cause of infertility in women that is mostly overlooked. Obesity (having a BMI of more than 30) is a risk factor for infertility that leads to hormonal aberrations that may become a cause of infertility. Same is true for anorexic and underweight women

What are some of the main causes of male infertility?

Male infertility refers to abnormalities in the sperm count, morphology or motility that impairs the ability of the sperm to reach the Fallopian tubes or it’s ability to successfully fertilize an egg. Defects of the male genital tract include:

Recurrent infection of the male genital organs including the epididymis, vas deferens, testicles or glands
History of trauma or surgery involving male the genital tract
Exposure to radiation, X-rays, environmental or occupational toxins likes pesticides, fertilizers and other industrial toxins.
Physical damage caused by cancer, uncontrolled medical illnesses like diabetes, uremia or abnormalities of the endocrine glands that are responsible for release of hormones necessary for reproduction.
Genetic or acquired defects like undescended testicles, obesity, or penile issues may lead to infertility in men.
Altered biochemical environment of the body that alters the secretion of seminal glands or prostate gland or affects the metabolic activity of the sperm also causes infertility and includes excessive alcohol intake, tobacco or illicit drug consumption and intravenous drug abuse.

Speak to your healthcare provider if you are having difficulty in getting pregnant or impregnating your partner for early detection and timely treatment.

Cheers!

January 23, 2013 by Aaron Leave a Comment

Available treatments of Infertility

infertility doctor — There are a wide range of treatments available to help couples concieve

I want to start off with a hypothetical story about a Jim and Sandy. They are successful business professionals living a happy and prosperous life with just one discrepancy. They wanted a child really badly but despite conscious attempts and unprotected intercourse for years, Sandy never conceived. It was pretty devastating for both of them but somehow they made peace with themselves thinking that they can never have a child of their own.

But was she really infertile?

Infertility is a fairly common issue and according to research statistics, more than 12 to 15% of all couples face some difficulty in getting pregnant naturally and almost 7% of all the couples are infertile and cannot conceive without some kind of medical intervention.

Thousands of couples make peace with themselves, just like Sandy and Jim thinking that there is no treatment for infertility. That is simply not true. Nowadays there are a wide range of treatments available to help couple conceive ranging from the simple to the complex. The rest of this article will discuss some of the popular treatment modalities and interventions available today for couples fighting infertility.

What are some available treatments of infertility for women?

According to statistics, the primary cause of infertility is a defect in female in 40% of the cases that can be managed by medical or interventional methods of treatment available today.

Medicinal treatment:

In many women who present to fertility clinics, the primary defect is a hormonal imbalance that can be corrected by medications like Clomiphene citrate (Clomid). Irregularities of female reproductive hormones prevent ovulation, which is the primary cause of infertility in such cases. Restoration of ovulation by Clomiphene citrate induction involves increasing the release of female reproductive hormones from the pituitary such as FSH (Follicular Stimulating Hormone) and LH (Luteinizing Hormone); thereby helping women achieve a healthy pregnancy.

cure for infertility — Depending on your issue, medicine may beall that is required to help you get pregnant

Other popular medical treatments include:

Metformin is another medication that is employed in women with known history of polycystic ovarian disease.

Human menopausal gonadotropin is a hormonal aid used in women who are unable to conceive because of advancing age or hormonal problems. This directly stimulates the ovaries to produce hormones that are able to support a viable pregnancy by signaling the body to releasing the eggs and preparing the endometrium for implantation.

Hormonal therapy in the form of supplementation with estrogen or progestin during pregnancy that helps women with history of recurrent miscarriages; whereas Luteinizing Hormone is helpful in women who never ovulate because of LH surge failure.
Other popular medications include Bromocriptine, Human chorionic gonadotropin (hCG), Aromatase inhibitors and Gonadotropin-releasing hormone analogs.

Surgical treatment:

Sometimes long standing pelvic infections lead to scarring of fallopian tubes that becomes a cause of infertility and even with induction, the risk of ectopic pregnancy increases tremendously. In all such cases, the ideal treatment is tubal surgery or laproscopy to remove scarred segments of genital tract. Although, chances of conception are still low after that but it invariably helps a lot of women.

Uterine polyps and fibroids are two other common ailments in many women that will interfere with the proper implantation of a fertilized egg into the lining of the uterus. Depending on the severity of the condition different surgical interventions may be suggested. Operative hysteroscopy is the preferred method of treatment for polyps, and smaller fibroids as it is quicker and safer than older methodologies.

What are some available treatments of infertility in men?

Defects of sperm motility and morphology or a low count may all affect the ability of a man to impregnate his female partner. Sometimes, healthy lifestyle changes, dietary modification, abstinence from alcohol, tobacco and drugs may help but in majority of the cases, other treatments must be employed to treat infertility in men. These include:

Vitamin E therapy that helps in preventing oxidative damage to sperms and improves quality of semen.

Selenium is one of the popular remedies that are employed in treatment of infertility due to poor quality sperms.

Electric or vibratory stimulation is a technique used in males who are unable to ejaculate because of a spinal surgery, spinal injury or direct injury in the pelvic region that is interfering with the ejaculation. It is also helpful in males with history of pre-mature ejaculation.

What to do when nothing works?

In many cases, despite medicinal and interventional therapies, no fruitful results are seen. However, due to advancements in science and technology, there are a number of other interventions that can help infertile couples. Some of these treatments are:

Intra Uterine Insemination (IUI)

IUI is a procedure where processed sperm in injected directly into the uterus when the female partner is ovulating. The goal is to increase the number of viable sperm reaching the ovulated eggs. The procedure can help couples experiencing unexplained fertility, cervical issues, or other issues. This procedure is much less invasive and expensive than more complex treatments such as IVF and is often recommended to couples as a first line of treatment when there is not a solid reason to jump directly to more aggressive treatments.

In-vitro fertilization (IVF):

IVF or in-vitro fertilization is employed in women who are unable to conceive naturally because of a positive history of pelvic surgery, tubal pregnancy, pelvic inflammatory disease and other causes. The IVF procedure is made up of several key steps. First the stimulation phase, where the female partner takes medication to induce her ovaries to produce more mature eggs than she normally would. During this time she is carefully monitored to make sure the proper level of stimulation and that the eggs are properly mature for when they are retrieved. The doctor then surgically removes the mature eggs from the ovaries during the egg retrieval. These eggs are then fertilized in the embryology laboratory with the partner’s sperm (or donor sperm in some cases). The resulting embryos are carefully monitored and when the time is right(usually three or five days after the retrieval) are directly implanted back into the uterine cavity so they can develop normally.

In some cases, women are unable to produce healthy mature eggs at all despite stimulation or induction. In all such cases, IVF can be successful performed by using donor eggs.

Intracytoplasmic sperm injection:

Intracytoplasmic sperm injection is another well-known technique used in conjunction with IVF that is employed in cases where either male sperm count is deficient or most of the sperms are morphologically abnormal. In this procedure, a normal sperm is directly injected into each mature egg obtained through an IVF cycle.

Surgical sperm aspiration:

This procedure is employed in males who cannot ejaculate successfully due to inflammation or infection induced blockade of male reproductive tract. Surgical sperm aspiration can be performed by aspirating the sperm directly from testicles, vas deferens or epididymis.

How to make use of Assisted Fertilization Techniques?

Although, assisted fertilization techniques carry a ray of hope for infertile couples, the chances of having a successful IVF or ICSI can be low. Research studies conducted by medical researchers in Harvard Medical School in Boston and Beth Israel Deaconess Medical Center identified that out of 14,248 IVF performed from 2000 to 2005 only 3,126 were successful and resulted in live-birth of full-term babies. In order to optimize your chances of conception, it is very important to consider following things and speak to your fertility doctor about it.

Maternal age: is a huge factor when determining your likely success rate. For example, the average couple under 35 can expect a success rate of around 60%, that rate drops to around 10% for the average couple over 42
Pre-implantation Genetic Diagnosis: In some cases when one or both genetic parents have a known medical condition, it becomes important to determine the the genetic combination of the embryos by Pre-implantation Genetic Diagnosis before implantation in order to increase the chances of producing an offspring free of the genetic disorder. This will likely reduce your chances as there is no way of determining if or how many your embryos will meet the requirements.

Speak to your healthcare provider in detail about the possible techniques or procedures that may be helpful for you and maintain a healthy and stress-free lifestyle to avoid gestational problems.