How to Understand Infertility

Transcript My name is Dr. Daniel Evan Stein, and I am the co-director of the Continuum Reproductive Center in New York City. Continuum Reproductive Center, also known as the CRC, is a division of reproductive endocrinology, in the department of obstetrics and gynecology at Saint Luke’s Roosevelt Hospital Center in Manhattan. I have been practicing …

Transcript In order to find a infertility specialist, the first thing you have to do is differentiate between someone who calls themselves an infertility specialist and a true infertility specialist. Many gynecologists will state that they’re infertility specialist on their shingles or in their advertisements, but a true infertility specialist is somebody who’s specially trained …

Transcript In vitro fertilization or IVF is not always successful the first time it is attempted. In the IVF process eggs are retrieved from a woman’s ovaries after taking ovarian stimulation medications anywhere from 10-12 days typically. Once the eggs are retrieved, they are fertilized with the sperm sample. The embryos are created and the …

Transcript A common request now is for women to freeze their eggs. We have seen the requests for egg freezing increase dramatically over the past five years. The reason for this is that the technology now exists to freeze eggs effectively, where it did not exist before. In egg freezing, a woman undergoes in vitro …

Transcript One of the biggest risks from infertility treatments, particularly assisted reproductive technologies like inseminations and in vitro fertilization is multiple pregnancy. The risk of twins can occur in up to 30% of pregnancies that result from assisted reproductive technologies. Multiple pregnancy is not always a desired outcome. Twin pregnancies are generally safe and generally …

Transcript A frequently asked question is “Can I choose the gender of my baby using in vitro fertilization?” The answer is, in fact is “Yes.” However, there are times when it may make sense and other times when it does not. In order to be essentially guaranteed of the sex which you prefer to have, …

Transcript For many women, one of the first tests ordered during a fertility evaluation is called the AMH level. AMH stands for anti-Mullerian hormone. That hormone is a protein produced by the cells that surround the egg. Those cells are called granulosa cells. High levels are associated with a lot of granulosa cells which is …

Transcript The success of the assisted reproductive technologies depends on both the patient factors as well as on the specific technology being utilized. As women get older, the chances of any assisted reproductive technology, or ART, is diminished. Certain ART procedures give a higher chance of pregnancy than others. For example, in vitro fertilization gives …

Transcript A common term used in infertility is assisted reproductive technology, or ART. ART by definition, refers to any treatment in which the removal of eggs or sperm, or manipulation of eggs, sperm or embryos occurs outside the body. Intrauterine inseminations, which a man provides a semen sample for processing prior to injection into the …

Transcript Intrauterine insemination, also known as IUI is a process by which sperm is placed into the uterine cavity by the fertility specialist, during the cycles in which women are trying to conceive. Intrauterine insemination is used in cases in which there is male factor infertility, for example cases in which sperm count is diminished …

Transcript Age is a very important factor for determining a woman’s ability to conceive. As women get older, the chances of conception go down dramatically, particularly, as women get past their mid-30s. It’s very important that woman see their fertility doctor at this point in time if they haven’t conceived within six months after the …

Transcript A woman’s chances of infertility increases by certain life habits and by certain physiological factors. Age is a primary factor. As women become older, the number of eggs that they have become fewer and the quality of those eggs diminishes. In addition, women with high risk sexual behavior, that is multiple partners with unprotected …

Transcript Women who use fertility medications, particularly those drugs that stimulate multiple follicles to develop, are at risk for a disorder called ovarian hyperstimulation syndrome, also known as OHSS. OHSS is a result of the stimulation of the ovaries with medications. It doesn’t happen in very many people, but it can occur in up to …

Transcript A common question many women ask is during my in vetro fertilization cycle “Can I smoke, can I drink alcohol, can I use certain recreational drugs, can I even have intercourse?” These are all very good questions. There are obviously many very good reason to not smoke and drink for health related issues. From …

Transcript In cases of which a woman has conceived and has had multiple embryos transferred to the uterus. She may be at risk of multiple pregnancy. Pregnancies that are twins, triplets, quadruplets, and more are at higher risk of pregnancy loss and perinatal complications as compared to other pregnancies in which only one embryo was …

Transcript One of the most common questions is “How many embryos should be transferred back to the uterus at the time of in vitro fertilization?” Once the eggs are retrieved from the ovaries, the eggs are fertilized, and a few days later there are hopefully a significant number of embryos that are potentially capable of …

Transcript Many women, as they age, still would like to be able to use their own eggs to conceive. In many cases, that’s a very reasonable, appropriate thing to do, and we do do extensive ovarian testing, both by ultrasound and by blood work, to determine if a woman’s chances of conceiving using her own …

Transcript During the process of in vitro fertilization, eggs need to be harvested from the ovaries to then be available for fertilization and the development of embryos. The actual retrieval of the eggs occurs under general anesthesia and occurs in the IVF suite of the fertility office. A woman will not have anything to eat …

Transcript Many infertility treatments require that a man produce a sperm sample. These include intrauterine inseminations and in vitro fertilization. When a man is instructed to provide sperm for insemination or in vitro fertilization, he can do so by producing the sample at home or in the physician’s office where there is often a specialized …

Transcript Over the years I have met several men who use anabolic steroids for increasing muscle mass. These men are often athletes competing at a very high level of competition or weight lifters, wrestlers or just general body builders. Many of the men have never considered the possibility that the use of these anabolic steroids …

Transcript Abnormal semen analysis are one of the most common causes for difficulty conceiving in a couple. In an abnormal semen analysis, one of the most common abnormalities is a low sperm count. Sperm counts are considered low if the count is generally less than 20 million sperm per milliliter of ejaculate. Some experts consider …

Transcript A semen analysis is one of the most important tests to get at the initial visit for infertility. Sperm abnormalities are associated with approximately 40% of cases of infertility in couples. A semen analysis is done usually in the reproductive doctor’s office or in certain commercial laboratories. A semen analysis looks at a variety …

Transcript Perhaps the most challenging aspect of fertility care is dealing with the advanced age of both the women and the men involved. As women age, the chances of fertility decline significantly. A woman who is 18 years old has a significantly greater chance of conceiving in a cycle than a woman who is 30 …

Transcript Physicians who are specially trained to care of infertile couples are called reproductive endocrinologists. Reproductive endocrinologists deal with many aspects of infertility, including problems in sperm, Fallopian tubes, the uterus, ovulation, and other issues. The basis of much of reproductive endocrinology is, in fact, endocrinology–which is the study of hormones and their effects within …

Transcript A significant number of women that I see are interested in using sperm donation. Many of these women are single women who are choosing to conceive on their own or cases in which I have many lesbian couples who are trying to conceive with the use of donor sperm. Sperm donation is, therefore, very …

Transcript Many couples require a donation in order to achieve pregnancy. In order for them to do that they need the eggs from a young donor. Many young woman are interested in being donors. What these woman need to understand is that they need to have good egg quality and good egg numbers in order …

Transcript One of the most important services that a fertility specialist can offer a couple is egg donation. There are many situations in which egg donation is required. Many women do not have eggs of their own, or have such a low number of eggs, or a very, very low number of low quality eggs, …

Transcript For some couples to achieve pregnancy, the use of a surrogate is required. Fortunately, these are the minority of cases. Many women are confused about when surrogacy is required. If a woman has poor egg quality, a surrogate is not going to be helpful for her to achieve a pregnancy. For women with poor …

Transcript Charting of the menstrual cycle is one of the first tools that a woman can use to determine when she’s ovulating. In general, as the menstrual cycle progresses, and progesterone is produced at the time of ovulation, a woman’s temperature begins to rise. We call that a biphasic curve. In the first 14 days …

Transcript Not all couples who come to see the fertility doctor are childless. Many couples, in fact, have had children prior, or have gotten pregnant prior and terminated pregnancies, but are now having difficulty conceiving. When a woman has a previous child or a previous pregnancy, and is now infertile, we use the term “secondary …

Transcript Every medication used for the treatment of infertility has its own set of side effects. Some of these are very mild, and in many women there are no side effects at all. Some of them can be somewhat severe however and have to be recognized. For some of the oral medications that we use …

Transcript A vasectomy is a procedure performed on men to render them infertile. Vasectomy involves opening up the scrotum, having the vas deferens suture ligated after being cut, and therefore interrupting the communication of the sperm down the male reproductive tract. Vasectomies are often performed in couples who no longer want to conceive, and in …

Transcript In vitro fertilzation, also known as IVF, is a very commonly done procedure for infertility in the United States and all over the world. Candidates for IVF include women with fallopian tube disease, certain age-related effects on fertility, and male factors in fertility. In vitro fertilization can also be done for genetic reasons if …

Transcript One of the concerns many women have when undergoing fertility treatment is the possibility that fertility treatments could enhance their chances of developing cancers later in life. There is much truth and myth involved in this question. For the most part, fertility treatments are very safe, in particular when they are administered by a …

Transcript Pregnancy can only occur at the time of ovulation. It’s very important that sperm is in the reproductive tract before ovulation occurs or on the day of ovulation. Sperm introduction into the reproductive tract after ovulation will not result in pregnancy. In order for a woman to determine when she’s ovulating, there are various …

Transcript There are certain environmental factors that can lessen the chances of fertility occurring in a couple. Both men and women are subject to certain environmental toxins that can affect their fertility potential. In women in particular, smoking is perhaps the greatest threat to fertility. Smoking, particularly one pack a day smoking, or even less …

Transcript There are a variety of diagnostic tests done specifically on women to try to determine the cause for low fertility or infertility. One of the first things that we do is check what we call an ovarian reserve number. What ovarian reserve is, is a description of a woman’s chances of conceiving with her …

Transcript It seems nowadays everyone knows someone who has undergone fertility treatments; it even seems, perhaps, infertility is on the rise. That so many women are having trouble conceiving where as it didn’t occur before. I’m not sure if that is in fact the case. Yes, there are definitely factors that cause infertility to be …

Transcript Many women who present with infertility also have a disease called endometriosis. Endometriosis is a condition in which the uterine lining, also known as the endometrium, implants in places other than the uterus. It can implant places like the ovaries, the fallopian tubes, or the bowl, and in rare cases even go up in …

Transcript Fertility treatments can be very expensive, and they’re not always covered by a person’s insurance company. Some insurance companies do, in fact, include fertility treatment and fertility medications and the full diagnostic evaluation in their coverage plan. Some do not. And sometimes, it has nothing to do with the insurance company, but specifically, what …

Transcript One of the things that makes most women very apprehensive about fertility care is the administration of medications to themselves. Medications that are given orally are easy. Medications that are given by injection often cause fear not only in the woman, but in her partner, who is often asked to do the injections. Fertility …

Transcript Couples who see their fertility physician will often be prescribed certain medications to help them become pregnant. The medications that are given really depend on the what the condition is that is being treated. For example, women who have problems with ovulation may first be treated with certain oral medications, which many women have …

Transcript At the very first visit that I see a couple suffering from infertility, one of the first blood tests I order is a thyroid level, specifically, thyroid hormone levels. The thyroid gland, present in the neck, is very important in setting the metabolism for the body. The thyroid gland also, unbeknownst to many women, …

Transcript Many people who suffer from infertility want very much to find a cure. There are certain conditions that cause infertility, that are in fact curable. Some are not. The cure would depend on the condition being considered. For example, in cases in which a woman might have completely blocked Fallopian tubes as a result …

Transcript It is very important that when a couple first sees the doctor for infertility that a semen analysis is scheduled. Forty percent of cases of infertility are due to problems in the male, particularly in the sperm morphology, motility, or concentration. A semen analysis will evaluate those factors and look at the volume of …

Transcript Infertility occurs in about 15 to 20% of American couples. The causes are multiple. Perhaps the most common cause for infertility is male factor. Many couples don’t realize that. Approximately 40% of the cases of infertility are due to abnormalities in the sperm, either in the movement of the sperm or the shape of …

Transcript Many woman seeking fertility treatment do have depression. Sometimes the depression precedes the infertility. Sometimes it is a result of the inability to conceive. Depression is rampant in the United States. It occurs in all walks of life. There is no evidence that depression itself causes infertility, although there have been many articles to …

Transcript Miscarriages are one of the most frustrating things that can occur in infertility patients. Miscarriages can occur in any woman. They are more common in women attempting to conceive by infertility treatments or who just have a history of infertility. Miscarriages are much more common in couples undergoing infertility treatments than in those who …

Transcript Many physicians recommend that patients undergo a laparoscopy for fertility purposes. There are conditions in which a laparoscopy makes sense. First, let me explain what laparoscopy is. Laparoscopy is a procedure, a small incision is made in the belly button in the operating room under anesthesia. Through that incision, a telescope with a camera …

Transcript Sometimes, I’m asked if a myomectomy can improve somebody’s fertility. First, let me explain what a myomectomy is. A myomectomy is a procedure in which fibroid tumors, which are smooth benign tumors of the uterus, can be removed. Myomectomies can be done by an open incision, or they can be done using a laparoscope, …

Transcript A lot of people ask about the injections used for infertility. The injections are used only in certain cases. There are many different treatments for infertility, but if your doctor prescribes injections it is specifically for inducing more follicles to grow. That’s the purpose, to try to get more follicles in the ovaries to …