Female Causes of Infertility:.doc
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Female Causes of Infertility:.doc Female Causes of Infertility:.doc Document Transcript

  • http://rgi2.com/conditions.html RGI's Institute for Human Reproduction (IHR) treats both female infertility and male infertility problems. Causes of infertility can be related to both sexes. Approximately 60% of infertility is caused by female conditions, while approximately 40% is male-related. It is important to note, however, that in 25% of couples both partners will have a fertility problem. Female Causes of Infertility: • Ovulatory Dysfunction • Tubal Infertility • Endometriosis • Reproductive Surgery • Other Infertility Conditions • Immunological Infertility • Hormonal Infertility • Unexplained Infertility • Tubal Ligation Reversal • Repeated Pregnancy Loss • Advanced Female Age Male Causes of Infertility: • Testes Dysfunction http://rgi2.com/ovulatory_dysfunction.html Ovulatory Dysfunction This is the single most frequent cause of female infertility and denotes a problem with the monthly release of an egg (ovulation). There are varying causes for ovulatory dysfunction; the most frequent one is Polycystic Ovarian Syndrome (PCOS). RGI has extensive experience in treating women with all forms of ovulatory problems including: • Hypothyroidism, an under-active thyroid • Hyperthyroidism, an over-active thyroid • Post-partum thyroiditis • Thyroid autoimmunity
  • • Adrenal hyperplasia • Polycystic Ovarian Syndrome (PCOS) Diagnosis: Your medical history is useful in diagnosing ovulatory dysfunction. Other tests may be required including: • FSH Blood Level • Progesterone Blood Level • Ultrasound • Endometrial Biopsy Treatment: If you are not ovulating, your infertility specialist may prescribe a medication to stimulate your ovulation. If the treatment plan is to take medication to ovulate, your infertility specialist will want to monitor you carefully to see if and when you are ovulating. Monitoring usually involves: • Ultrasound • Blood Tests Next Steps: If you have Ovulatory Dysfuntion your next step should be: • Check out our Pregnancy Success Rate • Obtain a Free e-Mail Consultation • Arrange a Telephone Consultation http://rgi2.com/tubal_infertility.html Tubal Infertility Tubal factor infertility accounts for about 20-25% of all cases of infertility. This category includes cases in which the woman has completely blocked fallopian tubes and also women who have either one blocked tube or tubal scarring or other tubal damage. Most tubal disease is caused by an episode of tubal infections (pelvic inflammatory disease, PID) or a condition called endometriosis. In cases of relatively minor tubal damage it can be difficult to be certain that the infertility problem is
  • solely due to the tubal damage. There may be other significant contributing causes that are resulting in the problem conceiving. In general, the standard infertility testing is performed on all couples and if no other cause of infertility is found, the presumptive diagnosis can be tubal factor. However, if the degree of tubal scarring is very minimal, a diagnosis of unexplained infertility may be warranted. Treatment: Tubal infertility can be treated with tubal surgery or in vitro fertilization. Tubal Infertility Treatment Value: IHR is known worldwide for the treatment of tubal occlusions with trans-vaginal catheter techniques and has been a pioneer in treating tubal disease for many years. We have helped many couples overcome this problem. Next Steps: If you have Tubal Infertility your next step should be: • Check out our FAQs • Obtain a Free e-Mail Consultation • Arrange a Telephone Consultation • Obtain an Office Consultation http://rgi2.com/endometriosis.html Endometriosis Endometriosis, a cause of female infertility, is a condition in which endometrial tissue, the tissue that lines the inside of the uterus, grows outside the uterus and attaches to other organs in the abdominal cavity such as the ovaries and fallopian tubes. Endometriosis is a progressive disease that tends to get worse over time and can reoccur after treatment. Symptoms include painful menstrual periods, abnormal menstrual bleeding and pain during or after sexual intercourse. A laparoscopy, an outpatient surgical procedure, is necessary to confirm a diagnosis of endometriosis after a medical history review and pelvic exam. After the initial diagnosis, your physician will classify your condition as stage 1 (minimal), stage 2 (mild), stage 3 (moderate) or stage 4 (extensive) based on the amount of scarring and diseased tissue found. Treatment:
  • Some people believe that endometriosis, and not ovulatory dysfunction, is the single most frequent cause of infertility. Unfortunately, the diagnosis of endometriosis is not very reliable since it requires surgery (laparoscopy) and, even then, microscopic disease may be overlooked. Endometriosis can affect the ovaries (and probably egg quality), can increase the risk of miscarriages and may cause infertility. For treatment of the infertility associated with mild to moderate endometriosis, controlled ovarian hyperstimulation with intrauterine insemination is often attempted and has a reasonable chance to result in pregnancy if other infertility factors are not present. If this is not effective after about 6 cycles (maximum), then in vitro fertilization should be considered. Infertility in women with severe endometriosis is often resistant to treatment with ovarian stimulation plus intrauterine insemination. If the pelvic anatomy is very distorted, insemination would probably be futile. These women will often require in vitro fertilization in order to conceive. Endometriosis Treatment Value: IHR has been a pioneer in the research of immunological infertility and pregnancy loss and the significant autoimmune abnormalities associated with endometriosis. Treatment for endometriosis associated with infertility needs to be individualized for each woman. There are no easy answers, and treatment decisions depend on factors such as the severity of the disease and its location in the pelvis, the age of the woman, length of infertility, and the presence of pain or other symptoms. Next Steps: If you have Endometriosis and are seeking to become pregnant your next step should be: • Check out our FAQs • Obtain a Free e-Mail Consultation • Arrange a Telephone Consultation • Obtain an Office Consultation http://rgi2.com/surgical_infertility.html Reproductive Surgery In some situations, the condition causing infertility is not treatable through the use of medication or procedures including intrauterine inseminations and ovarian drilling. For these cases, surgical options are explored to treat the condition in the female or male. With the ascent of IVF (in-vitro fertilization), fewer indications for surgical infertility exist today than a decade ago. Nevertheless, there are still many occasions where competent surgery can make a difference. Examples are myomectomies (the surgical
  • removal of fibroid tumors from the uterus), ovarian cystectomies (the surgical resection of ovarian cysts), tuboplasticies (the surgical correction of abnormal fallopian tubes) and many other procedures. Treatment: Female surgical treatment options include: Hysteroscopy - outpatient procedure in which your doctor will use a narrow fiberoptic telescope inserted into your uterus through your cervix, to look for and sometimes remove adhesions inside your uterus. Laparoscopy - outpatient surgical procedure in which your doctor will use a narrow fiberoptic telescope inserted through an incision near your navel to look for and sometimes remove adhesions in your pelvic cavity, remove ovarian cysts or remove or repair a fluid-filled hydrosalpinx. Fallopian Tube Sterilization Reversal (reanastomosis) - A tubal reversal is a surgical procedure performed to reconnect the two ends of the fallopian tubes in an effort to reverse sterilization. Hydrosalpinx removal - A hydrosalpinx is an obstructed fallopian tube that leads to an accumulation of fluid. Removal of the affected tube can increase IVF success rates. Male surgical treatment options include: Testicular biopsy - in-office surgical procedure in which several small pieces of testicular tissue are removed and examined for sperm which can be used in fertility procedures. Testicular sperm aspiration (TESA) - involves a needle biopsy of the testicle in which a sample of tissue is taken directly from the testis and used to extract sperm for IVF or ICSI. Percutaneous sperm aspiration (PESA) - involving a needle inserted into the epididymis in an effort to locate and aspirate a pocket of sperm. Vasectomy reversal - A vasectomy reversal is often performed as an outpatient procedure and is done to reverse a previous vasectomy and restore the male's ability to release sperm into his semen from the testicles. Surgical Treatment Value: IHR physicians are all well trained as gynecological surgeons and are especially well versed in the performance of minimally invasive surgeries, such as operative laparoscopy and operative hysteroscopy. Next Steps: If you have need for Surgical Infertility Treatment your next step should be: • Check out our Pregnancy Success Rate • Obtain a Free e-Mail Consultation • Arrange a Telephone Consultation • Obtain an Office Consultation
  • http://rgi2.com/other_infertility.html Other Infertility Conditions Besides the major causes of female infertility, there are other, less frequent conditions that can lead to infertility. For example, premature ovarian failure (POF) can be caused by an autoimmune attack of the ovary or a genetic problem in the female. Genetic problems can cause infertility in a number of different ways. Treatment: IHR has state-of-the-art diagnostic tests to help determine the cause of the infertility issue and build a treatment plan for you Other Infertility Treatment Value: IHR has the expertise to treat infertility problems relating to genetics and determine the cause of the infertility problem Next Steps: If you have Other Infertility Conditions your next step should be: • Check out our FAQs • Obtain a Free e-Mail Consultation • Arrange a Telephone Consultation • Obtain an Office Consultation http://rgi2.com/immunological_infertility.html Immunological Infertility Whether abnormal female immune functions can cause infertility remains controversial. We believe in the concept of immunological infertility and offer under experimental protocols, various treatment options. Treatment:
  • No definitive treatment plan. A trial of ovulation induction and insemination followed by in vitro fertilization with ICSI (a process that involves injecting a sperm directly into an egg) seems to be the best treatment available. Immunological Infertility Treatment Value: We offer the best diagnostic test and treatment options available. Next Steps: If you have Immunological Infertility your next step should be: • Check out our Pregnancy Success Rate • Obtain a Free e-Mail Consultation • Arrange a Telephone Consultation • Obtain an Office Consultation http://rgi2.com/hormonal_infertility.html Hormonal Infertility Various hormonal abnormalities can lead to infertility. Examples are hypothyroidism (low thyroid function), hyperprolactinemia (high male hormone levels) and luteal phase defect (low progesterone levels). IHR physicians are experts in treating these and other endocrinological abnormalities. Diagnosis & Treatment: The reproductive endocrinologist will evaluate specific situations and perform tests in both the male and female partners to determine the cause of infertility. The physician is looking for answers to the following questions: • Is the female ovulating regularly? • Is the male producing healthy, viable sperm? • Are the female's egg and the male's sperm able to unite and grow normally? • Are there any obstacles to proper implantation and maintenance of the pregnancy? Treatment Value : Specific treatment for infertility will be determined by your physician based on:
  • • your age, overall health, and medical history • extent and cause of the disorder • your tolerance for specific medications, procedures, or therapies • expectations for the course of the disorder Once a diagnosis is made, the specialist can work with you to determine the course of treatment. Depending on the cause of infertility, there are many options to offer an infertile couple. The types of treatments may include the following: • medications • intrauterine insemination • surgery • assisted reproductive technology (ART) • in vitro fertilization (IVF) • intracytoplasmic sperm injection (ICSI) • gamete intrafallopian transfer (GIFT) • zygote intrafallopian transfer (ZIFT) • donor eggs • embryo cryopreservation Next Steps: If you have or suspect Hormonal abnormalities your next step should be: • Check out our FAQs • Obtain a Free e-Mail Consultation • Arrange a Telephone Consultation • Obtain an Office Consultation http://rgi2.com/unexplained_infertility.html Unexplained Infertility Unexplained infertility is a diagnosis of exclusion, when the standard investigation of both the female and male partner has ruled out other infertility diagnoses. It doesn't mean that there is no reason for the infertility, but that the reason is unable to be identified at that time. Approximately 10 to 15 percent of
  • couples will receive the diagnosis of unexplained infertility. The conventional infertility evaluation in the female may include: medical history, physical examination, tests of blood hormone levels, ovulatory function, and hysterosalpingogram (HSG) (an x-ray of uterus and fallopian tubes). Laparoscopy, which involves the insertion of a thin, lighted telescope-like instrument into the abdomen to look at the uterus, ovaries, and fallopian tubes, may be necessary to exclude factors such as endometriosis and adhesions (scar tissue) which may not be apparent by HSG. The conventional infertility evaluation in the male may include: medical history, physical examination, semen analysis, and hormonal testing. Of course, the unexplained infertility diagnosis is totally dependent on how extensive a diagnostic work- up has been performed: the more limited the work-up, the more frequent the diagnosis of unexplained infertility will arise. Many cases of unexplained infertility are nothing else but undiagnosed cases of endometriosis and immunological infertility. Our physicians always perform exhaustive diagnostic work- ups before reaching the diagnosis of unexplained infertility. However, once such a diagnosis is reached, IHR physicians are experts in offering up the appropriate empiric treatments. Treatment: There is no consensus as to the optimal therapy for the treatment of unexplained infertility, since many couples with one to three years of unexplained infertility will conceive spontaneously. In the female, empiric treatment (infertility treatments when no known cause of infertility has been diagnosed) with ovulation induction drugs for three to six cycles combined with intrauterine insemination (IUI) (inserting prepared semen directly into the uterus), followed by IVF or gamete intrafallopian fertilization (GIFT), is an approach frequently used. GIFT is an assisted reproductive technique that involves injecting a mixture of eggs and sperm directly into the fallopian tube. When unexplained infertility is diagnosed., treatment options include no intervention, intrauterine insemination, empiric clomiphene cycles with or without insemination, superovulation with insemination using gonadotropins, GIFT and IVF. Evaluation of each individual situation will help determine the most advisable course of action. Treatment Value: Recent research indicates that pregnancy rates with these therapies are equal to or higher than pregnancy rates of couples with other infertility diagnoses. In the future, increased understanding of human reproductive physiology will allow more effective therapies for patients with unexplained infertility. Next Steps:
  • If you have Unexplained Infertility your next step should be: • Check out our FAQs • Obtain a Free e-Mail Consultation • Arrange a Telephone Consultation • Obtain an Office Consultation http://rgi2.com/tubal_ligation.html Tubal Ligation Reversal Many women who have had tubal ligations often opt to achieve pregnancy later in life. In-vitro fertilization (IVF) or tubal ligation reversal, are two options for these women. Determining which is the best option for you depends on several factors, including a woman's age, the method of tubal ligation, and remaining tubal lengths. Treatment: Tubal ligation reversal involves microsurgical techniques to open and reconnect the fallopian tube segments that remain after a tubal ligation procedure. Usually there are two remaining fallopian tube segments - the proximal tubal segment that emerges from the uterus and the distal tubal segment that ends with the fimbria next to the ovary. The procedure that connects these separated parts of the fallopian tube is called microsurgical tubotubal anastomosis, or tubal anastomosis for short. In in-vitro fertilization, eggs are obtained from the female, after her ovaries have been stimulated with infertility drugs through an egg retrieval. While the patient is sedated for five to ten minutes, under ultrasound control, a needle is inserted into the ovaries and eggs are aspirated. These eggs are then fertilized in the laboratory (in-vitro) with the partner's sperm and the ensuing embryos are watched for three to six days while they start dividing. On the third day, when the better embryos have reached eight- cell stage, most patients undergo an embryo transfer. With a tiny catheter, usually unperceivable to the patient, embryos are placed into the uterine cavity. A pregnancy test (hCg) is administered approximately ten days later to determine if our patient has become pregnant. Treatment Value : For those women who do choose tubal ligation reversals, IHR has accomplished laparoscopic surgeons to perform this procedure.
  • Next Steps: If you are interested in a Tubal Reversal your next step should be: • Check out our FAQs • Obtain a Free e-Mail Consultation • Arrange a Telephone Consultation • Obtain an Office Consultation http://rgi2.com/repeated_loss.html Repeated Pregnancy Loss Recurrent pregnancy loss is defined as the loss (miscarriage) of three or more consecutive pregnancies. Almost 20% of all pregnancies (one in five) end in miscarriage. The risk of miscarriage is 9.5% for women younger than age 24. This risk rises steadily with age, increasing to 11% by age 30 and reaching 33% in women age 40. For women over 44 the incidence of miscarriage increases dramatically to 53%. Pregnancy loss can take a tremendous emotional toll. However, 60% of all women who are diagnosed with unexplained recurrent pregnancy loss achieve a successful pregnancy with minimal treatment. The rate of success improves to over 75% for women who suffer recurrent loss as the result of an identifiable cause and undergo appropriate treatment. Treatment: Our laboratory workup is designed to identify possible causes for a woman's recurrent pregnancy loss. These factors include: Anatomical Factors, Genetic Factors, Infection, Immune Factors, Endocrine Factors, Unexplained Factors. Anatomical factors: Uterine abnormalities are a possible cause of recurrent pregnancy loss. A saline- ultrasound or an x-ray dye examination can be performed to evaluate the uterus. Surgery to correct uterine abnormalities is an effective and low-risk outpatient procedure. Genetic Factors: Approximately 70% of early spontaneous miscarriages are associated with fetal chromosomal abnormalities. In addition, 30% of second trimester miscarriages and 3% of stillbirths have abnormal chromosomes. In most cases, the couple is chromosomally normal and the fetal chromosomal abnormality is a random event. Preimplantation genetic diagnosis [PGD], can now be performed in conjunction with IVF and allows genetic testing to be done on embryos prior to transfer. PGD can benefit women with a history of repeated miscarriages, those at risk for having a child with an inherited genetic
  • disorder (e.g., cystic fibrosis, muscular distrophy), or those who have failed to achieve pregnancy after multiple attempts with IVF. Infection: Any severe maternal infection that leads to bacteria (or viremia) can cause sporadic miscarriage. However, the role of infection in the cause of recurrent miscarriage is unclear. Immune Factors: There is a well-established association between recurrent miscarriage and antiphospholipid antibodies (aPL) - a class of proteinsthat in some cases appears to attack an early developing pregnancy. The live birth rate may be as low as 10% in women with recurrent miscarriages attributed to aPL. The live birth rate significantly improves to 70% when aPL is treated with low dose aspirin together with low dose heparin. Endocrine Factors: Systemic maternal endocrine disorders such as diabetes mellitus and thyroid disease have been associated with miscarriage. But well-controlled diabetes is not a risk factor for recurrent miscarriage, nor is treated thyroid dysfunction. Inadequate secretion of progesterone during the menstrual cycle and in the early weeks of pregnancy is considered a possible factor in many cases of recurrent miscarriage. Another possible endocrine factor is the prevalence of polycystic ovaries (PCO), a condition of the ovaries where there are many medium-sized follicles around the rim of the ovaries, often seen with the ovulation disorder polycystic ovary syndrome (PCOS). Unexplained Factors: For a number of women, the recurrent episodes of pregnancy loss will remain unexplained despite careful investigation. It is important for these women to know that the prognosis for future pregnancy with counseling alone is approximately 75%. Treatment Value: IHR is renowned worldwide for its research in the area of repeated pregnancy loss. IHR physicians are experts in determining the cause of repeated pregnancy loss and in the various treatment options, if such options exist - even if experimental in nature. Finally, IHR is home to one of the nation's best known reproductive immunological laboratories. Since the correct diagnosis of repeated immunological pregnancy loss is dependent on the availability of a comprehensive immunology laboratory, IHR is uniquely equipped to diagnose and treat this condition. Next Steps: If you have Repeated Pregnancy Loss your next step should be: • Check out our FAQs • Obtain a Free e-Mail Consultation
  • • Arrange a Telephone Consultation • Obtain an Office Consultation http://rgi2.com/advanced_age.html Advanced Female Age As a woman ages, the chance of having a healthy baby decreases. This is partly due to aging ovaries having fewer eggs to release. The eggs are also aging, which may affect the egg quality. Compared with a younger woman, it is more likely that an older woman's eggs are unable to go through the normal cell division that results in a healthy, thriving embryo. She is less likely to get pregnant, more likely to have a baby with abnormal chromosomes, and more likely to miscarry even if the developing fetus has normal chromosomes. The following human reproduction circumstances may qualify you for participation: • Advanced Female Age • Poor Ovarian Response to Prior Stimulation • Age - Inadequate Response to Prior Stimulation • Multiple Failed IVF (in-vitro fertilization) Cycles • Immunological Disease Treatment: As a participant in IHR Infertility Program, your treatment will be individualized to your special circumstances. We are proud to have become known as Chicagoland's "programs of last resort". Even some of our human reproduction competitors refer their poor prognosis patients to IHR. They know that we will give them a chance. Treatment Value : Most fertility centers will not accept patients into treatment if their chance of conceiving is judged to be improbable. At IHR we believe that our principal responsibility is not to our program statistics, but to our patients. We strongly believe that the well-informed couple, who fully recognizes their low chance of conception but still wishes to conceive, is entitled to receive their desired treatments. Next Steps: If you are at an Advanced Female Age or have Premature Aging Ovaries your next step should be:
  • • Check out our FAQs • Obtain a Free e-Mail Consultation • Arrange a Telephone Consultation • Obtain an Office Consultation http://rgi2.com/testes_dysfunction.html Testes Dysfunction Like causes of female infertility, causes of male infertility can be multifaceted and deserve full investigation. In contrast to female infertility, all causes of male infertility affect only one target organ, the testes. Treatment: IHR's urologist, has expertise in the following areas: • Evaluation and treatment of male infertility • Microsurgical vasectomy reversal • Sperm procurement techniques • Microsurgical varicocele ligation • Management of testicular failure and hypogonadism • Sperm cryopreservation/banking • Evaluation and treatment of ejaculatory disorders • General urology Treatment Value: A semen analysis is the primary test used to determine male fertility. Semen analysis results can be normal, mildly, moderately or severely abnormal or may show no semen at all, a condition called azoospermia. Whatever the severity of semen analysis, IHR has the expertise to virtually guarantee fertility to almost all affected males. Next Steps: If you have Testes Dysfunction your next step should be: • Check out our FAQs
  • • Obtain a Free e-Mail Consultation • Arrange a Telephone Consultation • Obtain an Office Consultation