Fertility

What is Intrauterine Insemination (IUI)? 

Intrauterine insemination (IUI) is a fertility procedure designed to assist couples in achieving pregnancy.  It involves placing specially prepared sperm directly into the uterus, thereby increasing the likelihood of fertilization.  This process helps the sperm reach the egg more efficiently. 

Who Might Consider IUI? 

IUI may be a suitable option for individuals and couples facing certain fertility challenges, including: 

• Unexplained Infertility: When the cause of infertility remains unclear after thorough evaluation, IUI is often considered as an initial treatment strategy.  It is frequently combined with medications to stimulate egg production. 

• Mild Endometriosis:  This condition, where tissue like the uterine lining grows outside the uterus, can impact fertility.  IUI, in conjunction with medications to promote the development of healthy eggs, can be a viable treatment approach. 

• Problems with sperm delivery:  IUI alone can be used when the male partner cannot become or stay erect or has ineffective or absent ejaculation. Ex. Retrograde ejaculation. Prior surgeries or medical conditions, such as diabetes, can cause retrograde ejaculation. 

• Cervical Factor Infertility: The cervix, the lower, narrow portion of the uterus, and the cervical mucus it produces play a role in sperm transport.  If the cervical mucus is too thick or if there are other cervical scares that prevents the sperm from entering the uterus from the vagina, or the uterus shaped abnormally, sperms may have difficulty reaching the egg. IUI bypasses the cervix, delivering sperm directly to the uterus and improving the chances of fertilization. 

• Lack of ovulation (anovulation):  Most of the time female patients who do not release an egg regularly (ovulate) can become pregnant through regular sexual intercourse, but sometimes, IUI may be helpful in addition to medications that cause ovulation. 

IVF is a fertility treatment that involves combining eggs and sperm in a laboratory setting.  The resulting fertilized egg, called an embryo, is then transferred to the uterus. 

ICSI is a specialized technique used in conjunction with IVF.  It involves injecting a single sperm directly into an egg to facilitate fertilization. 

When is ICSI Recommended? 

ICSI may be a beneficial option in several situations, including: 

• Ejaculatory Dysfunction:  Men who are unable to ejaculate may benefit from ICSI. 

• Obstructions in the Male Reproductive Tract:  Blockages that hinder the passage of sperm can be circumvented with ICSI. 

• Low Sperm Count:  Men with a low sperm count (fewer than 15 million sperm per milliliter) may opt for ICSI. Low sperm counts can arise from various factors, such as varicoceles (enlarged veins in the scrotum), infections, hormonal imbalances, genetic conditions, or lifestyle choices like smoking, excessive alcohol intake, or obesity. 

• Suboptimal Sperm Quality:  ICSI can be useful when sperm quality is compromised.  This includes issues with sperm movement (motility), shape (morphology), viability (percentage of live sperm), or semen volume.  Sperm quality can be affected by age, varicoceles, infections, hormonal imbalances, or genetic conditions. 

• Retrograde Ejaculation:  In this condition, semen flows backward into the bladder instead of exiting the penis. ICSI can be used to retrieve sperm from the bladder. 

• Previous IVF Failures:  If traditional IVF has not resulted in embryo formation, ICSI may be considered. 

• Advanced Maternal Age:  Women over the age of 35 may be offered ICSI as part of their IVF treatment. 

• Use of Frozen Eggs or Sperm:  ICSI is commonly used when conceiving with previously frozen (cryopreserved) eggs or sperm. 

PGT is a sophisticated screening method used in conjunction with in vitro fertilization (IVF).  It analyzes embryos for potential genetic or chromosomal variations before they are transferred to the uterus. This process helps identify genetic disorders or chromosomal problems, allowing for the selection of embryos with the highest likelihood of resulting in a healthy pregnancy.  PGT can be a valuable tool for couples seeking to improve their IVF success rates. 

Is PGT Right for Me? 

While PGT is not a standard part of every IVF cycle, it is often recommended for couples who have certain risk factors. The aim of PGT is to minimize the risk of miscarriage, unsuccessful IVF cycles, and the transmission of genetic conditions to offspring.  Fertility specialists may suggest PGT in the following circumstances: 

• Family History of Genetic Disorders: Couples with a family history of inherited genetic conditions may be at increased risk of passing these genes to their children. PGT can screen embryos for these specific genetic variations, enabling the selection of unaffected embryos for transfer. 

• Recurrent Pregnancy Loss:  Couples experiencing repeated miscarriages, possibly due to chromosomal abnormalities in the embryos, may benefit from PGT.  This testing can help identify embryos with chromosomal issues that could increase the risk of future pregnancy loss. 

• Parental Age:  As individuals age, particularly women over 35, there is a greater chance of genetic variations and chromosomal abnormalities in the embryos.  PGT can assist in selecting chromosomally typical embryos, potentially increasing the likelihood of a successful pregnancy. 

• Known Genetic Conditions:  Couples who are carriers for or concerned about passing on specific genetic conditions may use PGT to screen embryos and select those that are not affected by the condition. 

By identifying and selecting embryos without these variations, PGT can improve the chances of a healthy pregnancy and provide reassurance to couples undergoing IVF. 

Sperm freezing, also known as sperm cryopreservation, is a process that preserves sperm for future use.  This offers individuals the opportunity to have biological children at a later time, regardless of certain life circumstances.  Sperm freezing provides flexibility and peace of mind in various situations, including: 

• Age-Related Fertility Decline:  As men age, while they continue to produce sperm, some aspects of sperm quality can gradually decline.  Freezing sperm at a younger age can preserve sperm quality at that point in time, offering a potential option for fatherhood later in life. 

• Cancer Treatment: Cancer treatments, such as radiation, chemotherapy, surgery, and hormone therapy, can sometimes negatively impact fertility in both men and women.  For men, sperm freezing prior to undergoing cancer treatment can preserve their fertility and offer the possibility of having children after treatment is completed. 

• Medical Conditions Affecting Fertility:  Certain health conditions, such as diabetes, polycystic ovary syndrome (PCOS), thyroid disorders, endometriosis, and hyperprolactinemia, can affect fertility.  Sperm freezing allows men facing these health challenges to preserve their sperm and potentially have children when their health improves, and they are ready to start a family. 

Embryo freezing is a technique used to preserve embryos for future use.  This offers couples the possibility of additional pregnancies without having to repeat the process of ovarian stimulation and egg retrieval.  The advanced freezing method commonly used is vitrification, a rapid freezing process. 

Why Freeze Embryos? 

• Extra Embryos from IVF:  A successful IVF cycle can often result in multiple embryos.  Couples may choose to freeze any remaining, unused embryos for future attempts to conceive. 

• Preimplantation Genetic Testing (PGT):  Embryos are typically frozen after they have been biopsied for PGT, as it takes time to receive the test results.  Freezing allows for the selection of genetically healthy embryos for transfer later. 

• Fertility Preservation:  Embryo freezing can also be used to preserve fertility for individuals facing certain medical situations.  This includes those undergoing hormone therapy, cancer treatment, gender affirmation surgery, or other medical interventions that may impact their reproductive capacity. 

• Ovarian Hyperstimulation Syndrome (OHSS) Prevention:  In some cases, physicians may recommend embryo freezing to reduce the risk of OHSS, a condition that can sometimes occur after ovarian stimulation. Freezing and delaying the embryo transfer can help mitigate this risk. 

• Optimizing Pregnancy Chances:  If certain hormone levels are elevated during an IVF cycle, embryo freezing may be advised to improve the chances of a successful pregnancy in a subsequent cycle.