Women are born with millions of eggs, however, the number of eggs decreases progressively from birth (1-2 million) to puberty (500,000) and then menopause (1,000). The eggs age at different rates among women regardless of their health status. In general, the quality of a woman’s eggs decreases progressively from puberty. By age 37, only 25,000 eggs remain and the decline accelerates (40 years – only 1,000 eggs and most of them are poor quality)
Fertilized eggs of poor quality may lead to miscarriages, birth defects and or unhealthy babies
What can Seed of Life offer
We offer women of child-bearing age an opportunity to determine the current status of their ovarian reserve through our Fertility Assessment Program. For starters, the couple must undergo a series of comprehensive investigations.
How to Start the Program
We have formulated a set of test that both partners need to undergo as the first step to achieving the ultimate goal of pregnancy.
1. The following are included in the fertility assessment program:
- New Patient-Physician Consult
- Baseline Ultrasound
- Evaluation of the womb and number of eggs potentially stimulating during that menstrual cycle
- Day 2 Hormones including FSH, LH, Estradiol Lab Work
- Assessment of the quality of eggs
- Baseline Anti-Mullerian Hormone (AMH) Lab Work
- Assessment of the quantity of eggs
- Thyroid Function (Free T4, T3, TSH, Thyroglobulin Antibody, Thyroid Peroxidase Antibody)
- Viral screens (Rubella IgG, Hepatitis A, B, C, HBs Antigen, Hbs Antibody, Anti-HIV, Syphilis Screen)
- Breast Ultrasound; Mammogram for patients ages >35 or family history of breast cancer
- Prolactin, Hb electrophoresis, CMV IgG, IgM
- Papsmear Screen
- Cervical Infection Screen
- Hysterosalphingogram (HSG)
- Sperm Assessment
- Scrotal Ultrasound
- Hormone tests (FSH Male, ICSH, Testosterone, Prolactin Male)
- Hb electrophoresis
- Viral screens (Rubella IgG, Hepatitis A, B, C, HBs Antigen, Hbs Antibody, Anti-HIV, Syphilis Screen)
2.Follow-up appointment with physician to review test results
Basic Fertility Treatment
If you’re like most couples who are trying to conceive, you might want to get pregnant sooner rather than later.
Having intercourse and keeping track of your ovulation using an ovulation kit definitely helps but there are other ways couples can boost their fertility.
Superovulation + Intrauterine Insemination
Intrauterine insemination (IUI) is a procedure that can treat male and female infertility in a natural approach. In intrauterine insemination, the man’s sperm are directly inserted into the woman’s uterus. This prevents any complications the sperm may have in reaching the uterus. IUI is the most common form of artificial insemination. This may be a good choice when the man’s sperm count is low or when the woman has endometriosis.
The procedure starts with placing washed sperm in the women’s uterus when she is ovulating. During this procedure, a thin catheter is passed through the cervix into the uterus. IUI is especially useful when sperm has had difficulty reaching the egg(s). It is frequently used for the treatment of mild to moderate male factor problems such as poor sperm function.
Some hindrances to success include a woman’s older age, poor egg or sperm quality, or severe fallopian tube damage.
In addition to IUI, there are other methods that have allowed couples to enjoy the joy of pregnancy and childbirth after months, even years, of failed attempts to get pregnant. Here is a brief overview of some of the most common infertility treatments:
Timing of Ovulation (TOO)
Some patients would want to opt doing a natural approach of conceiving before deciding to do a more proactive approach such as IVF. In this program we will monitor the patient closely through daily scans and blood tests to determine when ovulation occurs. This program is best for timed intercourse or assists the patient by giving trigger medications to assist release of eggs and induce ovulation. Further treatment may depend upon the results of this program.
Superovulation is one of the most common treatments for many causes of infertility. This process involves the stimulation of a woman’s ovaries through the use of follicle stimulating medications or fertility drugs. Superovulation is frequently used with Intrauterine Insemination (IUI).
Frequently asked questions
Frustrations with Ovarian Aging
Over the years one of the common frustrations women have voiced is that they wish they had known that their eggs were aging at a faster rate than normal. With the advancements in egg freezing over the last five years, more women would benefit from knowing the status of their egg quality as early as feasible. Women whose eggs are still viable can consider delaying starting their families depending on their age. Women whose eggs have a decrease in quality or quantity may consider preserving their fertility by freezing eggs or embryos before further compromise occurs based on age or other medical factors.
Family History of Infertility
There are also women whose mother or siblings have experienced infertility and were diagnosed with decreased egg quality or quantity at a young age. These women would also benefit greatly from understanding their egg health early in their lives
1.What is infertility?
A couple is considered infertile if the woman, aged less than 35 years old, is unable to conceive within a year of regular unprotected sex. If more than 35 years old, a couple is considered infertile if the woman is unable to conceive within 6 months of regular unprotected sex.
Infertility can also refer to the biological inability of an individual to contribute to conception, or to a female who cannot carry a pregnancy to full term.
Studies indicate that slightly over half of all cases of infertility are a result of female conditions, while the rest are caused by either sperm disorders or unidentified factors.
Many physical and emotional factors can cause infertility. It may be due to problems in the woman, man, or both.
2.Is infertility a common problem?
Infertility is fairly common. After one year of having unprotected sex, about 15 percent of couples are unable to get pregnant.
In United States, about 6% of married women 15–44 years of age are unable to get pregnant after one year of unprotected sex (infertility).
About 12% of women 15–44 years of age in the United States have difficulty getting pregnant or carrying a pregnancy to term, regardless of marital status (impaired fecundity).
3.What are the risk factors for infertility?
Risk factors for women’s infertility include ovulation problems, blocked Fallopian tubes, uterine problems, uterine fibroids, age,stress, poor diet, athletic training, and those risk factors listed for men.
Risk factors for men’s infertility include alcohol and drug use, toxins, smoking, age, health problems, medicines,radiation, and chemotherapy.
Others Risk Factors:
- Age – a woman’s fertility starts to drop after she is about 32 years old, and continues doing so. Male fertility progressively drops too after the age of 40.
- Smoking – smoking significantly increases the risk of infertility in both men and women and may also undermine the effects of fertility treatment. Even when a woman gets pregnant, if she smokes, she has a greater risk of miscarriage.
- Alcohol consumption – a woman’s pregnancy can be seriously affected by any amount of alcohol consumption. Alcohol abuse may lower male fertility. Moderate alcohol consumption has not been shown to lower fertility in most men, but is thought to lower fertility in men who already have a low sperm count.
- Being obese or overweight – in industrialized countries overweight/obesity and a sedentary lifestyle are often found to be the principal causes of female infertility. An overweight man has a higher risk of having abnormal sperm.
- Eating disorders – women who become seriously underweight as a result of an eating disorder may have fertility problems.
- Being vegan – if you are a strict vegan you must make sure your intake of iron, folic acid, zinc and vitamin B-12 are adequate, otherwise, your fertility may become affected.
- Over-exercising – a woman who exercises for more than seven hours each week may have ovulation problems.
Not exercising – leading a sedentary lifestyle is sometimes linked to lower fertility in both men and women.
Sexually transmitted infections (STIs) – chlamydia can damage the fallopian tubes, as well as making the man’s scrotum become inflamed. Some other STIs may also cause infertility.
- Exposure to some chemicals – some pesticides, herbicides, metals (lead) and solvents have been linked to fertility problems in both men and women.
- Mental stress – studies indicate that female ovulation and sperm production may be affected by mental stress. If at least one partner is stressed it is possible that the frequency of sexual intercourse is less, resulting in a lower chance of conception.
4. Is infertility just a woman’s problem?
About one-third of infertility cases are caused by women’s problems. Another one third of fertility problems are due to the man. The other cases are caused by a mixture of male and female problems or by unknown problems.
5. What causes infertility in men?
Infertility in men can be caused by different factors and is typically evaluated by a semen analysis. A specialist will evaluate the number of sperm (concentration), motility (movement), and morphology (shape). A slightly abnormal semen analysis does not mean that a man is necessarily infertile. Instead, a semen analysis helps determine if and how male factors are contributing to infertility.
Conditions that can contribute to abnormal semen analyses include—
- Varicoceles, a condition in which the veins on a man’s testicles are large and cause them to overheat. The heat may affect the number or shape of the sperm.
- Medical conditions or exposures such as diabetes, cystic fibrosis, trauma, infection, testicular failure, or treatment with chemotherapy or radiation.
- Unhealthy habits such as heavy alcohol use, testosterone supplementation, smoking, anabolic steroid use, and illicit drug use.
- Environmental toxins including exposure to pesticides and lead.
6. What increases a man’s risk of infertility?
This can be caused by heavy alcohol use, drugs, environmental toxins, smoking cigarettes, age, medicines or radiation treatment and health problems such as mumps, serious conditions like kidney disease or hormone problems.
7. What causes infertility in woman?
Women need functioning ovaries, fallopian tubes, and a uterus to get pregnant. Conditions affecting any one of these organs can contribute to female infertility.
A woman with irregular periods is likely not ovulating. This may be because of several conditions and warrants an evaluation by a doctor. Potential causes of anovulation include the following:
- Polycystic ovary syndrome (PCOS). PCOS is a hormone imbalance problem that can interfere with normal ovulation. PCOS is the most common cause of female infertility.
- Functional hypothalamic amenorrhea (FHA). FHA relates to excessive physical or emotional stress that results in amenorrhea (absent periods).
- Diminished ovarian reserve (DOR). This occurs when the ability of the ovary to produce eggs is reduced because of congenital, medical, surgical, or unexplained causes. Ovarian reserves naturally decline with age.
Premature ovarian insufficiency (POI). POI occurs when a woman’s ovaries fail before she is 40 years of age. It is similar to premature (early) menopause.
- Menopause . Menopause is an age-appropriate decline in ovarian function that usually occurs around age 50. It is often associated with hot-flashes and irregular periods.
- The most commonly used markers of ovarian function include follicle stimulating hormone (FSH) value on day 3–5 of the menstrual cycle, anti-mullerian hormone value (AMH), and antral follicle count (AFC) using a transvaginal ultrasound.
Less common causes of fertility problems in women include:
- Blocked Fallopian tubes due to pelvic inflammatory disease, endometriosis, or surgery for an ectopic pregnancy
Physical problems with the uterus (Uterine Contour).
- Uterine fibroids, which are non-cancerous clumps of tissue and muscle on the walls of the uterus.
8. What things increases woman’s risk of infertility?
Female fertility is known to decline with:
- Age. Many women are waiting until their 30s and 40s to have children. Aging not only decreases a woman’s chances of having a baby but also increases her chances of miscarriage and of having a child with a genetic abnormality.
- Aging decreases a woman’s chances of having a baby in the following ways—Her ovaries become less able to release eggs.
- She has a smaller number of eggs left.
- Her eggs are not as healthy.
- She is more likely to have health conditions that can cause fertility problems.
- She is more likely to have a miscarriage.
- Excessive alcohol use.
- Extreme weight gain or loss.
- Excessive physical or emotional stress that results in amenorrhea (absent periods).
9. How long should a couple try to get pregnant before calling their doctor?
Most experts suggest at least one year for women younger than age 35. However, women aged 35 years or older should see a health care provider after 6 months of trying unsuccessfully. A woman’s chances of having a baby decrease rapidly every year after the age of 30.
10. How long will the doctor find out if the couple have infertility problem?
Doctors will begin by collecting a medical and sexual history from both partners. Blood and imaging tests are most often needed.
In men, doctors usually begin by testing the semen. They look at the number, shape, and movement of the sperm.
This will also include:
- Exam of the testes and penis.
- Ultrasound of the male genitals (sometimes done).
- Blood tests to check hormone levels.
- Testicular biopsy (rarely done).
In women, these may include:
- Blood tests to check hormone levels, including progesterone and follicle stimulating hormone (FSH).
- FSH and clomid challenge test.
- Antimullerian hormone testing (AMH)
- Hysterosalpingography (HSG)
- Pelvic ultrasound
- Thyroid function test
11. How do doctors treat infertility
Infertility can be treated with:
- Fertility treatments such as intrauterine insemination (IUI) and assisted reproductive technology.
- Medicines to treat infections and clotting disorders
- Medicines that help the growth and release of eggs from the ovaries
- Many times these treatments are combined. Doctors recommend specific treatments for infertility based on the factors contributing to the infertility.
- The duration of the infertility.
- The age of the female.
- The couple’s treatment preference after counseling about success rates, risks, and benefits of each treatment option.
- Couples can increase the chances of becoming pregnant each month by having sex at least every 3 days before and during ovulation.
- Ovulation occurs about 2 weeks before the next menstrual cycle (period) starts. Therefore, if a woman gets her period every 28 days the couple should have sex at least every 3 days between the 10th and 18th day after her period starts.
- Having sex before ovulation occurs is especially helpful.
- Sperm can live inside a woman’s body for at least 3 days.
- However, a woman’s egg can only be fertilized by the sperm for a few hours after it is released.
- Women who are under or overweight, may increase their chances of becoming pregnant by getting to a healthier weight.
12. How often is assisted reproductive technology (ART) successful?
Success rates vary and depend on many factors, including the clinic performing the procedure, the infertility diagnosis, and the age of the woman undergoing the procedure. This last factor—the woman’s age—is especially important.
CDC collects success rates on ART for some fertility clinics. According to the CDC’s 2012 ART Success Rates, the average percentage of fresh, nondonor ART cycles that led to a live birth were
- 40% in women younger than 35 years of age.
- 31% in women aged 35–37 years.
- 22% in women aged 38–40 years.
- 12% in women aged 41–42 years.
- 4% in women aged 43–44 years.
- 2% in women aged 44 years and older.
ART can be expensive and time-consuming, but it has allowed many couples to have children that otherwise would not have been conceived. The most common complication of ART is a multiple fetus pregnancy. This is a problem that can be prevented or minimized by limiting the number of embryos that are transferred back to the uterus. For example, transfer of a single embryo, rather than multiple embryos, greatly reduces the chances of a multiple fetus pregnancy and its risks such as preterm birth.