Infertility Explanations & Definitions:
- PRIMARY INFERTILITY -
Defined as the inability to conceive after one year of unprotected intercourse (6 months if the woman is over age 35) or the inability to carry a pregnancy to live birth.
- SECONDARY INFERTILITY -
The inability to conceive or carry to term after having one or more children.
Is also referred to as a reproductive endocrinologist (RE), is simply an obstetrician-gynecologist (OB/GYN) who has completed additional training in the form of a 2-3 year fellowship in the treatment of infertility (reproductive endocrinology). Upon completion of training, a specialist seeks board certification from the American Board of Medical Specialties, which requires successful completion of oral and written exams. Only those physicians who complete the fellowship and pass the exam can become board-certified fertility specialists. All physicians have gained skills and training through experience, be sure to evaluate and ask for qualifications before exploring any fertility options and or treatments. *Unlike the fertility specialist, OB/GYN's for the most part are not going to be able to fully evaluate, test, diagnose and monitor any further treatments for possible infertility. Be sure to ask their opinions and guidance if you feel you need or desire to gain further help conceiving.
There are numerous well-known clinics within the Houston area. Be sure to do your research they are not all equal or believe in the same ethics, moral code. As with any doctor be sure to know your stance or at least make sure they will be willing to work with you for what is most comfortable for you and your spouse. See Fertility Treatment Questions or contact us to discuss the hard issues.
Women's Basic Anatomy & Physiology:
Menstrual Cycle - Well we all know what this is... or we should. However please review as you begin wanting to get pregnant to make sure you know all you can. Especially watching your cycle count (average menstrual cycle is between 28 to 32 days), trying basal body temperature tracking and watching your cervical mucus (see natural family planning below) these are all good steps to further understand and know your body before beginning any fertility treatments, doctor visits or becoming frustrated. It is also very important to realize that a menstrual cycle is different in every woman and can even change from month to month. Awareness is key with Fertility and Infertility.
Estrogen - is the primary female sex hormone and is responsible for the development and regulation of the female reproductive system and for the changes seen in a female during puberty.
Progesterone - Often called the “Hormone of Pregnancy,” is responsible for creating a favorable environment inside the uterus for implantation of a fertilized egg to occur and for maintaining the pregnancy after fertilization. For instance thickening of the uterus lining once ovulation occurs.
Follicle - A female’s egg that (usually) matures over the first fourteen days of a woman's cycle under the influence of the hormones FSH and LH. The then mature follicle releases an ovum into the fallopian tubes where it will travel to the uterus. The follicle will then become what is known as a corpus luteum which is responsible for producing progesterone. Should a pregnancy occur the corpus luteum will continue to produce progesterone until the placenta is mature enough to take over progesterone production.
Ovulation - the release of eggs is *Most common cause of female infertility is the failure to ovulate". Even if egg is not normally released from the ovaries on a monthly basis, it may be possible for a doctor to induce it with controlled ovarian stimulation of medicines.
Embryo - A Human Life in its earliest form. An embryo is formed when egg & sperm unite, followed within twenty-four hours by the alignment of their DNA.
Follicle Stimulating Hormone (FSH) - is produced by the pituitary gland. In women, FSH helps control the menstrual cycle and the production of eggs by the ovaries. The amount of FSH varies throughout a woman's menstrual cycle and is highest just before she releases an egg (ovulates). In men, FSH helps control the production of sperm. The amount of FSH in men normally remains constant.
Luteinizing Hormone (LH) - is produced by the pituitary gland. In women, LH helps regulate the menstrual cycle and egg production (ovulation). The level of LH in a woman's body varies with the phase of the menstrual cycle. It increases rapidly just before ovulation occurs, about midway through the cycle (day 14 of a 28-day cycle). This is called an LH surge. Luteinizing hormone and FSH levels rise and fall together during the monthly menstrual cycle. In men, LH stimulates the production of testosterone, which plays a role in sperm production.
Implantation Bleeding - This light bleeding or spotting is among the very first pregnancy signs. Implantation bleeding is thought to happen when the fertilized egg (embryo) attached to the lining of the uterus. Some women experience this while others never do, which is normal. It can often be confused with having menstrual bleeding of your period, however implantation bleeding is light or spotting not a heavy flow. If heavy bleeding please contact your doctor. It is a normal symptom no need to be alarmed and it can come with cramping. Just like mild discomfort and cramping can occur in some women as their uterus changes once pregnant.
Basic Fertility Testing:
Hormone Evaluation - There are several hormones that must work together in the female body for pregnancy to occur and progress properly. Levels of reproductive hormones FSH, LH, and estradiol are measured on day three of the woman's menstrual cycle to determine her ovarian reserve (remaining egg supply). Hormone fertility testing can also detect the presence of excess androgens — male hormones produced by a woman's ovaries and adrenal glands. Elevated androgen levels may indicate polycystic ovarian syndrome (PCOS).
Semen Analysis - Is an important part of a basic infertility evaluation for a couple. It will check the quality and quantity of the sperm in the semen. The clinics will generally want you to give the sample in the office, since it is important that the analysis take place as soon as possible. Although some clinics do allow a 1 hour window for drop-off, ask for what makes (both of you) most comfortable. Ethically there are things you can do if as a couple you are not comfortable with the collection of this test. *Please contact us if you need suggestions or advice. And husbands remember, as self-conscious as you might feel, a semen analysis is a commonplace test, and the results could save you months of worry and stress.
If the first semen analysis is normal, your doctor may order a second test to confirm the results. Two normal tests usually indicate that you do not have any significant infertility problems. If something in the results appears irregular, your doctor might order further tests to pinpoint the problem.
Transvaginal Ultrasound - A test uses high-frequency sound waves to create an image of the uterus, ovaries, and fallopian tubes. This image allows the physician to detect any irregularities. It can also help us monitor the growth of the ovarian follicles.
Saline Infusion Sonogram (SIS) - Is an Ultrasound test done after a saline solution has been infused into the uterus through the cervix. The saline solution distends the uterus and acts as a contrast to the internal structure. This procedure provides more detail than a conventional ultrasound.
Hysterosalpingogram (HSG) - An important part of a basic infertility evaluation. It is a radiology procedure that is used to detect irregularities inside of the woman's uterus and fallopian tubes. Dye is injected in the uterus and the results are yielded by an x-ray showing whether or not the dye is passing through the tubes, meaning they are open.
Hysterscopy - A procedure frequently utilized in the diagnostic evaluation of infertility, by looking inside your uterus in order to diagnose and examine. It is also commonly performed prior to more advanced fertility treatments such as in vitro fertilization. Hysteroscopy is generally performed under anesthesia or conscious sedation. It involves placing a small camera through the cervix and directly examining the uterine cavity. Abnormalities, such as endometrial polyps, scar tissue, and small fibroids can identified and frequently treated in the same procedure. It is also possible to evaluate the status of the fallopian tubes with hysteroscopy by utilizing a tubal catheterization procedure. Your physician will discuss if this procedure is an option for you.
Laparoscopy - During the laparoscopy fertility testing procedure, a small instrument called a laparoscope is inserted through a minute incision in the woman's navel. The instrument's tiny camera allows the fertility specialist to look for abnormalities of the uterus, ovaries, and fallopian tubes such as fibroid tumors, scar tissue, and endometriosis.
Pregnancy Blood Test (HCG) - If the egg is fertilized and implants into the uterus, the fertilized egg/embryo will begin to secrete HCG. Which is the signal to continue producing progesterone, which is the hormone responsible for helping maintain the pregnancy. As the pregnancy progresses, more HCG will be secreted. These increasing levels will be detectable in both blood and urine. A healthy pregnancy should see levels double every 48-72 hours during the first 6 weeks of pregnancy, reaching their peak at 8-11 weeks of pregnancy.
A loss of a pregnancy before the 20th week of pregnancy, most often occurring before the 12th week of pregnancy (first trimester), after the 20 weeks the fetal death is known as a stillbirth. About 10-20% percent of known pregnancies end in miscarriage, and more than 80% of these losses happen before 12 weeks. The underlying cause in about half of cases involves chromosomal abnormalities. The most common symptoms of a miscarriage is vaginal bleeding, this may occur with our without pain. Red blood tissue or clot like material may also come out the vagina. Other conditions that can produce similar symptoms include an ectopic pregnancy and implantation bleeding.
PLEASE CONTACT YOUR DOCTOR RIGHT AWAY IF EXPERIENCING SYMPTOMS.
** If you do have a miscarriage it is a death and loss that is painful please seek out counseling and support (we highly suggest a Christian counselor to help guide you through the grief with Hope). **
Or tubal pregnancy is one in which the fertilized egg (embryo) implants outside the uterus, usually in the fallopian tube (before reaching uterus). In up to 1 of every 50 pregnancies, this occurs and in rare cases, the fertilized egg attaches to one of your ovaries, another organ in your abdomen, the cornua or horn of the uterus or even the cervix. Regardless, these are serious and will need immediate attention and emergency treatment. Symptoms include abnormal vaginal bleeding, pelvis or abdomen pains, bloating, vomiting. Most often, ectopic pregnancy happens within the first few weeks of pregnancy. You might not even know you're pregnant yet, doctors usually discover it by the 8th week of pregnancy. This is emotionally hard and in most cases will be a miscarriage (read above).
PLEASE CONTACT YOUR DOCTOR RIGHT AWAY IF EXPERIENCING SYMPTOMS.
Natural Family Planning (NFP):
is a method used to help a couple determine when sexual intercourse can and cannot result in pregnancy. This is a focus on knowing your body or possibly fertility (which is a very smart and wise step to take for any couple wanting to become pregnant and know your body before doctors may need to become involved). NFP is a collection of methods using your body's menstrual cycle, and the number of changes that occur in a woman's body to determine the fertile days of the month. It is also a form of birth control that does not use any drugs or devices. It combines calendar/charting, basal body temperature, and cervical mucus methods.
Basal body temperature tracking helps identify a change in temperature that occurs after ovulation and remains elevated until your next period. By looking at the chart from a few cycles, your temperatures can reveal a pattern from which ovulation can be anticipated.
The consistency of your cervical mucus changes during the menstrual cycle. And can help you become aware of ovulation. For example: the wetness increases daily, slippery, clear, stretchy and egg white. Ovulation generally occurs within 1-2 days of your peak day of stretchy mucus.
Clomid - A medication often used as a first-line therapy to induce ovulation in women. Clomid works by telling the body to produce more FSH and LH, which are the hormones responsible for stimulating the follicle to mature and grow so that ovulation can occur.
Follicle Stimulating Hormone (FSH) - Hormone that is primarily responsible for the maturation of ovarian follicles. Usually given in shot form, on a daily basis within certain peak times of your cycle. Typically used in conjunction with a IUI or some patients continue with intercourse, depending on their preference with doctors recommendations.
Internal Uterus Insemination (IUI):
Fertility treatment used with explained and unexplained infertility in both men and women. During IUI, sperm is deposited at the cervix or inside the uterus by mechanical means during ovulation. Often ovulation inducing medications are used in conjunction with IUI. Most fertility doctors suggest this option because it bypasses all the elements/mechanisms that could be causing fertility issues.
In Vitro Fertilization (IVF):
A complex series of surgical procedures used to treat fertility or genetic problems and assist with conception. A fertility treatment in which eggs are removed from the woman's ovaries and fertilized with her spouses sperm in the lab and embryo (union of sperm/egg) are transferred (placement of the embryo into the uterus) takes place in the laboratory or fertility clinic.
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Egg Retrieval - During this process, ovaries are stimulated (usually with injected medications) to release mature eggs that will be surgically removed (retrieval) and later be used in fertilization.
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Fertilization - A sperm sample is taken from male and then used for fertilization in the lab. After successful fertilization, the new embryo continues to grow and divide in the lab for approximately 3-5 days.
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Embryo transfer - After 3-5 days, the embryo transfer (surgical procedure) takes place into the woman's uterus.
Polycystic Ovarian Syndrome (PCOS):
Is a complex endocrine system disorder with no clear cause. PCOS is the most common endocrine system disorder among women of reproductive age. Infrequent or prolonged menstrual periods, high testosterone levels (which causes excessive hair growth, weight gain or even obesity) insulin resistance and infertility are all regularly occurring with PCOS. It can be very difficult to diagnose due to its wide variety of presentations. A combination of medical history, physical examination, lab work, and imaging is needed to properly diagnose this disorder. Insulin resistance is thought to be leading cause of infertility among women with PCOS. Too much circulating insulin in the woman's body interrupts normal hormone function and can prevent ovulation from occurring. Menstrual symptoms include the absence of, heavy, infrequent, irregular, short, light or spotting during menstruation. Medication such as Metformin which decreases the amount of insulin in the body can help restore normal hormone function and ovulation in women with PCOS and has shown to be successful.
A condition in which endometrial tissue forms outside the uterus, sometimes causing (minimal or severe) pain and infertility. Endometrial tissue that is found outside the uterus responds to the menstrual cycle in much the same way as the endometrium in the uterus responds. At the end of every cycle, when hormones cause the uterus to shed its endometrial lining, endometrial tissue growing outside the uterus will break apart, bleed and may result in scar tissue.