Infertility

A couple is diagnosed as infertile if it takes them more than a year of trying to become pregnant. For couples where the woman is over 35, this timeframe may be reduced to six months. That’s because age is a major risk factor for infertility.
There are also a number of other risk factors for male and female infertility. Some of them can be modified through simple changes in lifestyle. Others may need more intensive treatment while still others cannot be changed.

1 In Vitro Fertilization (IVF)

In vitro fertilization (IVF) is a procedure used to treat fertility problems and assist with the conception of a child. During in vitro fertilization, mature eggs are retrieved from your ovaries and fertilized by sperm in a lab. Then the fertilized egg (embryo) or eggs are implanted in your uterus. One cycle of in vitro fertilization takes about two weeks. In vitro fertilization is the most effective form of assisted reproductive technology (ART).
The chances of giving birth to a healthy baby after using in vitro fertilization depend on various factors, including:
• Maternal age. The younger you are, the more likely you are to get pregnant and give birth to a healthy baby using your own eggs during in vitro fertilization.
• Embryo status. The live birth rate is lower when frozen embryos are used instead of fresh embryos. The use of fresh or frozen sperm, however, hasn’t been shown to affect success rates.
• Reproductive history. Women who’ve previously given birth are more likely to be able to get pregnant using in vitro fertilization than are women who’ve never given birth. Success rates are lower for women who’ve previously used in vitro fertilization multiple times, but didn’t get pregnant.
• Cause of infertility. Having a normal supply of eggs increases your chances of being able to get pregnant using in vitro fertilization. Women who have endometriosis are less likely to be able to get pregnant using in vitro fertilization than are women who have tubal damage or blockage.
• Lifestyle factors. Women who smoke typically have fewer eggs retrieved during in vitro fertilization. Smoking can lower a woman’s chance of success using in vitro fertilization by 50 percent.

2 Intrauterine insemination (IUI)

Intrauterine insemination (IUI) is a procedure to treat infertility. The procedure for IUI is straightforward; it takes about 15 to 20 minutes and is usually done in a doctor’s office or clinic. Sperm that have been “washed” and concentrated are placed directly in your uterus on the day after your ovary releases one or more eggs to be fertilized. The hoped-for outcome of intrauterine insemination is for the sperm to swim into the fallopian tubes and fertilize a waiting egg, resulting in a normal pregnancy.

Why IUI is done?

A couple’s ability to become pregnant depends on many different factors. IUI is used most often in couples who have:

  • Mild male factor infertility. Your partner’s semen analysis, one of the first steps in the medical assessment of infertility, may show below-average sperm concentration, weak motility of sperm, or abnormalities in sperm size and shape (morphology). IUI can overcome these problems because preparing sperm for the procedure helps separate the highly mobile, normal sperm from those of lower quality.
  • Cervical factor infertility. Your cervix provides the opening between your vagina and uterus. With intercourse, the sperm swim through the cervical opening into your uterus, then to the fallopian tubes to search for a waiting egg. The fluid produced by the cervix around the time of ovulation is supposed to provide an ideal environment for sperm to travel from your vagina to the fallopian tubes. However, if the cervical fluid is too thick it may impede the sperm’s journey. IUI bypasses the cervix, depositing sperm directly into your uterus and increasing the number of sperm available to meet the awaiting egg.
  • Semen allergy. Rarely, women have an allergy to proteins in their partner’s semen, so ejaculation into the vagina causes redness, burning and swelling where the semen has contacted the skin. A condom can protect you from the symptoms, but it also prevents pregnancy. If your sensitivity is severe, IUI can be effective, since many of the semen proteins are removed before the sperm is inserted.
  • Unexplained infertility. IUI is often performed as a first treatment for unexplained infertility, sometimes in conjunction with ovulation-inducing medications.

Before IUI

Intrauterine insemination involves careful coordination before the actual procedure.

  • Preparing the semen sample. Your partner provides a semen sample at the doctor’s office. Because nonsperm elements in semen can cause reactions in the woman’s body that interfere with fertilization, the sample will be “washed” in a way that separates the highly active, normal sperm from lower quality sperm and other elements. The likelihood of achieving pregnancy increases by using a small, highly concentrated sample of healthy sperm.
  • Monitoring for ovulation. Because the timing of IUI is crucial, your doctor may monitor you for signs of impending ovulation using transvaginal ultrasound, which that lets your doctor visualize your ovaries and egg growth. Alternatively, you may be asked to monitor yourself using an at-home urine ovulation predictor kit.
  • Determining optimal timing. Just before ovulation, your body produces luteinizing hormone (LH). If you’re coordinating IUI with your normal cycle, you’ll go in for insemination the day after the LH surge. If you’re using ovulation-inducing medications, you may be given an injection of human chorionic gonadotropin (HCG) to make you ovulate, and then go in for the insemination the next day.

During IUI

The IUI procedure itself requires no medications or pain relievers. First, a speculum will be inserted into your vagina — similar to what you experience during a Pap test. Then a long, thin, flexible tube called a catheter is inserted into your vagina, through your cervical opening and into your uterus. A vial containing the small sample of healthy sperm is attached to the end of the catheter, and the sperm sample is pushed through the tube into your uterus.


After IUI

After insemination you’ll be asked to lie on your back for a brief period. After the procedure is over, you can get dressed and go about your normal daily activities. You may experience some light spotting for a day or two after the procedure.


Results

Wait for two weeks before taking an at-home pregnancy test, when pregnancy hormone levels are at a measurable level. Testing too soon could result in a false-negative — meaning that the test result is negative when, in fact, you really are pregnant. Conversely, if you’re using ovulation-inducing medication such as HCG, testing too soon could produce a false-positive — a test result that indicates a pregnancy when you really aren’t pregnant — due to the HCG that’s still circulating in your body.