What are your other options

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What are your other options?
INFERTILITY
STERILITY

• By Sarah Steiner
• Per. 2

MEDICATIONS
SURROGACY
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First Steps

• If problems with fertility occurs, a thorough
  evaluation is essential
• Many questions need to be answered
• Is the female ovulating properly?
• Are the fallopian tubes functioning?
• Are the males sperm normal and functional?
• Current statistics show that there is a female
  problem in about 35 of cases, male problem in
  about 35 of cases, a combined problem in 20,
  and about 10 are deemed unexplained because
  all the test results were normal

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Main Causes

• Many kinds of defects, whether birth or acquired,
  can cause problems with fertility
• Endometriosis a condition found in females in
  which the endometrial tissue, or lining of the
  uterus, spreads outside the uterus and sometimes
  even implants on the ovaries and other pelvic
  organs
• Found in 35 of infertile women
• Depending on the severity can be treated using
  drugs or surgery

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Adhesions

• Adhesions also known as scar tissue, that can
  form in the uterus and be associated with
  endometriosis
• Occurs in a majority of women after pelvic
  surgery or trauma to the uterine cavity
• Often treated with laparoscopy, in which a
  telescope-like instrument with a camera is
  inserted into the pelvic cavity through a tiny
  incision just about the navel

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Fibroids

• Fibroids are benign tumors that grow in the
  uterine wall, and can also be attributed to
  difficulty conceiving
• Although fibroids are common, they only cause
  about 3 of infertility cases
• They push into the cavity of the uterus and make
  it almost impossible for the embryo to implant
• Usually removed through surgery

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Uterine Malformation

• Uterine Malformation makes it very difficult to
  conceive and successfully carry a pregnancy
• Bicornate Uterus is the most common type of
  congenital malformation where the uterus is
  formed like a heart rather than a pear allowing
  less space for the embryo to grow
• Septate Uterus is where the uterus is divided by
  a wall on the inside, which can sometimes extend
  the entire length of the uterine cavity
• In both cases surgery can be preformed in order
  to try and fix it

Septated Uterus
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Causes

• The womans age has a strong bearing on
  fertility, and as the woman ages, the chance of
  successfully conceiving decreases, as all of a
  females eggs are present at birth and never
  resupplied
• By age 30, 7 of couples were infertile
• By age 35, 11 of couples were infertile
• By age 40, 33 of couples were infertile
• At age 45, 87 of couples were infertile
• Other problems with fertility can arise when
  males have a very low sperm count, low sperm
  motility, or poor sperm quality

A dark, low quality egg with an irregular shape
from a 41 year old
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Clomiphene Citrate

• If the problem is found to be related to
  irregular ovulation, the initial step usually
  requires a treatment of Clomiphene Citrate, which
  is an oral prescription that stimulates FSH
  (follicle-stimulating hormone), corrects
  irregular ovulation, and helps increase egg
  production
• Shown to induce ovulation in about 80 of women,
  out of which about ½ achieve pregnancy
• Clomiphene fools the body into believing that the
  level of estrogen is low, resulting in the
  hypothalamus sending a signal to the pituitary
  gland to release more FSH into the bloodstream.
  The high level of FSH stimulates the development
  of a follicle and egg, followed by a sure of LH
  (luteininzing hormone) which causes the egg to be
  released

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In Vitro Fertilization

• During IVF, medications are used to help
  stimulate the development and release of a
  womans eggs.
• Eggs and sperm are then collected and placed
  together in a laboratory dish to fertilize.
• If the eggs are successfully fertilized, the
  embryos are then transferred back into the
  womans uterus or fallopian tubes

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• Four stages
• Ovarian stimulation goal is to create a large
  number of mature follicles as to increase chances
  of fertilization
• Egg Retrieval medication is used to stimulate
  the release of mature eggs (then doctors withdraw
  as many eggs as possible)
• Fertilization approximately 50,000 sperm are
  placed with each egg in an incubator where they
  will hopefully be fertilized, eggs will be
  examined under microscope to determine if
  fertilized, and will be transferred into the
  uterus within about 72 hours
• Embryo transfer embryos are placed in a tube
  and transferred back into uterus

Singer Celine Dion seeks in vitro fertilization
to conceive another child at the age of 37
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Intracytoplasmic Sperm Injection (ICSI)

• ICSI is a procedure used alongside IVF if the
  male has abnormal sperm counts, motility, or
  quality
• Laboratory technician, using a microscope
  attempts to inject a single sperm directly into
  each egg
• Embryo is then transferred into the uterus in the
  same way as IVF
• Video

http//www.rmanj.com/images/icsi.mpg
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Assisted Hatching

• Just prior to implanting in the uterus, the
  embryo must emerge from its covering in a process
  known as hatching
• In some women, especially as they age, the
  membrane around the embryo hardens and interferes
  with the hatching process
• In some cases, hatching is assisted by thinning
  the membrane using a dilute acidic solution or
  lasering a small hole in the shell

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Egg Donations

• In egg donation, IVF is preformed in the same
  way, except that the egg used is not from the
  woman who wishes to have the child, it is from a
  donor
• The donor usually receives fertility medications
  to stimulate the production of multiple eggs,
  while the recipient may also receive medications
  so that her cycle mirrors that of the donor and
  that her body is prepared for the embryo

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Sperm Donations

• Sperm donation occurs when the males sperm can
  not be used and donated sperm must be used
• Can be obtained from sperm banks, and is used in
  exactly the same manner as in IVF
• Sperm donations can sometimes be avoided by using
  TESA (testicular sperm aspiration) or MESA
  (microscopic epididymal sperm aspiration), which
  are procedures used to retrieve sperm when there
  are none in the ejaculate
• Men who have little or no sperm in their
  ejaculate due to a blockage or absence of the vas
  deferens, require TESA or MESA
• If enough sperm is then retrieved after one
  procedure then the extra can be frozen for future
  use
• Video
• http//www.rmanj.com/images/micro1.mpg

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Freezing

• Cryopreservation also known as freezing, it
  involves storing the embryos at a very low
  temperature so they can be preserved and used at
  a later time
• Often done when there are more embryos or sperm,
  then necessary at that time
• IVF success rates are generally lower with frozen
  embryos, although they have been improving
• Egg and ovarian tissue freezing are still
  experimental techniques
• Have the potential to be helpful for women with
  cancer, as chemotherapy and radiation treatment
  can be harmful to the eggs

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Surrogacy

• Involves one woman carrying a pregnancy for
  another
• Gestational surrogacy when a woman carries a
  pregnancy created by the egg and the sperm of two
  other people
• Traditional Surrogacy when the surrogate is
  inseminated with the sperm or the male partner of
  an infertile couple
• The female partner or couple must legally adopt
  the child after birth

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How much is too much?

• Many of these procedures are very expensive and
  invasive
• Health insurance may only pay for some of the
  treatments, creating a financial burden on many
  couples
• How far should they go to have a child that is
  biologically theirs before adopting? How far is
  too far?