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F.A.Q. FREQUENTLY ASKED QUESTIONS
Infertility is a disease of the reproductive system that impairs one of the body's most basic functions: the conception of children. Conception is a complicated process that depends upon many factors: on the production of healthy sperm by the man and healthy eggs by the woman; unblocked fallopian tubes that allow the sperm to reach the egg; the sperm's ability to fertilize the egg when they meet; the ability of the fertilized egg (embryo) to become implanted in the woman's uterus; and sufficient embryo quality.
Finally, for the pregnancy to continue to full term, the embryo must be healthy and the woman's hormonal environment adequate for its development. When just one of these factors is impaired, infertility can result.
No one can be blamed for infertility any more than anyone is to blame for diabetes or leukemia. In rough terms, about one-third of infertility cases can be attributed to male factors, and about one-third to factors that affect women. For the remaining one-third of infertile couples, infertility is caused by a combination of problems in both partners or, in about 20 percent of cases, is unexplained.
The most common male infertility factors include azoospermia (no sperm cells are produced) and oligospermia (few sperm cells are produced). Sometimes, sperm cells are malformed or they die before they can reach the egg. In rare cases, infertility in men is caused by a genetic disease such as cystic fibrosis or a chromosomal abnormality.
The most common female infertility factor is an ovulation disorder. Other causes of female infertility include blocked fallopian tubes, which can occur when a woman has had pelvic inflammatory disease or endometriosis (a sometimes painful condition causing adhesions and cysts). Congenital anomalies (birth defects) involving the structure of the uterus and uterine fibroids are associated with repeated miscarriages.
Couples are generally advised to seek medical help if they are unable to achieve pregnancy after a year of unprotected intercourse. The doctor will conduct a physical examination of both partners to determine their general state of health and to evaluate physical disorders that may be causing infertility. Usually both partners are interviewed about their sexual habits in order to determine whether intercourse is taking place properly for conception.
If no cause can be determined at this point, more specific tests may be recommended. For women, these include an analysis of body temperature and ovulation, x-ray of the fallopian tubes and uterus, and laparoscopy. For men, initial tests focus on semen analysis.
Most infertility cases -- 85 to 90 percent -- are treated with conventional therapies, such as drug treatment or surgical repair of reproductive organs.
In infertile couples where women have blocked or absent fallopian tubes, or where men have low sperm counts, in vitro fertilization (IVF) offers a chance at parenthood to couples who until recently would have had no hope of having a "biologically related" child.
In IVF, eggs are surgically removed from the ovary and mixed with sperm outside the body in a Petri dish ("in vitro" is Latin for "in glass"). After about 40 hours, the eggs are examined to see if they have become fertilized by the sperm and are dividing into cells. These fertilized eggs (embryos) are then placed in the women's uterus, thus bypassing the fallopian tubes.
IVF has received a great deal of media attention since it was first introduced in 1978, but it actually accounts for less than five percent of all infertility treatment in the United States.
Yes. Since 1981, when IVF was introduced in the U.S., more than 45,000 American babies have been born from IVF and over 70,000 from all assisted reproductive technologies. The average live delivery rate for IVF in 1995 was 22.5 percent, about the same as the 20 percent chance in any given month that a reproductively healthy couple has of achieving pregnancy and carrying it to term.
There has been concern that the health of the children born as a result of fertility treatment might be impaired. A study of 5856 babies born from all the fertility clinics in Sweden between 1982 and 1995 were compared with a similar number in the general population in the same period. The authors investigated the incidence of childhood cancers through the Swedish Cancer Register related to maternal age, parity, previous subfertility, year of birth, and multiple pregnancies.
There was a very significant increase in the multiple pregnancy rate (27%) compared with 1% in the control group. This meant that more children were born preterm (37 wks) than in the controls (30.3% vs 6.3%) and more had low birth weights (2500g - 27.4% vs 4.6%). Malformations occurred in 5.4% of all the babies born in the in vitro fertilisation group and the rates of neural tube defects and oesophageal atresia were higher than in those of the control groups. The was no increase in childhood cancer in the IVF group.
The authors conclude that the frequency of multiple births and maternal characteristics were the main cause of adverse outcomes and not IVF itself.
They felt that there was a continuing need to decrease the occurrence of prematurity after IVF, that there was a continuing trend in reducing the number of embryos transferred (generally only 2 in Sweden) - in about 20% of the cases only 1 embryo was transferred.
There is a conflict of interest between higher success rates associated with more embryos transferred and the long term disadvantages of increased risk of multiple births and the associated abnormalities. They conclude that further research is needed to enable clinicians to select one viable embryo for insertion to enable the effectiveness of treatment to be maintained while substantially lowering the medical risks to the children born.