Infertility is a disease defined by the failure to establish a clinical pregnancy after 12 months of regular, unprotected sexual intercourse or due to an impairment of a person’s capacity to reproduce either as an individual or with his/her partner. 

Ok, Ok, we tried to write this section a hundred times with the standard medical terminology and stats as we started above, but we believe that if you’re here, you have an idea about what infertility is, as you’re living it.

The bottom line, you’ve been getting down and dirty for at least 12 months (6 if you’re older than 35) without a successful pregnancy.

In some cases, infertility is established prior to attempting to conceive because of physical and diagnostic findings.

Who has infertility? Here are some stats…

Depending on where you live, up to 15% of couples have trouble getting pregnant or sustaining a pregnancy. 

Unfortunately, these stats are limited to couples, but millions of women dealing with certain medical diagnosis’ such as PCOS and Endometriosis may have trouble conceiving well before they are in a couple and should therefore consider fertility preservation treatments. 

7.4 million women, or 11.9% of women in the U.S., have received some type of infertility services in their lifetime. (2006-2010 National Survey of Family Growth, CDC).

Approximately one-third of infertility is attributed to the female partner, one-third attributed to the male partner and one-third is caused by a combination of problems in both partners or, is unexplained. (American Society For Reproductive Medicine)

Why Do I Have Infertility?

While some infertility diagnoses are easier to pinpoint due to a woman’s age, genetics or underlying health conditions such as diabetes, thyroid or STD’s; there are no statistical findings that can pinpoint to a specific reason most suffer from infertility.

It’s a frustrating answer to read, but healthy adults are just as likely to suffer from infertility as those who may be considered unhealthy. 

This medical condition does not discriminate by age, race or status. It’s important to accept this, as in most cases there is nothing that you could have done to prevent this.

We hope that Embie, along with our community, can become advocates for the next generation to receive better reproductive health care and diagnosis earlier in life. When issues are looked for and found earlier, it will give individuals more choices and control over the viability of their future fertility.  

The post What Is Infertility and Who has it? appeared first on Embie | IVF, IUI ; Egg Freezing Tracking App!.

If you are experiencing irregular or painful periods, inovulation, multiple miscarriages or you and your partner had multiple STD’s you should seek the advice of a specialist earlier. 

How do I find a specialist?

Depending on where you live, your health system may require you to see your General Practitioner/Family Doctor or Gynecologist as a first step to a diagnosis. 

Your ultimate goal should be to be seen by a Reproductive Endocrinologist. 

In the U.S. REs do not require a referral as they work in the private medical sector, but you should see your OB/GYN as well in case parts or all of your medical diagnostic tests can be covered by your health provider. 

More on how to find a specialist and questions to ask your RE can be found here.

How is the cause of my infertility diagnosed?

Once you’ve gone to a specialist, multiple physical and diagnostic tests will be performed to determine you and your partners general, hormonal and reproductive organ health.

With infertility, you’ll often find the below “base” tests, with additional tests being administered as you continue treatment if there’s no success. 

Finding a specialist who is willing to go deeper than the base tests earlier in your diagnosis process is crucial as it could save you so much time, money and heartache on this journey. 

Infertility diagnostic testing can include, but are not limited to the below:

For the woman:

Hormonal Profile on Day 3-5 of your menstrual cycle:

• Estrogen (E2)
• Progesterone (additional test on day 21 of cycle)
• FSH
• LH
• TSH
• Testosterone
• DHEA-S
• Prolactin
• AMH (Done on day 2 or 3 of your cycle)

Uterine Health:

• Hysterosalpingogram (HSG) 
• Sonohysterogram
• Ultrasound to check for AFC, Cysts, Fibroids and Ovaries.
• MRI (if cysts, endometrioma or Large fibroids are found)

For Both Partners:

General Health Blood & Urine Tests:

• SMAC
• CBC / Blood Count
• Glucose 
• PTT & PT
• CMV IgG+IgM
• Toxoplasmosis
• VDRL
• Urine Analysis 
• Blood Type + RH
• Some Vitamin deficiencies such as Vitamin B and D.

Sexual Health:

• Pap (Woman only)
• HIV
• Hepatitis B
• Hepatitis C
• STD Profile

Genetics:

• Tested based on family history and ethnical background. 

Autoimmune and blood disorder tests are normally ordered down the road, but they are worth bringing up to your doctor if you or your partner suffer from a related issue or have a family history with them.

For Men:

Sperm Health:

• Sperm Analysis 
• DNA Fragmentation and Antibodies (if sperm analysis returns with a severe issue)

Hormonal Panel:

• Testosterone
• Estrogen
• LH
• FSH
• TSH

Your RE will analyze the results of these tests to determine an initial cause of infertility and treatment path, which we discuss here. 

Unfortunately, 1 in 5 couples will receive an initial unexplained infertility diagnosis. This is when all baseline tests seem to return as normal, and no specific cause can be determined at that time.

Note that egg quality and certain diseases such as endometriosis can only be diagnosed with more invasive procedures. 

If any of the above tests for male related infertility return abnormal, we recommend you seek the opinion of a Urologist who specialises in male infertility, beyond your RE.

The post How To Diagnose Infertility? A List of Tests & What Specialist To See appeared first on Embie | IVF, IUI ; Egg Freezing Tracking App!.

The good news is that approximately 85-90% of infertility cases are treated with drug therapy or surgical procedures. Fewer than 5% need advanced reproductive technologies (ART) like in vitro fertilization (IVF).

If you’ve been diagnosed with endometriosis or uterine factors such as blocked tubes, fibroids, polyps and septums; your RE may opt to perform a surgical procedure such as hysteroscopy and laparoscopy to correct these anatomical factors and for you to continue to try to conceive naturally before drug therapy and ART are introduced. This is great news as these infertility treatments cost far less and are not as emotionally taxing. 

Severe endometriosis, DOR, the removal of tubes or an ovary or severe male factor may result in fast tracking directly to IVF. 

Each woman or couple’s path can be different, but in most cases once drug intervention is introduced, the following options are available:

Medicated Cycle with Timed Intercourse 

Timed intercourse is a simple and least invasive infertility treatment option for infertility. It involves monitoring your cycle via ultrasound and hormone testing. You’ll then having sexual intercourse around the time you are predicted to be most fertile. 

Medications such as Clomid and Letrozole/Femara are used to stimulate the ovaries, and are often coupled with ovulation induction to control the timing of your ovulation.

IUI / Artificial Insemination

A step above timed intercourse, Intrauterine insemination ( IUI ) – a type of artificial insemination — places Sperm that have been washed and concentrated directly in the uterus around the time your ovary releases one or more eggs to be fertilized.

IUI requires your cycle to be monitored via ultrasound and hormone testing. 

Depending on your diagnosis, you may try a natural or medications IUI cycle. Medicated cycles normally involve the low dosage use of ovarian stimulation and induction drugs to control the timing of your ovulation. 

IVF

In vitro fertilization (IVF) is the most advanced reproductive technology available to infertility patients today.

During IVF, the ovaries are stimulated to produce a large amount of follicles while being closely monitored via ultrasound and hormone testing. Mature eggs are then collected (retrieved) via a surgical procedure from the ovaries and fertilized by sperm in a lab. 

The fertilized egg (embryo) or eggs (embryos) are monitored and either transferred freshly to the uterus or frozen for transfer at a later date via an FET.

IVF with ICSI

Intracytoplasmic Sperm Injection (ICSI) is an add-on to IVF that helps fertilization occur when the sperm cannot penetrate (proven or suspected) the outer layer of an egg, for a variety of reasons. 

During ICSI, an embryologist identifies the best looking single sperm and injects it directly into the cytoplasm of the egg using a tiny needle called a micropipette. 

While ICSI greatly improves the likelihood of fertilization, it does not guarantee it. The ICSI procedure fertilizes 50 to 80 percent of eggs, but results vary depending on maternal age, egg quality, and sperm quality.

The post What Are My Options for Infertility Treatment? appeared first on Embie | IVF, IUI ; Egg Freezing Tracking App!.

We polled our users for their most important factor in choosing a clinic (or perhaps leaving one for another) and the answer was overwhelmingly about the clinic’s personal care and direct access to the RE.

Your infertility journey is one filled with stress, anxiety and the unknown – making your mental health and care just as important as the medical care you’ll receive. Your clinic becomes an extension of your family as they help you literally extend it. 

Before choosing an infertility clinic consider the personal care you’d like to receive and ask yourself and the clinic the following questions: 

• How accessible is my RE/specialist? How does he/she communicate during a cycle? Is he/she available via email or just by phone?
  
• How difficult was it to schedule an appointment with the clinic? Did you have to wait a long time for a nurse or receptionist to call you back? Was there a long wait in the office once you arrived? – Not feeling like a number in a baby making factory is imperative in this process.
  
• What is most important to you when it comes to bedside manner? Empathy, warmth, informative communication, and a clinic that felt invested in your success we’re some of the top reasons for choosing an RE amongst our users.

You also want to learn about the Clinic’s diagnostic testing and the proposed course of care. Here are questions to ask during your initial consultation:

• What is the process for diagnosing my infertility? What tests will be conducted? What is their position on autoimmune, genetic and blood diseases as factors in infertility?
  
• If you already know your diagnosis, is this an area of speciality for this clinic? Ask your RE to explain his experience and success rate with your specific diagnosis and age.

• Are the treatment protocols personalized by diagnosis/couple? What is the process for treatment? What is the timeline for starting treatment or in between cycles if a treatment has failed?
  
• Is the clinic available for monitoring and procedures during the weekends and holidays? How early in the morning do they open / how late do they stay open? Does the lab testing get done at the clinic or go to a 3rd party lab/provider?
  
• If doing IVF, what are the clinic’s thoughts on Fresh vs Frozen transfers, Day 3 Embryos vs Blastocysts, and why?
  
• What happens when a treatment cycle fails? Is there a plan beyond the first few steps of treatment? How does the clinic handle further diagnostic testing?
  
• If important to you, what is the clinic’s position on a holistic approach to care? Do they recommend supplements? Are there lifestyle changes I can make to help my diagnosis? Is there a trained mental health specialist on staff? What do they think about eastern medicine treatments such as acupuncture, reflexology and herbs?
  
• What are the costs associated with testing, treatments and medication? Does my insurance/health care provider cover any of these costs? Does the clinic accept coverage from any other provider? Are there payment plans? Does the clinic guarantee success?
  
• What are the clinic’s success rates for live birth amongst my age group? 

Many fertility centers host open houses so you can meet the doctors before scheduling a consultation and visiting/getting the opinion of multiple RE’s is highly recommended. 

Luckily there are also sites like SART in the US, HFEA in the UK and Global Clinic Ratings with worldwide listings that allow you to do a bit of research prior to choosing the right doctor for you and your partner.

Just remember, this is an important decision that shouldn’t be made out of pressure or stress. You deserve the best care possible. You deserve to feel seen. You should trust your RE and if at any point you don’t feel this way, it’s OK to change your mind/clinics.

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