There are two types of infertility. Primary infertility and secondary infertility.

 Primary infertility is the term used to describe a couple that has never been able to conceive a pregnancy, after at least 1 year of unprotected intercourse.

Secondary infertility describes couples who have previously been pregnant at least once, but have not been able to achieve another pregnancy.

Causes of infertility include a wide range of physical as well as emotional factors. Approximately 30 - 40% of all infertility is due to a "male" factor such as retrograde ejaculation, impotence, hormone deficiency, environmental pollutants, scarring from sexually transmitted disease, or decreased sperm count. Some factors affecting sperm count are heavy marijuana use or use of prescription drugs such as cimetidine, spironolactone, and nitrofurantoin.

A "female" factor -- scarring from sexually transmitted disease or endometriosis, ovulation dysfunction, poor nutrition, hormone imbalance, ovarian cysts, pelvic infection, tumor, or transport system abnormality from the cervix through the fallopian tubes -- is responsible for 40 - 50% of infertility in couples.

The remaining 10 -30% of infertility cases may be caused by contributing factors from both partners, or no cause can be identified.

It is estimated that 10 - 20% of couples will be unable to conceive after 1 year of trying to become pregnant. It is important that pregnancy be attempted for at least 1 year. The chances for pregnancy occurring in healthy couples who are both under the age of 30 and having intercourse regularly is only 25 - 30% per month. A woman's peak fertility occurs in her early 20s. As a woman ages beyond 35 (and particularly after age 40), the likelihood of getting pregnant drops to less than 10% per month.

 

Tests

A complete history and physical examination of both partners is essential.

Tests may include:

• Semen analysis -- the specimen is collected after 2 to 3 days of complete abstinence to determine volume and viscosity of semen and sperm count, motility, swimming speed, and shape.
• Measuring basal body temperature -- taking the woman's temperature each morning before arising in an effort to note the 0.4 to 1.0 degree Fahrenheit temperature increase associated with ovulation.
• Monitoring cervical mucus changes throughout the menstrual cycle to note the wet, stretchy, and slippery mucus associated with the ovulatory phase.
• Postcoital testing (PCT) to evaluate sperm-cervical mucus interaction through analysis of cervical mucus collected 2 to 8 hours after the couple has intercourse.
• Measuring serum progesterone (a blood test).
• Biopsying the woman's uterine lining (endometrium).
• Biopsying the man's testicles (rarely done).
• Measuring the amount of luteinizing hormone in urine with home-use kits to predict ovulation and assist with timing of intercourse.
• Progestin challenge when the woman has sporadic or absent ovulation.
• Serum hormonal levels (blood tests) for either or both partners.
• Hysterosalpingography (HSG) -- an x-ray procedure done with contrast dye that looks at the route of sperm from the cervix through the uterus and fallopian tubes.
• Laparoscopy to allow direct visualization of the pelvic cavity.
• Pelvic exam for the woman to determine if there are cysts.

 

Titled/Tipped Uterus:

tipped uterus is the term used to describe a uterus that is tilted backwards away from the belly. The condition is also referred to as a retroverted uterus or tilted uterus. All three terms are interchangeable. The uterus is normally suspended in a straight up and down position or slightly forward toward the belly. A tipped uterus is usually something you are born with, but can be caused by labor while giving birth or by disease. It occurs in approximately 20% of women.

 

Endometriosis

Fast Facts about Endometriosis:

Common name:	Endometriosis or Endo
Medical name:	Endometriosis
Number of women affected:	At least 5.5 million women in North America alone have endometriosis.
Common symptoms:	Very painful cramps or periods, heavy periods, chronic pelvic pain (which includes lower back pain and pelvic pain), intestinal pain, pain during or after sex, infertility.
Common treatments:	Pain medication Hormone therapy Surgery—laparoscopy (pronounced lapp-are-ah-skoe-pee) or laparotomy (pronounced lapp-are-ah-toe-mee)
Does this disorder affect fertility/childbearing?	About 30 percent to 40 percent of women with endometriosis are infertile, making it one of the top three causes for female infertility. However, endometriosis-related infertility is often treated successfully using hormones and surgery.

 

Endometriosis occurs when tissue like that which lines the inside of uterus grows outside the uterus, usually on the surfaces of organs in the pelvic and abdominal areas, in places that it is not supposed to grow.

The word endometriosis comes from the word “endometrium”—endo means “inside” and metrium (pronounced mee-tree-um) means “mother.” Health care providers call the tissue that lines the inside of the uterus (where a mother carries her baby) the endometrium.

Health care providers may call areas of endometriosis by different names, such as implants, lesions, or nodules.

 

Most endometriosis is found in the pelvic cavity:

• On or under the ovaries
• Behind the uterus
• On the tissues that hold the uterus in place
• On the bowels or bladder

In extremely rare cases, endometriosis areas can grow in the lungs or other parts of the body.

General symptoms of endometriosis can include (but are not limited to):

• Extremely painful (or disabling) menstrual cramps; pain may get worse over time
• Chronic pelvic pain (includes lower back pain and pelvic pain)
• Pain during or after sex
• Intestinal pain
• Painful bowel movements or painful urination during menstrual periods
• Heavy menstrual periods
• Premenstrual spotting or bleeding between periods
• Infertility

Endometriosis can affect any menstruating woman, from the time of her first period to menopause, regardless of whether or not she has children, her race or ethnicity, or her socio-economic status. Endometriosis can sometimes persist after menopause; or hormones taken for menopausal symptoms may cause the symptoms of endometriosis to continue.

About 30 percent to 40 percent of women with endometriosis are infertile, making it one of the top three causes of female infertility. Some women don’t find out that they have endometriosis until they have trouble getting pregnant.

If you have endometriosis and want to get pregnant, your health care provider may suggest that you have unprotected sex for six months to a year before you have any treatment for the endometriosis.

The relationship between endometriosis and infertility is an active area of research. Some studies suggest that the condition may change the uterus so it does not accept an embryo. Other work explores whether endometriosis changes the egg, or whether endometriosis gets in the way of moving a fertilized egg to the uterus.

 

Common Medications for Infertility:

 

Clomid-

Clomiphene citrate (CC, Clomid, Serophene) is often the first fertility drug that couples come in contact with. It is (relatively) inexpensive as fertility drugs go, it is easily taken (orally rather than by injection) and it is the first line drug used for ovulation induction in patients with PCOS and other ovulatory disorders. It has been used for patients with luteal phase defect. It can also be used to assess ovarian reserve or, in other words, the likelihood that a woman's ovaries can still produce viable eggs. Clomid is not useful for women whose ovaries have reached the end of their working life.

Clomid is actually quite a potent and somewhat complicated medication. It is capable of reacting with all of the tissues in the body that have estrogen receptors. These tissues include hypothalamus, pituitary, ovary, endometrium, vagina, and cervix. Clomid influences the way that the four hormones required for ovulation, GnRH, FSH, LH and estradiol, relate and interrelate. While we do not completely understand the mechanisms by which this drug works, in essence it appears that Clomid fools the body into believing that the estrogen level is low. This altered feedback information causes the hypothalamus (an area of the brain) to make and release more gonadotropin releasing hormone (GnRH) which in turn causes the pituitary to make and release more FSH and LH. More follicle stimulating hormone and more luteinizing hormone should result in the release of one or more mature eggs - ovulation.

When used for ovulation induction, Clomid is taken orally for approximately five days early in the menstrual cycle. Depending upon your clinic protocol this may start as early as day 3 or as late as day 5. It is important to remember that the first day of the menstrual cycle is the first day of normal bleeding, not spotting. Most women begin with an initial dose of one tablet (50 mg.) per day. This dose may be increased by your physician in subsequent cycles if pregnancy does not occur. Once ovulating, most pregnancies occur in the first 6 cycles of treatment. Clomid is said to be able to induce ovulation in as much as 85% of the women who use it, though only half of those will actually become pregnant. Most authorities agree that continuing for more than 6 ovulatory cycles in not likely to increase the chances of success.

Twin pregnancies may occur in as many as 5% of the women who use Clomid. Triplet pregnancies are far more rare. Other reported adverse effects include ovarian enlargement 13.6%,Vasomotor Flushes 10.4%, abdominal or pelvic discomfort, distention or bloating 5.5%, nausea and vomiting 2.2%, breast discomfort 2.1%, visual symptoms (blurred vision, lights, floaters, waves, unspecified visual complaints, photophobia, diplopia, scotoma, etc.) 1.5%, headache 1.3% and abnormal uterine bleeding (intermenstrual spotting, menorrhagia)1.3%. Although there has been much talk about the relationship of clomiphene (and other fertility drugs) to ovarian cancer the vast majority of the evidence now seems to point at infertility itself, rather than the use of fertility drugs as being the primary explanation for the slightly increased incidence of reproductive cancers in the infertility population. (See recent discussion on our boards.)

Clomid has been used to induce ovulation for more that thirty years. There is not any evidence that it causes an increase in congenital abnormalities or birth defects in children. It is not associated with an increase in premature labor or in other complications of pregnancy.

GONAL-F:

GONAL-f contains follitropin alfa, which is similar to follicle stimulating hormone (FSH) found naturally in humans.

In women

GONAL-f can be used to bring about the development of follicles in women who are not ovulating and who have not responded to treatment with clomiphene citrate.

GONAL-f is also used to stimulate the development of several follicles in women undergoing assisted reproductive technologies (ART) such as in vitro fertilisation (IVF).

In men

GONAL-f is used in combination with human chorionic gonadotrophin (hCG) to stimulate the production of sperm.

GONAL-f is given as a subcutaneous (under the skin) injection in the stomach or thigh.

The injection site should be changed daily to lessen possible injection site reactions.

If your doctor or nurse decides you can give the injections yourself, the doctor or nurse will teach you the injection technique. Do not self-inject until you are sure of how to do it.

Your doctor may monitor your response to GONAL-f by using ultrasound, blood tests or semen analysis.

Things you must do

You are required to see your doctor regularly so you can be monitored closely throughout your treatment.

If you are about to be started on any new medicine, tell your doctor and pharmacist that you are using GONAL-f.

If you plan to have surgery, tell your doctor or dentist that you are using GONAL-f.

Tell all doctors, dentists and pharmacists who are treating you that you are using GONAL-f

GONAL-f does not interfere with your ability to drive a car or operate machinery.

For Women

Tell your doctor immediately if you become pregnant while using GONAL-f.

Things you must not do

If you are self-injecting do not:

• stop using GONAL-f without telling your doctor;
• change the dose unless your doctor tells you to. Changing your dose without advising your doctor can increase your risk of unwanted side effects or can prevent the drug from working properly;
• give this medicine to anyone else, even if their symptoms seem similar to yours or if they have the same condition as you.

Things to be careful of

For Women

• Treatment with GONAL-f and hCG may increase your risk of multiple pregnancies or births;
• Ovarian Hyperstimulation Syndrome (OHSS) - may occur (see side effects).

To minimise this risk, your doctor may monitor your treatment with regular ultrasounds and blood tests.

SIDE EFFECTS

Tell your doctor as soon as possible if you do not feel well while using GONAL-f. All medicines can have side effects. Sometimes they are serious, most of the time they are not.

If you get any side effects, do not stop using

GONAL-f without first talking to your doctor.

However, should you notice any of the following side effects contact your doctor immediately or go to the accident and emergency section of your nearest hospital:

• swelling of the face, lips tongue, or other parts of the body;
• shortness of breath, wheezing or difficulty breathing;
• skin rash, itching or hives;

For women

Tell your doctor if you notice any of the following:

• headache, dizziness;
• stomach cramps or pain;
• nausea, vomiting;
• diarrhoea;
• breast tenderness;
• hair loss, dry skin;
• pain, redness, itching or swelling at the site of injection;
• ovarian enlargement, bloating.

These are common side effects.

If any of the following happen, stop using GONAL-f contact your doctor immediately or go to the accident and emergency section of your nearest hospital:

• inflammation, swelling or clotting of the blood vessels;
• severe pelvic pain, nausea and vomiting and weight gain, these are early warnings of OHSS.

Other side effects associated with OHSS are:

• severe enlargement of the ovaries, indigestion, diarrhoea, reduced amounts of urine, weight gain, shortness of breath.

Ectopic pregnancy (embryo implanted outside the womb) may occur after treatment with GONAL-f. This is a rare side effect.

For men

Tell your doctor if you notice any of the following:

• acne;
• some breast development;
• weight gain.

These are common side effects.

Other side effects not listed above may also occur in some patients. Tell your doctor if you notice anything else that is making you feel unwell.

Do not be alarmed by this list of possible side effects. You may not experience any of them.

Repronex

is a fertility medication that is injected either subcutaneously or intramuscularly. It contains follicle stimulating hormone and luteinizing hormone purified from the urine of postmenopausal women.

MENOTROPINS (Pergonal®, Humegon®, Menopur®, Repronex®), is a combination of two hormones, called follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Both of these hormones occur naturally in both men and women, and help with fertility. In men, these hormones can help stimulate the development of sperm. In women, these hormones stimulate the development of eggs within the ovary. To increase a woman's chance of getting pregnant, menotropins are used in combination with other fertility drugs. Menotropins are also used for in vitro fertilization ('test tube baby') programs. Menotropins are also known by the name 'HMG'. Generic menotropins injections are not yet available.

They need to know if you have any of these conditions:
•benign pituitary tumor
•cyst on the ovary
•ovarian failure
•testicular failure
•thyroid disease
•vaginal or unusual bleeding
•an unusual or allergic reaction to menotropins, other medicines, foods, dyes, or preservatives
•pregnant (this medicine should not be used if you are already pregnant)
•breast feeding
 

Follistim

Follicle stimulating hormone (FSH) is a naturally occurring hormone. FSH is important in the development of follicles (eggs) produced by the ovaries. FSH is also important in the development of sperm.

•

Follistim is used to stimulate a follicle (egg) to develop and mature. It is used when a woman desires pregnancy and her ovaries can produce a follicle but hormonal stimulation is not sufficient to make the follicle mature. Follistim is also used to stimulate the development of multiple eggs for in vitro fertilization. Follistim can be used by men to increase the production of sperm.

•

Follistim may also be used for purposes other than those listed in this medication guide

Follistim will not induce ovulation if the ovaries are not capable of producing an egg. Also, Follistim will not induce the production of sperm if the testes are not capable of producing sperm.

•

Before using this medication, tell your doctor if you

·

might be pregnant;

·

have a thyroid problem;

·

have adrenal dysfunction;

·

have cancer or a tumor of the breast, ovary, uterus, hypothalamus, or pituitary gland;

·

have undiagnosed abnormal vaginal bleeding; or

·

have ovarian cysts or enlargement not due to polycystic ovary disease (PCOD).

•

You may not be able to use Follistim, or you may require a dosage adjustment or special monitoring if you have any of the conditions listed above.

•

Treatment with Follistim increases the likelihood of multiple births. Multiple births carry additional risk both for the mother and for fetuses. Discuss the risk of multiple births with your healthcare provider.

•

Tell your doctor if you are allergic to neomycin or streptomycin. The Follistim AQ Cartridge may contain traces of these antibiotics and may cause allergic reactions.

•

Do not use this medication if you are pregnant. Follistim is in the FDA pregnancy category X. This means that Follistim is known to cause birth defects in an unborn baby (when used beyond the period of ovulation).

•

It is not known whether Follistim passes into breast milk. Do not use Follistim without first talking to your doctor if you are breast-feeding a baby.

 

More on Fertility Drugs:

Lupron

The brand name of leuprolide acetate. It is a GnRH analog used in fertility treatments to stimulate and then supress hormones like FSH and LH to help increase the number of follicles produced in a given menstrual cycle for the purpose of assisted reproduction. It is given as an injection.

 

 

 

Herbal Fertility medications:

Dong quai ( Angelica sinensis ), also known as Chinese Angelica, has been used for thousands of years in traditional Chinese, Korean, and Japanese medicine. It remains one of the most popular plants in Chinese medicine, and is used primarily for health conditions in women. Dong quai has been called "female ginseng," based on its use for gynecologic disorders such as painful menstruation (dysmenorrhea) or pelvic pain, recovery from childbirth or illness, and fatigue/low vitality. It is also given for strengthening xue (loosely translated as "the blood"), for cardiovascular conditions/high blood pressure, inflammation, headache, infections, and neuropathic (nerve) pain.

Chaste Tree Berry has medicinally active components that act upon the pituitary gland, specifically on the production of luteinizing hormone to influence progesterone levels during the luteal, or late, phase of the menstrual cycle.

Female Fertility Remedies:
There are a variety of different herbal remedies available to help increase female fertility levels. Common herbs for female fertility include:

 

• Red Clover: Red clover is one of the most popular fertility remedies. High in vitamins, calcium, and magnesium, red clover helps to nourish the uterus and relax the nervous system, enabling conception. It is taken as a tea, daily.
• Raspberry Leaf: Raspberry leaf is high in calcium and therefore works to restore hormonal balance. It is excellent when taken alongside red clover.
• Lady’s Mantle: This herb assists in building up the uterine lining and regulating menstruation. It is meant to be drunk as a tincture, once a day.
• False Unicorn Root: False unicorn root not only restores hormonal balance in women, but it also helps to stimulate the ovaries and encourage ovulation.
• Stinging Nettle: Stinging nettle contains high levels of chlorophyll and minerals, which helps to regulate the body’s hormones as well as ovulation and menstruation. It is taken as a tea once daily.

 

Male Fertility Remedies:
There are a few herbal remedies that are designed to target male fertility issues. Popular remedies include:

 

• Astralagus: Astralagus has long been used to treat male infertility. It is thought to improve conception rates by improving sperm motility and concentration.
• Panax Ginseng: Also known as Chinese or Korean ginseng, panax ginseng is a popular infertility remedy in traditional Chinese medicine. It is believed to increase firmness and length of an erection, as well as increase testosterone levels, sperm count, and sperm motility.

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