Infertility: What is it?

Condition of the reproductive system that prevents the The diagnosis of infertility is usually given to couples who
have been attempting to conceive for at least 1 year without success. What causes infertility in men? Azoospermia (no sperm cells are produced) Oligospermia (few sperm cells are produced). Sperm cells are malformed or they die before they can reach the egg. Genetic disease such as cystic fibrosis or a chromosomal abnormality. (rare) conception of children.

ZIFT-Zygote Intra Fallopian Transfer Zygote-the immediate product of fertilization *Similar to IVF, but the zygote is transferred sooner, at 24 hours post fertilization. It is inserted during a laparoscopic surgical procedure, into the fallopian tube. Side Effects, Pros and Cons are the same as IVF with a few differences: Due to the surgical insertion of the zygote into the fallopian tube, theres an increased risk for bleeding, infection and allergic reactions to the anesthesia. Ectopic pregnancy is also a great concern. The woman must have at least one working fallopian tube to be a candidate Cost: $15, 000 to $20, 000+ usually more expensive than IVF. Effectiveness: Dependent on maternal age and viability of sperm, but success is usually about 26%, resulting in live births. GIFT-Gamete Intra Fallopian Transfer Gamete-the reproductive haploid cells, egg and sperm Similar to the ZIFT and IVF, but fertilization is not confirmed prior to insertion. The harvested eggs and sperm are mixed and inserted in the fallopian tube through the same laparoscopic procedure as ZIFT. This may also be done with donor sperm, if the woman has indications for IVF/GIFT.

What causes infertility in women? Ovulation disorders (Affect 25%) Blocked fallopian tubes (endometriosis) Congenital anomalies (birth defects) Aging (egg production declines after 35 )
How is infertility diagnosed? Doctor will conduct physical examination Interview both partners about sexual habits **If no cause can be determined at this point, more specific tests may be recommended

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Tests for men General physical examination Semen analysis Hormone testing Transrectal and scrotal ultrasound
Tests for women Ovulation testing. Hysterosalpingography Laparoscopy Hormone testing Ovarian reserve testing Genetic testing Pelvic ultrasound Evaluation is expensive and in some cases involves uncomfortable procedures, and the expenses may not be reimbursed by many medical plans. Psychosocial Reactions: Shock Guilt Isolation Depression Stress on the Relationships Cultural & Religious Considerations

Side Effects, Pros and Cons are similar to ZIFT/IVF, but the biggest disadvantage is fertilization is NOT confirmed prior to transfer. This is also an advantage, because some infertile couples face moral and religious dilemmas when considering fertilization outside of the womb. This could be a viable option for them.
Cost: Generally the same as ZIFT and more expensive than IVF. Most insurance companies do not cover GIFT. Effectiveness: Also dependent on maternal age, but success is about 20% resulting in live births.

Infertility and Reproductive Technology

Fall 2013

References James, P. (2011). Fertility medication. Retrieved from Fertility listings: http://www.fertilitylistings.com/articles/drugs/fertility-medication Marshall, M. (2010). How do artificial insemination and IUI work? Retrieved from WebMD: http://www.webmd.com/infertility-andreproduction/insemination-procedures-for-infertility Mayoclinic staff. (2010). Intrauterine insemination (IUI): Why it's done. Retrieved from Mayo Clinic: http://www.mayoclinic.com/health/intrauterineinsemination/MY00104/DSECTION=why-its-done Nihira, N. (2010). Fertility drug types: Injectables, hormones, clomid, and more. Retrieved from WebMD: http://www.webmd.com/infertilityand-reproduction/guide/fertility-drugs Lowdermilk, D. L., Perry, S. E., & Cashion, K. (2010).Maternity nursing. (8th ed. ed.). Maryland Heights, MO: Mosby.

Jessica, Diane, Leeah and Brandi KCC-ADN

Artificial Insemination

Infertility
Drug Options

IVF-In-vitro Fertilization:
In Vitro=outside of the body (in a laboratory dish) Fertilization=sperm has entered and attached to the egg

Medication is often the first step in treating infertility. For women, there is a wide array of drugs for various fertility problems. Some medications are also utilized for male fertility problems. The following are the most utilized fertility drugs. Clomid is the first line of infertility treatment and costs $50 per cycle. An initial dose of 50mg is taken for five days, and ovulation can be expected in seven days. It can be taken up to six months before deemed unsuccessful. There are fewer severe side effects and 60-80% of women will be able to ovulate while on Clomid, with 50% of them becoming pregnant within three cycles! Gonadotropin, luteinizing hormone (LH) and follicle stimulating hormone (FSH) - These injected hormones can be used for twelve days in order to raise estrogen and help with ovulation. Men also utilize gonadotropins to increase sperm counts. However, serious risks such as an increased risk for miscarriage and hypertrophy of the ovaries can occur. The chances of ovulation with these medications are high and as many as 50% eventually become pregnant while on these medications. Along with the above listed side effects, all ovulation stimulating drugs runs the risk of multiple pregnancies. As most gonadotropins are subcutaneous injections, sites must be rotated. Costs for gonadotropin drugs can cost $2,000$4,000/month Antagon is a drug that reduces ovulation in women who are undergoing IVF. Side effects are stomach pain, headache and fetal defects. Cost: $530 per injection.

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Five basic steps in IVF process 1. Monitor and stimulate the development of healthy egg(s) in the ovaries. 2. Collect the eggs. 3. Secure the sperm. 4. Combine the eggs and sperm together in the laboratory and provide the appropriate environment for fertilization and early embryo growth. 5. Transfer embryos into the uterus.

Artificial insemination is a direct insertion of sperm into the womans cervix, uterus or fallopian tube, allowing the sperm to bypass possible obstructions. Intrauterine insemination (IUI) is the most popular procedure used. Other techniques Intracervical Insemination (ICI) and Intratubal insemination (ITI) Steps: 1. Doctor will make sure the woman is ovulating prior to procedure using an ovulation kit 2. Semen is collected. 3. Semen is washed in the laboratory within one hour of ejaculation 4. The best sperm is chosen, placed in a catheter and introduced to the uterus through vagina and cervix 5. Woman should remain lying for 30-45mins. Then resume normal activities Side effects: Cramping during the procedure and slight bleeding afterwards. Injections can be painful and the side effects of the drugs may include hot flashes, breast tenderness, fluid retention, a bloated feeling, moodiness, depression and/or tenderness in the ovaries. Advantages: Short, simple, painless procedure, usually the choice for initial treatment of infertility Disadvantages: ovulation and timing of procedure is important, may need to do multiple attempts if unsuccessful; success rate is less than 50% chance of getting pregnant Effectiveness: IUI success rate of getting pregnant approximately 10% and 15% with injected FSH medication. Costs: Less expensive than in-vitro fertilization (IVF) varies from clinic to clinic but generally cost between $300-500 per IUI attempt. Additional costs include: sperm washing $100, ultrasound to monitor progress $300, fertility drugs $100-200

Advantages: Couples with infertility problems now have an opportunity to have offspring of their own through this kind of technology and success rates are promising. Side effects: Ovary stimulation carries the risk of hyper stimulation, where the ovaries become swollen and painful. This condition, Ovarian Hyper stimulation Syndrome, is usually rare, mild, and involves the following potential side effects: nausea, vomiting, lack of appetite, or a feeling of being bloated. Danger signs Severe abdominal pain Severe nausea or vomiting Decreased urinary frequency Dark-colored urine Shortness of breath Ten pound weight gain within three to five days Effectiveness: The success rate of IVF clinics depends on a number of factors including patient characteristics and treatment approaches. It is also important to understand that pregnancy rates are not the same as live birth rates. In the United States, the live birth rate for each IVF cycle started is approximately: 30 to 35% for women under age 35 25% for women ages 35 to 37 15 to 20% for women ages 38 to 40 6 to 10% for women ages over 40 Costs There are fertility packages available, financing payment plan, and also pharmacy financing plan. Single cycle plan ~ $9000 or multiple cycle plan ~ $16500 not including medications.