Optimum fertility based on life cycle analysis is between the ages of 20 and 25 and then, declines gradually. Sometime between the ages 35-37, the approach to treatment takes on a more aggressive role as fertility declines more rapidly. The Center for Advanced Reproductive Medicine and Infertility is equipped to test your fertility potential at any age group and helps you achieve the best balance of treatment.
The effect of aging on infertility is most pronounced among those who postpone child-bearing due mainly to strong pressures to prioritize their careers. Relative fertility is decreased by half among women in their late 30’s compared with women in their early 20’s. For men, semen parameters decline after age 35 but does not appear to decrease appreciably until after 50. The defect in fertility decline with age seems to come from genetic defects which develop in the sperm and egg cells over time.
For purposes of counseling patients, this is usually the 6 days leading up to ovulation (which is usually 14 days before a menstrual period). This fertility window can be used by couples wanting to try it out first in the natural way and as such, be given the advice to time their intercourse.
Very thin or obese individuals are at risk for infertility. Although clinical studies suggest that patients stand to have the best chances to get pregnant at the ideal body mass index or BMI (19 to 25), the BMI range of 19 to 35 seems to work. If your BMI is out of this range, the center can help you, especially if you have irregular menses.
There is little evidence that dietary variations such as vegetarian diets, low-fat diet, high-protein diet or herbal remedies can affect fertility. However, it is wise to seek out a balanced intake. Heavy seafood intake has been associated with infertility due to high mercury levels. We advise women to take 400 micrograms of folic acid daily to reduce the risk of central nervous system defect in their newborn.
A healthy balance of meals is usually all that Is needed. But there will be instances when your doctor may prescribe vitamin and mineral supplements and antioxidants to improve on certain parameters needed for optimum fertility.
There is no evidence to suggest that prolonged abstinence from ejaculation improves semen parameters. In fact, it may work to the contrary, as damaging free-radical molecules appear in the semen in fasted patients. This rather touchy topic can be best explained in a consultation with doctors who may need more information from you.
In a majority of cases, regular monthly menses mean regular ovulation. Some tests may further confirm if ovulation occurs. These useful tests include pelvic ultrasound (done in the appropriate time, many times done in series), or Leuteinizing Hormone (LH) tests by blood or urine. Another method is the use of commercially available LH or ovulation kits, but some special advise from your doctor may have to be given regarding their optimal effectivity.
There is no measured amount in scientific studies but it is a well-documented fact that smoking accelerates the rate of egg depletion in the ovaries. Smoking increases the miscarriage risk. Smoking may decrease sperm density and motility. Smoking increases damage to DNA in both sperm and egg. It would be wise to stop smoking.
We advise up to 2 cups of coffee per day, if you are optimizing your fertility. More than 5 cups a day decreases fertility. More than 3 cups a day during pregnancy increase miscarriage risk. Even though the fertility risks associated with alcohol has not been fully established, one serving of alcohol a day seems harmless.
For optimized natural fertility, 3 times a week is the norm. Sub-normal semenology reports may benefit from less frequent contacts but done during the fertile window. Prolonged periods of abstinence from intercourse is not advised.
Observing sperms in the laboratory, vaginal lubricants seem to decrease fertility. These include K-Y Jelly, Touch and Astroglide. Saliva has the same effect in inhibiting sperm motility and velocity. Mineral oil-based lubricants and hydroxymethylcellulose appear to have no effect. However, in all these, there is no live study to prove the laboratory findings. If there is a need for lubrication, we recommend mineral oil, canola oil and hydroxymethylcellulose.
Stress plays a role in infertility by altering the hormonal environment in which the gametes thrive. Regular communication with your spouse, between the couple and the center and within your social circle may help. Other methods include yoga, acupuncture and naturopathy.
There is strong mounting evidence that acupuncture works in certain conditions of infertility and erectile dysfunction. To identify these, we advise patients to consult with an infertility specialist.
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Intrauterine insemination (IUI) is a fertility procedure in which sperm are washed, concentrated and injected directly into a woman's uterus. In natural intercourse, only a fraction of the sperm make it up the woman's genital tract. IUI increases the number of sperm in the fallopian tubes, where fertilization takes place. IUI may be done in a natural cycle, but is commonly performed with fertility medications to enhance ovulation. Thus, for the infertility couple, IUI is commonly performed as a low-tech, cost-effective approach to enhancing their fertility.
IUI is typically the first procedure utilized if a woman cannot conceive either naturally or with the use of fertility medications alone. It may be recommended for several diagnoses of infertility, some of which include:
Intrauterine insemination is not considered to be an effective treatment for:
Because sperm are inseminated into the uterus, it is important that the woman has no serious fertility problems. Prior to initiating IUI treatment, the woman must have at least one documented open fallopian tube as demonstrated by a hysterosalpingogram (tubal dye study), and has a normal uterine cavity.Because IUI relies on the natural ability of sperm to fertilize an egg within the reproductive tract, it is important that tests for male infertility indicate reasonable sperm function (count, motility and morphology). An average total motile sperm count of 10 million is the standard threshold utilized when deciding if IUI should be considered, or, if the couple should look at other options such as in-vitro fertilization (IVF) with Intracytoplasmic sperm injection (ICSI).
IUI is usually done with concomitant controlled ovarian stimulation using fertility medications, such as clomiphene citrate or injected gonadotropins. IUI can be timed via ovulation induction protocols, as when the patient’s ovulation is being monitored by her physician or, through the use of ovulation predictor kits that the woman can do herself. Response to ovulation medication via ovarian follicle growth (size and number of follicles) will be assessed through serial transvaginal ultrasound monitoring (Figure 1). This will determine the proper timing for the IUI procedure.Prior to IUI, a semen sample will be collected from the male partner through ejaculation into a sterile container and then washed. Sperm washing refers to the laboratory technique that separates sperm from semen, and non-motile sperm from motile sperm. Approximately 2 hours are required to process the sperm. The IUI procedure usually takes place quickly after sperm washing has been completed. To prepare for the IUI procedure itself, a speculum will be inserted into the woman’s vagina and then a thin, flexible catheter, or tube, will be placed into the cervix. Washed sperm (Figure 2a) are then injected directly into the uterus with a syringe (Figure 2b). The procedure is not uncomfortable for most women and takes 5-10 minutes from start to finish.
While complications of the IUI procedure itself are uncommon, they can include brief uterine cramping and infection. Risks of controlled ovarian hyperstimulation with IUI are increased when fertility medications are used. These include multiple pregnancy and Ovarian Hyperstimulation Syndrome (OHSS). OHSS is a serious complication, which may result in fluid imbalance, blood clotting problems, cardiopulmonary compromise, and rarely, even death. Thus, it is advised that IUI using controlled ovarian stimulation protocols be handled by a competent Reproductive Endocrinology and Infertility specialist.
It is suggested in most clinical guidelines that 3-6 repeat cycles of IUI may be done, granting that there are no serious causes of infertility identified. If unsuccessful, then in vitro fertilization or IVF is the next appropriate treatment option.
With clomiphene citrate and IUI, pregnancy rates average 7% per cycle. FSH ovarian stimulation (injectable gonadotropins) and IUI treatment have a reported pregnancy rate of 12% per cycle. However, there may be other factors that need to be considered in predicting possible success in IUI. These include age of the wife, quality of semen of the husband, and cause of the infertility.
In vitro fertilization (IVF) is a method of assisted reproduction in which a man's sperm and a woman's eggs are combined outside of the body in a laboratory dish. One or more fertilized eggs (embryos) may be transferred to the woman's uterus, where they may implant in the uterine lining and develop. Excess embryos may be cryopreserved (frozen) for future use. Initially, IVF was used to treat women with blocked, damaged, or absent fallopian tubes. Today, IVF is used to treat many causes of infertility, such as endometriosis and male factor, or when a couple's infertility is unexplained.
IVF was initially used to treat women with blocked, damaged, or absent fallopian tubes. Today, IVF is used to treat many causes of infertility, such as endometriosis and male factor, when a couple's infertility is unexplained or in women with advanced maternal age where her chances for pregnancy are rapidly declining and IVF remains as the best possible option.
The basic steps in an IVF treatment cycle are ovarian stimulation, egg retrieval, fertilization &embryo culture, and embryo transfer. During ovarian stimulation, medications or "fertility drugs," are used to stimulate multiple eggs to grow in the ovaries rather than the single egg that normally develops each month. Using ultrasound examinations and blood testing, the physician can determine when the follicles are appropriate for egg retrieval (Figure 1). Generally, eight to 14 days is required. When the follicles are ready, hCG or other medications are given.Egg retrieval is done before ovulation occurs, usually 34 to 36 hours after the hCG injection. It is usually accomplished by transvaginal ultrasound aspiration, a minor surgical outpatient procedure (Figure 2) that is done with some form of analgesia administered. The eggs are aspirated from the follicles through the needle connected to a suction device with the guidance of ultrasound probe inserted through the vagina. Removal of multiple eggs can usually be completed in less than 30 minutes. In some circumstances, one or both ovaries may not be accessible by transvaginal ultrasound and laparoscopymay then be used to retrieve the eggs using a small telescope placed in the umbilicus. In the phase of fertilization and embryo culture,the retrieved eggs are examined in the laboratory for maturity and quality (Figure 3). Mature eggs are fertilized by micro-insemination or intracytoplasmic sperm injection (ICSI). The next day, the eggs are evaluated for signs of fertilization and are kept under special conditions to allow further growth and development. Depending on the program, developing embryos may be cultured in the IVF lab for two to six days after the egg retrieval and become.embryos from 2-cells to blastocysts (Figure 4).
During embryo transfer, the physician and the embryologist inform the couple about the quality and number of available embryos and discuss the options before the couple decides on the number of embryos for transfer. Once a decision is made, the embryologist loads the embryo/s into a transfer catheter while the physician prepares the patient. No anesthesia is necessary, although some women may wish to have a mild sedative. Once the catheter is prepared, it is quickly handed over to the physician who gently guides the tip of the transfer catheter through the cervix and places the fluid containing the embryos into the uterine cavity (Figure 5). The patient is then given additional medications for 2 weeks after which a serum pregnancy test is done.
The average time that is required to complete one IVF cycle (from start of ovarian stimulation to testing for pregnancy) is about four to six weeks, depending on the chosen ovarian stimulation protocol appropriate for your case.
Intracytoplasmic sperm injection (ICSI) is the step in the IVF process which aims to achieve fertilization for the collected eggs. In ICSI, a single sperm is directly injected into each mature egg (Figure 6). ICSI is usually performed when there is a likelihood of reduced fertilization, i.e., poor semen quality, history of failed fertilization in a prior IVF cycle, etc.
Your chances will depend on a few factors, most crucial of which are women’s age, presence of co-morbidities (endometriosis, previous ovarian surgery), and quality of husband’s sperm). In addition, success rates vary from center to center and between practicing clinicians. Generally, pregnancy rates from a single IVF cycle may range from 20% to 80% depending on the clinical picture per case. Do ask your doctor regarding your chances after full evaluation.
Patients themselves may help increase their chances by approaching their ideal body weight and by avoiding avoiding certain lifestyle habits (smoking, alcohol-drinking, caffeine-drinking). Studies have shown that women who are within normal body mass index (BMI) 20-24 kg/m2 tend to have a higher chance of success during IVF than women who have higher or lower BMI values. Similarly, some reports have shown that cigarette-smoking and alcohol-drinking, by either the wife or the husband especially during the time of IVF treatment significantly decreases their chances of a successful outcome. A similar recommendation regarding coffee-drinking has also been reported. For these reasons, these lifestyle habits must be avoided during an IVF try.
The average cost of one IVF cycle in CARMI should be around P250,000 to P300,000 unless certain other services were added to the specific programs. These rates are the lowest in the country and are comparable to the rates in Taiwan, Vietnam, and Thailand. All this for top-of-the-line services and excellent success rates.
Acupuncture is a technique of Traditional Chinese Medicine (TCM), which is a system that focuses on treating the person, not just the symptoms. TCM is based on the philosophy that Qi (chee), translated as ‘vital energy’ or ‘life force,’ influences the activities of the entire human being, and that disturbances in the harmonious flow of Qi bring about imbalance, thus illness. The ultimate goal of TCM treatment is to attain a state of homeostasis by regulating the body’s Qi through different techniques.Acupuncture is the technique of TCM where hair-thin needles are inserted into specific sites on the body known as ‘acupoints.’ The sensations felt in the process are believed to influence the flow of qi, regulating its flow, to bring a state of balance and harmony to the body. When this is achieved, the body is able to cultivate itself into optimal health and fertility may be restored.
Acupuncture has been used in the treatment of infertility in China ever since the Sui Dynasty (589 AD). Following the principles of TCM, the practitioners stimulate acupoints to strengthen the reproductive organs, regulate the production of hormones, and restore deep relaxation to body and mind. Both partners may receive a series of acupuncture treatments to promote optimal reproductive fitness overall.Scientific research has shown that acupuncture potentially benefits fertility in women by 1) balancing hormone levels 2) regulating menstrual cycles 3) increasing blood flow to the reproductive organs including the endometrial lining 4) promoting endorphin-mediated stress relief. Among subfertile men, some studies have shown that acupuncture may also potentially 1) improve sperm count 2) improve viability, motility, and functionality of sperm 3) reduce the number of sperm defects.
Although acupuncture has yet to be fully embraced by modern medicine and that a lot of issues remain controversial from its perspective, more and more health facilities all over the world have accepted acupuncture into their infertility programs. Certain centers in such countries as the US, UK, Canada, Sweden, and Germany have included acupuncture protocols into their IVF programs. A top IVF facility in the US reports that 60% of their patients undergo acupuncture treatment.
Acupuncture is similar to physical therapy in that it is a process-oriented method of medical intervention. Patients commonly treated for 2-4 months before an insemination or in vitro fertilization. This period of treatment seems to have a therapeutic effect.There are variations though in treatment approach. A Scandinavian protocol encourages women to receive acupuncture treatments pre and post embryo transfer. In a US study, the most effective fertility treatments involve a combination of acupuncture and traditional medical interventions.
There are many scientific journal articles that suggest a beneficial effect of acupuncture in conjunction with IVF. Among them is a 2002 German study that showed significantly increased pregnancy rates by using acupuncture on the same day of embryo transfer. More recently, a 2008 meta-analysis published in the British Medical Journal reported increased clinical pregnancy and live birth rates. Although there are also a number of scientific studies that suggest no benefit in including acupuncture with IVF, there are no articles that suggest harm. As a consequence, there has been a steady increase in ART centers which have incorporated acupuncture treatment into their programs.
While some patients respond to acupuncture quickly, acupuncture certainly does not work overnight. Most patients require a series of ongoing treatments over a few months to a year. The recommended treatment schedule is based on consideration of a variety of factors in each individual case. In many cases, we recommend that you start acupuncture treatment at least 2 months prior to the commencement of the IVF cycle and that you continue for 1 to 2 times a week until the day of the transfer.
Not usually. A very gentle needling technique is used and the sensation experienced from an acupuncture needle is not like that of a hypodermic needle. In fact, acupuncture needles are one-tenth the thickness of a hypodermic needle. Most patients do not mind the needles and enjoy their treatments. The needles are 100% sterile and are disposed after use.
There are minimal risks when using acupuncture for fertility treatment. A risk for miscarriage may develop if incorrect acupuncture points are used when a woman is pregnant. This is one reason why those wishing to include acupuncture in their treatment regimen should be treated by acupuncturists who are well versed in treating fertility disorders. Acupuncture though is not contraindicated for anyone regardless of their pathology or what medications they are taking.
The exact location of acupuncture points will vary from patient to patient and from treatment to treatment. Some of the most well-known acupuncture points, traditionally used to influence the function of the female reproductive organs, are located on the lower back, lower abdomen, and legs. The points on the lumbar, sacrum, and low abdominal regions are particularly important in consideration of female anatomy and the related nerve segmental innervations. The points on head, neck, upper back and arms are used in order to stimulate the autonomic nervous system and further induce the relaxation process.
Moxibustion is a form of fire heat treatment that stimulates specific acupuncture points of the body. Moxibustion has been used in tandem with acupuncture to treat a variety of diseases throughout Asia for thousands of years. Most women who have difficulty conceiving have symptoms of cold hands and feet even in the summertime and sufficient blood flow to their reproductive organs is often compromised. The heat stimulation applied on selected acupuncture points helps to increase blood circulation to the uterus and pelvic area and induces a deep relaxation response which aids fertility as well.
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