1. Infertility 101 Dana Ambler, DO Director, Donor Egg Program Associate Physician Conceptions Reproductive Associates

2. MythsFacts You’ll get pregnant if... you just relax you go on vacation you stop thinking about it you stand on your head after intercourse Stress –Little effect if regular menses & ovulate –Moderate stress has some effect on fertility –Severe stress- problems with ovulation and fertilityIntercourse –Having it will help you conceive

3. MythsFacts Most people who get pregnant at fertility clinics, have “mutiples” (twins, triplets and more) ~ 80% patients who conceive have a singleton pregnancy 10 - 20% will have twins <1% of all patients have triplets

4. MythsFacts Most people need to have multiple tests done to first diagnose the problem even before starting treatment Most couples need very few tests to determine the cause of the infertility –Semen analysis –Test for ovulation (Blood tests) –Test to check fallopian tubes

5. MythsFacts Insurance never covers the cost of infertility treatment Up to 30% of insurances cover some of the costs 15 states already have laws mandating fertility coverage It is critical to write your legislator if you think this is important

6. MythsFacts Miscarriages are caused by –Stress –Picking up something heavy –Having intercourse Miscarriages are usually the result of an abnormal egg and/or sperm resulting in an embryo with abnormal DNA This cannot be prevented once the embryo has formed

7. MythsFacts Egg quality decreases at the age of 32 Up to 10% chance of pregnancy per month if 35 and older Approximately 20% chance that pregnancy will result in miscarriage

8. Infertility Twelve consecutive months of unprotected intercourse without conception –>35 years old → six months –>40 years old → immediate evaluation Worldwide, 1 in 7 couples have problems conceiving 85-90% conceive in one year Primary Infertility and Secondary Infertility

11. Typical Evaluation History and Physical Exam (Female) –Duration of infertility? Previous treatment? –Regular menstrual cycles? Abnormal bleeding? –Severe pain with menses or intercourse? –Sexual history? Timing? Contraception? Lubricants? –Previous surgeries, hospitalizations, infections? –Medical conditions? –Occupation? Tobacco, alcohol, drug use?

12. Typical Evaluation Tests for Ovarian Reserve –Follicle Stimulating Hormone –Luteinizing Hormone –Estradiol –Anti-Mullerian Hormone –Ultrasound

13. Typical Evaluation (Female) Tests for Ovulation (if uncertain) –21 day progesterone –Ovulation predictor kit –Thyroid, Prolactin, vit D –Polycystic Ovarian Syndrome Syndrome

14. Typical Evaluation Test of Anatomy: –Hysterosalpingogram (HSG) –Laparoscopy (if suspect endometriosis or pelvic abnormality)

15. Typical Evaluation History and Physical Exam (Male) –Sexual history? Timing? Contraception? Lubricants? –Prior genital injury? Surgery? –Infections? –Drug/Medication Use? –History of fathering children? –Medical conditions? –Occupation? Tobacco, alcohol, drug use?

16. Typical Evaluation (Male) Tests for husband –Semen Analysis (SA) –Physical exam if SA is abnormal Varicocele? Normal testicular development? Laboratory evaluation

17. Infertility Statistics Age of female

18. Infertility Treatments Surgery Superovulation or Ovulation Induction Intra-uterine Insemination (IUI) In vitro Fertilization –Intracytoplasmic Sperm Injection (ICSI) –Complete Chromosomal Screening (CCS)

19. Treatment of Infertility Ovulation defect –Fertility medications –Other options Metformin (PCOS) Bromocriptine Dexamethasone Aspirin Progesterone DEPENDS ON AGE OF FEMALE

20. Intrauterine Insemination

21. In Vitro Fertilization Fallopian Tube disease Endometriosis Male Factor Infertility Multifactor or Unexplained Infertility Advanced Reproductive Age Premature Ovarian Failure Mullerian anomalies Medical Disease Genetic Disorders Previous treatment failures

22. Treatment of Infertility Male Factor –Referral to Urology –Antibiotics –Very little success with any treatment except IUI and IVF (medications seldom helpful) –High dose antioxidants and multivitamins –Surgery –Boxers not briefs –No hot tubs –No smoking/drugs

23. Treatment of Infertility “If every test is normal, why can’t we get pregnant?” Unexplained Infertility –Wait and see –Clomiphene + IUI (Inseminations) –Gonadotropins + IUI –In Vitro Fertilization (IVF)