1. Infertility Grand Challenge Seminar Fall, 2010

2. What is infertility? Infertility is the term health care providers use for women of normal childbearing age who are unable to get pregnant, and for men who are unable to impregnate a woman, after at least one year of unprotected sexual intercourse. Women who are able to get pregnant but who cannot carry a pregnancy to term (multiple miscarriages) may also be considered infertile.

3. What causes infertility? Pregnancy includes the following steps: A woman’s ovaries must be able to release a viable egg, which then must be able to travel down the fallopian tube. The man must be able to ejaculate, and his sperm must be able to travel to the fallopian tube. The sperm and egg must unite to fertilize the egg. The fertilized egg must attach to the inside of a receptive uterus (or implant) and be nurtured by the body to allow the fetus to develop and grow until it is ready for birth. Problems in any step of this process can cause infertility. In about 1/3 of cases, the problem is with the woman; in 1/3 the problem is with the man; and in 1/3 the problem is with both partners or is unknown.

5. Infertility in Women Most cases of infertility in women result from problems with ovulation. Some conditions affecting ovulation include premature ovarian failure in which the ovaries stop functioning before natural menopause, and polycystic ovary syndrome (POCS) in which the ovaries may not release an egg regularly or may not release a viable, healthy egg. Among women who have PCOS, even when a healthy egg is released and fertilized, the uterus may not be receptive to implantation of a fertilized egg, which results in infertility. Other causes of infertility might include: Blocked fallopian tubes due to endometriosis, pelvic inflammatory disease, or surgery Physical problems with the uterine wall Uterine fibroids

6. Infertility in Men The male fertility process involves the production of mature sperm and getting the sperm to reach and fertilize the egg. Male fertility also requires many conditions to be met: The ability to have and sustain an erection, Having enough sperm, Having enough semen to carry the sperm to the egg, Having sperm of the right shape that move in the right way. A problem meeting any of these conditions contributes to infertility. Like female infertility, male infertility can result from physical problems, such as testes that don’t make enough normal sperm, hormonal problems, and lifestyle or environmental factors.

7. Treatment In about 2/3 of cases, treatment is successful There are a variety of ways to treat infertility, including: Medication Surgery Intrauterine insemination/artificial insemination (woman is injected with carefully prepared sperm from the husband, partner, or a donor) Assisted reproductive technology (ART)

8. ART ART includes all fertility treatments in which both eggs and sperm are handled. In general, ART procedures involve surgically removing eggs from a woman’s ovaries, combining them with sperm in the laboratory, and returning them to the woman’s body or donating them to another woman. They do NOT include treatments in which only sperm are handled (i.e., intrauterine— or artificial—insemination) or procedures in which a woman takes medicine only to stimulate egg production without the intention of having eggs retrieved.

9. Kinds of ART In Vitro Fertilization (IVF) Eggs are removed from the ovary, placed in a petri dish, and fertilized with a few drops of sperm. When fertilized eggs begin to divide they are implanted in the uterus, or frozen. Intracytoplasmic sperm injection A sperm is injected into the egg and then the fertilized egg is implanted. Gamete Intrafallopian transfer. Eggs and sperm are transferred into the woman’s fallopian tubes. In Vivo Fertilization Another woman is artificially inseminated with a man’s sperm. When an embryo has formed, it is transferred to the first woman’s uterus. Surrogate mother. Type 1. Another woman is artificially inseminated with a man’s sperm, and bears the child which is returned to the couple at birth. Type 2. An embryo is produced through IVF and then implanted in the surrogate who bears the child.

10. Considerations about ART Fertility treatments can be disruptive, painful, require multiple cycles. When to stop treatments Many services with varying degrees of skill and success Legal considerations Ethical considerations Financial considerations

11. Success of ART In 2006, 142,435 ART cycles were performed at 430 reporting clinics in the United States. Resulting in 43,412 live births (deliveries of one or more living infants) and 57,569 infants. Although the use of ART is still relatively rare as compared to the potential demand, its use has doubled over the past decade. Today, over 1% of all infants born in the United States every year are conceived using ART.

12. Sources American Society for Reproductive Medicine (2008) Assisted Reproductive Technologies: A guide for patients. Retrieved from the Internet on Oct. 28, 2010 at http://www.asrm.org/uploadedFiles/ASRM_Content /Resources/Patient_Resources/Fact_Sheets_and_Inf o_Booklets/ART.pdf http://www.asrm.org/uploadedFiles/ASRM_Content /Resources/Patient_Resources/Fact_Sheets_and_Inf o_Booklets/ART.pdf Fertility. Retrieved from the Internet on Oct. 28, 2010 at http://www.nichd.nih.gov/health/topics/http://www.nichd.nih.gov/health/topics/ infertility_fertility.cfm