Infertility Guide

Everything You Want to Know About PCOS

PCOS is one of the most common of women’s health concerns, and one of the most common reasons women have trouble trying to conceive. It’s estimated that around 10 million women in the United States suffer from PCOS.  In addition to trouble getting pregnant, there are a number of unfortunate physical problems that can occur from PCOS.

What is PCOS?

First you need to know what PCOS is. PCOS is a collection of symptoms based on hormone levels. It has to do with the way the body produces hormones, and how that affects ovulation. There are a number of characteristics that suggest a woman might have PCOS, such as:

• Hirsutism (which is excessive facial hair or body hair)
• Obesity
• Acne
• Skin tags
• Irregular or infrequent periods
• Thinning hair
• Difficulty trying to conceive

Experts in the medical community aren’t entirely agreed about what constitutes PCOS, but a general-accepted definition includes “Anovulation in the presence of androgen excess, in the absence of other endocrine disorders.”

Why PCOS causes problems with conception

The key factor with PCOS is that ovulation isn’t occurring, or at least it’s not occurring on a regular basis. When ovulation doesn’t occur, you can’t become pregnant.

The excess of androgens – a hormone produced by the ovaries – interferes with ovulation. There’s also some relationship between PCOS and insulin resistance. Insulin helps to bring glucose to your tissues and store it for energy. High insulin levels mean higher blood lipids (including cholesterol) and it can also stimulate the production of excess androgen.

Risk factors for PCOS

Some women are more likely to develop PCOS than others. For example, a woman who has a relative with PCOS has a 50% chance of getting it as well. Women who have two or three blood relatives with diabetes are at an increased risk of developing PCOS, as are women who are overweight.

Treating PCOS

There are a number of ways to treat PCOS, but you need to make sure you’re having conversations with your doctor about whether or not they seem to be working. Many general practitioners may not have a whole lot of experience treating PCOS, and you might ask to be referred to a specialist.

Everything You Want to Know About  IVF

In Vitro Fertilization, or IVF, is a procedure in which a woman’s eggs are combined with a man’s sperm inside a laboratory dish. The eggs and sperm are placed inside a dish along with a special culture that allows the eggs and sperm to survive outside the woman’s body. The dish is kept in an incubator and monitored closely by laboratory personnel to watch for fertilization and cell division to occur. Once the eggs have developed into 2-8 cell embryos, the embryos can then be transferred back into the woman’s body. This process can take up to five days depending on the clinic you use.

Reasons to have IVF

IVF is usually not the first treatment option for infertile couples. Your doctor may try other options including fertility medications or IUI before resorting to IVF. IVF may be advised if you or your partner have been diagnosed with any of the following problems:

• Endometriosis
• Ovulation problems
• Damaged or blocked fallopian tubes
• Problems with the uterus
• Low sperm count or sperm motility problems
• Unexplained infertility

What should you do if you think you need IVF?

Most couples will get pregnant on their own within 12 months of actively trying to get pregnant simply by having regular unprotected intercourse. If you have been trying to get pregnant on your own and are concerned that you might have fertility problems, it is good to start off by seeing a general gynecologist. You should talk to your general gynecologist about your concerns, discuss your medical history, and ask him at what point he would refer you to a fertility specialist. If you are under 35 and have been trying to get pregnant for a year or more, your doctor may refer you to a fertility specialist. If you are 35 or older, your doctor may refer you for fertility treatment after just six months of trying.

Tests that are done before IVF:

Before resorting to IVF, your doctor may want to do some testing to determine what is causing your fertility issues. Some tests that are commonly done before IVF include:

• HIV & hepatitis test: (for safety reasons you and your partner’s blood will need to be tested prior to having IVF)
• Female fertility tests: Before having IVF, you may be required to have blood testing done to check your hormone levels, determine egg quality, and verify whether or not you are ovulating. Your doctor may also want to check the structure of your uterine cavity and check for any blockage of your fallopian tubes. You may be given a test called an HSG, or hysterosalpingogram, which is a special x-ray of the uterus and fallopian tubes. It allows your doctor to see any abnormalities in the uterus or if your tubes are blocked.
• Male fertility tests: Your partner may be required to have a semen analysis done before having IVF. A sample of your partner’s semen may be sent off for analysis to check his sperm count, sperm motility, and sperm quality.
• Mock Transfer: Some clinics will do a mock transfer before doing IVF. During a mock transfer, your doctor will insert a catheter into your uterus, much like he would during a real transfer. This mock transfer allows him to measure the depth of your uterus and to determine the best way to insert the catheter during the real transfer.

IVF Treatment: What to expect

IVF involves fertilizing your eggs in a laboratory dish and then transferring them back into your body. In order for IVF to be successful, you will need to ovulate and produce multiple eggs for fertilization. To make this happen, your doctor will give you fertility medication at the start of your cycle that will stimulate your ovaries to produce several mature eggs for fertilization. Your doctor will have you come in for blood work and an ultrasound to check the development of your eggs. Once your eggs are mature, your eggs can be retrieved for fertilization.

You may be sedated or given local anesthesia for the egg retrieval procedure. The eggs are removed from your ovaries by inserting a thin needle through the back of the vagina. Using an ultrasound to guide him, your doctor will gentle suction the eggs and follicular fluid into test tubes. You may feel some cramping on the day of the procedure. Your doctor may prescribe pain medication to relieve discomfort.

Your partner will provide a semen specimen the day of the procedure. This semen will be used to fertilize your retrieved eggs. If your partner has a low sperm count, a procedure called intracytoplasmic sperm injection may be performed in combination with IVF. This procedure takes a single sperm and injects it directly into the egg to fertilize it.

Your partner’s sperm and your eggs will then be placed inside a laboratory dish and monitored for up to five days. Each of your eggs will be watched until they develop into a group of cells called an embryo. Once your embryos are ready, they can be transferred into your uterus. Your doctor will place up to four embryos inside your uterus during the transfer. To transfer the embryos, he will insert a thin catheter through your cervix and into your uterus, releasing the embryos at the top of your uterus. After the embryos are transferred, you will need to rest. You may stay in bed for several hours following the transfer before you are discharged. If the transfer was successful, you should know within a couple weeks.

IVF Success Rates

IVF success rates vary. Certain fertility problems are more challenging to treat than others. Your age is also a big factor in the success rate of IVF. Likewise, some clinics have higher success rates than others. The CDC keeps track of statistics for all assisted reproductive technology procedures performed in fertility clinics in the US. According to the most recent report from 2005, the percentage of cycles resulting in live births is approximately:

• 37% for women under age 35
• 30% for women age 35-37
• 20% for women age 38-40
• 11% for women age 41-42

Chances of having twins with IVF

If you have IVF, you will have a higher chance of having twins or multiples. Having twins or multiples puts you at a higher risk for having a miscarriage or other pregnancy complications. During each IVF cycle you can transfer up to four embryos. Transferring four embryos will improve your chances of getting pregnant, but it will also increase your chances of having a multiple pregnancy.
According to the CDC, the percentage of IVF pregnancies with twins is approximately:

• 33% for women under age 35
• 27% for women age 35-37
• 22% for women age 38-40
• 13% for women age 41-42

How much does IVF cost?

According to the American Society of Reproductive Medicine, the average cost of one IVF cycle is about $12,400. The price for IVF, however, will vary depending on where you live and the amount of cycles you have done.