Infertility

With more information being made available on-line, and support groups helping to increase awareness of infertility, patients have a seemingly limitless amount of information now available to them. One direct result of the ongoing information revolution is that patients today are becoming more knowledgeable and empowered than ever before.

Infertility is the inability to conceive after a year of unprotected intercourse in women under 35, or after six months in women over 35, or the inability to carry a pregnancy to term. Couples who have known barriers to fertility, such as endometriosis, polycystic ovarian syndrome, male factor infertility, irregular cycles, etc., do not need to sit out the traditional waiting period to seek expert care for infertility.

A thorough history should include information about past surgical history, medical history, exposures to tobacco, alcohol, environmental toxins, a history of sexually transmitted diseases, a careful menstrual history, a history of any past pregnancies, a through review of all organ systems, and any other relevant information.

Pelvic pain Menopause PMS Infertility Recurrent Pregnancy Loss Prolactin Polycystic Ovaries Pelvic SurgeryEndometriosis Fibroids Reversal of Tubal Ligation Ectopic Pregnancy Multiple Gestation Endometrial Polyps Preimplantation Genetic Diagnosis (PGD)

Extend Fertility™ and Reproductive Medicine Associates of New York (RMA of NY) today announced initial results in the ongoing Extend Fertility-sponsored multi-site study designed to further the science and efficacy of oocyte cryopreservation or “egg freezing.”

The purpose of this proposal is to outline suggested clinical pathways for the management of infertility and common reproductive endocrinology problems. The goal is to create an approach that provides the greatest success while using limited resources in the most cost-effective fashion.

A fact that makes reproductive medicine unique is a specific and quantifiable end point- a healthy baby. Each infertile couple and each and every assisted reproduction technology (ART) program are vitally interested in success rates. The stakes are high. Truly, success breeds success.

Polycystic ovary syndrome is characterized by enlarged ovaries, multiple peripherally arranged cysts and increased stromal density(1). Polycystic ovary syndrome is responsible for approximately 25-30% of infertility in women, which is mainly anovulatory(2). Ovulation can be induced with antiesterogens in many women but a proportion fail to respond and even in those who ovulate, the pregnancy rate is often low and the miscarriage rate is high.

Pregnancy loss is a frustrating and challenging problem for couples and clinicians alike. Although medical textbooks specifically target the recommended "work-up" towards those patients labeled as "recurrent" or "habitual aborters", it is important, in this author's opinion, to consider certain specific aspects of evaluation after any miscarriage.

This question is in reference to a 36 year old woman that needs to know if there is any other way to concieve once the tubes have been clipped and burned?

In women with severe clomiphene-resistant PCOS, we proposed thatthe insulin-lowering agent troglitazone (Rezulin®) could have a positive impact on the ovarian microenvironment by supporting normal follicular growth, ovulation, and successful pregnancy.

So far medicine has had nothing to offer the man with azoospermia because of testicular failure, in the way of treatment. His only treatment choices were: adoption, or donor insemination.

Researchers have been investigating the role of various genes which may play an important role in PCOS. One of these candidate genes appears to be in the area and possibly in the insulin receptor gene of chromosome 19.

One of the most publicized papers of the 1999 American Society of Reproductive Medicine/ Canadian Fertility and Andrology Society was the research presented by Dr. Oktay, Dr. Karkujaya, Dr. Gosden and Dr. Schwartz from Cornell University in New York and and from the University of Leeds in the UK. They successfully auto-transplanted frozen-banked ovarian tissue and demonstrated the resumption of ovarian function.

Ectopic pregnancy, or preembryo implantation outside the endometrial cavity (i.e., fallopian tube, cervix, abdominal or pelvic cavity), is a potentially fatal condition with an incidence of 1:150 diagnosed pregnancies.

Lowering insulin levels with metformin in women with polycystic ovary syndrome but without overt diabetes increases the likelihood of conception and reduces risk of miscarriage, researchers report here.

Serum Estradiol/Progesterone Ratio on Day of Embryo Transfer May Predict Reproductive OutcomeFollowing Controlled Ovarian Hyperstimulation and In vitro Fertilization

The association between premature ovarian failure (POF) and the FMR1 repeat number (41> CGGn< 200) has been widely investigated. Current findings suggest that the risk estimation for POF can be calculated in the offspring of women with pre-mutated FMR1 alleles.

In recent years, clinical assisted reproduction techniques (ART) are increasingly being practiced worldwide, which in turn has led to an accumulated surplus of cryopreserved embryos within fertility clinics [1,2].

Premature ovarian failure (POF) is a primary ovarian defect characterized by absent menarche (primary amenorrhea) or premature depletion of ovarian follicles before the age of 40 years (secondary amenorrhea).

Stein and Leventhal were the first to recognize an association between the presence of polycystic ovaries and signs of hirsutism, amenorrhea, oligomenorrhea and obesity. Subsequently, it was reported that after successful wedge resection of the ovaries in women diagnosed with Stein-Leventhal syndrome, menstrual cycles became regular and these patients were able to conceive.

Polycystic ovary syndrome is characterized by anovulation (irregular or absent menstrual periods) and hyperandrogenism (elevated serum testosterone and androstenedione). Patients with this syndrome may complain of abnormal bleeding, infertility, obesity, excess hair growth, hair loss and acne.

The uterus can lie in different positions in the pelvis, and it may vary from one woman to another. Most commonly, the uterus lies horizontally over the bladder, as do the ovaries. As the uterus enlarges with pregnancy, or perhaps with a large fibroid, it will cause increasing pressure on the bladder, and this results in increasing urinary frequency, pressure symptoms, and perhaps lower abdominal protrusion.

I have been involved in learning about and helping to develop alternatives to hysterectomy for many years. I have been instrumental in refining the use of the laser in an office setting to treat pre-malignant diseases of the cervix. I have treated thousands of women with the laser, many of whom would have otherwise had a more invasive treatment or hysterectomy.

A very common question of perimenopausal women is whether or not they are still able to get pregnant, and this inquiry may originate from one of two concerns. Some women in the perimenopausal range may still want to conceive, either to start a family or to add to an existing one, and are seeking information to help with that decision.

The majority of women in the perimenopausal period have completed their childbearing and resolutely do not want to conceive at this age. This gives rise to the question as to what contraceptive method they should use to prevent an unwanted pregnancy. At this stage in their lives, an unintended pregnancy would be devastating, and it is something they are usually very eager to avoid.

If you have just been told that you may need to have a hysterectomy, what are you feeling? Frightened, uncertain, vulnerable, angry, out of control -- don't panic. I don't think anyone could have had any more of a negative reaction than I did when I was told, "you should probably think about having surgery."

More than 10 million American women suffer from excessive menstrual bleeding or heavy periods, a condition known as menorrhagia. In fact, more than 20 percent of the 600,000 hysterectomies performed annually in the United States treat menorrhagia. But because this health issue is so rarely discussed, few women realize that the condition can be easily treated during a 30-minute outpatient procedure as opposed to having a hysterectomy.

Does hysterectomy mean a woman's sex life is ruined? Here, Paul Indman, MD, shares his take: orgasm is still in the cards for many women.

Patients with endometriosis can have symptoms varying from constant excruciating pelvic pain to no symptoms whatsoever. Paradoxically, the extent of endometriosis has no correlation to the amount of pain a women will experience. Some women with severe endometriosis do not have any symptoms and may not know they have endometriosis until a pelvic mass is detected on a routine pelvic examination or a problem with infertility is discovered.