Infertility is something only those who have experienced it understand fully. It is not just a medical issue with which to be dealt; it is something that infuses every part of your life. Although infertility is a personal journey, it is one that many travel and sharing that journey has never been more possible than today.

Infertility Support

When a couple is diagnosed with fertility problems, the fertility treatment center is likely to recommend a support group. Many people find support groups helpful as they seek treatment and experience the many complicated emotional, social, economic and medical issues associated with infertility. Some of the advantages of local infertility help and support groups include:

• A close local group can be a source of information on local infertility helps
• Provide the opportunity to know others in the area who are dealing with the same issues
• A resource for local fertility centers

Online Forums Provide Infertility Help

With the advent of the internet, many online support groups have been created to provide valuable infertility help. While every person is unique, in the vastness of online support groups a person is very likely to find someone who’s diagnosis and circumstances are very similar to their own. Online support groups can provide the knowledge that there are many people out there who have been right where you are, and lead very full and happy lives while they deal with the many complexities of infertility. Some of the many advantages of online infertility help includes:

• The opportunity to remain somewhat anonymous allows the participant to express thoughts and fears more feely than they might otherwise in person.
• Online forums disseminate information very quickly and are often the best place to learn about new treatments, adverse effects and other relevant information.
• Dealing with anger and sadness may also be easier when discussed with the privacy that an online forum provides.

Online Forums Can Provide Practical Infertility Help

Although there are many medical issues with which online forums can provide help, everyday practical help is also very valuable. Dealing with infertility is emotionally exhausting, and many people can unknowingly be hurtful. It is difficult to be happy when it seems nearly every occasion is an opportunity to be reminded of your desire to have a child. An online support group can help in dealing with the emotions that come up when a kind, but somewhat thoughtless sister-in-law constantly updates her website with the potty training progress of her 1 year old or what to say when someone asks, yet again, if you plan on having children. many groups are for men or women only and gives each the place to vent feelings without the feeling of being monitored. An online community can help in dealing gracefully with the many every day situations that come up, such as:

• Attending baby showers for family and coworkers
• Lost pregnancies
• Probing questions
• Well meaning but uninformed advise
• Marital problems
• Financial stresses
• Dealing with physicians when you do not see eye-to-eye
• Practical help in dealing with the side effects of infertility treatments

Dealing with infertility can be a long and painful journey but one that can be rewarding with the added help of those who understand the difficulty personally. There is an amazing wealth of information and infertility help right at the finger tip, and always, many willing to share in the journey.

The use of cryopreservation in fertility treatments has been widely applied since the 1980s when pregnancy and live birth was first achieved from a frozen and thawed embryo. Since that time, reproductive technology continues to advance and now, in addition to embryo cryopreservation, egg cryopreservation is also becoming more common. New to reproductive technology, egg freezing is giving additional choices to couples trying to conceive or wishing to extend or preserve their time of conception. Having been recently developed, a relatively few number of people have yet chosen to have their eggs thawed yet although early results show a better than 20% success rate.

What is Embryo Cryopreservation?

Embryo cryopreservation, or embryo freezing, is a commonly used form of assisted conception treatment for couples experiencing fertility problems. Typically, to assure the highest possibility of success, more embryos are created than will be used in one IVF cycle. When there are embryos that are not used in an IVF treatment, many couples opt to preserve them for possible use in a subsequent treatment cycle. In order to be preserved, the embryos undergo the following process:

• The embryos are placed in thin vials which resemble straws
• A preservation solution is added to the vile to protect the embryo
• The vials are stored in a controlled freezer containing liquid nitrogen

The Thawing Procedure

• The Embryo is brought to room temperature
• The embryo is cleaned of any preservation fluid
• The embryo is warmed to body temperature

The Transfer Procedure

• A thin catheter is gently guided through the cervix and into the uterus
• The embryo is transferred to the uterus

Many women report that the Frozen Embryo Transfer (FET) process is much less stressful than a “fresh” embryo transfer and many fertility specialists have much better results using embryo cryopreservation.

What is Egg Freezing?

Very new in reproductive technologies, egg freezing is offering new possibilities in couples trying to conceive. The egg freezing process is very much like the embryo cryopreservation process. In egg freezing, some of a woman’s eggs are collected to be frozen and used at a later date. Like in embryo cryopreservation, the eggs are stored in protective medium and frozen. Although so new that very little data has yet been obtained, the process is proving very promising. Already, 300 pregnancies have been achieved using the process. Typically, the process is considered for women 40 years old or younger. Though the principle is the same, there are some slight differences in the process which include:

• Some of the media used to process the eggs is different
• The eggs require a different cooling rate
• Egg freezing has not been around as long as embryo cryopreservation and long term data is not available

Preserving Fertility Options

Both embryo cryopreservation and egg freezing are options for those either having difficulty conceiving or those who wish to preserve fertility options and start a family at a later time.

Infertility is a personal and often emotionally draining journey that, while in it, feels desperately alone and as if there is no end. If you are having trouble conceiving, it may be encouraging to know that there is hope. Here are a few infertility success stories — personal journeys which may inspire you.

Amanda’s Story
After trying to conceive for 31/2 years Amanda went to see a fertility treatment center where she was diagnosed with polycystic ovaries. After some hard and stressful times, IVF helped her complete her family.

Zannyha’s Story
At 25, Zannyha and her husband were surprised to find that they were pregnant without trying too hard. The pregnancy was completely uneventful until the very last moment when her daughter went into fetal distress and was born dead. After this heartbreaking tragedy, the couple decided to wait before tying to have another child. After 3 years, when they decided they were ready to try again, they found it difficult to get pregnant. Within 5 years they had cashed in retirement funds and sold their home to pursue treatments at the fertility treatment center. The stress began to have an impact on their relationship and she felt that sex was purely for the purpose of getting pregnant, lacking romance or emotion. Just when they though all hope was gone, they found they were pregnant with their beautiful baby girl.

Helen’s IVF Story
Never dreaming that infertility would be part of her life, 33-year-old Helen and her husband went to a fertility treatment center after 2 years of trying to conceive. After a devastating miscarriage and months of emotional highs and lows, the couple welcomed a baby girl who is the joy of their life.

Kellie’s Story
Infertility is difficult, especially when you are surrounded by young couples all starting families. For Kellie, living on a Military base while experiencing fertility problems was a heart rending experience. With a husband who was deployed 3 times to Iraq, it was easy to assume that stress could be a contributing factor. Weight may have also been a contributing factor she feels and underwent a gastric bypass. However, after seeing the help of RE, she was diagnosed with Polycystic Ovarian Syndrome (PCOS). Soon, Kellie had the wonderful news that she was pregnant and after a grueling pregnancy, welcomed a new little girl to the family.

Mary’s Story
Mary and her husband endured 8 emotionally draining years of visiting the fertility treatment center and learning all there is to know about infertility. Having a child just did not seem like it would be part of their future, until, Christmas morning brought happy news.

PJ’s Story of Premature Menopause
At 35, PJ never guessed that she and her husband would have difficulty having a child. After a year of trying, she and her husband decided to see a specialist at the fertility treatment center for help. After 3 failed IUIs, they decided to investigate other options. Soon, PJ found to her surprise that she had conceived naturally.

For most Americans, Traditional Western Medicine is all they have ever known. Naturally, when experiencing infertility, they turn to the possible solutions offered by western medicine. However, western medicine is not the only approach available as more and more western medical practitioners open the door to alternative therapies that are widely accepted and relied upon outside of the United States.

Most times, when we think of fertility treatments, we think of the many advances that modern medicine has brought to fertility treatment centers and their patients. However, fertility treatments were not invented or popularized in the west. The benefits of acupuncture and Traditional Chinese Medicine (TCM) as treatment for infertility can be found in literature dating back to 11AD, and western medicine is only recently recognizing the benefits.

What is Acupuncture?
The ancient Chinese practice of acupuncture involves the placement of thin needles at particular points and intervals on the body to direct and stimulate the body’s vital energy (qi). In TCM, a disruption in the energy patterns is thought to cause disharmony in the body which causes it to not function properly. It is painless and has no harmful side effects.

How Does Acupuncture Affect Infertility?
Exactly why acupuncture affects infertility has failed to be understood or scientifically explained by western medicine, but many studies show that it clearly does – positively. Although the practice continues to be considered alternative medicine, many studies are being done, and the subject is gaining widespread attention. Some possible reasons for acupuncture’s favorable influence on fertility include:

• The stimulation of the central nervous system which causes an increase in neurohormones and neurotransmitters
• Changes in the nervous system which regulate body temperature
• Changes in blood pressure, regulating blood flow to reproductive organs
• The releasing of endorphins
• Stimulating egg production
• Stimulating sperm health

What Do Studies Show?
In 2002, a study conducted in Germany followed 80 women who either received both acupuncture and IVF or IVF alone. It is reported that 42% of the women receiving both treatments became pregnant, while only 26% of those receiving IVF treatments alone became pregnant. An even more recent study conducted in the U.S. followed 114 Women. The study showed some compelling results:

• 51% of the women receiving both treatments became pregnant
• 36% of the women receiving IVF alone became pregnant
• 8% of the women receiving acupuncture experienced miscarriage
• 20% of those receiving IVF alone experienced miscarriage
• The group receiving acupuncture also experienced fewer ectopic pregnancies

Western Medicine Embracing Possibilities
Although, undoubtedly, much research will continue in the area, western medicine is embracing the possibilities that acupuncture offers. In fact, many acupuncturists are seeing an increase in referrals from primary care physicians and fertility treatment center endocrinologists. Additionally, many progressive fertility treatment centers now have acupuncturists on staff.

How or why acupuncture affects the ability to become pregnant remains elusive to modern science. However, the positive impacts for many are undeniable. Many find the possible benefits, coupled with no adverse impact, make acupuncture worth investigating.

Conflicting reports concerning the Sperm Injection Fertility Method have many couples  asking their fertility treatment center for clarification. A study, involving 1,000 babies born after intracytoplasmic sperm injection, ICSI, seemingly confirmed fears that there is an increased risk of birth defects when compared to the general population of all babies conceived using some type of fertility treatment or babies born without the use of any fertility treatments.

What is Intracytoplasmic Sperm Injection (ICSI)

Used primarily in male factor infertility, the ICSI process involves the fertility treatment center embryologist first selecting viable sperm using micromanipulation tools. The sperm is then injected through the outer shell of the egg and egg membrane, then into the cytoplasm of the egg. Fertilization using this process occurs in about 85% of cases.

ICSI is Most Commonly Performed in These Cases

Although there is no specific standard of care concerning which cases should or should not use ICSI, most fertility treatment centers consider them in these common scenarios:

• When there is a concern over a low yield of egg retrieval
• For couples having already attempted IVF treatment an experienced no or low rate of fertilization
• In male factor infertility cases that do not wish to use donor sperm
• Couples with low sperm concentrations or low sperm motility

What Do Studies Show?

Several studies conducted since the procedure was introduced in 1991 have, not surprisingly, conflicting findings. In most studies, there does seem to be an increase in the rate of  birth abnormalities in those babies conceived using ICSI as opposed to those conceived naturally. The controversy lies in how those results are interpreted.

A new Swedish study published in the Journal of Human Reproduction says that fears of birth defects resulting from the procedure are largely unfounded. The study asserts that the perceived increase in the rate of birth defects is mainly attributable to, or the result of, conditions associated to multiple or premature births. About 50% of the reported cases involved only minor conditions.

One Plausible Link

However, one specific birth abnormality did seem to be over-represented. Hypospadias may possibly be attributed to ICSI and is associated with paternal fertility problems. Hypospadias is an abnormality of the penis where urine passes through an abnormally placed opening on the undersurface of the penis. The condition is not serious and can be easily treated with plastic surgery.

On Going Studies

The ICSI procedure is fairly new and ongoing studies will no doubt continue and may shed new light on this treatment. ICSI for many couples represents their greatest hope of achieving a pregnancy and undue weight should not be placed on these results. The latest studies should reassure those seeking ICSI as a fertility treatment option, rather than cause concern. Couples considering ICSI should remember that thousands of healthy, normal babies are born every year using this procedure.

Any couple considering Intracytoplasmic Sperm Injection as a fertility option should discuss any concerns they may have with their fertility treatment center doctor.

Fertility Option After Cancer Treatment – Ovarian Tissue Transplant

The development of better cancer treatments has resulted in much improved survival rates for cancer patients, which in turn, has led to many new options and concerns. One of the many concerns for young female cancer patients is the high risk of premature ovarian failure as a result of the life saving cancer treatments. The risk of ovarian failure varies depending on many factors:

•The patient’s age
•Area or field of  irradiation

Additionally, the type of chemotherapy used plays a huge role, with the group called alkylating agents posing the greatest risk. This group includes:

•Busulfan
•Chlorambucil
•Cyclophosphamide
•Ifosfamide
•Nitrosoureas
•Melphalan
•Procarbazine

Bone marrow transplantation is thought to be most responsible for ovarian failure with 80% of patients experiencing premature failure.

New Treatment Therapies
Until very recently, fertility treatment centers could offer those patients very few options. Today, one of the most exciting and promising treatment options is the cryopreservation of ovarian tissue as a method of preserving fertility. This treatment option is best for patients too young or are otherwise not a candidate for egg or embryo banking.

What is Cryopreservation of Ovarian Tissue?
Cryopreservataion of ovarian tissue is performed before radiation or chemotherapy treatments and does not require ovarian stimulation. Performed at a fertility treatment center or at an oncofertility center, an ovary is removed from the patient and then frozen. The outpatient laparoscopic procedure takes under an hour, is simple, done under general anesthesia and is not especially painful. Recovery time is minimal and patients can begin cancer treatments in a few short days after the procedure.

Usually within 5 years, after the patient is cleared of cancer, the ovarian tissue is then grafted back onto the patient’s fallopian tubes, and in many cases, restores fertility.

Areas of Concern
Patients should make sure that their physician is very familiar with medical oncology, histopathology and reproductive endocrinology. Although no cancer recurrance from ovarian grafts has been reported has been reported yet to date, it is still a concern. Not every patient is a candidate for the procedure and type of cancer plays a critical role in whether or not this therapy is a suitable option. Of particular concern is breast cancer, as this cancer metastasizes haematogenously.

A thorough evaluation of the tissue must be made to rule out any metastasis.  Additionally, a physician may find the procedure is not an option for young breast cancer patients as the patient may be harboring certain gene mutations which may also harbor a co-existing primary ovarian cancer.

The occurrence of ovarian cancer in women under the age of 35 is rare, but it is still a risk that should be considered. Patients with endometrial cancer are also not considered candidates. As promising as the treatment may be, not every treatment is right for every patient. Cryopreservataion of ovarian tissue is still a very new procedure and any concerns should be discussed with your fertility treatment center reproductive endocrinologist.

Early Endometriosis – Surgical Treatment Leads to Unexplained Fertility Outcomes

Fortunately for those who have experienced difficulty conceiving, many significant advances have been made in reproductive diagnosis, treatment and technology. These advances have helped fertility treatment centers to determine the individual causes of infertility and develop an optimum treatment strategy for many couples.

Endometriosis and Unexplained Infertility
However, even in light of these advances, some causes and contributing factors in infertility remain elusive or disputed. Endometriosis, for example, remains a source of controversy. While it is widely accepted that advanced stage endometriosis causes a significant disturbance of the pelvic anatomy which can cause infertility. The impact of early endometriosis is not as clear.

What Is Endometriosis
Endometriosis is a common gynecological disease which occurs in  3-10% of women of reproductive age. In women experiencing infertility, the rate increases to between 20 and 40% of that population. It is defined by the American Medical Association, as the presence of endometrial cells outside of the uterus that may result in pain and infertility.

How Does Endometriosis Develop?
Although not fully not understood, it is thought that the disease develops as a result of the drainage of menstrual debris, cells and blood, back into the abdomen and pelvis through the fallopian tubes. Genetics are likely to also play a contributing role, as women with close relatives suffering from the disease are nearly 7 times more likely to develop the disease.

Clinical Diagnosis
There are several possible ways of diagnosing endometriosis, with varying levels of accuracy. A fertility treatment center may base a diagnosis on the presence of pelvic pain, excessive menstrual pain, and painful intercourse. However, not all patients, even with advanced cases experience pain. A physical examination confirm the presence of the disease, but also may not be reliable or conclusive. Frequently, a diagnosis is reached based on the exclusion of possibilities. The most reliable form of diagnosis is surgical.

Does Surgical Treatment of Endometriosis Improve Fertility?
Many studies have been done to determine the pregnancy rate between women who were surgically treated for endometriosis and those using controlled ovarian hyperstimulation and intrauterine insemination, and the verdict is still out. Part of the problem is that a clear understanding of the association has yet to be determined.

However, it has been established that the management of the disease through medications alone does not positively impact a person’s ability to become pregnant. The question then becomes, which is more effective; surgical treatment or COH- IUI? In many randomized trials, fertility treatment centers found that women with early stage endometriosis and surgically treated did see an increased rate of pregnancy, as did those using COH-IUI.

Fertility Treatment Centers Help Develop Treatment Strategy
There is much data to support that ablative therapy is as effective as surgical therapies but must be considered on a case by case basis. Most fertility treatment centers agree that management plans for couples experiencing unexplained infertility and endometriosis must be individualized based on many clinical factors, such as:

• The stage of endometriosis
• The age of patient
• The anatomy
• The duration of infertility
• Other contributing factors

Based on your individual clinical profile, your fertility treatment center will develop a plan that is most likely to yield positive results. Discuss your options with your physician.

For many couples experiencing fertility problems, in-vitro fertilization can seem like the one last hope at having the baby that they so desire. Already they have endured months of quenched hopes when they come to the fertility treatment center and embark on an emotional journey of treatment. Most people do expect fertility treatments to be a hard and emotional process-but few are aware of the true magnitude. The process is grueling, both physically and psychologically, and there is little way to prepare for it except through experience.

The Emotional Process of IVF
Since IVF has the highest success rates, and often considered the last course of action, it  is difficult to leave room for the possibility of failure. Seemingly endless trips to the fertility treatment center, shots, date checking, temperature taking, and scheduling all take the forefront of the relationship leaving little room for much else. The days are filled with expectation, and the relationship is consumed with this one goal.

Financial Factors
In addition to the monthly cycle of high hopes and deep disappointments, the couple often begins to feel financial pressures mounting. No doubt most couples would give up anything to have a child, but it does not mean that it will come without difficulty, or that other unexpected expenses will not arise.

After Failed IVF
Many couples experience a wide range of feelings after an IVF failure. There are likely strong feelings of grief, disappointment, and even guilt. The woman may not only feel a deep loss for herself, but also a terrible guilt in not being able to conceive and carry a child her partner so longs for. There may be some secret resentments, however unreal, unreasonable or unfair.  There may be some regret in investing so much of their  time, money and energy into something, only to be so terribly let down.

Grief
As hard as the in-vitro fertilization process can be, while in it, there is always at least the hope of future success. If the IVF process has not been successful, the emotions can range from deep disappointment to a deep depression. Initially, the hopelessness can be overwhelming. Grief has as a schedule unique to each person that can not be forced, hurried or ignored. The good news is; grief does have an end. The time spent in the fertility treatment process with all the hopes and dreams, will remain important and vivid, but the emotions will eventually become bearable.

The Good News
While experiencing depression is a real and reasonable reaction, it does have an end. Studies show that even though infertility can shake the foundations of a relationship, most develop a core strength that others, not experiencing the hardship, do not have. One study notes that an overwhelming majority of couples successfully take an alternate path to parenthood.
Getting on Track
The key to getting through the most difficult times is getting the right help. After  and unsuccessful procedure, the fertility treatment center is like to be able to connect you to professionals that deal specifically with the issues you are facing. Most fertility treatment centers also have support groups to offer the unconditional support of common experience.

A couple experiencing infertility faces an emotional journey filled with many questions and considerations. After choosing a reputable fertility treatment center, it is important to discuss those concerns with the reproductive endocrinologist in the development of a treatment plan.

One of the most common concerns about fertility treatment is whether or not there is a connection between fertility medications and ovarian cancer. Early reports suggested a strong link, but those reports have since been challenged. This concern has been at the center of debate and research for over a decade with experts falling on both sides of the argument.

Recent Studies in ovarian Cancer and Fertility Medications
One of the most in depth studies to date exploring the possible link between fertility medications and ovarian cancer found no convincing association between the two. The study, which was published in the February 2009 British medical Journal followed a group of women under the care of a fertility treatment center and given either gonadotropins, clomiphene citrate, human chorionic gonadotropin, or gonadotropin-releasing hormones, and were compared with women who were not given the drugs.

The study, which is consistent with other recent studies, did calm some fears but did not completely rule out a possible cancer link. The study did note a slight elevation in the instances ovarian cancer and the use of clomiphene, but so low that it cold be a statistical aberration.

The Early Data
One of the major flaws in 1990s research was that it compared statistics from the general population of mostly fertile women with data collected from women being treated at fertility treatment centers, which makes the data skewed. Conversely, critics also note that the study did not follow women long enough and many cases of ovarian cancer occur past the age of 45 where the study ended.

Most Resent Studies
Another recent study suggested that there may be an increased risk of ovarian cancer for those who took clomiphene citrate for more than 12 cycles, compared to those who took the medication for less than 12 cycles. Though the results are unclear and the actual incidence of ovarian cancer very low, it is recommended that individuals considering fertility treatments consult their physician and ask about the fertility treatment center’s practice regarding clomiphine citrate.

Understanding Ovarian Cancer
The risk for developing ovarian cancer in a woman’s lifetime is between 1-2%. Women with certain conditions that may cause them to seek the help of a fertility treatment center such as endometriosis or “unknown infertility” are at a higher risk of developing the disease.
The known causes are multifactorial and include:

• Early onset of menses
• Irregular cycles
• History of untreated infertility
• Never having children

The study also notes that some factors may help reduce a woman’s risk of developing ovarian cancer. Some of those factors include:

• Use of oral contraceptives
• Removal of ovaries
• Late onset of Menses
• Early onset of menopause
• Repeated pregnancies
• Prolonged lactation

Though most studies either find no link, or the incidence is low and the connection unclear, most fertility treatment centers will suggest each patient weigh the desire of having a child against any possible risks.

Surgical Reversal of Tubal Ligation Versus IVF
As one of the results of divorce and subsequent remarriage, a common question posed to fertility treatment centers is whether microsurgical tubal reversal (MTR) or IVF is a better option to attain pregnancy when no other factors contribute to infertility. Both options are clinically reasonable and each woman should become educated about the advantages and disadvantages of each before making a decision.

About Tubal Ligation Reversal Surgery
Tubal ligation reversal is a procedure that rejoins the segments of the fallopian tubes so that eggs can become fertilized. It was once primarily performed in an inpatient situation, requiring 3 hours of surgery, several day hospital stay and month long recovery though things have vastly improved. Fertility treatment centers now perform tubal reversals as an outpatient procedure, frequently using laparoscopy technology; greatly reducing pain, recovery time and procedure expense.

Pregnancy Success Rates After Tubal Ligation Reversal
It is difficult to get specific estimates on the success rates for pregnancy after tubal ligation reversal because not as many studies have been done and, like in IVF, success varies between fertility treatment centers. While studies do suggest that IVF has a higher immediate success rate, it is limited to the amount of procedures a patient can afford, should it not be successful or more children are wanted. The opportunity to conceive after a reversal of tubal ligation is limited only by the couple’s individual contributing fertility factors.

Contributing Factors
As in any course of fertility treatment, it is difficult to know the exact possibility of success or failure. Whether it is success or failure, for the patient experiencing it; it is 100%. It is however possible to know the facts and weigh the possibilities in the balance.

• Before making a decision, it is advisable to know the male partner’s sperm quality. If it is poor and either low in count or motility, it may necessitate and IVF procedure.
• Age of the patient in any fertility treatment is always a consideration. The chances of pregnancy significantly decrease at age 43.
• The status of the tubes also plays an important part. The length of the remaining stumps can determine increase the patients chances if they are longer or decrease the chances if they are shorter. The condition of the fimbria at the end of the tube which essentially pick up the egg upon release, also determines the chances of success.
• Current pelvic conditions. The amount, extent and location of scar tissue can impact the successful outcome after a reversal.

Advantages of Tubal Reversal
There are two main advantages to a surgical reversal of a tubal ligation. One is that because no fertility medication is used, the multiple pregnancy rate is only 2% compared with 25% for IVF treatment. The second major advantage is that there is no need to have another procedure to try to achieve another pregnancy.

When weighing the options, it is important to discuss the options with the reproductive endocrinologist and know the preference of the fertility treatment center, as well as their expertise in tubal reversals.