Infertility

From Wikipedia, the free encyclopedia

Infertility primarily refers to the biological inability of a person to contribute to conception. Infertility may also refer to the state of a woman who is unable to carry a pregnancy to full term. There are many biological causes of infertility, some which may be bypassed with medical intervention.[1]
Women who are fertile experience a natural period of fertility before and during ovulation, and they are naturally infertile during the rest of the menstrual cycle. Fertility awareness methods are used to discern when these changes occur by tracking changes in cervical mucus or basal body temperature.

Definition
There are strict definitions of infertility used by many doctors. However, there are also similar terms, e.g. subfertility for a more benign condition and fecundity for the natural improbability to conceive. Infertility in a couple can be due to either the woman or the man, not necessarily both.

[edit] Infertility
Reproductive endocrinologists, the doctors specializing in infertility, consider a couple to be infertile if:
the couple has not conceived after 12 months of contraceptive-free intercourse if the female is under the age of 34
the couple has not conceived after 6 months of contraceptive-free intercourse if the female is over the age of 35 (declining egg quality of females over the age of 35 account for the age-based discrepancy as when to seek medical intervention)
the female is incapable of carrying a pregnancy to term.

Subfertility
A couple that has tried unsuccessfully to have a child for a year or more is said to be subfertile meaning less fertile than a typical couple. The couple's fecundability rate is approximately 3-5%. Many of its causes are the same as those of infertility. Such causes could be endometriosis, or polycystic ovarian syndrome.

Primary vs. secondary infertility
Couples with primary infertility have never been able to conceive,[2] while, on the other hand, secondary infertility is difficulty conceiving after already having conceived (and either carried the pregnancy to term, or had a miscarriage). Technically, secondary infertility is not present if there has been a change of partners.

Prevalence
Generally, worldwide it is estimated that one in seven couples have problems conceiving, with the incidence similar in most countries independent of the level of the country's development.
Fertility problems affect one in seven couples in the UK. Most couples (about 84 out of every 100) who have regular sexual intercourse (that is, every 2 to 3 days) and who do not use contraception will get pregnant within a year. About 92 out of 100 couples who are trying to get pregnant do so within 2 years. [3]
Women become less fertile as they get older. For women aged 35, about 94 out of every 100 who have regular unprotected sexual intercourse will get pregnant after 3 years of trying. For women aged 38, however, only 77 out of every 100 will do so. The effect of age upon men’s fertility is less clear.[3]
In people going forward for IVF in the UK, roughly half of fertility problems with a diagnosed cause are due to problems with the man, and about half due to problems with the woman. However, about one in five cases of infertility have no clear diagnosed cause [4]
In Britain, male factor infertility accounts for 25% of infertile couples, while 25% remain unexplained. 50% are female causes with 25% being due to anovulation and 25% tubal problems/other [5]
In Sweden, approximately 10% of couples are infertile.[6] In approximately one third of these cases the man is the factor, in one third the woman is the factor and in the remaining third the infertility is a product of factors on both parts.

Causes
This section deals with unintentional causes of sterility. For more information about surgical techniques for preventing procreation, see sterilization.
Common causes of infertility:
Ovulation problems
tubal blockage
male associated infertility
age-related factors
uterine problems
previous tubal ligation
previous vasectomy
unexplained infertility
Tuberculosis (TB

Virus
German scientists have reported that a virus called Adeno-associated virus might have a role in male infertility[7], though it is otherwise not harmful[8].

Causes in either sex
For a woman to conceive, certain things have to happen: intercourse must take place around the time when an egg is released from her ovary; the systems that produce eggs and sperm have to be working at optimum levels; and her hormones must be balanced.[9]
There are several possible reasons why it may not be happening naturally. In one-third of cases, it can be because of male problems such as low sperm count.Some women are infertile because their ovaries do not mature and release eggs. In this case synthetic FSH by injection or Clomid (Clomiphene citrate) via a pill can be given to stimulate follicles to mature in the ovaries.
Problems affecting women include endometriosis or damage to the fallopian tubes (which may have been caused by infections such as chlamydia).
Other factors that can affect a woman's chances of conceiving include being over- or underweight for her age - female fertility declines sharply after the age of 35. Sometimes it can be a combination of factors, and sometimes a clear cause is never established.
Factors that can cause male as well as female infertility are:
Genetic Factors
A Robertsonian translocation in either partner may cause recurrent spontaneous abortions or complete infertility.
General factors
Diabetes mellitus, thyroid disorders, adrenal disease
Hypothalamic-pituitary factors
Kallmann syndrome
Hyperprolactinemia
Hypopituitarism
Environmental Factors
Toxins such as glues, volatile organic solvents or silicones, physical agents, chemical dusts, and pesticides. [10][11]

Combined infertility
In some cases, both the man and woman may be infertile or sub-fertile, and the couple's infertility arises from the combination of these conditions. In other cases, the cause is suspected to be immunological or genetic; it may be that each partner is independently fertile but the couple cannot conceive together without assistance.

Unexplained infertility
In about 15% of cases the infertility investigation will show no abnormalities. In these cases abnormalities are likely to be present but not detected by current methods. Possible problems could be that the egg is not released at the optimum time for fertilization, that it may not enter the fallopian tube, sperm may not be able to reach the egg, fertilization may fail to occur, transport of the zygote may be disturbed, or implantation fails. It is increasingly recognized that egg quality is of critical importance and women of advanced maternal age have eggs of reduced capacity for normal and successful fertilization.

Assessment
If both partners are young and healthy, and have been trying for a baby for 12 months to two years without success, a visit to the family doctor could help to highlight potential medical problems earlier rather than later. The doctor may also be able to suggest lifestyle changes to increase the chances of conceiving. [12]
Women over the age of 35 should see their family doctor after six months as fertility tests can take some time to complete, and age may affect the treatment options that are open in that case.
A family doctor will take a medical history and give a physical examination. They can also carry out some basic tests on both partners to see if there is an identifiable reason for not having achieved a pregnancy yet. If necessary, they can refer patients to a fertility clinic or a local hospital for more specialized tests. The results of these tests will help determine which is the best fertility treatment.

In vitro fertilisation

In vitro fertilisation
From Wikipedia, the free encyclopedia
(Redirected from In-vitro fertilization)

"IVF" redirects here. For other uses, see IVF (disambiguation).
"Test tube baby" redirects here. For other uses, see Test tube baby (disambiguation).
In vitro fertilisation (IVF) is a process by which egg cells are fertilised by sperm outside the womb, in vitro. IVF is a major treatment in infertility when other methods of assisted reproductive technology have failed. The process involves hormonally controlling the ovulatory process, removing ova (eggs) from the woman's ovaries and letting sperm fertilise them in a fluid medium. The fertilised egg (zygote) is then transferred to the patient's uterus with the intent to establish a successful pregnancy. The first "test tube baby", Louise Brown, was born in 1978.

The term in vitro, from the [Latin] root meaning within the glass, is used, because early biological experiments involving cultivation of tissues outside the living organism from which they came, were carried out in glass containers such as beakers, test tubes, or petri dishes. Today, the term in vitro is used to refer to any biological procedure that is performed outside the organism it would normally be occurring in, to distinguish it from an in vivo procedure, where the tissue remains inside the living organism within which it is normally found. A colloquial term for babies conceived as the result of IVF, test tube babies, refers to the tube-shaped containers of glass or plastic resin, called test tubes, that are commonly used in chemistry labs and biology labs. However, in vitro fertilisation is usually performed in the shallower containers called Petri dishes. (Petri-dishes may also be made of plastic resins.) However, the IVF method of Autologous Endometrial Coculture is actually performed on organic material, but is yet called in vitro. This is used when parents are having infertility problems or they want to have multiple births.
Contents[hide]
1 Indications
2 Method
2.1 Ovarian stimulation
2.2 Egg retrieval
2.3 Fertilisation
2.4 Selection
2.5 Embryo transfer
3 Pregnancy rates
3.1 Effect of stress
3.2 Live birth rate
4 Complications
4.1 Birth defects
5 Cryopreservation
5.1 Embryo cryopreservation
5.2 Oocyte cryopreservation
5.3 Ovarian tissue cryopreservation
6 Variations
7 Embryo & Oocyte Donation
8 Acupuncture
8.1 Acupuncture Mechanisms
8.2 Electro-acupuncture in oocyte retrieval for IVF
9 History
10 Ethics
10.1 Issues
10.2 Pregnancy past menopause
10.3 Same-sex couples
11 Religious objections
12 Availability and utilisation
13 See also
14 References
15 Further reading
16 External links
//

[edit] Indications
Initially IVF was developed to overcome infertility due to problems of the fallopian tube, but it turned out that it was successful in many other infertility situations as well. The introduction of intracytoplasmic sperm injection (ICSI) addresses the problem of male infertility to a large extent. (Male infertility consists of failure to produce sperm.)
For IVF to be successful it may be easier to say that it requires healthy ova, sperm that can fertilise, and a uterus that can maintain a pregnancy. Due to the costs of the procedure, IVF is generally attempted only after less expensive options have failed.
This means that IVF can be used for females who have already gone through menopause. The donated oocyte can be fertilised in a crucible. If the fertilisation is successful, the zygote will be transferred into the uterus, within which it will develop into an embryo.

[edit] Method

[edit] Ovarian stimulation
Treatment cycles are typically started on the third day of menstruation and consist of a regimen of fertility medications to stimulate the development of multiple follicles of the ovaries. In most patients injectable gonadotropins (usually FSH analogues) are used under close monitoring. Such monitoring frequently checks the estradiol level and, by means of gynecologic ultrasonography, follicular growth. Typically approximately 10 days of injections will be necessary. Spontaneous ovulation during the cycle is typically prevented by the use of GnRH agonists or GnRH antagonists, which block the natural surge of luteinising hormone (LH).

[edit] Egg retrieval
Main article: Transvaginal oocyte retrieval
When follicular maturation is judged to be adequate, human chorionic gonadotropin (hCG) is given. This agent, which acts as an analogue of luteinising hormone, would cause ovulation about 42 hours after injection, but a retrieval procedure takes place just prior to that, in order to recover the egg cells from the ovary. The eggs are retrieved from the patient using a transvaginal technique involving an ultrasound-guided needle piercing the vaginal wall to reach the ovaries. Through this needle follicles can be aspirated, and the follicular fluid is handed to the IVF laboratory to identify ova. It is common to remove between ten and thirty eggs. The retrieval procedure takes about 20 minutes and is usually done under conscious sedation or general anesthesia.

[edit] Fertilisation
In the laboratory, the identified eggs are stripped of surrounding cells and prepared for fertilisation. In the meantime, semen is prepared for fertilisation by removing inactive cells and seminal fluid. If semen is being provided by a sperm donor, it will usually have been prepared for treatment before being frozen and quarantined, and it will be thawed ready for use. The sperm and the egg are incubated together at a ratio of about 75,000:1 in the culture media for about 18 hours. In most cases, the egg will be fertilised by that time and the fertilised egg will show two pronuclei. In certain situations, such as low sperm count or motility, a single sperm may be injected directly into the egg using intracytoplasmic sperm injection (ICSI). The fertilised egg is passed to a special growth medium and left for about 48 hours until the egg consists of six to eight cells.

[edit] Selection
Laboratories have developed grading methods to judge oocyte and embryo quality. Typically, embryos that have reached the 6-8 cell stage are transferred three days after retrieval. In many American and Australian programmes[citation needed], however, embryos are placed into an extended culture system with a transfer done at the blastocyst stage at around five days after retrieval, especially if many good-quality embryos are still available on day 3. Blastocyst stage transfers have been shown to result in higher pregnancy rates.[1] In Europe, transfers after 2 days are common. Preimplantation Genetic Diagnosis (PGD) procedures may be performed prior to transfer.[2]

[edit] Embryo transfer
Main article: Embryo transfer
Embryos are graded by the embryologist based on the number of cells, evenness of growth and degree of fragmentation. The number to be transferred depends on the number available, the age of the woman and other health and diagnostic factors. In countries such as the UK, Australia and New Zealand, a maximum of two embryos are transferred except in unusual circumstances. In the UK and according to HFEA regulations, a woman over 40 may have up to three embryos transferred, whereas in the USA, younger women may have many embryos transferred based on individual fertility diagnosis. Most clinics and country regulatory bodies seek to minimise the risk of pregnancies carrying multiples. The embryos judged to be the "best" are transferred to the patient's uterus through a thin, plastic catheter, which goes through her vagina and cervix. Several embryos may be passed into the uterus to improve chances of implantation and pregnancy.

[edit] Pregnancy rates
Pregnancy rate is the success rate for pregnancy. For IVF, it is the percentage of all attempts that lead to pregnancy, which generally refers to treatment cycles where eggs are retrieved and fertilised in vitro. Statistics referring to "pregnancy" may refer to just a positive pregnancy test, and not necessarily "viable pregnancy" which implies the detection of a fetal heart beat. Pregnancies that are delivered with a viable baby is called live birth rate. Increasingly a distinction is also made between singleton and multiple pregnancies as multiple pregnancies, specifically more than twins, should be avoided because of the associated maternal and fetal risks.
With enhanced technology, the pregnancy rates are substantially better today than a couple of years ago. In 2006, Canadian clinics reported an average pregnancy rate of 35%.[3] A French study estimated that 66% of patients starting IVF treatment finally succeed in having a child (40% during the IVF treatment at the center and 26% after IVF discontinuation). Achievement of having a child after IVF discontinuation was mainly due to adoption (46%) or spontaneous pregnancy (42%).[4]

[edit] Effect of stress
According to a 2005 Swedish study published in the Oxford Journal Human Reproduction, 166 women were monitored starting one month before their IVF cycles and the results showed no significant correlation between psychological stress and their IVF outcomes. The study concluded with the recommendation to clinics that it might be possible to reduce the stress experienced by IVF patients during the treatment procedure by informing them of those findings. While psychological stress experienced during a cycle might not influence an IVF outcome, it is possible that the experience of IVF can result in stress that leads to depression. The financial consequences alone of IVF can influence anxiety and become overwhelming. However, for many couples, the alternative is infertility, and the experience of infertility itself can also cause extreme stress and depression.

[edit] Live birth rate
Live birth rate is the percentage of all IVF cycles that lead to live birth, and is the pregnancy rate adjusted for miscarriage and stillbirth. These percentages are for successful pregnancies, regardless of the number of children born, as twins and larger multiple-order births are more common in IVF cycles.
In 2006, Canadian clinics reported a live birth rate of 27%.[3] A summary of 2006 reports from US clinics for cycles that did not involve donor eggs gave success rates varied widely by the age of the prospective mother, with a peak at 42.6% for 27-year-olds. Rates for younger patients were slightly lower, with a success rate of 35.3% for those 21 and younger, the youngest group evaluated. Success rates for older patients were also lower and decrease with age, with 37-year-olds at 27.4% and no live births for those older than 48, the oldest group evaluated. [5]
IVF attempts in multiple cycles result in increased cumulatve live birth rates. Depending on the demographic group, one study reported 45% to 53% for three attempts, and 51% to 71% for six attempts.[6]

[edit] Complications
The major complication of IVF is the risk of multiple births. This is directly related to the practice of transferring multiple embryos at embryo transfer. Multiple births are related to increased risk of pregnancy loss, obstetrical complications, prematurity, and neonatal morbidity with the potential for long term damage. Strict limits on the number of embryos that may be transferred have been enacted in some countries (e.g., England) to reduce the risk of high-order multiples (triplets or more), but are not universally followed or accepted. Spontaneous splitting of embryos in the womb after transfer can occur, but this is rare and would lead to identical twins. A double blind, randomised study followed IVF pregnancies that resulted in 73 infants (33 boys and 40 girls) and reported that 8.7% of singleton infants and 54.2% of twins had a birth weight of <>

Mom Delivered Eight (8) Kids

Nadya Denise Doud-Suleman Gutierrez
From Wikipedia, the free encyclopedia

Nadya Denise Doud-Suleman Gutierrez, known as Octomom in the media, is an American woman who came to international attention when she gave birth to octuplets in January 2009.[1][2] The Suleman octuplets are only the second full set of octuplets to be born alive in the United States and, one week after their birth, surpassed the previous worldwide survival rate for a complete set of octuplets set by the Chukwu octuplets in 1998. The circumstances of their high order multiple birth have led to controversy in the field of assisted reproductive technology as well as an investigation by the Medical Board of California of the fertility specialist involved.[3] Public reaction turned negative when it was discovered that the single mother already had six other young children at home at the time and was not financially independent.

Suleman, who was unemployed and on public assistance programs at the time, conceived the octuplets and her six older children via in-vitro fertilization (IVF).

Early life and education
Although Suleman was born in 1975, two dates of birth have been given for her; one is October 12th, while the other is July 11th. It was reported that the birthdate recorded for her as the mother on the birth certificates of her children was July 11th. She was reportedly born in either Bellflower or Fullerton, California [5] (depending on sources) as the only child of Edward and Angela Doud. Her parents married in Las Vegas in 1974, and divorced in 1999.[6][7]

She held a psychiatric technician license, and worked as a psychiatric technician at Metropolitan State Hospital, where her back was injured while at work. She filed a worker's compensation claim in 1999 while working at the hospital, and again filed another claim in 2001 with the Workers' Compensation Appeals Board and over the course of time, received approximately $167,000 in benefits.[8] She attended California State University, Fullerton (CSUF) and received a Bachelor of Science degree in child and adolescent development in 2006. Suleman returned to CSUF to pursue a master's degree in counseling, leaving the program in 2008.[9]


Marriage and divorce
Nadya married Marcos Gutierrez in 1996. According to Gutierrez, they separated in 2000 because they could not conceive children together. Gutierrez filed for divorce in November 2006 and the divorce was finalized in January 2008.[10] Despite their divorce, in an interview with People Weekly, he spoke highly of her and expressed that he wishes her the best.[11]

Children
Nadya Suleman began IVF treatments in 2001 from Doctor Michael Kamrava. In each of her six pregnancies she was implanted with six embryos.[12] The treatments resulted in four single births and one fraternal twin birth, with four boys and two girls born between 2001 and 2006.[13]

Elijah Makai Solomon (boy, 7 years)
Amerah Yasmeen Solomon (girl, 6 years)
Joshua Jacob Solomon (boy, 5 years)
Aiden Solomon (boy, 3 years)
Calyssa Arielle Solomon (girl, twin, 2 years)
Caleb Kai Solomon (boy, twin, 2 years)
Noah Angel Solomon (boy)
Maliyah Angel Solomon (girl)
Isaiah Angel Solomon (boy)
Nariyah Angel Solomon (girl)
Makai Angel Solomon (boy)
Josiah Angel Solomon (boy)
Jeremiah Angel Solomon (boy)
Jonah Angel Solomon (boy)

Octuplets
Main article: Suleman octuplets
Suleman has stated that in 2008 she had six embryos left over from her previous in-vitro fertilization treatments. She requested that all of the remaining embryos be implanted despite the norm for a woman her age being two or three implanted at the most.[3] Part of her reasoning for attempting a sixth pregnancy was so that the frozen embryos would not be destroyed. The six remaining embryos were implanted and two of the embryos split into twins, resulting in a total of eight embryos. Her health and gestational status were followed from her first trimester. Five fetuses were evident after just one month and when offered the option of selective reduction, Suleman declined.[14]

News of the octuplets caused an international media frenzy.[15] Public reply was largely negative and even included death threats.[16] There has been much public discussion about Suleman's decision to have the octuplets, including a minor protest outside the Suleman home.[17] Many expressed concern that Suleman's decision for more children would burden taxpayers via public support.[18][19][20]

As of March 2009, Suleman lives elsewhere,[21] and there was concern the octuplets would not be released from the hospital with Suleman expressing concern about losing custody of them.[22] However, as of April 14, 2009, all of the children are home, although public outrage has not subsided. In the early morning hours of April 1, the day she would bring the seventh octuplet home, vandals threw a baby seat through the back window of her Toyota minivan.[23][24][25]


Public profile
With the 2009 birth Suleman captured the public eye and by the end of January the media began referring to her as "Octomom". Suleman hired the Killeen Furtney Group as her initial public relations company, with Wes Yoder providing a small amount of pro bono advice. Both groups soon ended their involvement after receiving death threats.[26] Her next spokesman was Victor Munoz,[27] who quit on March 6, 2009.[28]

On February 5, 2009, Nadya Suleman granted a television interview to NBC's Ann Curry. Suleman rejected suggestions that her decisions have been selfish or that she may not be able to care for her children. Suleman stated that she felt society is unfairly judging her because she is a single mother. Suleman also said she will get by with the help of family, friends, and her church, and she plans to return to school in the fall.[29]

In February 2009, Vivid Entertainment made Suleman a $1 million (US) offer to star in a pornographic movie.[30] Suleman has declined their offer.[31]

On March 25, 2009, Suleman and Gloria Allred appeared together on the Dr. Phil Show. Allred had a list of criticisms regarding Suleman's performance as mother and homemaker.[32]

On April 16, 2009, Suleman revealed she has struck a deal for a reality TV show in the UK, though the Hollywood Reporter said some U.S. networks are reluctant to pick up the show. [33] Suleman signed an agreement with the Los Angeles Superior Court on July 24 to have each of her children earn $250 a day to star in a reality show that is to start filming on September 1.[34]

On August 10, 2009, Fox announced that a two-hour special entitled, "Octo-Mom: The Incredible Unseen Footage", which aired on August 19.[35]


Extended family
Before knowledge of the octuplets became public, Suleman had been living with her six older children and mother in a small three-bedroom house in Whittier, California. Property records show the Suleman house in mortgage default, scheduled to be sold at auction in May 2009.[36] Suleman's parents filed for bankruptcy in 2008, citing nearly $1 million in liabilities.[37]

Suleman's father, 67-year-old Edward Doud Suleman,[38] identifies himself as a former Iraqi military man and says he is returning to his native Iraq as a translator and driver in order to financially support his daughter and her fourteen children.[39] Suleman's mother, 69-year-old Angela Victoria Suleman, a retired teacher, has helped to look after the first six children. She has indicated that she is overwhelmed looking after them, and has been critical of her daughter in her earlier public statements.[40]