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1. I've seen ads for a fertility clinic that guarantees success in helping women have babies.
Testimonials Consider me skeptical. Can this or any other clinic really back up such a claim ?

FAQs
2. My wife and I have been trying to conceive for two years without any luck. I had two sperm
Payment Options counts taken (16 million after three days of abstaining and 28 million after seven days). I have
read that any count under 20 million is "functionally sterile" and the likelihood of conceiving is
IVF humor
remote. Is a count under 20 million a great cause for concern? If I abstain from sex for longer
Pregnancy tracking and periods of time (more than seven days) will my count increase ?.

assistance service

3. I have no problem with erection, but no semen comes out from either masturbation or even
intercourse. A doctor has checked for prostate problems and it is negative. I used to be able to
produce semen. I am diabetic ?

4. Until about two months ago my husband was a very heavy drinker. He has had no booze in
more than two months. The doctor says my husband's sperm count was that of a 20-year-old's,
but there was little to no motility. Is there something that can be done about the motility? Could
the alcohol have any effect on this problem? If so, how long will the effects last, and what can
we do to correct it ?

5. My wife and I have been trying to conceive for six years. I have been told that my body
temperature is too high, particularly in my testicles, and this is the cause of my low sperm
count. Is there any solution for us? I once used a device to cool the scrotum area with the slow
release of water. Is this effective ?

6. My husband was just started on a series of testosterone injections for a low testosterone
level (198). His semen analyses were very variable -- 17.1, 5.1, 50.5 and 21.5 million with good
motility and morphology, but with low volume ( 1.5-3mL per specimen). Do you think these
injections will help?

7. How long should one wait after a varicocelectomy to see results? I have heard three to nine
months. My husband had a varicocelectomy three months ago and the summary says there
has been no significant results. Is this likely to improve with time? Exactly how is the surgery
supposed to help, and why might it take a while for results to show ?

8. My husband had a sperm count done and it showed not even one sperm. He then had an
LH and an FSH drawn. Both were somewhat elevated. His urologist told him that he shouldn't
bother to do any further testing. Is this true? Or are there any other tests or procedures that
can be done to see if he is able to produce sperm ?

9. We have been married for four years, and my husband has a very low sperm count (10,000)

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with very little motility, dead sperm and deformed ones. The doctor said we should do
intrauterine insemination. Is this painful for the woman? Does it work in a situation like ours?
Can we use my husband's sperm ?

10. I am 37 and have no children. I have been diagnosed as having a thin endometrium (3-
5mm). Since July 1997 I have had two miscarriages (one blighted ovum and one lost between
8-12 weeks after a heartbeat was detected at eight weeks). I had spotting and bleeding in both
cases and D&Cs with both. I am now on a second round of a hormone treatment with
Progynova & Provera after an ultrasound checkup showed a first round produced no visible
improvement. This time an estrogen patch will be used & Sildenafil(Penegra) will be advocated
for use vaginally. Are there any additional ways to improve the endometrium thickness -- say,
diet, homeopathic remedies, acupuncture, etc.? Can you suggest any other sources of
information on this topic ?

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11. Does Viagra have any effect on sperm in a man trying to have a child? Does it affect the
sperm count, mobility, etc. ?

12. After years of trying, my husband and I finally had a baby girl through in vitro fertilization. I
don't want her to suffer with fertility problems as an adult. Is it possible that infertility is
hereditary ?

13. Does the color of semen give any indication of fertility? Does it make a difference if semen
is clear or white?

14. What is the incidence of infertility worldwide ?

15. My husband and I have an active sex life, we are both healthy, and my periods are regular.
However, we have still not conceived?? Please help !

16. Is infertility exclusively a female problem ?

17. How can I determine my "fertile" period ?

18. What are the most common causes of infertility ?

19. My gynecologist has done an internal examination and said I am normal. Do I still need to
get tests done to determine why I am not conceiving ?

20. What is the general progression of infertility treatment ?

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21. Do painful periods cause infertility ?

22. What treatment options do infertile couples have ?

23. My periods come only once every 6 week. Could this be a reason for my infertility ?

24. How successful is infertility treatment ?

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25. My husband's blood group is B positive and I am A negative. Could this blood group
"incompatibility" be a reason for our infertility ?

26. Are there particular factors influencing the success of a treatment ?

27. After having sex, most of the semen leaks out of my vagina. How can we prevent this ?
Should we change our sexual technique ? Could this be a reason for our infertility ?

28. What about success rates of IVF ?

29. My colleagues at work tell me that if we "work" hard at getting pregnant, and want it
enough, we definitely will ! In fact, my mother in law is even suggesting that the fact that I am
not conceiving means that subconsciously I do not wish to have a baby ( because it may
interfere with my career) and that this psychological barrier is the reason for our infertility.

30. Are there particular health risks for women undergoing infertility treatment ?

MORE QUESTIONS..........

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1. I've seen ads for a fertility clinic that guarantees success in helping women have
babies. Consider me skeptical.Can this or any other clinic really back up such a claim ?

It should be the goal of every clinic to succeed in helping every couple that hopes to conceive.
In reality, though, this can not be guaranteed. In our practice, we work with couples to explore
the causes of their infertility and to outline all possible treatment options. By empowering
couples to explore these options and participate as a partner in the decision-making process,
we believe each and every couple is helped. What these ads refer to is a financial agreement
offered by some clinics to couples whose history suggests that they're likely to be successful in
conceiving a child through reproductive technologies. If the couple is accepted into the clinic,
they pay in advance for a specified course of treatment. If the couple successfully conceives
and the woman carries the pregnancy beyond the first trimester, the clinic keeps the money. If
the couple is not successful, their money is returned. In general, patients pay much more for
these "guaranteed" treatments than they would for a single cycle of in vitro fertilization therapy.
These programs remind me of the ancient Chinese practice that required patients to pay their
physicians for staying well and not for treating illnesses.

2. My wife and I have been trying to conceive for two years without any luck. I had two
sperm counts taken (16 million after three days of abstaining and 28 million after seven
days). I have read that any count under 20 million is "functionally sterile" and the
likelihood of conceiving is remote. Is a count under 20 million a great cause for
concern? If I abstain from sex for longer periods of time (more than seven days) will my
count increase ?

The issues about sperm count are more complicated than you might realize. To begin with,
there are a number of measurements involved in the semen analysis. First, we look at the
concentration -- how many sperm there are per milliliter of semen (the fluid). Next, I need to
know how many mL of semen are present. So a count of 40 million sperm per mL with only
1cc of fluid may not be as good as a count with 16 million and 4mL. I like to see more than 20
million sperm per mL and 2-5cc of semen. Another measurement to consider is what
percentage of the sperm are moving forward progressively; 50 percent motility is considered
normal. The next factor is sperm morphology -- that is, what percent of sperm look normal.
When you assess the fertilizing potential of a given specimen, you must consider all these
factors. Thus, a slight abnormality in sperm count may be compensated for by better motility or
an increase in volume. So you can see this is a bit more complicated than just one number. We
find that delaying ejaculation may increase the total concentration of sperm and perhaps the
volume of semen. However, the percentage of normal sperm and the percentage of motile
sperm decreases with infrequent ejaculation. Overall, it appears that ejaculation three to four

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times per week will ensure the optimum number of "nice-looking" motile sperm. If your sample
shows a sufficient number of motile sperm, you may be rewarded by a treatment protocol that
includes ovulation induction and intrauterine insemination.

3. I have no problem with erection, but no semen comes out from either masturbation or
even intercourse. A doctor has checked for prostate problems and it is negative. I used
to be able to produce semen. I am diabetic ?

You probably have a common condition called retrograde ejaculation, which is frequently seen
in people with diabetes. The semen enters the penis via the ejaculatory ducts, which pass
through the prostate. At the time of ejaculation, a muscle at the opening to the bladder
squeezes shut. With each muscle contraction, the semen is propelled down the urethra and out
the opening of the penis. However, if there is nerve damage due to diabetes, the muscle at the
opening to the bladder will not close off properly, and the semen enters the bladder instead of
shooting out the end of the penis. Your urologist can diagnose this condition easily by checking
your urine for semen after ejaculation. If this is the problem, you may try medication to
strengthen the function of the muscle that closes the bladder. Or you may have sperm
collected from the bladder to use for insemination or for in vitro fertilization.

4. Until about two months ago my husband was a very heavy drinker. He has had no
booze in more than two months. The doctor says my husband's sperm count was that of
a 20-year-old's, but there was little to no motility. Is there something that can be done
about the motility? Could the alcohol have any effect on this problem? If so, how long
will the effects last, and what can we do to correct it ?

Alcohol may result in abnormal liver function and a rise in estrogen levels, which may interfere
with sperm development and hormone levels. Alcohol is also a toxin that can kill off the sperm-
generating cells in the testicle. As sperm take at least three months to develop, I would check
his semen again after a three- to four-month period of abstinence. In some situations, sperm
motility may be improved with alternative medicines called Addyzoa and Rejuspermin. If no
motile sperm are seen, a testicular biopsy may be necessary. If this reveals any live sperm,
you may consider in vitro fertilization with sperm injection (ICSI) to introduce the sperm into the
egg.

5. My wife and I have been trying to conceive for six years. I have been told that my body
temperature is too high, particularly in my testicles, and this is the cause of my low
sperm count. Is there any solution for us? I once used a device to cool the scrotum area
with the slow release of water. Is this effective ?

While body temperature -- about 98.6 degrees F. -- may be detrimental to sperm, the scrotum
is designed to keep the testicles from overheating. In fact, the supportive muscles of the
testicle are temperature sensitive. In a cold environment, the testicles pull closer to the body.
When the body temperature rises, the muscle relaxes, allowing the scrotum to descend and
keep the testicles at a more favorable temperature. A few years ago a device called the
testicular hypothermia device (THD) was available. Essentially it was a water-cooled jockstrap;
evaporating water kept the jockstrap a bit cooler than the surrounding environs. This was
believed to benefit men with varicoceles (dilated testicular veins). Unfortunately, the role of
high temperature regulation as a means to restore fertility for men with varicocele has never
been convincingly proven. In fact, more recent studies suggest that varicocele surgery may be
of limited value for all but large varicoceles. Rarely are any therapeutic efforts aimed at
improving sperm count or function effective. After six years of infertility, I would suggest that if
other fertility factors have reliably been ruled out by a trained fertility physician, you may wish to
consider either ovulation induction and intrauterine insemination or in vitro fertilization for male
factor infertility.

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6. My husband was just started on a series of testosterone injections for a low


testosterone level (198). His semen analyses were very variable -- 17.1, 5.1, 50.5 and 21.5
million with good motility and morphology, but with low volume ( 1.5-3mL per specimen).
Do you think these injections will help?

Low testosterone may result from two different types of abnormality. The first, a failing testicle,
is identified by the blood FSH level (too high a level means the testicle is failing) or small, very

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firm testicles, which may indicate previous infection or damage. The second condition occurs
when the testicle is not receiving appropriate hormonal stimulation from the pituitary gland,
which releases the hormones LH and FSH. LH stimulates the testicle to produce testosterone,
while FSH stimulates sperm production. In this case, examination of the testicle may
demonstrate normal to small testicular size with a softer-than-normal consistency.
Testosterone supplementation would not usually be the first treatment considered for infertility
associated with low testosterone. In my experience, the use of testosterone injections may
actually depress sperm production further. After a thorough medical history and examination
and a blood test to confirm normal liver function, I would consider the use of clomiphene, 1/2
tablet every other day. After three months a beneficial effect may be seen on semen analysis.
In your husband's case, it would appear that all but one of the specimens for semen analysis (
5.1 million sperm/mL) were normal. I would suggest consideration of clomiphene therapy
followed by a repeat semen analysis after three months. If infertility persists, ovulation
induction combined with intrauterine insemination would be the treatment of choice.

7. How long should one wait after a varicocelectomy to see results? I have heard three
to nine months. My husband had a varicocelectomy three months ago and the summary
says there has been no significant results. Is this likely to improve with time? Exactly
how is the surgery supposed to help, and why might it take a while for results to show ?

A varicocele is a dilation (enlargement) of the veins of the scrotum. This pooling of blood in the
testicle causes an increase in temperature, which may interfere with the testicle's production of
sperm. Up to 60 percent of men with varicocele will note an improvement in their sperm
production after surgical repair. Repair consists of tying or clipping the veins. This is performed
through a small incision in the groin. Improvement can be seen in as little as three months, and
further improvement may be seen for up to two years. If you see no improvement at all by six
months, you should consider alternative therapies .

8. My husband had a sperm count done and it showed not even one sperm. He then had
an LH and an FSH drawn. Both were somewhat elevated. His urologist told him that he
shouldn't bother to do any further testing. Is this true? Or are there any other tests or
procedures that can be done to see if he is able to produce sperm ?

What you were told is NOT true. There are many conditions that might result in an absence of
sperm in the ejaculate. We divide these conditions into three main classifications. The first
possibility is failure to stimulate sperm production by the testicles. Sperm production depends
on appropriate release of the hormones FSH and LH from the pituitary gland -- no LH/FSH, no
sperm production. In your husband's case, the FSH and LH are slightly elevated, so let's cross
this problem off our list. The next possible culprit is "outflow obstruction." The sperm are
produced in the testicles and mature in a nearby structure called the epididymis. Then the
sperm pass through the vas deferens and ejaculatory ducts, through the prostate and penis
and out of the body. If any of these passages are absent or blocked, sperm cannot reach the
ejaculate. Clues can be obtained by noting the volume of ejaculate. If ejaculate volume and
hormone levels are all normal, the problem might be a blockage close to the testicle, which
might be caused by infection. If volume is low, there may be a neurological abnormality that
allows the sperm to be diverted into the bladder, rather than taking the correct path down the
urethra to escape the male genital tract. Or there may be a blockage in the prostate gland that
can keep the sperm volume low. If this is suspected, the urologist will check the bladder for
sperm after ejaculation or perform a prostate ultrasound. While obstruction may be repaired
with microsurgery, the most cost-effective option is to surgically retrieve and cryopreserve
(freeze) sperm for later use in IVF and ICSI, procedures in which eggs are retrieved and a
single sperm is injected into each egg. The final possible culprit is the testicle. Is it doing its
job? The physical exam may provide clues. Is one of the testicles small & firm? Is there a
dilation of veins (varicocele) surrounding the testicle? These findings may suggest testicular
failure. Other tests may indicate that the testicle does a great job when it comes to making the
male hormone testosterone, but fails to make sperm. The elevated FSH is a clue to this
condition. This diagnosis is made by taking a small biopsy from the testicle, a simple outpatient
procedure. If no sperm-producing cells are seen, a condition called Sertoli-cell-only syndrome
is diagnosed. But the results can be misleading. It is best to do this in a fertility laboratory,
because often live sperm cells can be missed after processing. If an embryologist is present at
the time of biopsy, any live sperm can be cryopreserved for later use in an IVF cycle. If the
initial specimen is inadequate, additional biopsies or a biopsy from the other side may provide
adequate sperm for cryopreservation.

9. We have been married for four years, and my husband has a very low sperm count

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(10,000) with very little motility, dead sperm and deformed ones. The doctor said we
should do intrauterine insemination. Is this painful for the woman? Does it work in a
situation like ours? Can we use my husband's sperm ?

Intrauterine insemination (IUI) should not be painful. If the semen specimen is properly
prepared before insemination and the procedure is performed by a skilled physician, your
discomfort should be limited to mild cramping. In your case, IUI will work only if you choose to
use donor sperm. Pregnancy is unlikely using your husband's sperm for insemination. With
sperm counts that low, the only successful approach is to perform in vitro fertilization with
intracytoplasmic sperm injection (ICSI). With that procedure, results depend in large part on
your age and not his sperm count, as long as a few hundred motile sperm are available. If his
urologist has ruled out obstruction as the cause of the abnormal semen analysis, you may wish
to consider genetic testing. In about 10 percent of cases, a genetic abnormality or an
abnormality in a small section of his DNA (called a microdeletion) may be responsible for the
problem. If this is the case, you will need to be aware that the particular defect could be
inherited by a male offspring, who may subsequently have fertility problems.

10. I am 37 and have no children. I have been diagnosed as having a thin endometrium
(3-5mm). Since July 1997 I have had two miscarriages (one blighted ovum and one lost
between 8-12 weeks after a heartbeat was detected at eight weeks). I had spotting and
bleeding in both cases and D&Cs with both. I am now on a second round of a hormone
treatment with Progynova & Provera after an ultrasound checkup showed a first round
produced no visible improvement. This time an estrogen patch will be used &
Sildenafil(Penegra) will be advocated for use vaginally. Are there any additional ways to
improve the endometrium thickness -- say, diet, homeopathic remedies, acupuncture,
etc.? Can you suggest any other sources of information on this topic?

Thin endometrium at the time of ovulation can be a concern and may be a factor in poor
placental development and miscarriage. Normally, in response to estrogen, the uterine lining or
endometrium grows about 1-2mm every other day. By the time of ovulation, I like to see the
endometrium at least 8mm thick. The endometrium also has a very specific ultrasound
appearance marked by three bright lines. This is often called a grade-C or triple layer pattern,
and it is a good sign. Failure to develop a normal uterine lining may reflect any of several
factors such as infection, scarring from D&Cs, low estrogen levels, poor uterine blood supply or
maybe endometrial antibodies. Clomiphene (Siphene, Ovofar) is an antiestrogen and as such
can block the stimulatory effect that estrogen has on the endometrium and cause thin
endometrium. If clomiphene is the problem, other ovulation induction medications may be
chosen. Uterine leiomyomas or a condition called adenomyosis may also predispose to thin
endometrium. While adenomysosis may be successfully addressed with a GnRH-agonist such
as Lupride or Zoladex, success has been limited. The use of antibiotics or antioxidants such as
vitamin C has been proposed, but these too are rarely successful and little supportive data
exist. "Thin endometrium" is a finding -- not a condition or disease or syndrome. As such there
are few, if any, research papers addressing this problem specifically. I suggest that your
physician try to determine the cause in your case; then you can seek information about that
particular condition. Unfortunately, for most women with this finding, no discernible cause is
identified and treatment is rarely successful.

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11. Does Viagra have any effect on sperm in a man trying to have a child? Does it affect
the sperm count, mobility, etc.?

Viagra has no known effects on sperm production, morphology (shape), motility (movement) or
count. If a man has organic impotence -- meaning the problem is due to a medical rather than
psychological condition -- then Viagra may improve the chances for achieving conception
simply by restoring potency. Remember, though, that while Viagra can improve rigidity, it does
not necessarily bring about ejaculation. Many men with impotence may have diabetes or other
conditions that affect the penis. In this situation, the muscular sphincter that constricts to help
ejaculate the sperm may not close properly. In such a case, retrograde ejaculation occurs: The
sperm are shot into the bladder rather than out through the penis to begin their journey to find
an egg. If your partner is concerned about his fertility, I would suggest that he consider a
semen analysis, regardless of whether Viagra helps his performance. If he has psychological
impotence, counseling may be very helpful to ensure that pregnancy is advisable.

12. After years of trying, my husband and I finally had a baby girl through in vitro

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fertilization. I don't want her to suffer with fertility problems as an adult. Is it possible
that infertility is hereditary ?

Genetics sometimes plays a role in both female and male infertility. If you suffer from
endometriosis, your daughter is at increased risk for the same condition. Endometriosis, which
affects about 10 percent of all women, can cause tubal infertility. Another condition that could
be hereditary is polycystic ovarian syndrome - a source of ovulation problems. There also
seems to be a genetic component to certain aspects of male factor infertility. A small
percentage of men have microscopic abnormalities in the DNA of the Y chromosome that
leads to their infertility problems. With the advent of in vitro fertilization and ICSI (taking a
single sperm and injecting it into the egg) many of these men pass this genetic defect to their
offspring. But DNA isn't necessarily destiny. And even if your daughter does suffer from
infertility, it's unlikely that her struggle will be comparable to yours. When we compare our
present understanding of infertility and its treatment with that of 20 years ago, we realize that
we have made remarkable progress. Our ability to identify the cause of infertility and develop
cost-effective treatments continues to improve. I suspect that when your daughter comes of
age, the diagnostic and treatment options that will be available to her will certainly be different
and will likely make the process of infertility treatment much less of an ordeal.

13. Does the color of semen give any indication of fertility? Does it make a difference if
semen is clear or white?

The color of sperm is usually a whitish yellow and semitranslucent. The color does not seem to
play a role in fertility

14. What is the incidence of infertility worldwide ?

The World Health Organization (WHO) estimates that approximately 8-10% of couples
experience some form of infertility problem. On a worldwide scale, this means that 50-80
million people suffer from infertility. However, the incidence of infertility may vary from region to
region. In France, 18% of couples of childbearing age said that they had difficulties in
conceiving.

15. My husband and I have an active sex life, we are both healthy, and my periods are
regular. However, we have still not conceived?? Please help !

You need to remember that it's not possible to determine the reason for your infertility until you
undergo tests to find out if your husband's sperm count is normal; if your fallopian tubes and
uterus are normal; and if you are producing eggs. Only after undergoing these tests will your
doctor be able to tell you why you are not conceiving. While testing does cause considerable
anxiety, it's far better to intelligently identify the problem so that we can look for the best
solution.

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16. Is infertility exclusively a female problem ?

No. The incidence of infertility in men and women is almost identical. Infertility is exclusively a
female problem in 30-40% of the cases and exclusively a male problem in 10-30% of the
cases. Problems common to both partners are diagnosed in 15-30% of infertile couples. After
thorough medical investigations, the causes of the fertility problem remain unexplained in only
a minority of infertile couples (5-10%).

17. How can I determine my "fertile" period ?

Your fertile period is the time during which having sex could lead to a pregnancy. This is the 4-6
days prior to ovulation ( release of a mature egg from the ovary). Women normally ovulate 14
days prior to the date of the next menstrual period. If you are mathematically challenged, you
can use this online ovulation calendar .

18. What are the most common causes of infertility ?

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The most common causes of female infertility are ovulatory disorders and anatomical
abnormalities such as damaged fallopian tubes. Less frequent causes include, for example,
endometriosis and hyperprolactinemia. Causes of male infertility can be divided into three main
categories: Sperm production disorders affecting the quality and/or the quantity of sperm;
anatomical obstructions; Other factors such immunological disorders. Approximately a third of
all cases of male infertility can be attributed to immune or endocrine problems, as well as to a
failure of the testes to respond to the hormonal stimulation triggering sperm production.
However, in a great number of cases of male infertility due to inadequate spermatogenesis
(sperm production) or sperm defects, the origin of the problem still remains unexplained.

19. My gynecologist has done an internal examination and said I am normal. Do I still
need to get tests done to determine why I am not conceiving ?

A routine gynecological examination does not provide information about possible problems
which can cause infertility, such as blocked fallopian tubes or ovulatory disorders. You need a
systematic infertility workup.

20. What is the general progression of infertility treatment ?

A variety of procedures can be used to diagnose the cause of infertility in a couple; these
range from simple blood tests to more complicated analytical methods. In any case, diagnosis
is a crucial first step to determine the appropriate therapeutic path that should be followed. In
addition to the cause itself, other factors, such as the age of the woman, or problems shared
by both partners, might also influence the choice of treatment.

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21. Do painful periods cause infertility ?

Painful periods do not affect fertility. In fact, for most patients, regular painful periods usually
signal ovulatory cycles. However, progressively worsening pain during periods (especially when
this is accompanied by pain during sex) may mean you have endometriosis.

22. What treatment options do infertile couples have ?

Several options are offered to couples depending on the type of infertility that has been
diagnosed. The vast majority of female patients are successfully treated with the administration
of drugs such as clomiphene citrate, bromocriptine or gonadotrophins. Surgery can also be a
means to repair damage to the reproductive organs, such as those caused by endometriosis
and infectious diseases. Treatment options for male infertility also include the administration of
drugs, surgery and assisted reproductive technologies, such as intracytoplasmic sperm
injection (ICSI). Drug therapy and surgery have proved very successful for specific types of
male infertility. However, in a great number of cases, the reason why men have fertility
problems remains unexplained and the treatment methods applied are empirical. Some
patients nevertheless require more complex medical intervention. Assisted reproductive
technologies (ART) refer to several different methods designed to overcome barriers to natural
fertilization such as anatomical problems (e.g. blocked fallopian tubes). One of these
techniques, in-vitro fertilization (IVF), has now been practiced for more than 15 years. Overall,
the estimated number of infertile patients currently treated by ART is around 20%.

23. My periods come only once every 6 week. Could this be a reason for my infertility ?

As long as the periods are regular, this means ovulation is occurring. Some normal women
have menstrual cycle lengths of as long as 40 days. Of course, since they have fewer cycles
every year, the number of times they are "fertile" in a year is decreased. Also, they need to
monitor their fertile period more closely, since this is delayed (as compared to women with a 30
day cycle).

24. How successful is infertility treatment ?

When talking of success rates for any type of infertility treatment, one should bear in mind that
the average chance to conceive for a normally fertile couple having regular unprotected
intercourse is around 25% during each menstrual cycle. It is estimated that 10% of normally

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fertile couples fail to conceive within their first year of attempt and 5% after two years.
Comparable to normal fertility rates, effective treatments can be expected to have, on average,
up to a 25% success rate per cycle of treatment, and may therefore need to be repeated
several times before a pregnancy is achieved. Simple ovulation induction to compensate for
hormonal imbalances has a very high success rate; more than 80% of women suffering from
such disorders are likely to conceive after several cycles of treatment with drugs such as
clomiphene citrate or gonadotrophins.

25. My husband's blood group is B positive and I am A negative. Could this blood group
"incompatibility" be a reason for our infertility ?

There is no relation between blood groups and fertility.

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26. Are there particular factors influencing the success of a treatment ?

In any type of infertility treatment, important factors need to be taken into account when
referring to success rates. The age of the woman and the duration of the couple's infertility are
likely to influence the success of treatment. In women, fecundity decreases as age increases,
particularly after 40 years of age. When the woman is being treated, her chances of conceiving
can be lessened if her partner also has infertility problems (e.g. poor quality sperm).

27 . After having sex, most of the semen leaks out of my vagina. How can we prevent
this ? Should we change our sexual technique ? Could this be a reason for our infertility
?

Loss of seminal fluid after intercourse is perfectly normal, and most women notice some
discharge immediately after sex. Many infertile couples imagine that this is the cause of their
problem. If your husband ejaculates inside you, then you can be sure that no matter how much
semen leaks out afterwards, enough sperm will reach the cervical mucus. This leakage of
semen ( which is called effluvium seminis) is not a cause of infertility. In fact, this leakage is a
good sign - it means your husband is depositing his semen normally in your vagina ! Of course,
you cannot see what goes in - you can only see what leaks out - but the fact that some is
leaking out means enough is going in !

28. What about success rates of IVF ?

Overall, success rates for IVF have steadily improved over the last ten years. Birth rates for IVF
vary according to the expertise of the centers practicing this technique. However, centers in
Europe have reported pregnancy rates after one cycle of IVF equal or superior to 25%. In
1993, the French IVF registry (FIVNAT) reported a pregnancy rate of 25.4% per embryo
transfer on a total of 23,025 oocytes retrieved. Based on such results, after three to four cycles
of IVF, a woman under 40 whose partner does not have any fertility problems could reasonably
expect to give birth. Again, in general, success rates may vary from one center to another,
since they are influenced not only by the level of expertise of the medical team but also by the
characteristics of the patients treated. A clinic treating a large number of women over 40 is
likely to report lower success rates than a clinic having a majority of patients under 35.

29. My colleagues at work tell me that if we "work" hard at getting pregnant, and want it
enough, we definitely will ! In fact, my mother in law is even suggesting that the fact that
I am not conceiving means that subconsciously I do not wish to have a baby ( because it
may interfere with my career) and that this psychological barrier is the reason for our
infertility.

Unlike many other parts of your lives, infertility may be beyond your control. Don't blame
yourself if you are not getting pregnant - it's a medical problem which often needs appropriate
medical treatment. The attitudes you are encountering are often born out of ignorance - and
are a kind of "victim-blaming" - ignore them !

30. Are there particular health risks for women undergoing infertility treatment ?

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FAQs

Along with their intended benefits, drugs used to treat infertility may on occasion cause side
effects. In ovulation induction, close monitoring of follicular growth is crucial to ensuring
successful treatment. Monitoring techniques (such as ultrasound scan and blood tests) and
adequate use of treatment protocols help the physician to avoid ovarian hyperstimulation
syndrome (OHSS) and minimize the risk of multiple pregnancy. Current treatment protocols
have been designed to reduce the risk of multiple births and OHSS.

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