EDUCATION

For healthcare professionals, MDR offers a fully accredited educational symposia on drugs used in treating infertility. Over the past seven years we have provided training and CE credits to hundreds of nursing and other healthcare professionals in the comfort and convenience of their clinic. Our constantly updated speaker program provides comprehensive education on pharmacotherapy, efficacy, side effects, new drugs and protocols. Please contact your account representative, or our corporate office, for additional information.

QUESTIONS AND ANSWERS ABOUT HUMAN REPRODUCTION

What are the basics of human reproduction?

Normal human reproduction is an intricately orchestrated event that involves a female gamete, the egg, and a male gamete, the sperm. Fertilization occurs when the sperm and the egg combine to create a zygote. The zygote travels to the uterus where it develops as a fetus, typically over a 39 week period. This occurrence involves several complex processes within each partner.

A man develops sperm and makes testosterone in the testes that lie within the scrotum. Once made, sperm matures in the epididymus and is stored in the vas deferens. During intercourse, sperm travels up the vas deferens, receives fluid from the prostate and cowpers glands and exit out the urethra in the penis. A man releases millions of sperm during intercourse that can live approximately 3 days.

A woman is born with hundreds of thousands of immature ova. After puberty, an ova (egg) matures in the ovary and is released into the fallopian tubes once a month. Follicle stimulating hormone (FSH) causes the egg to develop and mature while luteinizing hormone (LH) causes the ovary to release the egg into the fallopian tube. In order to become pregnant, the egg must be fertilized by the sperm in the fallopian tube. Eggs, also known collectively as oocytes, live for up to 24 hours after being released from the ovary. After the egg is fertilized, the zygote travels to the uterus, implants into the uterine wall and grows into a baby.

If the egg is not fertilized, menses occurs. The first day of menstruation is referred to as day one of a woman's cycle. In a 28 day cycle, menstruation typically occurs from day 15. During this time, FSH stimulates the development and maturation of the egg. At about day 14, LH causes the ovary to release the egg to travel down the fallopian tube. If a woman does not conceive, at around 28 days, her uterus will begin to shed its lining which it had prepared to nourish a baby. This is known as menstrual flow.

What are some causes of infertility?

The odds of becoming pregnant during any given month is 25%. 60% of couples trying to get pregnant will succeed in 3 months and 85% will succeed in a year. Infertility is defined as the inability to become pregnant when not using contraception for a year. For women 35 and over or who have already had children, it is not becoming pregnant in 6 months.

40% of infertility is caused by a male factor, 40% is caused by a female factor, 10% is caused by both male and female factors, and 10% is unknown.

Not becoming pregnant is common and nothing to be ashamed of. A few years ago a study was conducted which showed that approximately 10% to 15% of couples between 15 and 44 years of age who wanted to have a baby were infertile. An increased number of women diagnosed as infertile can partly be attributed to the increased number of women waiting to become pregnant at a later age. The most fertile age for women is between 16 and 24.

Some behavioral causes of infertility are smoking, alcohol, certain medications, illegal drugs, excess caffeine, and use of lubricants. Infertility is also associated with anorexia nervosa, bulemia, poor diet, and extremes in physical activity.

Some environmental causes of infertility are lead, medical radiation, ethylene oxide, pesticides, and handling of industrial wastes.

Most infertility is caused by biological causes. Some infertile women do not ovulate regularly and can be treated with medications, such as clomiphene citrate. Some women have blocked or damaged fallopian tubes that do not allow the sperm and egg to join. An infection caused by an intrauterine device (IUD), a previous or ongoing STD such as chlamydia, gonorrhea, or mycoplasma can cause a blockage or damage. Surgery may be needed to repair the tubes. Endometriosis, a condition in which uterine tissue implants in the ovaries or other pelvic areas can cause infertility as well as an abnormal cervix. Age is also a factor in that the older a woman gets, the higher the chance of infertility.

Male factors include inadequate sperm count, abnormal sperm, or deficient sperm motility. Varicose veins on the scrotum account for 3050% of male infertility. Testicular injury, undescended testes, hormonal imbalances, or other chronic conditions may also cause infertility.

What are some common treatments of infertility artificial insemination?

Fertile females with subfertile male partners are usually treated with artificial insemination (AI). AI is a painless and simple procedure performed by a doctor. The doctor takes sperm from the male and inserts it into the uterus near the time of ovulation. This type of AI is called Intrauterine Insemination (IUI). In the cases of male sterilization, ejaculation problems, poor sperm penetration assay result, or immunologic infertility, therapeutic insemination (TID) with donor sperm may be used.

REPRODUCTIVE TECHNOLOGIES

Procedures that involve the use of various hormone medications to increase multiple egg development and increase the chances for pregnancy are called Assisted Reproductive Technologies (ART). There are many procedures that are tailored to each couple's needs.

In Vitro Fertilization (IVF)

IVF is a four stage process to help join sperm and egg. Fewer than 5% of infertile couples use IVF. Since its inception in 1981, more than 45,000 babies have been born with this technique.

• Stage 1: Follicles in the woman are stimulated by medications containing FSH and ovulation is stimulated by medications containing human chorionic gonadotropin.
• Stage 2: Mature eggs are removed with a needle from the woman's ovaries.
• Stage 3: Eggs are fertilized by the male partners or donor sperm in a laboratory petri dish.
• Stage 4: After fertilization is complete, the embryo/s are transferred back into the uterus. Typically 2 to 4 embryos are transferred.

Gamete Intrafallopian Transfer (GIFT)

GIFT is a laparoscopy procedure in which a doctor places sperm and egg directly into one of the fallopian tubes. Fertilization occurs in the fallopian tubes and the zygote moves down to the uterus just as in a natural fertilization. In GIFT, gametes (sex cells) are transferred, not an embryo. To be a candidate for GIFT, a woman must have at least one good fallopian tube. Zygote Intrafallopian Transfer (ZIFT)

ZIFT is similar to IVF, except that an embryo is placed inside the fallopian tubes, not the uterus.

Microsurgical Epididymal Sperm Aspiration (MESA)

When sperm cannot travel through the vas deferens, a doctor can remove it directly from the epididymus. The sperm is then used in IVF or ZIFT procedures that place the immotile sperm in direct contact with the eggs. MESA is an outpatient procedure.

Intracytoplasmic Sperm Injection (ICSI)

Men who produce low amounts of weak sperm may use ICSI. A single sperm is directly injected into the egg in the laboratory. Sperm samples from men may be taken from the epididymus using the MESA procedure or from men naturally.

Advanced Reproductive Care, Inc. (ARC®) www.arcfertility.com The nation's largest network of Reproductive Endocrinologists who service fertility patients to make the cost of fertility treatments predictable and affordable.