Fertility Issues

Preimplantation genetic testing (PGT) is the general term for genetic testing performed on embryos produced by in vitro fertilization (IVF) before the embryos are transferred to the uterus. The purpose of PGT is to improve the chances of having a successful embryo transfer.

Genetic testing does not impact or change the genetics of an embryo, but it does give doctors and prospective parents more information and may help them select the most viable embryos for transfer.  

There are three types of PGT: PGT for monogenic disorders (PGT-M), PGT for structural chromosomal rearrangements (PGT-SR), and PGT for aneuploidy (PGT-A). PGT-A is the most routine type performed and as such should be understood by prospective parents.

Diminished ovarian reserve is a condition in which the amount (quantity) of oocytes left in a women’s ovaries is low, as determined by ovarian reserve testing. This might result in infertility for some women. In addition, for females going through fertility treatments, DOR may put them at risk of having a poor response to fertility drugs.

Red light therapy is the use of visible light emitted from low-energy lasers with the goal of stimulating cellular processes. Red light is just one type of visible light on the electromagnetic spectrum (Figure 1). In addition to visible light, the electromagnetic spectrum includes radiowaves, microwaves, infrared (IR), ultraviolet (UV), X-ray, and gamma rays. The implementation of light sources as a form of therapy is sometimes called photobiomodulation, and it aims to promote healing, regenerative, and/or restorative function on target cells and tissues.

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Sexually transmitted infections (STIs) can potentially damage the reproductive organs and lead to infertility. It is crucial for sexually active individuals, regardless of age, gender, or sexual orientation to undergo STI testing regularly in order to proactively take responsibility for their sexual health. Early diagnosis and management of STIs are essential for avoiding long-term harm to reproductive organs and for maintaining fertility. This article covers what STIs are, how they may impact fertility, and options for their prevention and treatment.

Though a vasectomy was formerly considered a permanent sterilization procedure, modern developments have made reversal possible. This article will outline the various procedures for reversing a vasectomy and the likelihood of success in restoring fertility, including a comparison to alternative fertility options.

Menopause is a natural process all women will eventually go through as they reach middle age. During menopause, the ovaries stop releasing eggs, menstrual periods become less frequent and eventually cease, and hormones such as estrogen and progesterone decrease. While menopause marks the end of fertility, there is still a chance to become pregnant during menopause - either naturally or through fertility treatments.

Individuals who are transgender or transitioning face unique issues regarding fertility, family building, and fertility preservation. The term transgender describes individuals who do not identify with the sex they were assigned at birth. Gender identity is complex and exists on a spectrum. While some transgender people identify with a gender different than the sex they were assigned at birth (often referred to as genetic or biological sex), others do not identify as either of the traditional binary genders.  

Transgender men are individuals who were assigned female sex at birth but identify as male, while transgender women are those who were assigned male sex at birth and identify as female. Some transgender individuals prefer to be identified only as men/male or women/female, dropping the term transgender. Others prefer the terms trans man or trans woman. In this article we will discuss options for creating a family as a transgender individual as well as for those who are undergoing gender transition, and will use trans or transgender terminology for conciseness even as we recognize the differences in preferred language. We will also discuss pregnancy, the delivery process, and aspects of the postpartum course for these individuals.  

Transgender parenthood is fairly common. According to the U.S. Transgender Population Health Survey, 19 percent of transgender respondents were parents.ⁱ

ERA, which stands for endometrial receptivity analysis (previously known as endometrial receptivity array), is a diagnostic tool intended to determine how “receptive” the maternal uterine lining (endometrium) is towards implantation of a transferred embryo.^i,ii ERA evaluates the expression of genes involved in endometrial receptivity during the window of implantation (WOI). These results are then used to determine whether a patient should have a frozen embryo transfer with standard timing, or if timing needs to be adjusted to account for a displaced WOI, a process known as personalized embryo transfer (pET).

Acupuncture is a type of complementary medicine involving the insertion of small needles into specific acupuncture points in the body. It is believed to work by stimulating the nervous system, which can then affect muscles and glands. It has been estimated that over 30 percent of women undergoing fertility treatment will access an alternative medical approach such as acupuncture during their treatment.ⁱ  Fertility acupuncture gained popularity in North American around 2009. Since then, research of varying quality has been conducted to assess the role of acupuncture in both male and female fertility. Its effectiveness in helping improve fertility, especially with respect to IVF success rates, remains unclear.

This article focuses on sperm retrieval procedures, which are procedures that remove sperm from the testicles for the purpose of fertilizing an oocyte (egg). This may be used for men with no sperm in the ejaculate (azoospermia), but that still produce sperm in the testes.

There are two main types of techniques for surgical sperm retrieval: aspiration and extraction. Sperm aspiration involves using a needle to remove (aspirate) sperm from the epididymis or the testes. Sperm extraction takes a sample of the tissue, known as a biopsy, to collect the sperm. There are also different variations or subtypes of these procedures, as well as non-surgical approaches for those with ejaculation limitations.

Klinefelter syndrome (KS) is a genetic condition whereby a male is born with an extra X chromosome. This condition often impacts fertility in addition to potentially other areas related to health and development, though having this condition does not necessarily mean a person cannot have biological children. By understanding this condition's symptoms, causes, risks, and treatments, those with KS can navigate treatment options.

Pregnancy loss can be devastating under any circumstances, but repeated losses can be particularly difficult to deal with. Recurrent pregnancy loss is defined as having two or more miscarriages. Overall, the risk of pregnancy loss is approximately 25 percent, meaning 1 in 4 recognized pregnancies end in loss. The risk of having two or three pregnancy losses in a row is approximately 2.25 percent and 1 percent respectively. After three consecutive losses, the risk of another pregnancy loss rises to around 40 percent.ⁱ  

In order to understand recurrent pregnancy loss (RPL), it is important to know the potential causes of RPL and what tests and treatments are available to help women experiencing the devastating impact of recurrent miscarriage.

A dilation and curettage (D&C) is a surgical procedure that is used to remove tissue from the uterus, and while it is performed for a variety of reasons including diagnostic purposes, it is typically used following a miscarriage or for elective termination of a pregnancy. An understanding of what to expect before, during, and after a D&C is beneficial for navigating this procedure, as well as to learn about potential risks and alternative treatments.

Because hypothyroidism can play a role in infertility, a woman going through in vitro fertilization (IVF) should be aware of the symptoms of hypothyroidism and possible treatments.

Infertility is recognized as a disease by the World Health Organization (WHO), as well as many other professional societies, including the American Medical Association (AMA), the American Society for Reproductive Medicine (ASRM), and the European Society of Human Reproduction and Embryology (ESHRE).^i,ii,iii,iv Estimates of infertility frequency vary worldwide, and even differ depending on the way data is collected. Prevalence is the term used to describe how common a disease/condition is in a particular population. According to the US National Survey of Family Growth, approximately 19.4 percent of married heterosexual women aged 15-49 years have experienced infertility.^v Estimates in the UK population for a similar population were 12.5 percent.^vi Some studies indicate that the prevalence of male infertility is approximately 10-15 percent, but these estimates may not be accurate due to the lack of good quality evidence.^vii

Egg donation is a process in which a fertile woman donates her eggs (oocytes) to another individual or couple who want to conceive a baby. There are a number of steps involved in not only the decision to use donor eggs, but then to move forward once that decision has been made. For anyone considering using donor eggs, it is important to understand the details around how egg donation works, how to find an egg donor, and what success looks like in this type of fertility journey.

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Embryo implantation is a complex process and a significant step towards achieving a viable pregnancy. Implantation requires good quality embryos (both genetically and structurally normal), a receptive endometrium, and complex communication between the embryo and the uterine lining.ⁱ The term “implantation failure” describes the lack of a positive pregnancy test (increased human chorionic gonadotropin (hCG) levels) or the lack of an intrauterine pregnancy seen on ultrasound following in vitro fertilization (IVF) and embryo transfer.ⁱⁱ Recurrent implantation failure (RIF) is sometimes called repeated implantation failure, and the terms can be used interchangeably.

A miscarriage is the loss of a clinically confirmed pregnancy. For women hoping to conceive, it is important to have accurate information regarding pregnancy loss including prevalence, common causes, warning signs, and management options. An understanding of what to expect after miscarriage and what physical and emotional factors should be considered before trying to conceive again can also be highly beneficial.

Asherman’s syndrome is a rare condition defined by the formation of scar tissue in the uterine cavity. It does not have a genetic predisposition and can affect any woman, with a potential impact on fertility. Most cases develop in women who have undergone uterine surgeries. If a woman has received an Asherman’s syndrome diagnosis and is concerned about its impact on her fertility, it is beneficial to understand the symptoms, causes, and range of potential reproductive outcomes.

Monosomy X is a chromosome abnormality that occurs randomly during fertilization and affects only females. Also known as Turner syndrome (TS), this is a genetic condition that if present in a fetus causes significantly increased risk for miscarriage and prenatal complications, like heart defects. After birth, individuals with Turner syndrome are at increased risk for growth issues, learning disabilities, and infertility as adults. Fortunately, with proper early intervention and counseling on reproductive options and risks, women with TS may go on to have successful pregnancies.

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Polycystic ovary syndrome (PCOS) is a condition that is often associated with having a negative impact on a woman's ability to conceive. This syndrome is characterized by a range of symptoms, from unwanted hair growth to challenges when trying to conceive, and can be difficult to diagnose and treat.