Anatomy

For patients going through in vitro fertilization (IVF) or any type of fertility treatment, the clinic will build a comprehensive plan to examine all risk factors, health conditions, and reproductive issues that may interfere with the patients’ ability to conceive. Much of this plan will be related to the form and function of the female reproductive system, and the uterine lining (also called the endometrium or endometrial lining) is one part of the reproductive system that will be assessed.

The endometrial lining changes in thickness and appearance in response to the changing hormone levels throughout the menstrual cycle; therefore, it is part of the assessment for how a patient is responding to fertility treatment.

Embryo development is a delicate, multi-stage process. From the moment of fertilization, growth follows a pattern that can be influenced by many factors. With in vitro fertilization (IVF), that pattern closely mimics what happens in the human body during a natural pregnancy, when an embryo grows from a single cell to the blastocyst stage. However, rather than occurring in a fallopian tube and the uterus, the initial phases take place in a petri dish in a lab while being monitored by trained embryologists.

How an embryo develops in the first few days — specifically, its rate of growth and changes in structure — directly impacts whether the embryo will result in a healthy live birth. Learning how embryos grow during the IVF process can help patients understand what a desirable outcome looks like and whether their embryos have achieved certain milestones.

Though a vasectomy used to be considered a permanent sterilization procedure, modern developments have made reversal possible. This article will explain various vasectomy reversal procedures and the likelihood of success in restoring fertility. It will also review alternative fertility options.

Embryo implantation is a complex process and a significant step toward achieving a viable pregnancy. Implantation is aided by 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 — and therefore lack of increased human chorionic gonadotropin (hCG) levels, or the lack of an intrauterine pregnancy seen on ultrasound following in vitro fertilization embryo transfer.ⁱⁱ When implantation failure happens multiple times, it is known as recurrent implantation failure (RIF) or repeated implantation failure. The terms can be used interchangeably.

Turner Syndrome (TS), also known as monosomy X, is a chromosome abnormality that occurs randomly during fertilization and affects only females. It is a genetic condition that, if present in a fetus, causes significantly increased risk for miscarriage and prenatal complications such as heart defects.

After birth, individuals with Turner syndrome have an increased risk for growth issues, learning disabilities, and infertility as adults. Fortunately, with proper early intervention and counseling on reproductive options and risks, females with Turner syndrome may go on to have successful pregnancies.

As part of a reproductive treatment plan to assist in becoming pregnant, a physician may recommend medication to induce ovulation or to accompany timed intercourse, intrauterine insemination (IUI), therapeutic donor insemination (TDI), or in vitro fertilization (IVF). During treatment, a reproductive endocrinologist (RE) will most likely prescribe ovarian stimulation to maximize the number of eggs produced.

Polycystic ovary syndrome, or PCOS, is a condition that is often associated with having a negative impact on a female’s ability to conceive. It is characterized by a range of symptoms, from unwanted hair growth to irregular menstrual cycles, and can be difficult to diagnose and treat.

Pelvic inflammatory disease (PID) refers to an infection of the female reproductive system. It can occur without symptoms but may also cause mild to severe pelvic pain. In rare cases, PID can lead to chronic complications.ⁱ It is also a risk factor for female infertility.

Understanding what causes PID and how it is treated can help individuals avoid the long-term complications related to the disease.

At times, difficulty with conception can be traced to issues within the structure of the reproductive tract, such as the shape of the uterus or blockages in the fallopian tubes. If a physician suspects structural concerns, they may recommend a hysterosalpingogram. The hysterosalpingogram is a relatively common diagnostic procedure in reproductive medicine that gives doctors the ability to see how the uterus and fallopian tubes are shaped.

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

Endometriosis is a medical condition that affects millions of females worldwide, many of whom may develop endometriosis at an early age. Not only can endometriosis lead to severe pain (including very painful menstrual cramps) and pelvic inflammatory disease (PID), but it can also negatively affect fertility. Many reproductive-age females who have not been formally diagnosed with endometriosis may not realize that they have the condition until they experience challenges as they attempt to conceive children.

In order to recognize and subsequently treat endometriosis, it is critical to first understand the various types of endometriosis symptoms, surgical therapies, and fertility treatments available. Due to medical advances, there are treatments to effectively manage and treat endometriosis pain. In some cases, the most effective treatments are minor surgical procedures.

Egg freezing is a fertility preservation technique that was first made available in the late 1990s to females undergoing cancer treatments that could potentially affect their fertility. The egg freezing process is now also used by individuals to preserve their fertility for a wide range of reasons. Previously considered experimental, egg freezing is currently considered to have minimal risk and is even covered by some employers in the U.S. through health insurance.

For people who are thinking about in vitro fertilization (IVF), there is a great deal of information to absorb at once, and much of it can be confusing. In particular, the discussion of eggs (also called oocytes) versus follicles involves a significant dive into the mechanisms of egg development and maturation. While females may know they are born with all the eggs they will ever have, they may not necessarily understand how their eggs differ from follicles and how these terms are used during IVF. Understanding what each term means can make the process easier to navigate.

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

Asherman’s syndrome is a rare condition in which scar tissue is present in the uterine cavity. It is not a genetic condition; therefore, it can affect any female. In most cases, it develops in individuals who have undergone uterine surgeries. If someone has received an Asherman’s syndrome diagnosis and is concerned about its impact on their fertility, it is beneficial to understand the symptoms, causes, and range of potential reproductive outcomes.

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. Fertility acupuncture gained popularity in North American around 2009. Since then, it has been estimated that over 30 percent of females undergoing fertility treatment will access an alternative medical approach such as acupuncture during their treatment.ⁱ

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.