Cleveland Hospital Testing Out New Fertility Drug

University Hospitals is testing a new fertility drug, and is looking for women who are having difficulty getting pregnant to participate in the study. More Details

Local Doctor Looks At Psychological Effects Of Miscarriage

A local doctor, spurred by his own personal experience, incorporates the psychological impact of miscarriage into his work and research on the problem. More Details
VIDEO: Dealing With Miscarriage

1 In 15 Women Has Disease That Can Cause Infertility

Woman Finally Gets Pregnant After 7 Years Of Trying

Treatments For Male Infertility Often Simple, Successful

Infertility Treatment Can Take Toll On Marriage

In about 40 percent of all infertility cases, the cause is attributed to the man. A man may produce too few sperm, the sperm may have trouble moving, or a substantial percentage of the sperm may be abnormal.

Causes
Decreased fertility in men is generally due to problems with sperm. The causes are:

• Anatomic: The path of sperm to the ejaculate is blocked or the internal reproductive organs are not fully developed.


• Hormonal: Certain imbalances impede the body's ability to produce sperm.

Treatment
Treatments for male infertility include:

• Intrauterine insemination (IUI): Sperm are placed directly into the uterine cavity through a catheter near the time of ovulation.


• In vitro fertilization (IVF): Sperm and the woman's egg are placed in a laboratory dish.


• Intracytoplasmic sperm injection (ICSI): A single sperm is injected into a single egg using microscopic instruments.

In cases in which no sperm is present in the ejaculate, a number of surgical options for sperm retrieval exist:

• Testicular biopsy: Small pieces of testicular tissue are removed and examined for sperm.


• Testicular sperm aspiration (TESA): A needle biopsy of the testicle in which a sample of tissue is taken directly from the testis and used to extract sperm for IVF or ICSI.


• Percutaneous sperm aspiration (PESA): A needle is inserted into the tube collecting sperm from the testes to locate pockets of sperm.


• Testicular microdissection: Testicular surgery to locate areas of potentially active spermatogenesis (sperm creation).

Recurrent pregnancy loss is defined by three consecutive miscarriages. Miscarriages – pregnancies lost within the first 20 weeks of gestation – occur in 15 to 20 percent of pregnancies and are more prevalent during the first trimester. Fortunately, the likelihood for full-term pregnancy -- even after recurrent pregnancy loss – is about 50 to 70 percent.

Causes
Sometimes, the reasons for a miscarriage cannot be identified. But possible causes include genetic defects, an abnormally shaped uterus, uterine fibroids, scar tissue, hormonal imbalances, diseases related to the immune system, infection and illnesses such as diabetes. The most common of these factors is genetics, which can be linked to 50 to 60 percent of early miscarriages and usually are caused by an abnormal number of chromosomes. Increased age, smoking, caffeine, alcohol and the use of certain medications also can increase a woman's risk for miscarriage.

Treatment
The treatment of recurrent miscarriage depends on the cause.

• Genetic causes: There currently is no method of correcting genetic problems.


• Biological causes: An abnormally shaped uterus, fibroids or scar tissue can be corrected with surgery. However, surgical removal of fibroids does not guarantee a successful pregnancy.


• Illness and disease: Adequate control of diabetes and thyroid disease also is critical in trying to prevent recurrent pregnancy loss in women with those conditions. For women with antibody problems, certain medications have been found to be useful in achieving successful pregnancy outcomes. Blood thinners, such as heparin, baby aspirin, IVIg Therapy and even the addition of steroids can, in some cases, prevent further pregnancy loss.


• Hormonal imbalances: The use of progesterone to increase the blood levels of this hormone is commonly used, especially if it is found that the hormone concentration is low during the critical time of implantation. Some practitioners may even give this medication when the progesterone level has been tested and found to be normal. This is done because it has been shown that the progesterone level can fluctuate from month to month.

In dealing with recurrent pregnancy loss, although obvious problems can be corrected, a miscarriage can still occur. No treatment is guaranteed. On the other hand, even with repeated miscarriages, there is still a very good chance of achieving a successful pregnancy.

Polycystic ovarian syndrome (PCOS) is a common inherited disorder that affects 5 to 10 million women and is a leading cause of infertility. Symptoms include irregular ovulation and elevated male hormone levels (hyperandrogenism). PCOS also is characterized by severe obesity, excess hair growth, acne, high cholesterol and triglyceride levels, high blood pressure and enlarged ovaries.

Causes
The cause of PCOS is not entirely understood but appears to be related to insulin resistance.

Treatment
Currently, there is no cure for PCOS but it can be managed. A range of options has become available to treat the symptoms associated with the disease, including:

• Weight loss


• Hormonal (anti-androgen) therapy


• Insulin-lowering treatments


• Ovulation induction


• Assisted reproduction


• Ovarian drilling surgery

After age 35, a woman's fertility rapidly declines. By age 43, her fertility is significantly diminished because her ovaries are producing fewer viable eggs. Of women trying natural conception:

• At age 30, 75% will get pregnant within one year.


• At age 35, 66% will get pregnant.


• At age 40, 44% will get pregnant.

After age 35, a woman's success with fertility treatments starts fading as well. Problems that make natural conception difficult also affect in vitro fertilization. The quality of a woman's eggs is critical to her chances of becoming pregnant, particularly when using in vitro fertilization or other assisted reproductive technology (ART) procedures. Of women trying in vitro fertilization:

• 30% will give birth at age 30.
  
• 24% will give birth at age 35.
  
• 17% will give birth at age 40.
  

Couples experiencing conception problems often must strike a delicate balance between hope and anxiety on a monthly basis to keep their emotional health in check – hope that this is finally the month or anxiety that it isn't.

The sorrow, anger and frustration that may accompany fertility problems can find their way into other areas of life, battering your self esteem and placing undo strain on your relationships with family, friends and even co-workers.

More than 6 million couples in the United States experience problems conceiving, according to the American Society for Reproductive Medicine. But recent medical advances are helping to reduce those numbers and provide hope to many couples that have set their sights on parenthood.


The MacDonald Fertility and IVF Program at MacDonald Women's Hospital of University Hospitals Health System is focused on helping couples become families. The hospital's nationally recognized, board-certified team of experts offers comprehensive fertility treatments to couples that need help conceiving.

J. Ricardo Loret de Mola,

James H. Liu, MD

Arthur H. Bill Professor of Obstetrics & Gynecology

Francisco Arredondo, MD

Allen D Seftel, MD

Sheryl A. Kingsberg, PhD

Comprised of physicians, laboratory staff and technicians, program coordinators, nurses, psychologists and nutritionists, the MacDonald Fertility and IVF Team offers a wide range of clinical expertise covering a number of fertility issues, including:

• Female Infertility


• Male Infertility


• Hormonal abnormalities in Women and Men


• In Vitro Fertilization (IVF)


• Intracytoplasmic Sperm Injection (ICSI)


• Gamete Intra-fallopian Transfer (GIFT)


• Intrauterine Insemination


• Oocyte Donation


• Shared Oocyte Donation Program


• Embryo Cryopreservation


• Advanced Surgical and Endoscopic Surgery for the treatment of Endometriosis, Uterine Fibroids, Tubal Ligation Reversal and Uterine Anomalies.


• Treatment of problems with Ovulation-


• Sperm Donation


• Genetics Testing and Evaluation


• Recurrent Pregnancy Loss


• Uterine Fibroid


• Polycystic Ovarian Syndrome (PCOS)


• Menstrual Disorders


• Premature Ovarian Failure


• Menopause

For more than 100 years, MacDonald Women's Hospital has provided the highest quality, individual treatment to women of all ages. Whether you need adolescent gynecology services, prenatal care, breast health education, support during menopause or gynecologic oncology services, MacDonald Women's Hospital is Ohio's only true women's hospital, and the most comprehensive.

For more information about fertility enhancement or to schedule an appointment, please call MacDonald Women's Hospital at 1-800-800-UHHS, online at here or view the University Hospitals Health System site at www.uhhs.com.

If you would like to ask a question, please email us at alicia.scipione@uhhs.com.

University Hospitals of Cleveland
MacDonald Women's Hospital
11100 Euclid Avenue, Suite 1200
Cleveland, OH 44106

University Health Center at Landerbrook
5850 Landerbrook Drive, Suite 300
Mayfield Heights, OH 44124

UHHS Westlake Medical Center
960 Clague Road, Suite 1400
Westlake, OH 44145

Clinical Trials help medical researchers answer specific questions about the effectiveness of new therapies or ways of using established treatments. These trials are used to determine whether new drugs are safe and effective, and often are credited with helping doctors develop new advances in medical care.

Follow a local woman as she participates in a clinical trial that may eventually help her conceive.