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Fertility Treatment for Busy Professionals

Fertility Treatment for Busy Professionals

From TTC to a Viable Pregnancy

If you and your partner has been trying to conceive (TTC) and your busy with work commitments, here are few tips that help you save time and shorten the time to conceive. Understanding few basic fertility concepts are helpful. What is fertility? It is the ability to conceive with regular unprotected intercourse. If you are having adequate frequency of intercourse, then you have been trying, irrespective of timing of intercourse. If this goes on for one year, if less than 35 or 6 months if 35 or more, then you are having difficulty getting pregnant.Female age is the most important fertility factor

Percent of currently married, childless women 15-44 years of age who have impaired fecundity by current age (from CDC: The National Survey for Family Growth):

 

2002 2006-2010
   Total 15-44 years    25.3%   21.2%
   15-29 years    17.3%   11.0%
   30-34 years    24.5%   14.2%
   35-39 years    33.9%   39.3%
   40-44 years    42.8%   47.1%

The longer you try, without conceiving, the stronger the indication that you have a significant problem with fertility.

The factors that need to be tested at initial workup include:

i. Ovulation and ovarian reserve

ii. Fallopian tubes: open or not

iii. Male factor: sperm analysis and

iv. General factors related to safety: infectious diseases and genetic carrier screening.

But how do you get all that done, understand the results, decide with your reproductive endocrinologist on a fertility treatment plan and execute the plan promptly, while you hassle your daily work and life engagements? A coordinated effort between you, your fertility specialist and other personnel enables you to promptly understand your fertility potential. A flexible reproductive endocrinologist can grant you an appointment at a time that does not disturb your work schedule. At your initial visit, ultrasound is performed for evaluation of ovarian reserve and any abnormalities in the uterus. In the same day, blood is drawn from you and your partner and can be sent for testing. Also a sperm sample can be submitted in the same day or few days later for sperm analysis. Hysterosalpingogram (HSG) can be performed by your physician or a radiologist within 1-2 weeks. Then, Can you communicate electronically with your physicians? This enable efficient discussion of lab results and subsequent steps.

How Fast Can You Decide on a Fertility Treatment Plan? It depends on many factors related to the complexity of fertility issues uncovered during the workup, need for surgery e.g to remove fibroids, polyps or dilated fallopian tubes, proposed fertility treatment, need for genetic testing of embryos (PGD) and need for third party reproduction (donor eggs, donor sperm, gestational carrier). If complex treatment is required usually a second visit is helpful for evaluation of the uterine cavity, trial transfer, training on fertility medication self administration. Handling of insurance and dispensing fertility pharmacies also help reduce the burden on women busy with work engagements.

Many women are advised to continue to try to conceive naturally (3 to 6 months). For those requiring fertility treatment usually a fertility treatment plan can be executed in 10 to 20 days and within 5 to 8 visits. Again the flexibility of the practice in scheduling and communication allow you to execute  around your daily work and family commitment.

The flexibility of the fertility clinic, efficient planning of visits and use of secure electronic communication methods enables women to go through fertility treatment with minimal inconvenience and work interruption.

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Asian Women & Fertility Problems

Asian Women & Fertility Problems

Asian Women & Fertility Problems

Majority of Asian Women and Men agree that it is very important for them to have children. Unfortunately, many Asian couples face challenge trying to conceive naturally or using fertility treatment. The decline in natural fertility and the lower success of IUI and IVF in Asian women is documented in The US, UK, China, Japan, Korea and other Asian countries.

Fertility in Asian countries has declined to the population replacement rate 2.1 or lower. Many factors contribute to decline in natural fertility in Asian women;

Ovarian Reserve in Asian Women

When compared to Caucasian women, Asian women undergoing IVF significantly produce less eggs at all Anti-Mullerian hormone (AMH) levels, even in women with high AMH. AMH is the most accurate marker for ovarian reserve.

Gynecologic and medical disorders that impairs fertility: PCOS, endometriosis and Systemic lupus (SLE) are more common in Asian women.

Vaginismus : may interfere with regular intercourse in some Asian women.

Environmental Factors: Asian women has more exposure to methyl Mercury and vitamin D deficiency.

Culture : surveys of Asian women and men indicate that they are less likely to consent to be contacted for fertility research, are fatalistic about failure to conceive, less informed about fertility issues, only 36 percent knew that chances of getting pregnant declined with age, and are less likely to suspect a male factor.

Asian women are commonly late at seeking care for infertility and overestimate the chance for getting pregnant.

Genetics : Many genes are likely involved. FMR1 is a gene on X chromosome responsible for Fragile X syndrome and its variants. High repeats at this gene may reduce ovarian reserve.

Fertility Treatment Outcomes in Asian Couples

  1. Pregnancy and delivery rates are lower in Asian women following ovarian stimulation and IUI compared to white women
  2. IVF: when compared to white women in the US,  31 per cent of the Asian women gave birth successfully compared to 48 per cent of the white women. Asian women were also less likely to become pregnant; 43 percent against 59 per cent even after control for many fertility factors. Enodmetrial lining was thinner in Asian women compared to Caucasian women.

Asian women should be aware that fertility treatment may be less successful and seek care of a reproductive endocrinologist and fertility specialist as early as possible.

In addition there are other factors that require attention in Asian women during fertility treatment especially the higher prevalence of chronic hepatitis B infection.

After conception, asian women at are a higher risk for gestational diabetes.

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