Infertility means inability to reproduce after one year or for a woman aged 35 years or above, six months. A woman who is able to be impregnated but is unable to maintain her pregnancy can also be called infertile. About 30% of the time, infertility factors can be found in women.
Diagnosing infertility in women can be difficult. There are numerous procedures available, depending on the source of infertility. After trying to conceive a child for two years, around 95% of the couples are successful.
The process of getting pregnant involves multiple stages:
- The woman must go through ovulation
- The egg must proceed past the fallopian tube to the womb
- The egg must be fertilized by a man’s sperm
- The fertilized egg requires to be embedded in the uterus
In an instance where any of these stages is disturbed, infertility occurs.
The most obvious factor is the inability to be impregnated. Menstrual cycles that are too long, too short, absent, or irregular can mean that the woman is not ovulating. No outward symptoms may emerge.
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When should you seek professional help?
At least one year is recommended by most experts. Women 35 years old and above should seek medical expertise past 6 months of intercourse. In women, the chances of conceiving decrease every year following the age of 30.
Some health disorders may also hinder fertility. Women should seek medical help if they have:
- Irregular periods or absence of menstrual cycle
- Endometriosis
- Painful periods
- If they have had more than one miscarriage
- Pelvic inflammatory disease
It is better to consult a doctor before attempting to get pregnant. They can aid you in preparing your body for conception.
Causes of Female Infertility
Age: Women above 35 have a much lesser number of eggs. Since the amount of eggs deplete each year, it is increasingly difficult to get pregnant starting at this age.
Ovulation disorder: Disturbance in the functioning of pituitary gland which is responsible for regulating the menstrual cycle and the body’s hormones can result in ovulation disorder. Some women may suffer from very irregular menstrual cycle, or have no ovulation due to the following reasons:
- Thyroid disorder
- Stress
- Overweight
- Underweight
- Poor nutrition
Endometriosis: It is a condition where the tissue that constitutes the uterus lining enlarges exterior of the woman’s uterus. With every menstrual cycle, the tissue also witnesses bleeding resulting in pain and inflammation. Scarring can arise and obstruct the fallopian tube or damage the uterus, resulting in infertility.
Polycystic ovary syndrome: This syndrome disturbs the production of eggs in the woman’s ovaries. Prolonged or irregular menstrual cycle may be endured by a female suffering from this syndrome.
Symptoms include skin problems, insulin resistance, and weight gain. Some women can experience no symptoms at all. It is difficult to recognize this syndrome.
Fallopian Tube Blockage: Fallopian establishes a linkage between the ovaries and uterus. These tubes can become blocked or inflamed due to a number of reasons:
- Infection
- Pelvic inflammatory disease
- Endometriosis disease
Most eggs get fertilized in the fallopian tube. This condition can obstruct pregnancy.
Autoimmune diseases and some forms of cancer may also lead to infertility.
Risk Factors
There are women under certain categories who are more at risk of infertility. They can include:
Age: Older women have fewer chances of getting impregnated in comparison to younger. After reaching her 30s a woman’s quality of eggs deteriorates with each year.
Sexual history: Sexually transmitted diseases like gonorrhea and chlamydia can disrupt the fallopian tubes. Having unprotected sex with numerous partners heightens the probability of contracting STD infection which can cause problems for fertility.
Weight: Ovulation can be affected if the woman is severely over or underweight. Achieving a healthy body mass may increase the rate of ovulation and the chances of getting pregnant.
Smoking: Smoking can cause damage to a woman’s fallopian tubes and cervix. Smoking can also increase your chances of a miscarriage as well as ectopic pregnancy. It is believed to exhaust your eggs prematurely and age your ovaries. Avoid smoking before starting fertility treatment.
Alcohol: Excessive alcohol consumption must be avoided.
How to Prevent Infertility in Women
Healthy lifestyle choices can improve your overall health and promote fertility in both you and your partner
A woman can improve her chances of normal fertility by following some methods like:
- Maintain ideal weight
- Quit smoking
- Limit caffeine
- Reduce stress
- Avoid alcohol
Diagnosis of female infertility
Some of the fertility tests include:
- Ovulation testing: At home or over the counter ovulation kits are available to test the rate of luteinizing hormone that happens prior to ovulation. A blood specimen might be collected for inspecting progesterone or hormone levels, such as for prolactin, may also be examined.
- Hysterosalpingography: X-ray contrast is inserted into the woman’s uterus to search for discrepancies within the uterine cavity.
- Imaging tests: An ultrasound for the pelvic area can be performed to examine for fallopian tube or uterine disease
- Ovarian reserve testing: This will determine the number and quality of eggs ready for ovulation. Women upwards of 35 years may have to take this series of imaging and blood tests.
- Other hormone testing: Various hormone tests relating to reproductive processes may be done. For example, ovulatory hormones, pituitary and thyroid hormones.
Rarely, the following test may also be included:
- Genetic testing: To determine genetic issues that may obstruct fertility.
- Laparoscopy: Incision is created and a tiny viewing device is inserted to look for problems.
- Other imaging tests: Hysteroscopy may be recommended by your doctor to examine for fallopian tube or uterine disease.
Treatments for Female Infertility
1. Laparoscopy
If you have been diagnosed with a Pelvic or tubal disease, surgery can be initiated to reconstruct your reproductive organs. Laparoscopy is a surgical procedure where a laporoscope is inserted through an incision near your belly button to eliminate scarred tissue, open blocked tubes, remove ovarian cysts, or treat endometriosis.
A Laparoscopy is recommended when other methods fail such as ultrasound, and x-ray, cannot verify the source of the condition.
Indications for Laparoscopy
A laparoscopy can help diagnose many conditions that cause infertility such as:
- Blocked fallopian tubes
- Endometriosis
- Scar tissue build up
- Fibroids
- Any abnormality in the reproductive system
A physician may also recommend laparoscopy when the cause of infertility in a woman cannot be explained. When other diagnostic tests show normal results, this diagnosis is recommended.
By having a close look at the reproductive organs, your physician may be able to find out the issues preventing the conception.
Laparoscopy might be followed to:
- Inspect tissue mass
- Verify the cause of discomfort in the abdominal and pelvic area
- Validate Endometriosis
- Confirm Pelvic Inflammatory disease
- Inspect for obstruction in the fallopian tube
- Other cause for infertility
Procedure
General anesthesia is given to avoid discomfort during the procedure. A tiny incision is created nearby the naval. The laparoscope is set and the abdomen is aerated to make it easier for viewing the organs. The Laparoscope might also be supported with surgical equipment for removing scars or collecting tissue samples.
An additional incision may be created near the pubic area. This will create an extra opening for accomplishing minor surgeries.
Following the surgery, patients typically stay in the recovery room for about an hour. After this, they are transferred to an outpatient unit for examination.
What to Expect
It is normal to experience a minimal level of discomfort and pain after the surgery.
As the gas starts to dissipate from the body, you may experience pain in the abdomen or on the shoulders. Relieving all of the gas and the discomfort will take a couple of days. Drink peppermint tea and walk around to help speed it up.
Your physician will provide you with instructions during discharge concerning what to do and what to expect during the recovery.
When to Call Your Doctor?
Complications are quite rare but if you experience any of these issues, contact your physician right away:
- Fainting
- Severe, worsening pain
- Inability to use bathroom
- Constant nausea and vomiting exceeding 24 hours
- Swelling, redness, bleeding, and drainage near the incision
- Fever exceeding 100 degrees for 24 hours or heavier menstrual flow than usual, hefty bleeding with clots, soaked sanitary pads within 2 hours the day following surgery
If you experience any of these, communicate with a doctor
Benefits of Laparoscopy
Here are some benefits of laparoscopy:
- Less invasive
- Lower infection risk
- Smaller scar
- Faster recovery
- Possibility of correcting the issue during the surgery
The chance of getting pregnant also increases when a person receives treatment during the procedure.
Risks and Complications
Laparoscopy is overwhelmingly safe. Out of a possible 1000 women who opted for laparoscopy, only 3 endure complications. This risk can include bleeding, trauma to nearby organs, or issues related to anaesthesia.
Possible Side Effects
- Swollen Abdomen
- Sore throat
- Mild nausea
- Acidity or Gas
Vaginal bleeding post surgery for a period of a month is normal. Many women do not experience their normal menstruation up to 6 weeks post surgery. When normal cycle resumes, heavier bleeding and further discomfort might be felt.
Outlook
In many cases, you physician will be able to diagnose and repair any issues during the procedure. The results should be explained to you in detail after the surgery and even inform you about the next steps to be taken.
It is advisable to wait for several weeks or months before trying out IVF or other another treatment.
It is also recommended to abstain from sexual activity for a week.
2. In Vitro Fertilization
In this procedure, the retrieved sperm and egg are fused in a special dish external of the body and then transplanted into the woman’s uterus.
How Many Times Can IVF Be Tried?
Generally, it is recommended that partners try for at least 6 rounds of IVF for optimal results.
Reasons for Failure of IVF
Failure of IVF can depend on numerous reasons such as:
- Failure of the eggs to fertilize
- Low-quality eggs
- Insufficient quantity of follicles
- Embryo transplantation
- Non-conducive embryo
3. Intracytoplasmic Sperm Injection
Intracytoplasmic Sperm Injection or ICSI is a procedure in which the egg is directly injected with a sperm in a dish and then transplanted into the woman’s uterus.
Basically, it consists of five steps
- A pipette holds the developed egg
- A very sharp and hollow needle disables and obtains one single sperm
- The same needle is then precisely injected into the cytoplasm of the egg
- The sperm is then inserted into the egg. The needle will then be carefully detached
- The next day, the eggs are inspected for evidence of fertilization
Once the full steps of ICSI are accomplished, the embryo is embedded into the uterus of the patient.
Then signs of pregnancy are awaited. Ultrasound or blood test might be performed to determine pregnancy.
Will it Work?
50 to 80 per cent of eggs are fertilized through ICSI. However, the issues mentioned below might arise.
- All or some of the eggs may encounter damage
- The egg might fail to develop even after the injection of sperm
- The embryo may experience termination of growth
Effects on Child
The probability of conceiving a child through ICSI with defects is extremely low. It is only 1%.
Another risk is multiple births. It can be harmful to the mother as well as the children. But this risk can be avoided by precisely controlling the number of embryos transferred into the uterus
4. Hysteroscopy
Hysteroscopy is usually performed when your doctor wants to check the cause of your infertility or when your menstrual flow is heavy. This method allows your doctor to get an up-close look at your fallopian tubes and uterine cavity.
The procedure involves inserting a Hysteroscope into your uterus through the cervix. It is carried out to remove blocked tubes, divide scar tissue, remove polyps as well as fibroid tumors.
Who Needs This Procedure?
By inserting a thin tube with light (hysteroscope) inside your vagina, your doctor will be able to see the inside of your uterus and your cervix. If any abnormality is detected, samples will be taken for further lab testing.
Two most common reasons for performing hysteroscopy are infertility and heavy menstrual periods or bleeding.
Hysteroscopy is also recommended for these situations:
- Abnormal Pap test results
- There are polyps, scarring or fibroids on your uterus
- Difficulty getting pregnant or occurance of more than one miscarriage
- Bleeding after menopause
- Tissue sample retrieval from the uterus lining for biopsy
- Sterilization for permanent birth control
How it’s Done
A hysteroscopy is done either at your doctor’s clinic or in a hospital. You will either be under general anesthesia or awake for the procedure. If not under general anesthesia, you will be given medication to relax. Your doctor will use tools like dilators or medication to open up the cervix.
It’s also likely for your doctor to use a speculum, which is a tool to help keep your vagina open. Next, the hysteroscope will be inserted into the uterus through the vagina and the cervix.
Then, your doctor will push a liquid-like saline or carbon dioxide past the hysteroscope and into the uterus to clear out mucus and blood and expand it further. Afterwards, the light will be emitted through the hysteroscope to give a clear view of the lining and fallopian tubes.
If surgery is required, compact instruments are inserted past the hysteroscope and into the uterus
The duration varies from five minutes up to an hour.
After Procedure
Commonly, patients are able to go back home right after the surgery, but if you have been under general or local anaesthesia, you will need an adult companion to drive you home.
It is normal to experience mild bleeding or cramping after the procedure. It is also common to be gassy for 24 hours after the procedure. You may be prescribed medication depending on the severity of the procedure to help control the pain.
Before going home after the procedure, your doctor will brief you on how to take care of the treated area.
It is recommended to avoid sexual intercourse for a minimum of 2 weeks following the procedure.
Possible Complications of Hysteroscopy
Hysteroscopy is overwhelmingly safe and the chances of complications are less than 1%. Some of the risks may involve:
- Anaesthesia-related complications
- Heavy bleeding
- Infection
- Damage or tearing to the cervix although rare
- Damage to neighbouring organs like ovaries, bowel, or bladder
- The substance utilized to expand the uterus may result in adverse reactions
- Intrauterine scarring
- Inflammation in the pelvis
Use of gas may result in shoulder pain. It is also common to feel sick.
If any of the following symptoms are experienced, contact your doctor:
- High fever
- Severe abdominal pain
- Significant vaginal discharge or bleeding
5. Intrauterine Insemination (IUI)
IUI or Intrauterine Insemination is one of the most popular methods of artificial insemination. This was initially developed by medical scientists to breed livestock but later on was successfully adapted for human use.
Why Opt for IUI?
IUI can benefit individuals or couples with a wide range of needs. According to the Center for Disease Control and Prevention (CDC), it is said that 6% of women in the United States aged between 15 – 44 years fail to conceive or get pregnant after 1 year of unprotected sex.
It is recommended to consult a fertility doctor and discuss treatment options if you are:
- Past 35 years and trying to get pregnant
- Cannot get pregnant after a year of unprotected sex
- Not getting regular periods
It is also advisable to seek fertility treatment if you have had more than two spontaneous miscarriages.
Here are some medical conditions in which IUI can be helpful:
- Couples with healthy eggs and sperm but are unable to have sex due to possible medical conditions like erectile dysfunction.
- Women who are diagnosed with cervical factor infertility where the cervix is unable to produce mucus to help the sperm travel to the womb or the mucus kills the sperm due to some substances present in it.
- Endometriosis where the tissue in the uterine lining (womb) starts growing on other organs like the fallopian tube or the ovaries. IUI works in cases of mild to moderate endometriosis. Most women diagnosed with endometriosis are able to conceive naturally.
- Although rarely, some women may get allergic reactions to certain chemical proteins present in the semen or sperm. This can be prevented through the “washing” or separation process.
- Some men may not be able to produce a substantial amount of sperm for fertilization, or the sperms may be motile. In this case, the sperm fails to get inside the egg.
- Some medical treatments, like radiation therapy, may cause infertility. Patients may choose to freeze their sperm to be used in artificial insemination in the future.
IUI is also suggested in some cases where there is no clear reason behind the couple’s infertility.
Preparing the Semen Sample
Generally, the sperm is donated by the male partner, but if the partner cannot provide the sperm, a sperm donor can be an option. This is also a popular choice among single women or women who are in same-sex relationships and want to have a baby.
If a sperm donor is used, a sample is first sent to a sperm bank where it is quarantined and tested for any signs of transmittable diseases. Here the sperm is frozen and then thawed out for the procedure.
A chemical called cryptoprotectant is added to the sperm before freezing to protect the sperm from the extreme temperatures.
If the male partner is providing the sperm, the sample can be derived through several methods:
- Collecting semen from the condom after sexual intercourse
- Masturbation
- Sperm surgical aspiration where sperm is retrieved directly from the reproductive tract
- Electric or vibratory stimulation if the ejaculation cannot be done without devices or assistance
After retrieving the sperm, it is then “washed” or separated from any proteins or chemicals that could cause an allergic reaction in the uterus or interfere with the fertilization.
Procedure
Ovulation stimulation medications are used prior to intrauterine insemination. This invites careful examination to ascertain the maturity of eggs. The IUI procedure is conducted about the time of ovulation. This generally occurs about 24 hours post-surgery in Lh hormone which specifies that ovulation will take place.
The semen will be injected directly into the uterus using a fine catheter while keeping the vagina open with the help of a speculum. The sperm is pushed into the uterus through the cervix. This procedure augments the quantity of sperm increasing the probability of conception.
It takes only a few minutes and involves minimal discomfort. The next step will be to look out for signs of pregnancy.
Risks of Intrauterine Insemination (IUI)
The chances of having twins or triplets are heightened if fertility medication is undertaken during IUI such as gonadotrophin. It also minimizes the chances of infection.
The chances of complications also increase, such as miscarriage or premature birth when the woman conceives more than one fetus.
These days fertility medications are prescribed only when there is difficulty in production of egg cells from which the embryo develops, or there is difficulty in ovulation.
Ovarian Hyper-stimulation Syndrome(OHSS) also causes the ovaries to swell when IUI and fertility medication are combined. Although it is quite rare and the symptoms may be mild to moderate, it can cause serious complications.
Mild symptoms of OHSS include mild abdominal pain, bloating, possible nausea, and vomiting. Severe symptoms include shortness of breath, pain in the chest, and dehydration.
Paracetamol and hydration will typically ease the pain, but severe cases will require treatment at the hospital.
Success Rate
Although IUI may be less successful than more intensive alternatives like In-Vitro Fertilization(IVF), it still has a success rate of 5 – 15% during the first attempt.
The chances of success increase dramatically around the 6th insemination, especially for women under 40 years of age as per a study conducted in 2013 by a German clinic.
The study also revealed that the average number of attempts to get a successful conception was 2.24.
Doctors normally do not recommend IUI beyond the 6th cycle as the chances of conception decrease dramatically. At this stage, more invasive treatments like In-Vitro Fertilization (IVF) would be more successful.
A pregnancy test should be done at least 2 weeks after IUI as it takes time for pregnancy hormones to show up. For more accurate results, take a blood test.
Outlook
IUI or artificial insemination is a medical procedure to help a woman get pregnant.
The sperm is injected directly into the womb by a fertility doctor using specialized surgical tools. IUI is usually recommended for couples where either or both the partners are infertile as a result of previous treatments or underlying conditions.
The sperm is first collected from the male partner or a donor and then stored in very low temperatures before it is implanted into the woman’s uterus.
It usually takes a few cycles before a woman is able to conceive successfully. The rate of success is very high by the 6th cycle.
6. Medication to treat Female Infertility
Fertility drugs can help with many problems like increasing the chances of getting pregnant and also carrying the baby to the full term. These drugs target specific infertility issues so a woman should take them only at the recommendation of a doctor.
Note: Without a diagnosis, fertility drugs will not increase the possibility of conceiving.
If a couple cannot get pregnant, it could be due to infertility issues in both or either of the partners. It is recommended to seek medical treatment if the female partner fails to get pregnant or continually have miscarriages after attempting to get pregnant for 12 months or more.
Older women above the age of 35 years are recommended to seek treatment within 6 months of trying to conceive.
For those women who have medical conditions that could potentially affect pregnancy or have irregular menstruation, you should consult a doctor before you try to get pregnant.
Different Types of Fertility Drugs for Women
There are some fertility pills that can trigger ovulation when a woman does not ovulate regularly.
Other types of drugs include hormones that should be taken right before an artificial insemination.
Drugs That Cause Ovulation
There are some women who do not ovulate regularly while some do not ovulate at all. It is said that 1 out of 4 women cannot get pregnant because of ovulation issues.
Below are some drugs that can treat ovulation issues:
- Metformin: Also known as Glucophage, this drug can decrease the resistance to insulin. Polycystic Ovary Syndrome or a body mass index above 35 can cause resistance to insulin, which in turn creates issues with ovulation.
- Dopamine Agonists: This type of drugs reduces the level of a hormone known as prolactin. For some women, the presence of excessive prolactin can create issues with ovulation.
- Clomiphene: It is also known as Clomid. This is a drug that can trigger ovulation. It is commonly recommended as the first option during infertility treatment for women facing ovulation issues.
- Letrozole: Also known as Femara, this drug can trigger ovulation just like letrozole and clomiphene. Letrozole may be more effective for obese women, especially those diagnosed with PCOS.
In 2014, a study found that about 27.5% of women diagnosed with PCOS who regularly took letrozole were able to conceive as opposed to 19.1% of women who took clomiphene.
- Gonadotropins: These hormones can stimulate ovulation. This is usually recommended when all other treatments fail to work. Your doctor may typically recommend using a combination of a luteinizing hormone and a follicle stimulating hormone.
This treatment is usually administered in the form of a nasal spray or an injection.
It is said that out of about 10% of infertility cases, doctors are not able to find a cause. Medically, it is referred to as “unexplained infertility.” Drugs that trigger ovulation may be able to help in such cases.
A woman can optimize her chances of getting pregnant by timing sexual intercourse when under these medications. It can also address the issues of unidentified ovulation.
Hormones for Artificial Insemination
Not all cases of infertility can be treated by drugs.
When the cause of infertility cannot be determined by the doctor, artificial insemination is recommended.
Intrauterine Insemination or IUI is a procedure where the sperm is inserted directly into the uterus during ovulation. It may be able to treat cases where infertility is due to sperm mobility or cervical mucus or “unexplained infertility.”
Your doctor may prescribe these drugs before performing IUI:
- Ovulation Trigger: Since it is essential to perform IUI at the time of ovulation, doctors usually recommend shots to “trigger” ovulation like the Human Chorionic Gonadotropin (hCG) hormone.
- Ovulation Drugs: Letrozole or Clomiphene can stimulate ovulation and even release extra eggs.
- Progesterone: This hormone is usually taken through vaginal suppository and can sustain early pregnancy.
In Vitro Fertilization (IVF) is a procedure where one or more eggs are removed to fertilize with the sperm in a petri dish. The eggs are implanted into the uterus once it grows into embryos.
Drugs for IVF
Here are some drugs that IVF requires:
- Ovulation Suppression: IVF may not be successful if the ovulation happens too early. Gonadotropin antagonist hormones are usually prescribed to prevent the chances of ovulating too early.
- Ovulation Drugs: Like IUI, there is a higher chance for IVF to succeed if the ovaries are able to produce several eggs. Letrozole or clomiphene is usually prescribed for this.
- Ovulation trigger shot: Ovulation trigger shots like the hormone hCG can increase the rate of success in IVF.
- Progesterone: This drug helps to support early pregnancy through IVF.
During infertility treatment, a doctor may prescribe hormonal birth controls in order to regulate the period cycle. This will also prepare the body and make it more receptive to artificial insemination.
What to Expect
Before taking fertility drugs, make sure your doctor diagnose the problem using ovulation tests, blood tests, and image tests of the fallopian tubes and uterus.
You may also be asked to keep track of your period cycle and test the basal body temperature every morning.If the diagnosis is such that it may not be treated by medication, your doctor will recommend IVF or IUI.
It is essential to wait for a few months before starting the treatment as it is important to take fertility drugs on fixed days of the cycle. If it is not successful in the first treatment, you may be recommended more tests, another treatment, or even a different treatment.
Side Effects of Fertility Medications
It is common for women to experience side effects after taking fertility drugs, especially those medications that contain hormones.
Some of the common side effects include:
- Changes in mood including depression, anxiety, and mood swings
- Temporary side effects including breast tenderness, cramps, headaches, vomiting and nausea
- Ovarian Hyper-stimulation Syndrome
- Higher risk of pregnancy loss
- Multiple births
There is also the possibility of an increased risk of endometrial and ovarian cancers besides others.
Considerations
Infertility treatment is not covered under a lot of health insurance policies in the U.S. That said, if the infertility is a result of some serious medical issue like PCOS or infection, the insurance may cover the treatment.
The cost may be a concern for many individuals. You need to weigh on the potential benefits and costs when choosing the right treatment.
Here are some questions to ask your doctor:
- What’s the success rate of this procedure among patients with the same diagnoses as mine?
- How long does it take on average to successfully conceive through this treatment?
- What’s the overall cost for this treatment?
- Are there more affordable alternatives?
- What’s my chance of getting pregnant without fertility drugs?
- What else can I do to increase my chances of conceiving?
Male and female couples trying to get pregnant should both undergo fertility tests. In certain cases, both partners tend to have fertility problems and treating just the female partner will not help.
Not all infertility issues can be treated with drugs. For example, a blocked fallopian tube can be fixed by a procedure called hysteroscopy.
Outlook
It can be stressful trying to get pregnant with fertility issues.
It is possible for many women to get pregnant after undergoing infertility treatment, but a lot depends on the right diagnosis, especially with drug-based treatments. Therefore it is crucial to consult a doctor beforehand.
For women with infertility problems due to ovulation disorders, fertility drugs are the primary treatment.
7. Egg Donation
This can work if the woman has a regular uterus but the ovaries might be disturbed. Eggs are withdrawn from a donor who is under fertility drugs. The donor is usually younger.
What is Egg Donation?
Egg donation is a procedure that involves collecting eggs or oocyte from a donor possessing normal functioning ovaries. Using the receiving couple’s sperm, the egg undergoes fertilization through IVF. The embryos are fertilized in a laboratory for 3-5 days and then implanted into the uterus of the woman who volunteers to carry the baby.
Sometimes the specialists may choose to freeze all or some of the embryos for future use or implantation in other women.
Egg donation can benefit women who are not able to use their own eggs due to several reasons like advanced age, ovarian failure, or congenital anomalies in the fetus.
Back in 2014, a journal called Fertility and Sterility noted that about 93% of fertility clinics in the United States offered egg donation. It also indicated that this procedure led to a success rate of 49.4 – 50%
This article will talk about the criteria for selecting an egg donor, legal ramifications, and the procedure.
What to Expect
The specialists working at the fertility clinic will find a suitable donor after an intensive selection process. They will also look into all the legal procedures.
Before undergoing the procedure, donors will be required to take medications to stop the menstrual cycle. Taking this medication can cause some side effects, such as:
- Hot flashes
- Body aches
- Fatigue
- Headache
More fertility drugs will be prescribed to induce hyperstimulation, whereby the ovaries produce several eggs at once. This medication will be self-administered by the donors themselves by injecting it into a muscle or under the skin.
Although not common, some mild side effects include tender breasts, mood swings, and bruising at the injected area. In some rare cases, too many eggs may develop inside the ovaries and lead to a severe case of Ovarian Hyper-stimulation Syndrome (OHSS). This may require hospitalization.
It is also possible for donors to get pregnant before retrieving the eggs, so it is recommended to abstain from sexual intercourse or use contraceptive barriers like a condom.
The donor will have to go through frequent ultrasound examinations and blood tests throughout the cycle of donation to closely monitor how their body reacts to the medications.
Extraction Process
The donor will receive one last injection before the eggs are retrieved.
The eggs will be removed from the donor’s ovaries through trans-vaginal ovarian aspiration. In this process, an ultrasound probe will be inserted into the vagina, and then the egg will be removed with the help of a needle.
The procedure lasts about 30 minutes, and the donor may be given an anaesthetic, sedatives, or painkillers. Since the procedure is quite minor, there is no need to stay overnight at the hospital.
After the Donation
Recovery depends on person to person. While some can resume their normal activities the very next day, some need several days of rest.
Some programs also offer after-care services to donors. Egg donation may affect some women psychologically, requiring psychotherapy following the procedure.
Complications and Side Effects
There are very little chances of complications in egg donation. The medications and procedures are the same as women who use their own eggs and comes with the same risk level.
Using anesthesia during egg retrieval comes with some risks, but it is quite rare to cause serious issues.
In some cases, it may cause minor bleeding when the needle is inserted into the ovary. Although very rare, there is also the chance of causing damage to the bladder, bowel, surrounding blood vessels. Severe bleeding or damage is very unlikely.
There is also the chance of infection even after retrieving the eggs. This can be prevented with the help of antibiotics.
Sometimes, OHSS can also be triggered by the medication to induce ovulation, which can range from mild to severe. In any case, consult a doctor.
Severe symptoms that may require hospitalization include:
- Fast weight gain
- Difficulty in breathing
- Vomiting
- Stomach ache
Donor Criteria
There are several factors that affect the ability of a woman to donate her eggs.
These are the factors that reduce the chances of congenital anomalies and increase the success rate of pregnancy.
Donors are generally between the age of 21 to 35 years as women at this age respond more readily to fertility drugs and also often have better quality and higher quantity of eggs.
Women diagnosed with Hepatitis C and HIV or with a high risk of inherited diseases (e.g., cystic fibrosis gene) are not qualified to be egg donors.
Women who are exposed to high risks of contracting HIV or other infections are also not eligible for egg donation. Similarly, if a woman is not able to provide her family medical history in detail, she cannot donate her eggs.
Certain programs give higher preference to women who have already donated eggs before or have given birth.
Screening Process for Egg Donor
In order to avoid as much congenital anomalies and other complications as possible, reputed egg donor programs are rigorous with their screening process.
The screening process by a program may include all or several of these steps:
- Interview in person or by telephone
- Application
- Physical screening
- Drug tests
- Blood tests
- Examining the reproductive organs through ultrasound
- Donor’s personal and family psychological and medical history
- Screening for infectious disease
- Inherited disease screening
Psychological Screening
Donating one’s own egg can be an emotional experience, not just for the donor but also for the recipient. Reputed programs provide psychological screening for both individuals involved.
It is important to evaluate the mental health of the donor to make sure she is making an informed decision and also to make sure the resulting children are healthy.
Legal Implications
The laws regarding egg donation vary from country to country. In a country like the United States, it is legally allowed for a woman to donate her eggs both anonymously and otherwise, and it is also legal to be financially compensated for it.
Donors are required to sign a contract stating that they do not bear any legal rights or responsibilities to the resulting embryos or children.
The egg recipient is recorded as birth mother although she may not be a genetic relation to the child.
Identity of the Donor
Most programs prefer to keep the identity of the donor confidential. There are also cases where the recipients receive all the information on the donor except meet them in person or know their name.
Some egg donation programs may make arrangements for the recipient and donor to meet in person if both the parties are willing. In certain cases, the recipients may also allow the donor to contact the child after they have reached a certain age.
There are also cases where the egg donor already has a relationship with the recipients. This is mostly when the donor is a family member or a friend. In such cases, the program recommends making direct contact in order to arrange for the transfer process, screening, and treatment.
Costs of Egg Donation
An international non-profit organization called Parents Via Egg Donation has estimated that the overall cost of a fresh cycle of egg donation is between $35,000 to $50,000 in the U.S. In this case, recipients will not share the eggs with others in the program.
Generally, the cost for a shared egg cycle starts at approximately $18,000. If the eggs are already frozen at the donor bank, it will typically start from $16,000 and go all the way up to $20,000 in the U.S. while the rates are cheaper in countries like Thailand or even in the European countries.
Usually, egg donors are compensated for their effort and time, and the outcome doesn’t determine the payment.
Compensation depends on a lot of things and varies with each donation program. According to the American Society on Reproductive Medicine, it is ethical to pay women who donate their eggs.
The society has also found that the amount of money that is paid to the donor varies and depends on several factors like the egg donation program, region, etc.
Outlook
Egg donation is a simple and short procedure with a high success rate. The doctor will extract the egg from the donor after careful screening of the candidate.
The egg donor will first take medication to stimulate the ovaries by stopping the normal menstrual cycle. The doctor will administer painkillers, anaesthesia, or sedative for the procedure. Recovery may take a day to a few days, depending on the individual.
There are psychological and physical side effects associated with donating and implanting eggs, but overall, this is a well-tolerated and safe procedure. The level of confidentiality of this procedure will depend on both the donor and the recipient, whether they want to get to know each other or decide to keep it a secret. Many egg donors are financially compensated for their eggs and effort.
In order to minimize any possibility of congenital anomalies and genetic diseases, the screening process is rigorous and thorough. It is also the responsibility of the facility to clarify all legal implications to the recipient and donor of the eggs.
Can I Prevent Female Infertility?
Usually, there is nothing you can do to prevent female infertility that is caused by illness or genetic issues.
There are, however, many things you can do to decrease the chances of infertility:
- Take caution to prevent the possibility of contracting sexually transmitted diseases
- Avoid frequent or heavy alcohol consumption
- Avoid illegal drugs
- Practice good health practices and personal hygiene
- If you are sexually active, have checkups with a GYN at least once a year
Outlook
For couples who are struggling to conceive naturally or wish to have children past the reproductive age, there are so many effective options available. Many couples explore over-the-counter and traditional solutions before exploring other infertility procedures.
The first IVF baby was born in 1978, and by 2015, more than 5 million IVF babies were born.
With more advanced science and technology, fertility solutions are accessible to more people and with a high success rate.
Depending on the type of treatment, fertility procedures can be costly. However, there are different programs that can help with this.
References:
https://www.mayoclinic.org/diseases-conditions/female-infertility/symptoms-causes/syc-20354308
https://www.womenshealth.gov/a-z-topics/infertility
https://share.upmc.com/2018/09/common-causes-of-infertility/
https://www.glowm.com/section_view/heading/Hysteroscopy%20and%20Infertility/item/89
https://www.cdc.gov/reproductivehealth/infertility/
https://www.medicalnewstoday.com/articles/178635.php
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3859121/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4416474/
https://www.theguardian.com/society/2014/nov/23/whats-next-for-worlds-5-million-ivf-babies
https://www.ncbi.nlm.nih.gov/pubmed/25006718
