(Prophase -the first stage of mitosis or meiosis in eukaryotic cell division, during which the nuclear envelope breaks down and strands of chromatin form into chromosomes).
This pool of oocytes remains dormant throughout infancy until the onset of puberty. In sexually-mature females, at each cycle one such "sleeping beauty" is kissed by the luteinizing hormone (LH) "prince" and awakened to continue its meiotic division. Once maturation has been completed, the oocyte is released from the ovarian follicle into the fallopian tube, where it will eventually meet the spermatozoon and undergo fertilization.
Assisted reproductive technology (ART) includes all fertility treatments in which both eggs and sperm are managed. In general, these procedures conducted in the laboratory involve removing eggs from a woman’s ovaries, combining them with sperm, and returning the embryo(s) them to the woman’s uterus or donating the eggs to another woman.
In the United Kingdom, ART has been used since 1978, and in the United States since 1981, in order to facilitate conception, most commonly through transfer of fertilized human eggs into the uterus (in vitro fertilization - IVF).
This illustration was taken from the "Atlas of Reproduction" by Julio Herrero Garcia, Barcelona, Spain, Published by Serono 2006.
The information regarding the procedure has been summarized in this section of the website. In general, the ovaries are being stimulated by a combination of drugs to trigger the ovaries to produce more than the usual one egg per cycle. The eggs are being aspirated through the vagina under ultrasound guidance and delivered to the laboratory. In the laboratory the eggs are inseminated with sperm or injected with a single sperm. If fertilization occurs the embryo(s) is being transferred to the uterus and pregnancy is allowed to begin.
Definition of Infertility
Infertility is often defined as the inability to conceive after 12 months or more of unprotected, well-timed intercourse without pregnancy.
For young and healthy heterosexual couples having frequent intercourse, pregnancy will occur in about 85% and 93% after 1 year and 2 years, respectively, of attempt at conception.
This rule does not apply to couples where the female is >35 years of age, or where either partner has a history of fertility-related problems. If the woman is >35, and has been trying unsuccessfully for >6 months, further consultation regarding investigation and treatment should be considered. If the female has a history of gynecological problems, or if it is known that the partner has a low sperm count, they should not delay seeing a specialist regarding the fertility status.
Women 40 years and over: Begin investigation and treatment after 3 months.
Infertility can be defined as:
Primary Infertility: pregnancy has never occurred or Secondary Infertility: One or both partners have previously conceived, but a further pregnancy has proved unsuccessful after endeavoring to conceive for a full year.
Currently, in the United States about 20% of couples struggle with infertility at any given time.
It is well known that fertility in women decreases with increasing age, as illustrated by the following statistics:
• Infertility in married women aged 16–20 = 4.5%
• Infertility in married women aged 35–40 = 31.8%
• Infertility in married women over the age of 40 = 70%.
Of all cases of infertility, 35% may be attributed to the male, and 55% to the female; the remaining 10% is undetermined.
True infertility only occurs in a few specific situations:
• Women with blocked fallopian tubes
• Women without a uterus or egg follicles (menopause or premature ovarian failure)
• Men without sperm.
In these situations, successful conception will only occur by using specific medical technology. Occasionally, a third party is required to provide eggs, sperm or a uterus to carry the pregnancy.
Any other diagnoses in couples, apart from the three aforementioned, represent some degree of sub-fertility, i.e., there is some finite chance, however small, of conception without the assistance of fertility treatments. Fertility treatments in sub-fertile couples should be undertaken when the odds of conception could be improved by treatment.