Reproductive Endocrinology and Infertility

Finding the formula for fertilitySmiling Mother with her baby

Monmouth's board-certified reproductive endocrinologists work closely with couples in finding the formula for fertility through diagnosis and various treatment options.

A look at the statistics shows that the difficulty to conceive is traced to the man in 40 percent of all cases and to the woman in another 40 percent. Both sexes contribute to the difficulty 15 percent of the time, and the cause is unknown in the remaining 5 percent.

In recent years, a more sophisticated generation of medical therapies and surgical techniques have emerged, as reproductive medicine specialists continue to refine existing treatment methods to improve the chances of conception for couples with even the most difficult infertility problems.

Several major advances have been made in techniques used for in vitrofertilization (IVF), a popular process that involves joining a woman's egg and man's sperm in a specially cultured laboratory dish, where fertilization occurs and the fertilized egg then is implanted in the woman's uterus.

Intracytoplasmic sperm injection (ICSI) is emerging as the most effective IVF technique in overcoming male-related problems that involve low sperm counts or obstructive sperm problems. The procedure is performed by directly injecting a single sperm into a harvested egg in an attempt to create a viable embryo.

When sperm cannot be obtained because of certain medical conditions, including diabetes, trauma to the testicles and congenital problems, microsurgical epididymal sperm aspiration (MESA) may be considered. This procedure is performed by a urologist who works with a reproductive endocrinologist in surgically retrieving the most mature and motile sperm cells from the epididymis. They then are injected into the harvested egg.

On the female side of IVF, physicians are finding that an embryo left to mature for several more days in a laboratory dish before being placed in a woman's uterus can improve her chances of having a baby.

Called blastocyst transfer, the technique is performed when an embryo reaches four to five days old ---the blastocyst stage ---before being implanted in a new type of culture medium that is better at simulating conditions in a woman's tube and womb.

The technique also can reduce the number of multiple births because fewer and more mature embryos are transferred ---rather than multiple ones.

What are the chances of conceiving a baby with IVF and other assisted reproductive techniques? The national success rate averages about 26 percent — about the same as the rate for fertile couples who conceive on their own.