3627 University Blvd. South, Suite 450 Jacksonville, FL 32216 click here for directions
Tel: 800.777.IVF1 (4831)
Tel: 904.398.1473
1681 Eagle Harbor Pkwy Orange Park, FL 32003 click here for directions
Tel: 904.278.6837
2850 Keagy Road Roanoke, VA 24153
click here for directions
Tel: 800.777.IVF1 (4831)
Tel: 540.375.6607
A couple is considered to have fertility problems if they are unable to conceive after one full year of trying. Around 40 percent of fertility problems originate in the woman, and 40 percent originate in the man. For the remaining 20 percent of fertility problems, the causes are not determined. To learn more about the causes and treatment of infertility, please explore the topics on this page, and then contact Dr. Shaykh for a consultation today.
Female fertility problems are usually a result of either failure to ovulate or abnormalities of the fallopian tubes or uterus. A woman typically produces a single egg each month as a result of various hormonal changes. The egg develops within the ovary and is released upon maturation. It is then picked up by one of the fallopian tubes and moved toward the uterus. For conception to occur, the quality of cervical mucus at the time of ovulation must allow free passage of the sperm into the uterus, the woman’s egg must be fertilized during ovulation, and the fertilized egg must successfully travel through the fallopian tubes. If any of these processes are inhibited, the woman may not get pregnant.
Common female infertility problems are caused by:
The cervix is the entrance to the uterus, situated at the end of the vagina. Throughout a woman’s menstrual cycle, the cervix produces mucus, which changes in consistency at different stages of the cycle. Cervical mucus usually permits the free passage of sperm into the female genital tract during the time of ovulation. However, certain women possess sperm antibodies in the mucus and, during ovulation, sperm may be unable to pass through the cervical canal. Some of the treatment techniques that bypass hostile mucus include in vitro fertilization and intrauterine insemination.
The menstrual cycle is enabled by a number of glands and their hormones working in harmony. For ovulation to occur, a chain reaction involving the part of the brain called the hypothalamus, the pituitary gland, and the ovaries triggers the ripening of a woman’s eggs. Hormonal imbalance within any of these areas, due to stress, weight loss or gain, excessive prolactin production (the hormone that stimulates milk production), thyroid gland problems, and polycystic ovarian disease, can cause infertility. Ovulatory disorders are one of the most common causes of infertility in women.
In normal circumstances, the sperm fertilizes the egg on its journey down the fallopian tube. If a fallopian tube is blocked or scarred, it may impede the egg’s process, and prevent it from meeting up with the sperm. Tubal blockage can occur as a result of infection or surgery. A surgical procedure called laparoscopy can be used to check for obstructions, but in many cases pregnancy can only be achieved through in vitro fertilization.
Endometriosis occurs when tissue similar to that which normally lines the womb exists at other sites in the pelvis. At the time of menstruation, bleeding occurs from this tissue and may give rise to abdominal pain and painful intercourse. Blood-filled cysts may also develop within the ovaries. It is unclear why mild to moderate endometriosis reduces the ability of the tubes to pick up the eggs. Laparoscopic laser treatment may improve the fertility of patients with endometriosis. In cases of extensive endometriosis, especially in the presence of chocolate cysts (accumulations of old blood in the ovaries), correction through laparoscopy or conventional surgery may be required before embarking on IVF treatment. To learn more about endometriosis, visit our surgical treatment page.
After sperm are produced in the testes they move to the epididymis for maturation and storage. Completion of this process takes approximately three months. During sexual intercourse the sperm abandon the epididymis and travel through the vas deferens, where they are mixed with fluid secreted from various glands. This mixture of sperm and seminal fluid, called semen, is deposited in the vagina of the female partner following ejaculation. Causes of male infertility can be divided into two categories—physical abnormalities of the male reproductive tract, such as epididymal or vas obstruction, and impaired sperm production. In most cases of male infertility, however, the cause is unknown. To determine male infertility, a semen analysis is conducted. A normal assessment reveals a sperm count of more than 20 million sperm per milliliter of semen. In normal semen, at least 50 percent of the sperm are actively moving and more than 14 percent of the sperm are shaped normally. Medication rarely improves sperm count. Until recently there has been no effective treatment for male infertility. However, since the introduction of Intracytoplasmic Sperm Injection (ICSI) in which a single sperm is injected into the egg, the success rates for couples with male infertility problems have markedly improved.
In vitro fertilization (IVF) is the process of uniting oocytes (eggs) with sperm in the laboratory after the eggs and sperm have been collected. Embryos that develop from the fertilized egg are then transferred into the uterus to continue growth. IVF is a reasonable treatment for couples with various types of infertility such as blocked fallopian tubes, endometriosis, male factors, immunologic factors, or unexplained infertility.
The basic steps to an IVF cycle are:
Intrauterine insemination (IUI) involves the injection of treated sperm from the partner or donor into the woman’s uterine cavity. It is generally a painless procedure that takes only a few minutes and is performed in our office. IUI should be performed when the fallopian tubes are healthy and the sperm preparation is satisfactory. It may also be a treatment option for women who have cervical mucus hostility, and in some cases, for unexplained infertility. Donor insemination is used when a woman’s partner has no sperm in the seminal fluid, or for couples who do not wish to undergo the ICSI procedure.
Intracytoplasmic Sperm Injection (ICSI) has revolutionized the treatment of male infertility, offering assistance to couples that previously had to rely on the use of donor sperm. ICSI enables up to 95 percent of couples to reach embryo transfer. The main difficulty in treating male infertility used to be isolating adequate numbers of active sperm to combine with the eggs in the laboratory. Now with ICSI, very few sperm are required. Additionally, the ability of the sperm to penetrate the egg is not an issue since penetration is bypassed.
During the ICSI procedure, a high-powered microscope is used to enable the embryologist to perform precise surgical manipulations on the eggs and sperm. A tiny glass instrument called a micropipette is used to hold the eggs in place. The sperm is injected via a microneedle through the outer layers of the egg, past the shell, and into the main body of the egg.
Men with the following abnormalities in their semen are candidates for ICSI:
To schedule a consultation or second opinion with Dr. Marwan Shaykh, contact the Assisted Fertility Program today.
One in nine childless couples who are candidates for in vitro fertilization require oocyte donation. As part of our assisted reproduction services, an egg donation program is available.
Egg donation is an option for women with inactive ovaries, including:
Egg donation is also an option for women with active ovaries, including:
The goal of egg donation is to synchronize the recipient’s menstrual cycle with that of the donor, facilitating the most successful outcome. To accomplish this, the recipient is placed on hormone replacement therapy (HRT), which allows us to manipulate her cycle as needed.
Donated eggs from volunteers are fertilized with sperm from the recipient’s partner. Following fertilization, the embryos are transferred into the uterus or fallopian tubes of the recipient.
The demand for egg donation treatment is on the rise and most fertility centers have a waiting list, due to the limited supply of eggs. Egg donor candidates should be between the ages of 21 and 34, meet height and weight requirements (to minimize health risks), and be free of certain genetic defects and select medical conditions. A key aspect of most research protocols for donor egg IVF is an exhaustive screening for any physical or psychological problems. As many as a quarter of prospective patients may be eliminated from a study.
Qualified egg donor candidates who are interested in helping an infertile couple enjoy the gift of parenthood should contact either the Southwest Virginia Fertility Center in Roanoke, Virginia, or the First Coast Assisted Fertility Program in Jacksonville and Orange Park, Florida.
Following embryo transfer, surplus embryos can be frozen. The advantage of freezing embryos is that they can be replaced in a future cycle without the patient having to repeat drug treatment and surgery. We recommend embryo freezing if two or more embryos of good quality are available. The final decision, however, remains with the couple concerned.
Frozen embryo transfer has been practiced since 1987 and there appears to be no increased incidence of fetal abnormality in babies born following this procedure. About 70 percent of all frozen embryos survive the thawing process. Although some couples may have all of their embryos survive in good condition, others may not have any that survive. Embryos are frozen in batches of two or three and are thawed as a group, not individually.
Replacement of frozen embryos is relatively simple. The woman’s natural cycle is monitored using an ultrasound scan and ovulation predictor kits to time ovulation. Following ovulation, the embryos are thawed and transferred back to the uterus. If the woman’s cycle is irregular, we may recommend HRT, giving us control over the time of transfer. At our center, embryos can be frozen for up to one year, at which time the embryos may be donated to another couple, thawed in a culture and allowed to degenerate, or transferred to a long-term storage facility.