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21.10.2014


The progesterone challenge test is done by giving oral medroxyprogesterone acetate (Provera) 10 mg daily for 5-10 days or one intramuscular injection of 100-200 mg of progesterone in oil.
A positive response is any bleeding more than light spotting that occurs within 2 weeks after the progestin is given. If the patient experiences bleeding after the progestin she has estrogen present but is not ovulating (anovulation). If no withdrawal bleeding occurs, either the patient has very low estrogen levels or there is a problem with the outflow tract such as uterine synechiae (adhesions) or cervical stenosis (scarring). She bleeds after progesterone is withdrawn - showing that it is the lack of ovulation that is causing her not to have periods.
Give estrogen to ensure endometrial proliferation, followed by a progestin to induce withdrawal bleeding.
If bleeding occurs, amenorrhea is due to hypoestrogenism (hypothalamic amenorrhea or premature ovarian failure). If bleeding does not occur, then most likely it is an outflow tract obstruction - either Asherman's syndrome or cervical stenosis. A new report shows that sexually active women have a much better chance of getting pregnant than those who remain abstinent, a press release from Eurekalert reports.
Researchers from Indiana University have shown that sexual activity leads to physiological changes in the body of the woman that increases her chances of getting pregnant, even outside the window of ovulation. The report was recently published in the journal Fertility and Sterility and the journal Physiology and Behavior. The lead author on both papers is Tierney Lorenz, a visiting research scientist at the Kinsey Institute. Earlier studies have shown changes in immune function during pregnancy and after childbirth and changes in immunity across the menstrual cycle.
In the first paper, Lorenz and colleagues showed that sexually active women experienced greater changes in helper T cells and the proteins that T cells use to communicate, while in the second paper, they showed differences in antibody levels between sexually active and abstinent women. The conclusions could influence advice on how often to engage in sexual intercourse for couples trying to get pregnant. The Lancet says that all women in their 20s or early 30s should be given the chance to freeze their eggs or ovarian tissue, in case they need to postpone starting a family. However, could the present climate of fertility-paranoia be making expensive, complicated and unreliable options suddenly seem not only feasible and desirable, but also normal and routine? Astonishingly, in some quarters, the feeling still persists that women need to be warned about their “fertility cliff” – that is, how their ability to conceive falls away sharply by their mid-to-late 30s.
Far from being muted, this message seems to be on a tape-loop, hissing into the communal female ear, in the manner of scaremongering muzak in a lift that’s broken down between floors. Then there is age – isn’t it going to be difficult to engage twentysomething women, who are most likely to have success, rather than their late-thirtysomething counterparts? Moreover, isn’t it irresponsible to encourage women to put such inordinate faith in techniques that, while exciting and even liberating, are even now still developing and as yet have no guaranteed success rate?
What happens when women go through with this procedure, heavily rely upon it, only to find out later, with a terrible shock, that it simply didn’t work, a revelation that generally would only come years later? Some might say, well, those are the breaks, the risks would be spelled out, and women can make their own minds up. There remains a powerful argument for egg and tissue freezing – not as a sure thing (because what is?), but in terms of providing a valuable option for women who, for whatever reason, need to postpone having children.
However, isn’t it time society stopped treating women as if they were not only stupid, but stupid twice over? Many couples spend years trying not to get pregnant, so it's only understandable that they may have a few issues when it comes to trying to have a child.
However, many do not understand their personal fertility and the factors that affect fertility potential.
During National Infertility Awareness Week, we turn our efforts to helping those who hope for a family.
Researchers have found a direct link between paternal age and an increased risk of autism and schizophrenia. Although family fertility history is taken into account during treatment, it can neither help nor hinder fertility potential.
According to the Centers for Disease Control and Prevention, 11% of couples experience secondary infertility, which is defined as a couple with a child being unable to conceive again after a year.
The American Society for Reproductive Medicine estimates that up to 13% of female infertility diagnoses are due to smoking. To boost your odds, have sex before and during ovulation, as sperm can survive in the reproductive tract for three days.
A healthy body and mind can boost fertility, but it cannot reverse the age of ovaries and semen.
When men or women carry extra weight, hormonal shifts occur in the body that can affect ovulation and semen production.
Although it is estimated that 70% of women with infertility are also obese, losing as little as 5% to 10% of body weight can boost fertility in men and women. It has long been known that women should take folic acid to prevent certain birth defects, but folic acid is now known to be an important supplement in male fertility. Researchers at the University of California, Berkeley found that men had a higher rate of chromosomal abnormalities in their sperm when their diet was low in folic acid. For both men and women, sexually transmitted diseases can affect the ability to have children.


Having sex every day only slightly increases pregnancy when compared with having sex every other day, according to a study in the New England Journal of Medicine. On September 27, a diverse group—doctors, authors, filmmakers, trauma therapists, and members of the public—will convene in New York City to watch the infertility documentary The Cycle: Living a Taboo.
It’s good to redirect our attention from the depression and anxiety that we often associate with those seeking fertility treatments to a more complicated emotional cocktail that includes desperation, anger, and helplessness.
I have spent the past two years researching emotion’s impact on fertility treatment decision-making and informed consent, conducting lengthy interviews and survey research with approximately 400 in-vitro fertilization patients and 90 reproductive medicine professionals. Some infertile women do experience feelings of desperation, but common-sense understandings of what it means to be desperate range from unsophisticated to flagrantly wrong. Young women who decide to delay their first baby until their late-30s are running the risk of being left childless because of age-related infertility, scientists have warned. A woman’s fertility declines dramatically after the age of 35 and an increasing number of women are finding that they have to turn to IVF treatment to have any hope of becoming pregnant, experts said. The number of British women between the ages of 35 and 39 giving birth for the first time has increased from 6.8 per cent in 1986 to 17 per cent in 2008. Fertility specialists are increasingly concerned about the trend towards having children later in life because, although it can work for some women, it causes problems for many more because female fertility declines so rapidly after 35.
Women are born with a certain number of egg cells in their ovaries and these are gradually lost as they get older, Dr Stewart said. Although 1 in 6 couples in the UK today – that’s around 3.5 million people – face a range of problems trying to conceive a child, many still don’t wish to share the heartache with others and tell people that they are undergoing some sort of fertility treatment.
National Infertility Awareness Week has been launched by patient charity Infertility Network UK, which wants to make this a HUGE annual event and see everyone involved in fertility taking part in some way.
It’s time to bring infertility out of the closet and push it much higher up the medical, social and political agenda. For the first time ever, National Infertility Awareness Week will provide a dedicated and specific focus for the millions of women and men fighting this often misunderstood illness, and an opportunity for the doctors, healthcare professionals, psychologists and politicians to promote greater awareness about infertility. And even if you’re not directly affected by infertility, chances are you will know someone, work with someone, or be friends with someone who is. We’re on a mission to end the isolation and secrecy of infertility and we need you to support us in whatever ways you can.
The fertility challenged should not feel ashamed: it’s not always easy to have a baby and there’s no shame in that!
We have great plans for this week, which will end with the biggest event in the UK fertility calendar: The Fertility Show on November 2-3. We will be hosting a number of activities during the week, both online and off, for anyone who wants to take part.
We are asking people to bake cupcakes and sell them to workmates, friends and family to raise funds for us. It’s no wonder then that talk show host Jimmy Fallon waited two weeks after the birth of his daughter Winnie Rose to reveal that she was carried by a surrogate.
Fallon’s openness came as a surprise, considering that most celebrities have been notoriously mum on the subject. We should applaud Fallon—along with his wife and other high-profile women willing to share their stories—for going public with facts so many would prefer to keep hidden. With her blond bob, convertible car, cigarette in hand and cropped top emblazoned with the letters YOLO ("You Only Live Once"), this is an Alice in Wonderland the world has not seen before.
Aimed at 21- to 30-year-olds, the "Singaporean Fairytale" was created by four final-year university students who wanted to "find an interesting way to connect with young adults … on what it takes to start, live and be a family in Singapore", says the project manager, Chan Luo Er, 23. The fairytales – which have been distributed by leaflet to universities around Singapore – include versions of Cinderella, the Three Little Pigs, Rapunzel and Snow White, each involving a reworked tale that relates to fertility, sex or marriage, and a resulting moral. Jayne Torvill has spoken out about her difficult and heartbreaking experience of trying to conceive by IVF.
Despite improvements in IVF success rates, Jayne revealed how her desperation to become a mum took over her life before she came to the decision to adopt. Jayne, 55, half of the super skating duo Torvill and Dean, broke down on Piers Morgan's Life Stories as she spoke for the first time about her trials to get pregnant and how an ectopic pregnancy left her devastated. And with Anna Friel, 36, admitting she's looking into freezing her eggs for when boyfriend Rhys Ifans is ready to become a dad, we looked at what you need to know about your fertility now. The latest figures from the Human Fertilisation and Embryology Authority (HFEA) show that around 25 per cent of IVF cycles using a woman's own, fresh eggs, result in a live baby at the end. For frozen egg (which is what Anna Friel is talking about), success rates were similar for each age group but slightly less successful overall, with around 22 per cent of cycles ending up with a live baby.
A course of 2.5 mg of Premarin for 21 days including 10 mg of Provera on days 17-21 should be adequate.
However, IU research is the first to show that sexual activity plays a role in these changes in immune system. If you get a kidney transplant, there’s a 50 percent chance of rejection and you need to take anti-rejection medication. Which sounds reasonable – a kind of biological insurance policy for the complicated lives women lead.
On an economic level, the improved methods are expensive, in which case it seems unlikely that they would be offered universally. Still, strange isn’t it, how swiftly any area that involves “unnecessary” surgery on women becomes so pat? First, too stupid to be aware of the fertility paranoia swirling around them, and then so stupid that they allow themselves to be blinded by false hope in what might not turn out to be all-conquering science.


The more that men and women know about the realities of fertility, the more effectively they can have a baby, often without our help. Once a woman hits 40, there is a less than 5% chance (PDF) she will get pregnant in any given month (compared with 20% at age 30).
Believe it or not, smoking as few as five cigarettes a day each has been associated with lower fertility rates in both men and women. Ovulation -- when an egg drops from the ovary into the fallopian tubes -- occurs once a month, roughly seven to 10 days before a woman's period. The great news is that couples can team up to lose weight, become active together and boost their fertility. Coenzyme Q10 has also been found to increase sperm count and sperm motility, and vitamin E also improves low sperm count. It's better to opt for decaffeinated or half-caffeinated coffee, and remember there is caffeine in tea, colas and chocolate.
They will also participate in a forum to “challenge conventional wisdom and foster a new, more open dialogue about infertility.” This project is meant to give voice to important but often marginalized perspectives, including patients who are not only unsuccessful but traumatized by the fertility treatment experience. But while we collectively share and show compassion for our diverse reproductive experiences, we must clarify exactly what we mean when we discuss these emotions and how they bear upon patients’ competencies.
My research has revealed that, by themselves, generalized labels such as “desperate,” “angry,” and “vulnerable” are often misleading; they can actually do a disservice to and disparage the patients. This has been accompanied by significant increase in the number of women over 40 seeking fertility treatment, many of whom will ultimately fail to become pregnant, the experts said. With 1 in 6 people in the UK struggling to conceive, we need to raise the awareness though the roof.
Only be raising awareness, spreading the word and bringing infertility out of the closet will people feel more comfortable discussing this illness. Most activities focus on advocacy and public education but we are aiming to have some fun, especially with our ‘Great Cake Bake’. Maybe have a coffee morning, or just meet up with a few friends, ask them to make a small donation to I N UK and enjoy the cake!
Whatever you do, please DO SOMETHING and let’s put National Infertility Awareness Week on the map.
Like Lewis Carroll's original, this cartoon Alice is curious about the world – "she gives up her cash to fly around rash" – but the moral here is that this twentysomething Singaporean is so busy being "wild and reckless" that she stands to lose her chance of starting a family.
Faced with a rapidly ageing society, skyrocketing housing prices, low birth rates and a population that works the longest hours in the world, this country of 5.3 million people has made various attempts over the years to encourage its citizens to marry and procreate, from government-funded speed-dating schemes to educational flyers on how to flirt.
Women aged 35-37 have a success rate of 32.3 per cent but this decreases with each age group beyond 37.
Though the actress is more likely than most potential mums to be able to afford several rounds of IVF, the impact on your body and emotions is huge and shouldn't be taken lightly. If you think about it, most women, from the time they were young girls, wanted to have babies. It’s been blasted out enough times over the media megaphone: “Attention all thirtysomething women. However, before women whoop with relief and rush to clinics to get their eggs or tissue frozen, questions need to be asked. Arguably, these women would have been better off if they’d remained concerned about their waning fertility and therefore proactive about their situation. Just as the ugly, painful and problematic realities of plastic surgery are so often glossed over, simplified, sanitised and prettified, for the consumer, so too there is a danger that egg and tissue freezing techniques could end up marketed as some kind of quasi-feminist answer to a modern gal’s prayers, when the facts are so much more complicated. As a man ages, the concentration of mobile, healthy semen and semen volume overall will decrease. If STDs go untreated in women, they can lead to an episode of pelvic inflammatory disease, which is a leading cause of infertility. Before we encourage infertility patients to spring out of the stirrups to avoid an emotionally bumpy ride, it's good to question why so many stay on the path to fertility treatments nonetheless. We also have over 100 professional cake bakers on board who are supporting this wonderful event. Remember all the rampant speculating about whether Kate Middleton had infertility problems? A woman's egg supply takes a rapid decline in the late 20s, again in the 30s and then most notably after age 35. One survey of infertile couples conducted by the pharmaceutical companies Schering-Plough and Merck found that 61% hid their infertility from family and friends, and half didn’t share it with their mothers. People come in saying, ‘I know how old I am but I know there’s one good egg in there and I want to find it.’ But women run out of eggs at a pretty rapid rate.
And no woman has come to me after using a donor egg saying she doesn’t think of the baby as her own. There is at present a low success rate, though figures have been skewed by cancer patients undergoing the treatment – and the success rate improves for the more modern vitrification method. When I tell them, they’ll say, ‘But I just read that a Hollywood star was 48 and had twins!’ Sometimes those [celebs] don’t say they used donor eggs because their publicist wants everyone to think they’re a superstar.
They’re grieving the ability to have their own genetic child—they’ve got to go through a process.



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