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Adoption Information

Adoption Advice From the Heart; by Lahle Wolfe, IOH founder, and adoptive mom to three perfect children.


Infertility Ethics

There are many ethical issues associated with infertility and its treatment.

  • High-cost treatments are out of financial reach for some couples.
  • Debate over whether health insurance companies should be forced to cover infertility treatment.
  • The legal status of embryos fertilized in vitro and not transfered in vivo.
  • Pro-life opposition to thedestruction of embryos not transfered in vivo.
  • IVF and other fertility treatments have resulted in an increase in multiple births, provoking ethical analysis because of the link between multiple pregnancies, premature birth, and a host of health problems.
  • Religious leaders' instructions on fertility treatments.

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Support, Information & Resources

Australian Clinics

Australian Support Groups

International Links

Conceiving Concepts, Inc. has lots of info including support resources, natural fertility methods, causes of infertility & diagnoses, fertility news, and some excellent infertility articles including one on How to deal with infertility during the holidays. This site is well worth a look.

Infertility FAQ's and Info covers questions frequently asked regarding infertility, miscarriage, hints, humor, links, infertility acronyms and abbreviations.

The American Surrogacy Center provides extensive information on the medical and psychological aspects of egg donation and surrogacy. The legal aspects of Australian, US, and international surrogacy are comprehensively discussed and there are some very interesting articles.

Ferre Institute is an excellent infertility site with lots of information and brochures to covering topics such as Reviewing Your Options, Helping Others Understand, Coping With the Holidays, Miscarriage: Surviving Pregnancy Loss, We Can't Have a Baby Either, and Answering Your Questions about Infertility.

Fertile Thoughts is an excellent site with a lot of information about adoption and infertility FAQ's, and includes IVF/GIFT/ZIFT success rates (for the US).

INCIID. The InterNational Council on Infertility Information Dissemination has a glossary of infertility terms, fact sheets, and lots of articles.

Resolve is one of the better American sites for infertility. Apart from lots of general information, the American Statistics can be found free of cost under Sample Newsletters.

The Oxford Fertility Unit has lots of great pictures and videos of embryos.

Atlanta Reproductive Health Centre have a good site with lots of information on all aspects of infertility.

ASRM. The American Society for Reproductive Medicine has information which is particularly good for those just starting out on treatment. It also includes statistics which can only be acquired at a cost.

Scott & Janell Meyer's Infertility Support Page has lots of info and advice on Polycystic Ovarian Syndrome (PCO). It also includes topics like How to get diagnosed, and General infertility advice.

Perspectives Press have lots of useful Fact Sheets about adoption for both parents and children.

The Fertility Information Resource List (FIRL) offers excellent information such as Basic Infertility Testing and Criteria for selecting a Clinic. This site is well worth a look.

The Fertility Race have U.S. infertility statistics, and some excellent articles and stories with audio links.

Ferti.Net have have a section for Australia, and excellent information on fertility drugs and infertility in general.

American Society for Reproductive Medicine

International Council on Infertility Information Dissemination (INCIID)

The American Fertility Association (Offers support and advocacy for those dealing with infertility and reproductive health.)

RESOLVE: nationwide infertility nonprofit since 1974

Personal accounts of infertility and fertility treatments

A Torah Infertility Medium of Exchange (A T.I.M.E. a non-profit organization devoted to the support and education of Jewish infertile couples.)

"'Infertility time bomb' warning" at BBC News,

The Infertility Network (a registered Canadian charity which provides information & support to patients, parents & adult donor offspring)


Article Sources

Infertility (edited for content) from Wikipedia

International Council on Infertility Information Dissemination (INCIID) (FAQ)

American Society for Reproductive Medicine (FAQ)

Rowe PJ, Comhaire FH, Hargreave TB, Mahmoud AMA. WHO Manual for the Standardized Investigation, Diagnosis and Management of the Infertile Male. Cambridge University Press, 2000. ISBN 0521774748.

Domar AD, Zuttermeister PC, Friedman R. The psychological impact of infertility: a comparison with patients with other medical conditions. J Psychosom Obstet Gynaecol. 1993;14 Suppl:45-52. PMID 8142988.

 

Diabetes Medical Library                                   main "Disorders" page
Disorders Associated with Diabetes                                                   
main "Infertility & Adoption" page

Primary Infertility
Associated with Diabetes, Insulin Resistance,
Polycystic Ovarian Syndrome, and Thyroid Disorders
Article source" Infertility" (edited for content) from Wikipedia.com                                      Article disclaimer


Mini Site Index
What is Infertility?
Causes of Infertility
Primary vs Secondary Infertility

Female Infertility
Male Infertility
Combined and Unexplained Infertility
How Diabetes and other Metabolic Disorders can Affect Fertility
Treatment of Infertility
Costs Associated with Infertility (in dollars)
Ethics
Psychological Impact
Social Impact

What is Infertility?

Infertility is the inability to naturally conceive a child or the inability to carry a pregnancy to term. There are many reasons why a couple may not be able to conceive, or may not be able to conceive without medical assistance.

The International Council on Infertility Information Dissemination (INCIID) considers a couple to be infertile if::

  • they have not conceived after a year of unprotected intercourse, or after six months in women over 35;
  • there is incapability to carry a pregnancy to term.

Healthy couples in their mid-20s having regular sex have a one-in-four chance of getting pregnant in any given month. This is called "fecundity."  

    


Causes of Infertility

Primary vs. Secondary

According to the American Society for Reproductive Medicine, infertility affects about 6.1 million people in the U.S., equivalent to ten percent of the reproductive age population. Female infertility accounts for one third of infertility cases, male infertility for another third, combined male and female infertility for another 15%, and the remainder of cases are "unexplained"2.

A Robertsonian translocation in either partner may cause recurrent abortions or complete infertility.

"Secondary infertility" is difficulty conceiving after already having conceived and carried a normal pregnancy. Apart from various medical conditions (e.g. hormonal), this may come as a result of age and stress felt to provide a sibling for their first child. Technically, secondary infertility is not present if there has been a change of partners.

    


Female Infertility

Factors relating to female infertility are:

  • General factors
    • Significant liver, kidney disease
    • Psychological factors
  • Metabolic and autoimmune disorders including
  • Adrenal disease (i.e., Addison's Disease)
  • Hypothalamic-pituitary factors:
    • Kallmann syndrome
    • Hypothalamic dysfunction
    • Hyperprolactinemia
    • Hypopituitarism
  • Ovarian factors
  • Tubal/peritoneal factors
    • Endometriosis
    • Pelvic adhesions
    • Pelvic inflammatory disease(PID, usually due to chlamydia)
    • Tubal occlusion
  • Uterine factors
    • Uterine malformations
    • Uterine fibroids (leiomyoma)
    • Asherman's Syndrome
  • Cervical factors
    • Cervical stenosis
    • Antisperm antibodies
    • Insulinotherapy cervical mucus (for the travel and survival of sperm)
  • Vaginal factors
    • Vaginismus
    • Vaginal obstruction
  • Genetic factors
    • Various intersexed conditions, such as androgen insensitivity syndrome


Male Infertility

Factors relating to male infertility include:

  • Pretesticular causes
    • Endocrine problems, i.e. diabetes mellitus, thyroid disorders
    • Hypothalamic disorders, i.e. Kallmann syndrome
    • Hyperprolactinemia
    • Hypopituitarism
    • Hypogonadismdue to various causes
    • Psychological factors
    • Drugs, alcohol
  • Testicular factors
    • Genetic causes, e.g. Klinefelter syndrome
    • Neoplasm, e.g. seminoma
    • Idiopathic failure
    • Cryptorchidism
    • Varicocele
    • Trauma
    • Hydrocele
    • Mumps
  • Posttesticular causes
    • Vas deferensobstruction
    • Infection, e.g. prostatitis
    • Retrograde ejaculation
    • Hypospadias
    • Impotence
  • Genetic causes

Some causes of male infertility can be determined by analysis of the ejaculate, which contains the sperm. The analysis includes counting the number of sperm and measuring their motility under a microscope:

  • Producing few sperm, oligospermia, or no sperm, azoospermia.
  • A sample of sperm that is normal in number but shows poor motility, or asthenozoospermia.


Combined and Unexplained Infertility

Combined infertility.  In some cases, both the man and woman may be infertile or sub-fertile, and the couple's infertility arises from the combination of these conditions. In other cases, the cause is suspected to be immunological or genetic; it may be that each partner is independently fertile but the couple cannot conceive together without assistance.

Unexplained infertility.  In about 15 % of cases the infertility investigation will show no abnormalities. In these cases abnormalities are likely to be present but not detected by current methods. Possible problems could be that the egg is not released at the optimum time for fertilization, that it may not enter the fallopian tube, sperm may not be able to reach the egg, fertilization may fail to occur, transport of the zygote may be disturbed, or implantation fails. It is increasingly recognized that egg quality is of critical importance and women of advanced maternal age have eggs of reduced capacity for normal and successful fertilization.   


How Diabetes and other Metabolic Disorders can Affect Fertility

One of the functions of insulin is to act as a "fat" storing hormone.  Excess insulin can contribute to weight gain which in turn can decrease fertility.  A balance of hormones contributes to the ovulatory cycle of women, and carrying excess weight can cause an imbalance between estrogen and progesterone.  This can lead to an interruption of normal ovulation and menstrual cycles.

Many persons with type 2 diabetes are insulin resistant, that is, they make insulin but do not respond well to the normal action of  insulin.  Women that are insulin resistance overproduce insulin in order for their blood glucose levels to remain in a normal range.  This overproduction of insulin, especially when there is an accompanying unhealthy lifestyle, can lead to weight problems, as well as a disruption of normal hormone productions, setting the stage for female infertility.

Insulin resistance is commonly seen in women with polycystic ovarian syndrome (PCOS) and may also be seen in persons with hypothyroid disorders like Hashimoto's thyroiditis.  Treatment for insulin resistant metabolic disorders often includes insulin sensitizing medication (such as Glucophage) which may help restore normal ovulatory function.  Losing weight, even as little as 15% of excess body weight (or 10-15 pounds) may also result in spontaneous resumption of ovulation.  And, for those with thyroid problems, thyroid replacement hormones may help.

For those considering pregnancy, make sure that your blood glucose levels are well under control prior to becoming pregnant as well as during pregnancy to help reduce the risk of diabetes associated complications with pregnancy.

    


Treatment of Infertility

Depending upon the reason(s) for infertility, treatment options vary.  You may wish to consult a reproductive endocrinologist who specializes in both endocrine and infertility problems.  (Note:  because of the name polycystic ovarian syndrome (PCOS), many with this disorder believe it is a gynecological disorder of the ovaries -- it is not.  PCOS is a complicated syndrome that affects the ovaries and therefore, fertility, but it is not caused by the ovaries.  Women with PCOS may benefit from seeing an endocrinologist for treatment of this disorder.)

Treatment options for infertility in general, include:

  • Fertility medication which stimulates the ovaries to "ripen" and release eggs (e.g. clomifene citrate, which stimulates ovulation)
  • Surgery to restore patency of obstructed fallopian tubes (tuboplasty)
  • Donor insemination which involves the woman being artificially inseminated with donor sperm.
  • In vitro fertilization(IVF) in which eggs are removed from the woman, fertilized and then placed in the woman's uterus, bypassing the fallopian tubes. Variations on IVF include:
    • Use of donor eggs and/or sperm in IVF. This happens when a couple's eggs and/or sperm are unusable, or to avoid passing on a genetic disease.
    • Intracytoplasmic sperm injection(ICSI) in which a single sperm is injected directly into an egg; the fertilized egg is then placed in the woman's uterus as in IVF.
    • Zygote intrafallopian transfer(ZIFT) in which eggs are removed from the woman, fertilized and then placed in the woman's fallopian tubes rather than the uterus.
    • Gamete intrafallopian transfer(GIFT) in which eggs are removed from the woman, and placed in one of the fallopian tubes, along with the man's sperm. This allows fertilization to take place inside the woman's body.
  • Other assisted reproductive technology (ART):
    • Assisted hatching
    • Fertility preservation
    • Freezing (cryopreservation) of sperm, eggs, & reproductive tissue
    • Frozen embryo transfer (FET)  

    


Costs Associated with Infertility (in dollars)

Not everyone has insurance coverage for fertility investigations and treatments, especially when a couple already has children. Many procedures may be considered "experimental" and therefore, not covered.  Women with certain disorders may ask their doctor to prescribe medications that help restore ovulation as part of the treatment for an underlying disorder rather than list it is a treatment for infertility. 

The average cost (2005) of infertility treatment in the United States include:

  • Initial work-up: hysteroscopy, hysterosalpingogram, blood tests - $2,000
  • Artificial insemination - $500-900 per trial
  • Sonohysterogram (SHG) - $600- ,000
  • Clomiphene citrate cycle - $ 200- 500
  • Invitro Fertilization (IVF) cycle - $10,000 -14,000
  • Use of a surrogate mother to carry the child - dependent on arrangements but often exceed $15,000

Another way to look at costs is to determine the cost of establishing a pregnancy. Thus, if a clomiphene treatment has a chance to establish a pregnancy in 8% of cycles and costs $500, it will cost about $6,000 to establish a pregnancy,compared to an IVF cycle (cycle fecundity 40%) with a corresponding cost of($12,000/40%) $30,000.

Most insurances do not cover the cost of infertility treatment.  Although many states are starting to mandate basic coverage proposed 2006 legislation (S. 1955) may turn back much of the progress made by consumer insurance advocacy organizations.

If  S. 1955 passes it will permanently alter how health insurance is offered in the marketplace, undermining state regulations and consumer protections that require insurance companies to cover diabetes supplies and education, and will create disincentives for employers to hire older workers and people with chronic health conditions like diabetes.  This law will also have potential negative impact on persons with infertility issues; another high-cost insurance item..

    


Psychological Impact

Infertility may have profound psychological effects. Partners may become more anxious to conceive, ironically increasing sexual dysfunction. Marital discord often develops in infertile couples, especially when they are under pressure to make medical decisions. Women trying to conceive often have clinical depression rates similar to women who have heart disease or cancer.

A lot of women find themselves to be in-between worlds, so to speak. That is, infertile couples would be abnormal and fertile couples are normal. It’s about “us” vs. “them,” and infertile women would often compare themselves to fertile women. Such social comparisons permitted both self-evaluation and self-enhancement; they allowed women to determine where they “fit into the scheme of things” and to find the “slide rule” that would enable them to measure whether they were better or worse off, or “at least equal to everybody else.”

If infertility treatment is unsuccessful after several attempts, the most difficult decision a couple faces is whether to keep trying this or another treatment, or to discontinue treatment.  

Note:  As a woman who suffered primary infertility for more than 15 years, including failed infertility treatments, Islets of Hope founder Lahle Wolfe went on to successfully adopt three beautiful children.  At age 38, she finally was able to control her diabetes and received proper treatment for this first time for PCOS and Hashimoto's thyroiditis.  Although she was no longer attempting pregnancy, Wolfe did become pregnant (ironically, while on birth control pills to balance progesterone/estrogen levels as part of her PCOS treatment), and gave birth at age 39 to her unexpected miracle child, Elizabeth.  

Elizabeth was diagnosed with type 1 diabetes at age 4.

    


Social Impact

In many cultures, inability to conceive bears a stigma. In closed social groups, a degree of rejection (or a sense of being rejected by the couple) may cause considerable anxiety and disappointment.

There are also legal ramifications as well. Infertility has begun to gain more exposure to legal domains. An estimated 4 million workers in the U.S. used the Family and Medical Leave Act (FMLA) in 2004 to care for a child, parent or spouse, or because of their own personal illness. Many treatments for infertility, including diagnostic tests, surgery and therapy for depression, can qualify you for FMLA leave.

    

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Page Updated 05/16/2006