ASRM Patient Education Fact Sheets and Information Booklets are available in both HTML to view on the web and as PDFs to download.
Menstruation is considered normal when uterine bleeding occurs every 21 to 35 days and is not excessive. The normal duration of menstrual bleeding is between two and seven days. Abnormal uterine bleeding occurs when either the frequency or quantity of uterine bleeding differs from that mentioned above or the woman has spotting or bleeding between her menstrual periods.
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Like other organs in the body, a woman’s reproductive organs take shape when she is still a fetus inside her mother’s uterus. These organs include the uterus and fallopian tubes, which develop from two ducts known as the müllerian ducts.
When the abdomen (belly) is injured because of disease or surgery, adhesions (scar tissue) can form.
Adoption is an important family-building option to consider as an alternative to infertility therapy. Some couples explore adoption only after infertility treatment has proven unsuccessful. Others couples choose to forego treatment in favor of adoption. Still others have both adopted and biological children.
For many infertile couples, making the decision to adopt can be just as hard as undergoing fertility treatment. There are many questions, doubts, and fears that often come up. Some people choose to adopt instead of having fertility treatments, while others decide to adopt only after fertility treatment does not result in the birth of a child.
Fertility changes with age. Both males and females become fertile in their teens following puberty. For girls, the beginning of their reproductive years is marked by the onset of ovulation and menstruation. It is commonly understood that after menopause women are no longer able to become pregnant. Generally, reproductive potential decreases as women get older, and fertility can be expected to end 5 to 10 years before menopause.
Ovulation is the release of an egg from a woman’s ovaries and is essential for getting pregnant. Ovulation is spontaneously triggered about 36-40 hours after blood levels of a hormone called luteinizing hormone (LH) rise. This is called the LH surge. Once released from the ovary, the egg is picked up by and travels down the fallopian tube where it can meet sperm to become fertilized.
Vaccines help protect against specific infections by bacteria or viruses. They are administered by a health care provider (nurse or doctor) by injection, nasal spray, or a pill taken by mouth. Vaccines usually contain small pieces of the bacteria or virus in a weakened but live or killed form.
What is “third-party reproduction”?Third-party reproduction is an arrangement where a person or couple receives help from other(s) to have a child. This help can be in the form of donated eggs, sperm, or embryos; carrying the pregnancy; or a combination of these types of reproductive assistance.
Bioidentical hormones are hormones made from plants that mimic hormones your body produces. They may be made to order by a person or pharmacy (compounded) or made in bulk in a factory and regulated by the FDA (U.S. Food and Drug Administration). Some examples include 17-beta estradiol, estrone, progesterone, and testosterone. The term “bioidentical” can be confusing. It is a loosely defined word that does not mean any specific hormone or preparation, does not mean the medicine is more or less safe to use, and does not even mean necessarily that the medicine is found naturally in the human body.
There are many psychological, social, and economic issues associated with multiple pregnancies.
Women who can get pregnant without fertility drugs or medical procedures usually have only one baby. Women who need fertility treatment are at higher risk to get pregnant with twins, and rarely with triplets or more. This is called multiple gestation. Multiple gestation can increase the risk of pregnancy for the mother and for all the babies.
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Surgery can be used to treat problems with your ovaries or fallopian tubes such as cysts, endometriosis or infections. Adnexal surgery involves any of the organs that are on the sides of (“next to”) the uterus (womb), such as the fallopian tubes and ovaries.
Are parenting concerns of heterosexual couples different than those of gay or lesbian couples? .
Infertility is “the inability to conceive after 12 months of unprotected intercourse.” This means that a couple is not able to become pregnant after a year of trying. However, for women aged 35 and older, inability to conceive after 6 months is generally considered infertility.
An evaluation of a woman for infertility is appropriate for women who have not become pregnant after having 12 months of regular, unprotected intercourse.
When a couple has trouble having a baby, there's about a 50-50 chance that the man has a problem contributing to the pregnancy.
“Dilation and curettage” (D&C) is a short surgical procedure that removes tissue from your uterus (womb). You may need this procedure if you have unexplained or abnormal bleeding, or if you have delivered a baby and placental tissue remains in your womb. D&C also is performed to remove pregnancy tissue remaining from a miscarriage or an abortion.
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An ectopic pregnancy is any pregnancy that grows outside of the uterus (womb).
The diagnosis of an ectopic pregnancy is usually a surprise and is often emotionally traumatic. Many women are in the midst of enjoying their pregnancy when they receive the diagnosis. Some women diagnosed with an ectopic pregnancy do not even know they are pregnant and suddenly must contemplate the possibility of major surgery or medical treatment. This booklet is designed to provide information on the diagnosis and treatment of ectopic pregnancy.
Egg donation is when a woman (donor) gives her eggs to another woman (recipient) to allow the recipient to have a baby.
After the removal and fertilization of eggs with the use of in vitro fertilization (IVF), some women with multiple embryos (fertilized eggs) may decide to have a single embryo transferred to the womb even when multiple embryos are available (elective single embryo transfereSET).
In the current practice of in vitro fertilization (IVF), some patients may create more embryos (fertilized eggs) than they need. The extra embryos may be cryopreserved (frozen) so that they can be transferred later. However, sometimes these embryos may not be used. These patients have the option to have their embryos discarded, donated to research or donated to another woman to achieve pregnancy.
Endometrial ablation is a medical procedure that removes the lining of the uterus, called the endometrium.
Women with endometriosis may experience infertility, pelvic pain, or both. This booklet will describe options for diagnosing and treating pain or infertility that may be attributed to endometriosis.
When the tissue that normally lines the inside of the uterus (endometrium) is found outside the uterus, it is termed “endometriosis.”
When the tissue that normally lines the inside of the uterus (endometrium) is found outside the uterus, it is termed “endometriosis.” Endometriosis may grow on the outside of your uterus, ovaries, and tubes and even on your bladder or intestines. This tissue can irritate structures that it touches, causing pain and adhesions (scar tissue) on these organs.
If you haven’t been able to get pregnant after trying for 6 months, some tests can be done to help find the reason. Your doctor may test your hormone levels, your partner’s sperm, and your reproductive organs (ovaries, fallopian tubes, and uterus [womb]). During an exam of your uterus, your doctor will make sure there is nothing that could prevent the fertilized egg (embryo) from implanting (attaching to the uterine lining) and growing.
Infertility treatments that cause multiple eggs to develop make it more likely that you will become pregnant with twins, triplets, or more.
Vasectomy is currently one of the most common methods of sterilization in the United States. After your vasectomy, if you change your mind about having children, there are two procedures that can help you have a child with your partner. The two options are: a vasectomy reversal or sperm aspiration prior to in vitro fertilization (IVF).
Most people with disabilities are able and well-qualified to raise children. They should not be denied services only because of their disability. Disabled people are protected by the federal Americans with Disabilities Act. The Act makes it against the law to deny fertility services to a disabled person if the reason is based on stereotypes or doubts (with no proof) about his/her ability to take care of a child.
Uterine fibroids (also called myomas or leiomyomas) are benign (noncancerous) tumors of muscle tissue that can change the shape or size of the uterus and sometimes the cervix. They start in the smooth muscle cells inside the wall of the uterus (myometrium).
Gamete and embryo donation is using eggs, sperm, or embryos from someone else in order to help an intended parent(s) have a child. Intended parent is the term used for the person(s) who will raise the child(ren).
Gamete donation is giving sperm, eggs, both, or embryos to another person/couple so that another person/couple may have a child.
Birth defects, which occur in nearly one in 20 pregnancies, range in severity from minor anatomic abnormalities to extensive genetic disorders or mental retardation. Some couples have a greater than average risk of having a child with a birth defect. Genetic screening refers to the use of specific tests to determine which members of a population are at increased risk for an inherited condition.
A gestational carrier (GC), also called a gestational surrogate, is an arrangement where a woman carries and delivers a child for another couple or person (intended parent[s]).
Hirsutism is the excessive growth of facial or body hair on women. Hirsutism can be seen as coarse, dark hair that may appear on the face, chest, lower abdomen, back, upper arms, or upper legs. Hirsutism is a symptom of medical disorders associated with the hormones called androgens. Polycystic ovary syndrome (PCOS), in which the ovaries produce excessive amounts of androgens, is the most common cause of hirsutism and may affect up to 10% of women.
Hormonal contraceptives contain a progestin (progesterone medicine) with or without an estrogen. Both progestin and estrogen are made in a laboratory and are similar to the hormones that all women naturally produce. These two hormones together, or the progestin alone, work in several ways to prevent a pregnancy.
Damage and blockage of the end portion of a fallopian tube can cause it to become filled with fluid; the swollen and fluid-filled tube is called a hydrosalpinx.
High prolactin levels trigger the body to make milk for breastfeeding. In women who aren’t pregnant, prolactin helps regulate the menstrual cycle (periods). In men, prolactin affects sperm production.
Hypothyroidism (underactive thyroid) occurs when the thyroid gland produces less thyroid hormone than it should.
A hysterosalpingogram or HSG is an x-ray procedure performed to determine whether the fallopian tubes are patent (open) and to see if the shape of the uterine cavity is normal.
Infertility is a medical condition that touches all aspects of your life. It may affect your relationships with others, your perspective on life, and how you feel about yourself. How you deal with these feelings will depend on your personality and life experiences. Most people can benefit from the support of family, friends, medical caregivers, and mental health professionals. When considering infertility treatment options such as sperm, egg, or embryo donation or gestational carriers, it may be especially helpful to gain the assistance of a fertility counselor.
Infertility is typically defined as the inability to achieve pregnancy after one year of unprotected intercourse. If you have been trying to conceive for a year or more, you should consider an infertility evaluation. However, if you are 35 years or older, you should begin the infertility evaluation after about six months of unprotected intercourse rather than a year, so as not to delay potentially needed treatment. If you have a reason to suspect an underlying problem, you should seek care earlier.
Polycystic ovary syndrome (PCOS) is a common reproductive disorder, affecting 5% to10% of women of reproductive age. Women with PCOS have a number of conditions that may include irregular menstrual cycles, an increase in facial and body hair, increased weight, and infertility. Diagnosis is made on a combination of clinical, laboratory, and ultrasound findings.
A procedure called intracytoplasmic sperm injection (ICSI) can help fertilize the egg by injecting the sperm directly into the egg.
Injury to and/or infection of the endometrium may damage the lining and cause formation of adhesions (scar tissue) between the inner walls of the uterus. Asherman syndrome is the term used to describe adhesions inside the uterus. The scarring can be mild with thin stretchy bands of scar tissue or more severe with formation of thick bands. In the most severe cases, partial or total destruction of the inside of the uterus can occur.
Intrauterine insemination (IUI) is a procedure that bypasses the cervix and places sperm into a woman’s uterus around the time of ovulation.
A complete examination of a woman’s internal pelvic structures can provide important information regarding infertility and common gynecologic disorders. Frequently, problems that cannot be discovered by an external physical examination can be discovered by laparoscopy and hysteroscopy, two procedures that provide a direct look at the pelvic organs. These procedures may be recommended as part of your infertility care, depending on your particular situation. Laparoscopy and hysteroscopy can be used for both diagnostic (looking only) and operative (looking and treating) purposes.
Many women have pain in their pelvis (lower part of the belly) from time to time, usually during their period. However, if you have daily pelvic pain, it could be a sign of a bigger problem with your bladder, bowels, reproductive organs, or pelvic muscles. Many conditions cause pelvic pain, including endometriosis, adhesions, chronic appendicitis, or hernias.
Approximately 25% of infertile women have problems with ovulation. These include the inability to produce fully matured eggs or failure to “ovulate” (release) an egg. The inability to produce and/or release eggs is called anovulation. Fertility specialists use a group of medications, often called “fertility drugs,” to temporarily correct ovulatory problems and increase a woman’s chance for pregnancy. Fertility drugs may be used to correct other fertility problems such as improving the lining of the uterus (endometrium) in addition to inducing ovulation. In certain circumstances, these medications also may be used to stimulate the development of multiple eggs, such as in an in vitro fertilization (IVF) cycle. This booklet explains the basics of normal ovulation and the diagnosis and treatment of ovulatory problems. The specific uses for several types of ovulation drugs are presented, along with the intended results and possible side effects of each drug.
Surgery is termed “minimally invasive” if it uses small or no incisions (cuts). Surgeons see your body’s organs with the help of small telescopes and cameras. Surgical repairs are made with very small instruments. Most problems can be treated at the time of diagnosis as one procedure.
Multiple births are much more common today than they were in the past. According to the US Department of Health and Human Services, the twin birth rate has increased by over 75% since 1980, and triplet, quadruplet, and high-order multiple births have increased at an even higher rate. There are more multiple births today in part because more women are receiving infertility treatment, which carries a risk of multiple pregnancy.
Most women will use birth control pills at some time in their lives. But many women don’t know that birth control pills also can be used to treat a variety of female problems and can have some surprising health benefits.
Contraceptive agents work in many ways to prevent a pregnancy. They are usually divided into those that are either hormonal or nonhormonal. Most of the hormonal contraceptives work by changing a woman's hormone levels to mimic a pregnancy, therefore preventing eggs from being able to be released from the ovary. In contrast, nonhormonal contraceptive agents or devices work by preventing a man's sperm from joining a woman's egg.
Puberty refers to the specific physical changes that happen as a child develops into an adult. Though they happen in different areas of the body, these changes are all related to each other.
About 20% of infertility cases are due to a male factor alone. Another 30% involves both male and female factors.
Before attempting pregnancy, a woman should make sure she is healthy enough for pregnancy by adopting a healthier lifestyle and taking prenatal vitamins. If she has a medical or genetic condition, she should seek advice from a medical professional before conceiving (becoming pregnant).
Some women may need medicines to help them ovulate (release eggs). This is called ovulation induction and may be done for two reasons. The first is when a woman doesn’t ovulate regularly. The medicines make the ovary release eggs. The second is when a woman ovulates on her own, but still isn’t able to get pregnant. In that case, medicines may be given to help her release more than one egg as a part of a treatment for unexplianed infertility. Your doctor can determine if ovulation induction is right for you.
Osteoporosis is a disease characterized by low bone mass which leads to weakening of the bones. Osteopenia is a disease where the bone density is lower than average and can be a precursor to osteoporosis.
Often, women with polycystic ovary syndrome (PCOS) do not have regular menstrual periods. This usually means that a woman doesn’t ovulate (release an egg) every month and may have trouble getting pregnant. Hormone treatments like birth control pills can help make periods more regular but will prevent a woman from getting pregnant.
Ovarian Hyperstimulation Syndrome (OHSS) is an exaggerated response to the use of ovulation induction medications, especially during the use of injectable gonadotropin agents
A woman’s ability to get pregnant normally decreases as she gets older. In later life, women have fewer eggs, egg quality goes down, and eggs have more abnormalities in their chromosomes (genetic material). All these factors together mean that older women have lower pregnancy rates and higher miscarriage rates.
Ovulation, the release of an egg from its follicle in one of a woman’s two ovaries, is one of the most important factors in conceiving a child.
Polycystic ovary syndrome is a common hormone disorder that affects 5%-10% of women. Like all syndromes, PCOS is a collection of problems that are found together. Not all women with PCOS have all the same symptoms. To be diagnosed with PCOS, a woman must have 2 of 3 possible issues: chronic lack of ovulation (anovulation), chronic high testosterone (hormone) levels (hyperandrogenism), and ovaries that have multiple small cysts containing eggs (polycystic).
What is preimplantation genetic testing (PGT)?Your embryos can be tested for abnormal chromosomes before they are transferred to the uterus. This is called preimplantation genetic testing, or PGT. It is done in a lab, using in vitro fertilization (IVF). To learn more about IVF, please see the ASRM fact sheet titled In vitro fertilization (IVF). One or more cells from each embryo is sent for genetic testing. Genetically healthy embryos are transferred to the uterus, where they may attach to its lining and produce a pregnancy.
When a woman’s ovaries stop working before age 40, she is said to have premature ovarian failure (POF).
Progesterone prepares the lining of the uterus (endometrium) to allow a fertilized egg (embryo) to stick or implant. If a pregnancy does not take place, progesterone levels will fall and you will have your period. If an embryo implants into the lining of the uterus, the ovary will produce progesterone until eight weeks into the pregnancy. After that time, progesterone will be produced by the placenta throughout the rest of the pregnancy.
Recurrent pregnancy loss is a disease distinct from infertility, defined by two or more failed pregnancies.
Your reproductive system ages faster than you may realize. Some women, after completing college, settling into a career, or waiting for the right partner, find that they have problems getting pregnant due to age-related infertility.
Serious complications from the medications and procedures required for in vitro fertilization (IVF) are rare. However, as with all medical treatments, there are some risks.
Robotic surgery is a form of laparoscopy. Laparoscopy is minimally invasive surgery, usually performed in an outpatient setting. Small incisions about a half inch each are made in the abdomen that allow a surgeon to place a laparoscope (lighted camera) and surgical instruments through surgical incisions below the belly button.
Saline infusion sonohysterography (SHG or SIS) consists of imaging the uterus and uterine cavity using ultrasonography while sterile saline is instilled into the uterine cavity. The purpose of sonohysterography is to detect abnormalities of the uterus and endometrial (uterine lining) cavity.
You probably don't realize how many people have problems having sex. But sexual dysfunction is common: 43% of women and 31% of men report having at least one symptom.
Gonadotropins are fertility medications given by injection that contain follicle-stimulating hormone (FSH) alone or combined with luteinizing hormone (LH).
Most people understand that smoking increases the risk for heart, vascular, and lung disease. Many do not realize that smoking can also lead to problems with fertility in both men and women. Erectile dysfunction and pregnancy complication rates are also increased with smoking.
There are more than 10,000 spinal cord injuries per year in the United States. The majority of these injuries occur in healthy men of reproductive age. Spinal cord injury may produce both sexual and reproductive problems.
For many years, experts have focused on semen analysis, but research studies show that the number of sperm (count) and the movement of sperm (motility) do not always predict fertility very well by themselves. It may also be useful to look at the shape of the sperm (morphology), which is also one of the important parts of the semen evaluation.
Stem cells are special cells found in very early stage embryos (i.e., 5 days after fertilization of an egg) and in some types of adult tissue.
It is not clear how exactly stress impacts fertility. It is not known whether high levels of stress can prevent pregnancy or affect a woman’s chance of conceiving. We do know that reducing stress provides a better quality of life during times of intense personal challenge.
Why can men with SCI have infertility?There are several reasons a man with a spinal cord injury (SCI) might have infertility.
One group of methods that is becoming more popular for many women is Long-Acting Reversible Contraception (LARC). These methods do not fail as often and fewer women become pregnant because they are always in place and last for a long time. Because of this, the failure rate is less than 1 in 100. LARC methods reduce the number of times women get pregnant when they do not want to, called unintended pregnancy. The number of abortions is also lower when women use LARC. LARC methods include subcutaneous (under the skin) implants, intrauterine devices (IUDs), and injectable methods (a shot). The shot fails at a higher rate than other LARC methods because it does not last as long. LARC methods also help women in other ways and there are very few reasons they cannot be used. This page will tell you more about IUDs.
During the menopause transition, the length of menstrual cycles often changes and women may skip their menstrual periods more often. The duration of the menopausal transition varies from woman to woman but averages about five years.
The phrase “third-party reproduction” refers to the use of eggs, sperm, or embryos that have been donated by a third person (donor) to enable an infertile individual or couple (intended recipient) to become parents. Donors may be known or anonymous to the intended recipient. “Third-party reproduction” also includes traditional surrogacy and gestational carrier arrangements.
Many women have a miscarriage at one time or another. Miscarriages can happen for many reasons. Having a miscarriage doesn’t mean a woman will have another miscarriage if she tries again.
Fibroids usually do not require treatment because most patients with fibroids do not have symptoms.
Clinical trials are research studies that test how safe and effective new drugs, treatments, and devices are. Health-care providers find patients with specific characteristics or health problems to test the product. All clinical trials are reviewed by special committees called institutional review boards (IRBs) to make sure that the trials are safe and ethical.
A varicocele is a variation of normal anatomy in which veins in the scrotum (the sac that holds the testicles) become enlarged and sometimes even visible. Varicocele usually is first found at puberty and is much more common on the left side than on the right side. Sometimes it occurs on both sides.
Many women in the underweight, overweight, and obese categories will not have a problem becoming pregnant. But women who are not an ideal body weight may have problems with ovulation. This could lead to problems with fertility.
Uterine fibroids (also called myomas or leiomyomas) are benign (non-cancerous) tumors of muscle tissue that can enlarge and/or distort the uterus (womb) and sometimes the cervix.
Turner syndrome (TS) is an infrequent genetic disorder in females. About 1 in every 2,000 female babies born is affected.
Women who take fertility medicines to get pregnant have a higher chance of having more than one fetus in a pregnancy. Fetus is the term for developing humans from 11 weeks of pregnancy until birth. A multiple pregnancy or multiple gestation may have 2 fetuses (twin pregnancy), 3 fetuses (triplet pregnancy), or other (high-order multiple pregnancy).
This is a condition when a woman has 2 or more clinical pregnancy losses (miscarriages) before the pregnancies reach 20 weeks.
What are toxic environmental agents?These are harmful substances (chemicals, metals, pollutants) found in water, air, soil, foods, and consumer products.
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