Wednesday, October 14, 2009

Male Factor Infertility

Male infertility

When a couple has been trying to get pregnant for a long time, the partners often try to figure out the reason for their lack of success. Statistically, the reason involves male infertility about one third of the time, female infertility about one third of the time, and a combination of male and female infertility factors the remaining one third of the time. Consulting with a Reproductive Endocrinology and Infertility expert can significantly help to determine the range of causes and develop an infertility treatment plan.

Male infertility can be due to difficulty in completing intercourse, an inability of the sperm to live within the female reproductive tract long enough to fertilize the egg within the fallopian tube, or a problem with the production of normal sperm.

Difficulty with completing intercourse can be due to an erectile or an ejaculatory problem. Sometimes these problems can be effectively treated with medication. When treatment is not possible, but the man is able to produce a semen sample into a container, then intrauterine inseminations (IUI) that are timed at ovulation are often effective.

The sperm normally fertilizes the egg within the woman’s fallopian tube. There is usually a tremendous decrease in the number of motile sperm along this journey from the initial placement within the vagina (where sperm is usually destroyed within about one hour due to a difference in acidity between the semen fluid and the vaginal vault) to residing within the uterine cervical mucus (where sperm can usually survive comfortably for several days) to passage through the uterus and into the fallopian tube. Generally, it is estimated that if 50 million sperm are placed within the vaginal vault during intercourse only a few thousand of these sperm ever reach the fallopian tube, where they have a chance to fertilize the egg. When this type of male factor is a cause of infertility, then IUI (intrauterine insemination) procedures to place the sperm near the egg at the time of ovulation can be helpful.

The semen analysis is the most common test to determine whether normal sperm are being produced. The major variables that are tested include volume (amount of semen in the ejaculate), concentration (number of sperm per unit volume of semen), motility (percent of sperm that are moving), and morphology (shape of the sperm present). When these numbers fall within the normal range for semen analysis, the sperm is thought to be “good.” But really only a history of proven fertility, such as having achieved a pregnancy with someone in the past or having fertilization at IVF (in vitro fertilization), demonstrates that the sperm is actually capable of fertilizing a human egg. For most mild to moderate male infertility problems involving the production of normal sperm, IUI (intrauterine insemination) is a reasonable treatment alternative. If there is a severe male infertility problem with the sperm, then ICSI (intracytoplasmic sperm injection, which is a form of assisted fertilization) or the use of donor sperm may need to be considered.


Dr. Eric Daiter at The NJ Center for Fertility and Reproductive Medicine, LLC has extensive experience with male infertility and has personally performed thousands of semen analyses. He would be happy to help you. For an appointment to discuss your situation with Dr. Daiter, please call the office at 908 226 0250. Visit us on the web at http://www.drericdaitermd.com/or http://www.ericdaiter.com

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Monday, October 12, 2009

IUI cost

IUI, Artificial Insemination, treatment cycle cost (2009)

IUI (intrauterine insemination) is ideally performed just prior to ovulation (the release of a fertilizable mature egg). The sperm may survive and be able to fertilize a mature egg for several days following artificial intrauterine insemination (IUI) but the mature egg is probably only able to be fertilized for 1 to 2 days after ovulation.

The IUI procedure requires that the semen sample be prepared (washed) to remove the sperm (the male reproductive product that contains the potential father’s DNA) from the semen (liquid secreted from the seminal vesicles that contains prostaglandins). If prostaglandins are placed within the uterus, as would be the case if IUI were performed without washing the sample free of semen, then the woman would suffer terrible uterine cramps for several hours. Generally, in New Jersey IUI costs roughly 200-400 dollars and the washing procedure costs roughly 150-300 dollars.

The total cost of an IUI treatment cycle varies considerably depending on whether fertility ovulation enhancing medications are used. These medications can be expensive and the monitoring that is required for their safe use is also potentially expensive.

In natural ovulation cycles with IUI, where no fertility medications are used, the woman allows her egg to mature on its own and an IUI is performed at the time of ovulation. When a woman has highly predictable menstrual cycle intervals then ovulation can be predicted fairly accurately to occur about 14 days before the onset of the next expected menstrual flow. This timing can be confirmed with an ovulation predictor kit, which generally uses LH detection to determine when the LH surge occurs (the LH surge triggers the release of the mature egg at ovulation). LH ovulation predictor kits often contain several LH detection sticks (one test stick is used each day) and cost about 25-50 dollars per kit. Sometimes, several ovulation predictor kits are required per month if the timing of ovulation is less predictable. If the available ovulation predictor kits are not reliable for a particular woman or if additional accuracy is necessary, then serial ultrasound exams and blood work (for estradiol and LH concentrations) usually is able to determine follicular development more accurately. Often 2-4 ultrasound exams and blood tests are required per cycle. Each ultrasound exam costs roughly 150-350 dollars and blood work at Quest Diagnostics or LabCorp for these hormones can also be a few hundred dollars.

Clomiphene citrate (Clomid) is an ovulation inducing medication that may be effective to regularize or shorten the menstrual cycle intervals if a woman has very irregular menstrual cycle intervals. Clomid often costs less than 100 dollars per cycle and a few ultrasounds or blood tests may be suggested to monitor egg development.

Controlled ovarian hyperstimulation to produce many mature eggs per cycle provide “more targets” for the sperm to attempt to fertilize at IUI and provide a greater per cycle success rate. The medications used for controlled ovarian hyperstimulation are expensive, since each ampule of medication costs 35 – 80 dollars and a woman may use 2 - 6 amps of medication a day for up to 7-10 days (1,000 to 4,000 dollars a cycle depending on medication requirements). Monitoring egg development using 2-5 ultrasound examinations per cycle and blood work 2-5 times per cycle is required to safely administer these medications.

You can save a considerable amount of money as well as increase your chances for success if you consult a Reproductive Endocrinologist (infertility expert) early on to review the range and cost of infertility treatments that may be effective for your unique situation.

Dr. Eric Daiter at The NJ Center for Fertility and Reproductive Medicine, LLC has extensive experience with all types of infertility, the appropriate use of IUI, and he would be happy to help you. For an appointment to discuss your situation with Dr. Daiter, please call the office at 908 226 0250.
For more information please visit us on the web at http://www.drericdaitermd.com/or http://www.ericdaiter.com/

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