Anovulatory Infertility
Anovulatory Infertility

Anovulatory Infertility is a condition of female infertility wherein a woman does not release an egg even when she’s having a menstrual cycle. This may be the culprit if you’ve had regular flow throughout and still have no luck conceiving. In this case, you’re only bleeding, but there’s no oocyte to fertilize, causing pregnancy to be out of reach. 

Worry not, though, because this condition is curable through particular treatment regimens. Specifically, you could use either clomiphene citrate (Clomid), human menopausal gonadotropins (hMG), or follicle-stimulating hormone (FSH) with or without clomiphene. Note that while anovulation can be cured by medications, some common medications may cause it! These include treatments meant for other purposes, such as: 

NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)

NSAIDs are one of the most accessible drugs you can find; they’re an over-the-counter remedy requiring no doctor’s prescription. It’s an effective remedy to fight off urinary incontinence. The drugs are widely used to relieve inflammation, pain, swelling, and fever. In fact, you may even have some of its variations stocked up in your medkit, like aspirin and mefenamic acid. 

That’s right, these are medications you can freely access when you’re experiencing period pain. However, no matter how much they are blocking the discomfort, there are certain effects you should be aware of. NSAIDs can alter physiological processes, including those of your reproductive system. 

Studies suggest that these drugs inhibit ovulation by directly affecting the dominant follicle. Instead of splitting open to release an egg, the follicle remains in its unruptured state. This condition won’t last for a lifetime, though. Withdrawal and avoidance of these drugs may lead to pregnancy.

Skin Creams and Other Topical Products With Hormones

Anovulation can also be due to skin creams and other topical products containing various hormones. For instance, there are brands that purposefully include progesterone and estrogenic chemicals in their formula. While these are effective in addressing wrinkles, dark spots, and melasma, they have an adverse effect on women’s fertility. 

In particular, estrogens are a fool-proof way to increase collagen production and skin hydration. It’s a hormone known for decreasing skin aging, so they’re sought after in facial creams. However, in return, women gain an increase in estrogen exposure. These will have a great impact on hormone levels and can even affect ovum production in the long run. 

On the other hand, progesterone is a handy addition to topical products as it can treat bloating, tenderness, and fatigue. There’s a lot to be gained from using creams made with this hormone, but there’s a certain disclaimer. You should only be using this if you’re done with ovulation and entering the luteal phase of your cycle. It’s because the body only produces progesterone for thickening the uterine lining for a possible pregnancy.

Steroids and Anovulatory Infertility

You could classify steroids into two: anabolic steroids, which are a charm for bodybuilders, and corticosteroids which reduce pain and stiffness. The latter is an effective medication against asthma, inflammation, and flare-ups. However, there’s one unpopular result it can bring with constant use – steroids affect fertility. 

That’s right; if you’re planning on building a family, these drugs are a no-go. It’s a substance that can no doubt affect your menstrual cycle, making it irregular, heavier, and prolonged. It can even interfere with the body’s hormone production leading to anovulation.  

On the chance that you get pregnant even while taking steroids, there are bound to be some congenital disabilities. Pregnancy complications may arise and may lead to failure in fetus development. The thing is, these types of drugs should not be in contact with your body if you’re keen on conceiving and giving birth. 

Cortisone and Prednisone

Cortisone and Prednisone are types of corticosteroids meant to address various clinical problems. These include but are not limited to illnesses such as severe allergies, asthma, lupus, arthritis, and IBD. However, their downside is that they prevent the necessary hormone production for ovulation from occurring. 

This is especially the case if you’ve taken both drugs in high doses as a regular routine. The organic chemicals in your body, namely follicle-stimulating hormone, and luteinizing hormone become blocked in production. For reference, FSH and LH are a pair of hormones known to stimulate egg maturation in the ovaries. 

In general, corticosteroids are not recommended for those who are eager to conceive. Studies show that some women who took a single steroid shot had their menstruation cycles turn irregular. The fickleness of monthly periods is not a good sign, especially when it comes to reproductive health.

Herbs and Natural Remedies can Cause Anovulatory Infertility

If you believe you’re safe from anovulation because you’re all about the natural route, think again. Organic remedies may be eco-friendly and safer for your body, but they can also be the source of infertility. For instance, some herbs have hormone-like substances that can make your ovum production haywire. 

For instance, some organic supplements contain ingredients that are high in estrogenic substances. Think of ginkgo, ginseng, clover, and other herbal plants effective in altering the sex-hormone concentration. In turn, egg production will be affected, and conception won’t occur. 

This doesn’t mean you should completely stay away from herbs and natural remedies, though. They’re still a healthier, more sustainable alternative to chemically-processed substances. The best way to go is to schedule an appointment with your fertility doctor and take note of all the organic alternatives safe for use. 

To Conclude

Anovulatory Infertility is a treatable condition that is experienced by thirty percent of women. It’s not as uncommon as you think and can be remedied by withdrawing from the substances causing it. You can also opt to get medications specifically addressing ovulatory irregularities. 

Advancements in the medical world are growing rapidly, so you have access to various treatments in your hands. On the chance that you’re considering IVF, ask if they manage the patient journey with ART Compass. It’s a lab management software that can assist you with your conception goals through artificial intelligence.

COVID 19 Vaccine and Sterility
COVID 19 Vaccine and Sterility

The COVID-19 vaccine does not cause sterility! Misinformation spread on social media and false reports circulated have raised questions about whether the COVID-19 vaccine causes female sterility. As a result, there has been a concerning increase in vaccine hesitancy in reproductive-age women. Rest assured, these are unfounded claims. New research has proved that the vaccine does not cause female sterility.

Vaccine hesitancy among this group was largely caused by a false report, shared on social media, that said the spike protein on the coronavirus was the same as another spike protein syncytin-1, which is involved in the development and attachment of the placenta during pregnancy. The report claimed that receiving the COVID-19 vaccine would cause the body and immune system to attack the other spike protein (syncytin-1) and harm fertility. These two spike proteins are different. Receiving the COVID-19 vaccine does not affect the fertility of women hoping to conceive, including through in vitro fertilization (IVF).

Further, when Pfizer was testing vaccines, 23 women volunteer participants became pregnant and did not experience issues with fertility because of the vaccine. The only one who tragically suffered a pregnancy loss did not receive the vaccine, instead receiving the placebo.  

Report SARS-CoV-2 spike protein seropositivity from vaccination or infection does not cause sterility published in the American Society for Reproductive Medicine Journal Fertility & Sterility Reports debunks this myth of sterility at the hands of the vaccine.

Randy Morris, M.D. used IVF frozen embryo transfer (FET) to understand the impact of COVID-19 seropositivity (presence of a serological marker for SARS-CoV-2 in the blood) on embryo implantation. He did this by comparing the implantation rates for SARS-CoV-2 vaccine seropositive (received vaccine), infection seropositive (previously infected with COVID-19), and seronegative women. The study found no difference in maternal serum hCG levels after an embryo transfer or sustained implantation rates across the three groups. Serum hCG levels were measured because human chorionic gonadotropin (hCG) is produced by placental syncytiotrophoblasts following embryo implantation and can be used in the early detection of pregnancy.

The research shows that seropositivity to the SARS-CoV-2 spike protein, whether from vaccination or previous infection with COVID-19, did not hinder embryo implantation or the early stages of pregnancy. Neither infection with COVID-19 nor antibodies produced from the vaccine will cause female sterility. Infection with the disease, however, may have an impact on pregnancy and the mother’s health.

“We hope that all reproductive-aged women will be more confident getting the COVID-19 vaccine, given Dr. Morris’s findings that the vaccine does not cause female sterility,” said Hugh Taylor, M.D., president of the American Society for Reproductive Medicine. “This, and other studies of this nature, further reinforce the ASRM COVID Task Force guidance that, no matter where you are in the family-building process, the COVID-19 vaccine is safe and saves lives.”

Sources

https://www.asrm.org/news-and-publications/news-and-research/press-releases-and-bulletins/new-study-reveals-covid-vaccine-does-not-cause-female-sterility/
https://www.sciencedirect.com/science/article/pii/S2666334121000684
https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/covid-19-vaccines-myth-versus-fact
Vitamins and Infertility - Dietary sources of vitamins A, D, and E!
Vitamins and Infertility – Dietary sources of vitamins A, D, and E!

Can vitamins impact infertility? Certain vitamins are essential in maintaining fertility and we have included sources where you can find these vitamins to incorporate into your diet.

Vitamin A

Vitamin A is crucial for the functioning of various body systems and organs. One of these systems is the reproductive system.

Spermatogenesis  is quite dependent on vitamin a. It is what helps keep structures such as the epididymis and seminal vesicle functioning. without it, instead of finding those structures you might find “stratified squamous keratinizing epithelium.”

In females the problems could be found in ovulation. A study on vitamin A deficient rats showed that the rats were unable to ovulate and form corpora lutea routinely. researchers were also not able to see blastogenesis occur. vitamin A could play a crucial role even after fertilization! it has been shown that a mother’s vitamin A keeps the placenta in good condition.

In studies performed on pigs, it was observed that a lack of vitamin A resulted in several birth defects including cleft palate, lack of eye development etc. embryos observed during days 12.5-20.5 demonstrated a range of defects in vision related structures such as the retina and iris.

The nervous system also uses vitamin A for functions such as neural differentiation. Vitamin A deficient (vad) quail embryos have been observed to have underdeveloped hindbrains. They also did not have many spinal cord neurons. Some other problems were observed in vad rat embryos; these included:

There are many more conditions that can develop in embryos. however, making sure that you include sufficient amounts of vitamin A in your diet prevents such birth defects. It is important to keep in mind that eating healthy is very important during early pregnancy and even pre-pregnancy. It is often stressed by health professionals to get your vitamins from food rather than supplements, and the same is true for vitamins and infertility. Vitamin A can be found in variety of foods including:

References:

1. Clagett-Dame et al. “Vitamin A in Reproduction and Development” Nutrients. Mar 29 2011

2. “Vitamin A” Harvard T.H. Chan School of Public Health

Vitamin D

Scientists are still not completely sure whether vitamin d deficiency is associated with IVF outcomes. The authors of one study did conclude, however, that vitamin D does not affect pregnancy, live birth, and miscarriage rates. They found reason to believe vitamin D is involved in folliculogenesis, oogenesis and endometrial receptivity. Studies are split between whether vitamin D deficiency is a serious issue for individuals who plan on using ART. Certain fertility clinics screen patients for vitamin d deficiency prior to beginning treatment. A good level of vitamin D for fertility treatments is often considered to be 30 ng/ml. It is important to be able to maintain this level even throughout a pregnancy as studies have shown vitamin D deficiency may induce preeclampsia, gestational diabetes and other conditions. The reason for this may be that vitamin D is known to be involved in the embryo implantation process. It controls the genes that generate estrogen and also helps to shift around immune cells in the uterus to fight off infections. Some good sources of vitamin D include:

Serum Vitamin D status is associated with increased blastocyst development rate in women undergoing IVF.
• Strong relationship was observed between blastocyst development and VitD sufficiency- linking vitamins and infertility.

• For every single increase in a blastocyst generated or embryo cryopreserved, the likelihood of VitD sufficiency increased by 32%. 

•  There was no association between VitD and clinical pregnancy or live birth outcomes.

• Larger studies should investigate whether the effect on blastocyst development may affect subsequent clinical pregnancy and live birth rates.


Nikita L. Walz et al., RBMO 2020

References:

Vitamin E 

It is clear that micronutrients, vitamins and infertility go hand-in-hand. Researchers from another study were able to determine an association between recurring abortion and low plasma vitamin e levels and increased lipid peroxidation levels in women. Regarding fetus/embryo growth, it’s important to bring up the study of in vitro matured and fertilized bovine oocytes. The zygotes derived from them when cultured in vitamin E, vitamin C, and EDTA were more likely to enter the blastocyst stage than the control medium. Current studies indicate there is still more we need to know about vitamin E! The University of Rochester is currently conducting trials involving 48 infertile men and 20 fertile men on how vitamin E affects sperm fragmentation. DNA fragmentation occurs due to oxidative stress. Because vitamin E is an antioxidant, it can combat such oxidative stress. It leaves us questioning if vitamin E deficiency perhaps leads to DNA fragmentation? Want to try and incorporate more vitamin E into your diet? Here’s some foods that Healthline listed, which you should eat!

References:

1. Mutalip et al. “Vitamin E as an Antioxidant in Female Reproductive Health” Antioxidants. Feb 2018. 

2. Vitamin E and Male Fertility study on ClinicalTrials.gov

3. Olson et al. “Culture of in vitro-produced bovine embryos with Vitamin E improves development in vitro and after transfer to recipients.” Biol Reproduction. Feb 2000. 

Being pregnant during Covid-19 may be stressful and induce anxiety in many soon-to-be moms. However, that doesn’t mean that it’s impossible to get through! We outlined some of the guidance the CDC has released for pregnant women during Covid-19 because the sharing of useful information during a time like this is CRUCIAL. 

Are COVID-19 vaccines safe in pregnancy?

A. Probably yes.

B. Pregnancy and the COVID19 vaccine itself very much isn’t. It is very dangerous to pregnant women.

The impact of covid-19 on pregnant women has been a concern for many people. unfortunately, there isn’t too much data available because we’re still learning about the virus. THE CDC however suggests that pregnant individuals may be at a higher risk.

The CDC also states that the pregnant population could possibly suffer from adverse pregnancy outcomes, such as preterm birth. It is advised that pregnant individuals take the utmost caution during these stressful times and do not skip their prenatal care appointments.

Here is some data released by the CDC:

Being pregnant during the pandemic is unimaginably stressful. shout out to all those new moms out there! If you’re having a difficult time coping with the pandemic and the risks it imposes, you don’t have to go through this alone! Approach your physician with any questions.

And of course-keep, yourself occupied! staying at home doesn’t mean you can’t have fun! Video call some of your pals or start picking out that wallpaper for the nursery! and most important-stay safe. Wear a mask and wash your hands regularly for twenty seconds.

References:

https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/special-populations/pregnancy-data-on-covid-19.html

https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/pregnancy-breastfeeding.html

Image by Sarah Pflug

Biochemical pregnancy is one that occurs within just a few weeks of implantation. It is believed that biochemical pregnancies account for up to 75% of all miscarriages. Even at such an early stage, the embryo produces enough of the hormone human chorionic gonadotropin (hCG) to be detected by a pregnancy test. Sadly, however, the embryo does not develop into a healthy pregnancy. Biochemical pregnancy can be devastating for couples who are trying to start a family.⁠

Women who experience repeated IVF failures need to be evaluated thoroughly for both embryo competency and implantation dysfunction before and/or in the course of their next IVF attempt. Implantation problems should be evaluated before proceeding to the next IVF cycle. ⁠

Unexplained Infertility 

Unexplained infertility can only truly be diagnosed after a full and complete fertility evaluation of both the male and female partner.

An unexplained infertility diagnosis may be justified if it has been shown that…

You are ovulating regularly.

Your ovarian reserves are good. (Evaluated with blood work and/or an antral follicle count.)

Your fallopian tubes are open and healthy. (Evaluated with an HSG.)

Your partner’s semen analysis is normal (including total count, sperm movement, and sperm shape.)

There are no serious uterine fertility issues. (Evaluated with a hysteroscopy.)

If any of the above has not been evaluated, a diagnosis of unexplained infertility may be premature.

Some may also argue a laparoscopy is also needed to rule out endometriosis. Endometriosis cannot be diagnosed with blood work or ultrasound.

Other reasons for What is a biochemical pregnancy??: 

The interaction between the vaginal environment and sperm: After ejaculation, sperm must make their way out of the semen and into the cervical mucus. Then, they must swim up from the vagina, into the cervical opening, and eventually into the uterus.

Sometimes, there may be problems during that transition period, from the semen, into the cervical mucus, and up the cervix. For example, there may be antibodies in the cervical mucus or even the semen that attack the sperm.

This is known as hostile cervical mucus. How to effectively diagnose this problem isn’t clear, leaving cases like these frequently unexplained.

Poor egg quality: We have tests to determine if you’re ovulating, and testing to get a general idea of whether there is a relatively good quantity of eggs in the ovaries.

But there is no test to determine whether the eggs are good quality. Poor quality eggs may be caused by age, an underlying medical condition, or some yet unknown cause.

One study published in 2016 found that a newly discovered virus is more commonly found in the endometrial tissue of women with infertility than in women with proven fertility. But how to diagnose and treat this problem isn’t known.

Problems with a fertilized egg developing to a healthy embryo: Let’s say we get a healthy looking egg and sperm, and they become an embryo. Next, the cells inside the embryo divide and grow to eventually form a fetus.

Sometimes, this goes wrong. This is another problem that may be diagnosed during IVF treatment since embryos are monitored for normal cell division.

Primary Ovarian Insufficiency 

Primary ovarian insufficiency — also called premature ovarian failure — occurs when the ovaries stop functioning normally before age 40. When this happens, your ovaries don’t produce normal amounts of the hormone estrogen or release eggs regularly.

Women with primary ovarian insufficiency can have irregular or occasional periods for years and might even get pregnant.

Signs and symptoms of primary ovarian insufficiency are similar to those of menopause or estrogen deficiency. They include:

Irregular or skipped periods, which might be present for years or develop after a pregnancy or after stopping birth control pills

Difficulty getting pregnant

Hot flashes

Night sweats

Vaginal dryness

Dry eyes

Irritability or difficulty concentrating

Decreased sexual desire

Image by Sarah Pflug

In reality, there is no normal!! The menstrual cycles and timing intercourse begins and ends with menstruation and is divided by ovulation into the follicular and luteal phases. The fertile window, during which there is a probability of conception from unprotected sex, is defined as the day of ovulation and the 5 days preceding it (the time window for sperm survival).

All available data suggests that there may be significant variability in fertile days- i.e.. not exactly 14 days before your next period!

We suggest tracking your basal body temperature AND your LH surge to determine your fertile days- and really try to determine if you are getting ovulation each month to time intercourse very well.

Late Ovulation

Late ovulation is when you ovulate (i.e. your ovary releases an egg) after day 21 of your menstrual cycle. Women with regular cycles consistently have periods every 21 to 35 days. … Very rarely, women have a normal 28-day cycle but ovulate around day 17, 18, or 19 instead of around day 14.

In true late ovulation, you will have a short luteal phase. Some doctors think that the uterus may not have enough time between cycles to build up its lining for an embryo to attach. That could theoretically lower your odds of getting pregnant, but it’s far from certain.

Any time your cycles are long and irregular, it’s a good idea to check in with your doctor to rule out PCOS, hyperprolactinemia or hypothyroidism. Getting treatment for these conditions can greatly increase your chances of getting pregnant and having a healthy pregnancy.

Azoospermia: TESE, MESA, and PESA

In some individuals, spermatozoa may not be present in the ejaculate. This condition is called Azoospermia. This can be either due to problems in sperm production itself or due to obstruction to the flow of semen during ejaculation. Reproductive tract obstruction can be acquired – as a result of infection, trauma, iatrogenic injury which can occur during bladder neck, pelvic, abdominal or inguino-scrotal surgery.

Congenital anomalies may be relatively uncommon in the general population, but can occur in up to 2 percent of infertile men. Best known condition is congenital bilateral absence of the vas deferens (CBAVD) which occurs in almost all men with cystic fibrosis.

Two techniques – Epididymal sperm retrieval & micromanipulation have revolutionized treatment of male infertility in the past decade. Men with congenital bilateral absence of the vas defences (CBAVD) or reproductive tract obstruction are now able to achieve pregnancies with use of these advanced techniques. You must know the normal Menstrual Cycles and Timing Intercourse.

PESA

PESA or Percutaneous Epididymal Sperm Aspiration (PESA), does not require a surgical incision. A small needle is passed directly into the head of the epididymis through the scrotal skin and fluid is aspirated. The embryologist retrieves the sperm cells from the fluid and prepares them for ICSI.

MESA

Microsurgical Epididymal Sperm Aspiration (MESA) is used in conditions like obstructive azoospermia, involving dissection of the epididymis under the operating microscope and incision of a single tubule. Fluid spills from the Epididymal tubule and pools in the Epididymal bed. This pooled fluid is then aspirated. Because the epididymis is richly vascularized, this technique invariably leads to contamination by blood cells that may affect sperm fertilizing capacity in vitro.

TESA and TESE

TESE or testicular sperm extraction is a surgical biopsy of the testis whereas TESA or testicular sperm aspiration is performed by inserting a needle in the testis and aspirating fluid and tissue with negative pressure. The aspirated tissue is then processed in the embryology laboratory and the sperm cells extracted are used for ICSI.

We hear the names of these three hormones quite often but what do they even do? Why are they important? Understanding how our bodies work and what goes on inside them can help us navigate our fertility better. There is a lot of difficult and complicated terminology involved so today we’re here to help you understand the significance of FSH, AMH, and TSH!

There are three hormones that can indicate ovarian reserve: AMH (Anti-mullerian hormone), FSH (follicle stimulating hormone), and E2 (estradiol).⁠

FSH, AMH, and TSH! As part of a basic fertility workup, your doctor will likely order blood work to check your FSH levels. Sometimes called the day 3 FSH test, this is a simple blood test meant to measure the amount of follicle-stimulating hormone (FSH) in your bloodstream.⁠

Studies show AMH is the best indicator of ovarian reserve. AMH levels (low, normal, high) directly correlate to the number of eggs remaining. FSH can also detect ovarian reserve, but it’s important to check E2 along with it because high E2 levels can suppress FSH. Meaning, if your FSH levels are suppressed by E2, this FSH measurement may not accurately represent your ovarian reserve. ⁠

Thyroid Stimulating Hormone: Average TSH levels in infertile women are reportedly higher than those in normal fertile women. And elevated serum TSH levels are associated with diminished ovarian reserve in infertile patients. ⁠

Endometriosis 

Endometriosis can be a debilitating disease Ie. painful periods, bleeding and pain during ovulation, uncomfortable intercourse, heavy bleeding and chronic pelvic pain.

Endometriosis can impact fertility in several different ways. Scar tissue and adhesions can block the fallopian tubes and uterus, making the uterus inhospitable to an embryo and damaging egg quality. 

What we call Endometriosis is probably several different diseases lumped together, not just “one” thing. We suspect it is caused by multiple factors but much more research is needed!! 

The most alarming part of this disease is that there is an average delay of four to 11 years from the onset of symptoms to diagnosis. 

Women who are unaware of their diagnosis (obvi) can’t get it treated!! 

During the time you go untreated, the symptoms can get worse and multiply, increasing pain and further negatively impacting your fertility. 

One reason for this delay is that endometriosis needs to be diagnosed through an invasive laparoscopy, a surgical procedure performed in the abdomen or pelvis. You have to CONVINCE your doctor that the pain is not just “normal” period cramps. 

The Trigger Shot 

Once the ovarian follicles have achieved an adequate size and stage of development, a trigger injection is given to induce final maturation of the eggs. The timing of this injection is very important to the outcomes of your in vitro fertilization (IVF) cycle and needs to be precise. An egg retrieval procedure is then scheduled for 36 hours following this injection.⁠

When the hCG trigger is administered too early or too late, or too low a dosage of hCG is administered the result can be an increase in the percentage of immature (M-I) or mature M-II (but aneuploid), eggs at retrieval. ⁠

Cervical mucus and fertility play a fundamental role in the TTC process by nourishing and protecting sperm as it makes the long, arduous journey through the female reproductive tract to meet the egg. So, as you become more familiar with your cervical mucus, you will be able to better time having sex in order to conceive.⁠

In simple terms, cervical mucus is a fluid secreted by the cervix, the production of which is stimulated by the hormone estrogen. Throughout your menstrual cycle, the amount and quality of cervical mucus that is produced will fluctuate, and by observing these changes you can begin to predict the most fertile days in your cycle.⁠ That being said, “should” be able to detect cervical mucus changes however, according to the Mayo Clinic, 23 out of 100 women practicing the cervical mucus method to prevent pregnancy in the first year of use, will actually get pregnant. What that says to me is that a lot of women have trouble detecting this exact physiological change- so if you don’t detect it, don’t worry! 

As you approach ovulation, estrogen levels begin to surge, which causes the cervix to secrete more cervical mucus that is of a so-called “fertile quality”. This fertile-quality cervical mucus, also known as egg white cervical mucus (EWCM), is clear and stretchy, similar to the consistency of egg whites, and is the perfect protective medium for sperm in terms of texture and pH.⁠

Having enough egg white cervical mucus during your fertile window will actually improve your chances of conceiving. And, by noticing when your body is producing egg white cervical mucus, you will be able to identify your most fertile days.⁠

Cervical mucus plays and Fertility an important role in selecting motile, mostly morphologically normal sperm for fertilization. Insufficient production of fertile-quality cervical mucus or the presence of hostile cervical mucus may result from a variety of factors including diet, stress, hormonal issues, or even from taking prescription medications like Clomid.⁠

The in vitro sperm–mucus penetration test (SMPT) is a sperm function test which measures the ability of sperm in the semen to swim up into a column of cervical mucus or substitute. 

Normally, this cervical mucus is thick and impenetrable to sperm until just before release of an egg (ovulation). Then, just before ovulation, the mucus becomes clear and elastic (because the level of the hormone estrogen increases). As a result, sperm can move through the mucus into the uterus to the fallopian tubes, where fertilization can take place.

Abnormal mucus may do the following:

-Not change at ovulation (usually because of an infection), making pregnancy unlikely

-Allow bacteria in the vagina, usually those that cause infection in the cervix (cervicitis), to enter the uterus, sometimes resulting in the destruction of sperm

-Contain antibodies to sperm, which kill sperm before they can reach the egg (a rare problem)

However, problems with cervical mucus rarely impair fertility significantly, except in women who have chronic cervicitis or a cervix that has been narrowed (called cervical stenosis) by treatment for a precancerous abnormality of the cervix (cervical dysplasia).

Frozen Embryo Transfers- Can the embryo fall out?

After the embryo “fall out” has been transferred and inserted between the uterine walls, it’s not possible for the embryo to fall out as it is deep within the uterus and therefore you can safely continue with your normal routine after having an embryo transfer.

The transfer itself is a fairly simple procedure with very little discomfort. A thin, soft catheter is threaded through the cervix under ultrasound guidance, to be very exact in the embryo placement location, generally 1 to 2 cm from the top of the uterine cavity. After cleansing the cervix with solution, the fertility doctor will place an empty transfer catheter through the cervix into position inside the uterine cavity. Then the embryologist will bring the catheter containing the embryo(s) from the lab a few feet away, so we can minimize the time that the embryos are exposed.

Once we have the embryo(s), we feed the catheter with the embryo(s) fall out through the empty catheter that is in place. On the ultrasound screen, the patient will be able to watch the bubble of air and fluid the embryo is contained in getting placed gently into the uterine cavity. After placement of the embryo(s), the embryologist checks the catheter under the microscope to make sure that the embryo(s) is transferred properly. Then the patient can get up and go straight to the bathroom if needed.

After that, the embryos “fall out” have to implant into the uterine lining on their own over the next few days, with the goal of developing into a successful pregnancy.

But Shouldn’t I Go on Bed Rest?

Several recent studies have confirmed that immediate bed rest after embryo transfer is completely unnecessary. It may seem counter-intuitive, but, in fact, a study published in a well-respected peer-review journal, Fertility, and Sterility (Fertil Steril 2013; 100: 729-35), demonstrated better pregnancy rates with the immediate resumption of normal activities (including the bathroom) compared to bed rest right after the embryo transfer.

What is a Pessary??

Pessaries. A very messy and unpleasant part of many IVF cycles. What is a progesterone pessary? It’s a sort of wax-coated hormone delivery device that can be inserted into the vagina and or anus. The wax coating melts with your body heat to release the hormone you need. ⁠

When the wax coating melts, some of it will inevitably drop out. Vaginal insertion will likely be easier, but messier. Anal insertion will likely be a bit more awkward but overall less messy. In both scenarios irritation can occur- either of the cervix or bowels, causing you to have to switch routes. ⁠

The Preggars Kitchen has a wonderful and lighthearted essay on this topic. “Pessaries are the enemy of pants!” ⁠

In Vitro Maturation (IVM) was developed as an alternative to traditional Oocyte Maturation for IVF due to the adverse outcomes of ovarian hyperstimulation syndrome and the costs

Associated with the administration of FSH. The treatment also has the potential to overcome other causes of infertility such as male factor, and poor response to stimulation, and also has profound benefits for women who have an estrogen-sensitive tumor or with a prothrombotic medical condition and are undergoing oocyte or embryo cryopreservation.

IVM consists of collecting immature (ie. Geminal Vesicle or GV) oocytes and applying FSH and HCG in the culture media. 

In vitro maturation of immature oocytes from an unstimulated cycle is an emerging technology. One of the safest ways to prevent OHSS is to not stimulate the ovaries. During an in vitro maturation of oocytes cycle, the immature eggs are retrieved from ovaries that are barely stimulated or completely unstimulated.  The eggs are maturated in defined culture media for 24 to 48 hours and fertilized through IVF or ICSI. IVM is an experimental technique that consists of the in vitro conversion of oocytes at the GV stage to oocytes at the metaphase II stage.

This technology must include nuclear and cytoplasmic maturation of the oocyte and give rise to embryos that have a developmental potential that is similar to embryos obtained from standard IVF or from spontaneously in vivo matured oocytes. A few IVM practitioners advocated for “rescue IVM” in IVF conventional settings to prevent severe OHSS. “Rescue IVM” is when the physician has come to the conclusion that a safe conventional IVF cycle cannot be done so they change the treatment direction to an IVM protocol to cycle instead. If the aspiration happens prior to the follicle selection, then OHSS risk can be eliminated. 


Though IVM shows promising results, it is not mainstream for fertility treatment. Mainly because there are difficulties retrieving eggs from immature ovaries that are not stimulated, and a lower chance of live births compared to conventional IVF, and there is an increased rate of abnormalities in meiotic spindles and chromosomes from immature eggs.

Are you a candidate for IVM?

According to ASRM In vitro maturation: a committee opinion, candidates for IVM include:

• Candidates for IVM may include women at risk for OHSS, including women with PCOS or PCO-like ovaries.
• Efficacy of IVM in the context of estrogen-sensitive cancers, or in women with limited time for initiating fertility preservation before undergoing potentially gonadotoxic cancer treatments, is still not clear.
• IVM provides an alternate treatment protocol for these groups of women, with reduced patient burden due to shorter stimulation cycles, fewer injections, and associated reduced drug and monitoring costs.
• IVM should be offered by those with expertise gained by specific training, and should always be accompanied by appropriate counseling about expected results and informed consent. This technology is no longer considered experimental.
• IVM is not applicable to every patient; only those with a high AFC are good candidates.
• Patients should be made aware that blastocyst conversion is lower and that implantation and pregnancy rates may be reduced compared with conventional IVF. 
• Large trials comparing clinical outcomes of promising newer methods of IVM versus standard IVF, as well as long-term follow-up studies of neonatal health and developmental outcomes of offspring, are necessary. 

Is IVM Useful to Reduce Early Pregnancy Loss in PCOS Patients?

Early pregnancy loss in patients with polycystic ovary syndrome after IVM versus standard ovarian stimulation for IVF/ICSI was investigated by Mackens et al., (Human Reproduction, 2020). They found:

• Pregnancy achieved following IVM seems to be at greater risk for early pregnancy loss (EPL) when compared with a pregnancy achieved following conventional ovarian stimulation (OS), but only when a fresh embryo transfer is performed.
• This observation leads us to suggest that IVM per se does not adversely influence embryo and fetal development in the first trimester and points towards inappropriate endometrial function in IVM cycles.
• Adopting a freeze-all strategy is currently the best approach for embryo transfer in the IVM program.
• A well-powered randomized controlled trial comparing the outcomes of a freeze-all approach after IVM versus standard OS in a well-defined phenotypic group of PCOS patients would be the next step to corroborate the current conclusion.