The International Council on Infertility Information Dissemination, Inc

Chat Bytes: Acupuncture and Herbal Medicine Treatments for Infertility.

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Mike Berkley, L.Ac., FABORM is the founder and director of The Berkley Center for Reproductive Wellness. Mike is licensed and acupuncture board-certified in New York State and also certified in Chinese herbology by the National Certification Commission for Acupuncture and Oriental Medicine.

Mike graduated from The Pacific College of Oriental Medicine in New York in 1996, and he has been treating reproductive disorders since then. Berkley is the first acupuncturist/herbalist in the United States to work exclusively in the field of reproductive medicine.

He enjoys working in conjunction with some of New York’s most prestigious reproductive endocrinologists while delivering attention and treatments meeting fertility patients’ needs. Call (646) 832-4480 to schedule an initial appointment today.




Mike’s Personal Story

"I developed an interest in acupuncture and herbal medicine due to a very personal and difficult reason - infertility. My wife and I decided that we wanted to start a family soon after we got married. We tried and tried for two years before seeking the help of a reproductive endocrinologist. My wife was diagnosed with a bacterial infection and an autoimmune marker. At our follow-up examinations, we were “cleared” of all obstacles to conception and told to go home and “try.” We tried for another six months without success.

At this point, my wife sought out the help of an acupuncturist/herbalist who had some basic knowledge of reproductive issues. After treating with acupuncture and herbal medicine for six months my wife got nothing more than a regulated period. We were disappointed, then, the very next month, the miracle manifested! She was pregnant and she carried to term without a hitch. We had a beautiful 7.5-pound little tiger who is now a young man, healthy, happy, and productive! I was amazed, humbled, and enormously excited and gratified by the result which was yielded by what seemed like some hocus-pocus newfangled type of medicine, but it really worked.

It was then that I started to explore acupuncture and herbal medicine on my own. I had a curiosity to learn more. I couldn't believe it when I found out that this type of medicine had existed for 3,000 years and there are hundreds of medical texts dating back centuries on the subject of reproductive disorders and how to treat them.

I responded to an ad in the Village Voice for an open house at Pacific College of Oriental Medicine’s New York campus and left almost six years later with a degree in acupuncture and a National Board Certification in herbal medicine.

With license in hand, I devoted every free moment to studying Western medical and Chinese medical approaches to treating infertility. After years of study and clinical experience, I have been fortunate in that I have been able to develop my own unique acupuncture protocols and proprietary herbal formulas."

How to Become a Fertility Nurse

A close up of the face of a masked fertility nurse

How to Become a Fertility Nurse

Fertility nurses play a very important role when it comes to reproductive health. These nurses, also referred to as reproductive nurses, are there to provide help and support to women dealing with fertility issues. They might be asked to work with couples who have difficulty conceiving, menopausal women, and women going through infertility.

This is a great career choice and a good option for those who want to help women and couples deal with reproductive issues. Let's take a look at what you should do to become a fertility nurse. We'll also touch on what the job entails and some of the outlooks for the position.

What do Fertility Nurses Do Exactly?

Fertility nurses have a lot of responsibilities. One of your primary jobs will be to educate patients on different fertility treatments including the benefits and disadvantages of different options. Fertility nurses are also there to give patients and the ones close to them support and counseling. All of this will need to be done in a non-judgmental way. Also, these nurses might teach patients how to administer fertility treatments.

The responsibilities go way beyond working with patients. Fertility nurses have to be up-to-date on all the latest procedures in the field. They may also assist in cloning or stem cell research as well as facilitate the egg donation process. They will often act as bridges between the donor and the receiving parent.

On a typical day, nurses will have to interact with patients a lot. This makes it a great job if you love the public and want to help. This is also a great option for those who want a fulfilling nursing job and directly see the effects of their work. Parents often form a very special bond with their reproductive nurse and some have relationships that last a lifetime.

You will spend a lot of your day speaking with patients and conducting interviews. You might also be teaching medication administration, making follow-up appointments, and speaking about different treatment options with families. Besides, you might be asked to perform blood tests and scans, help with embryo transfers, and perform physical examinations, among other things.

How Can I Become One?

If you want to become a fertility nurse, you will first need to at least have an associate’s degree in nursing or a bachelor’s degree. The good news is that anyone can get their bachelor’s through accelerated BSN online programs even if they are not coming from a nursing background. Schools like Elmhurst have accredited accelerated BSN online programs that allow students coming from other fields to get their bachelor’s in as little as 16 months.

Once you have your degree, you will need to pass your National Licensure Exam (NCLEX-RN) so you can become a registered nurse. Only once you've gotten your RN license can you enter reproductive nursing. Know that you can also get additional certification through the National Certification Corporation. While it's not mandatory, it could increase your prospects and your salary. The exam is taken by computer and consists of multiple-choice questions related to reproductive health and nursing.

What are the Skills Needed to be a Good Fertility Nurse?

First of all, you need to have a real desire to learn and teach about reproductive health. Your true goal should be to help patients first and foremost. Reproductive nurses have to be patient and be great at simplifying complex concepts. Patience will be important as some patients may grow desperate and impatient themselves or disagree with what you have to say. Also, you will have to be compassionate. Couples who are going through infertility require support and you will need to learn how to support them while still being realistic. You have to be there to hear their concerns and help them throughout the process.

Reproductive nurses also have to be open to continuing education. This is one of the most dynamic fields in healthcare and changes to procedures and sometimes philosophies can be introduced overnight. So, know that you will need to dedicate your whole life to the field.

Another skill you will need to have as a fertility nurse is investigative skills. It is during interviews that you will get to know a lot about someone’s reproductive health. You might be able to get more information out of them if you know how to ask the right questions. Just doing this will make you much better at your job and will help you find better solutions for patients.

Last, but not least, fertility nurses need to be physically fit. Working in this position means that you'll be spending a lot of time on your feet looking after patients and you’ll need to have a basic level of fitness to be able to get through the day.

What Are the Prospects for Fertility Nurses?

The Bureau of Labor Statistics groups fertility nurses with registered nurses and the prospects for those is really good. Jobs for registered nurses are expected to grow by 7% leading into 2029, which is higher than the average for all professions. They can earn anywhere from $60,000 to $80,000 or more per year depending on their expertise and level of certification.

Another great thing about working as a fertility nurse is the specialization opportunities. This is a great way to transition into fields such as family nursing or become a NICU nurse. Some decide to become OB/GYNs or move into research. Fertility nurses are at the forefront of innovation in the field. They know practically better than anyone else what is going on the ground and the effects of different methods and treatments, which makes them a great fit for research. All of these positions are in very high demand and are some of the best paying in the nursing field.

Working as a fertility nurse is your chance to make a real difference in the life of someone else. It's a great career option with promising prospects, so, if you think you’re cut out for it, we suggest you look into it in more detail.

Mental Health and Starting a Family: A Guide

Happy couple looking at a pregnancy test

Mental Health and Starting a Family: A Guide

Starting a family is a life-changing experience which many people aspire to at some point in their life. Having a child truly is a miraculous experience which has the power to change everything, both regarding your life and regarding you as a person.

As with any life-changing event, your mental health may be impacted by the change, as well as being severely compromised if you have trouble starting a family or if you run into problems conceiving the way you had hoped. You may then feel as though you need further tailored support, such as from someone with a masters in mental health counseling.

Perhaps you have always thought that you would like to start a family and are wondering whether now the right time for you is. When making this decision, you may want to ask yourself the following questions:

  • Are you financially able to support a growing family?
  • Is your home equipped for a new baby, such as having the right amount of space and room?
  • How will your career be affected by having a baby? Are you ready to take a career break, or have your job take a back seat for a while?
  • Are you with the right person, or are you mentally ready to raise a child alone if you are considering family options as a single person?

This guide discusses the issues you may face where mental health is concerned, and important steps to consider when starting a family.

Mental Health and Trying for a Baby

Deciding to try for a baby and start a family is a significant step. No matter whether you've always planned for it or whether you've recently decided, it would be natural to feel overwhelmed by such a momentous decision. It's possible that your mental health can therefore be compromised if you feel the pressures, as well as the desperate desire, to start a family.

Although starting a family and trying for a baby is a wonderful thing, it can take a lot of planning, crucial steps and lifestyle changes. It may also take a very long time to conceive. This can easily affect your mindset and mental health if the routine becomes too draining or if you develop anxiety over not being able to conceive as quickly as you would have hoped.

It's important to be as positive and healthy as you can be while trying for a baby. Undue stress on the mind and body may only make it more difficult to naturally conceive or make it difficult to enjoy the process. To make everything easier, consider:

  • Seeking advice regarding how to improve your chances of conceiving
  • Try to avoid treating intimacy as a strict routine and instead try to conceive when you naturally feel ready to try
  • Speak to others about how you're feeling, including your partner if the situation is becoming overwhelming

Trouble with Conceiving: Which Steps to Take

It may be that, after trying to conceive for a significant period, it simply isn't working. This, naturally, can have a detrimental effect on your mental health, as not only are you not achieving the beginning of your new family, but you may also begin to worry why it is not working for you and whether there is any cause for concern health-wise for you and your partner.

In the first instance, it is crucial to speak to a medical professional regarding your trouble conceiving so that you can discuss the possibilities. Tests may need to be carried out, and your next options may need to be explored. This can be a difficult and worrying time which can take a toll on your mental health. Still, it's important to understand that difficulty conceiving in the first instance doesn't mean that you will never be able to start the family that you've been dreaming of. Alongside health and physical attention, you should also seek mental health support if necessary, from those with a masters in mental health counseling.

If you cannot conceive naturally, there are other steps you can take, such as:

  • Adoption
  • IVF treatment
  • Treatment options for infertility
  • Sperm or egg donation
  • Surrogacy

When considering which option may be right for you, be sure to do as much research as possible and gain the relevant medical advice. Taking one of these options, even if it means you can achieve the family you had hoped, can still be overwhelming and upsetting, therefore affecting your mental health.

Support is crucial during this key decision-making, so be sure to check your options from those with a masters in mental health counseling.

Mental Health and Helping Others

If you are a parent who has experienced mental health issues relating to starting a family, or perhaps an individual who has suffered from their mental health following infertility issues and not being able to start a family, maybe you're eager to help others struggling through the same — whether those with general mental health issues or specifically parents who are suffering through mental health concerning conception or raising a child.

There are various avenues to explore if you would like to help others, including seeking a career in counseling and a masters in mental health counseling so that you can support others going through the same journey or any related issues with mental health.

Wanting to start a family and either wanting to be a parent or becoming a parent, naturally means you're a compassionate and caring person who wants to help and care for others (your own child or family), so these are virtues which can be applied to counseling and helping others, too.

Mental Health and Adoption

Adoption can introduce a variety of mental health issues, both for you as a parent, and for an adopted child. For a parent choosing to adopt, it can be a difficult path if you always wanted to conceive naturally. It is a big step in deciding to seek an alternative to raising a family and helping a child who needs to have a home and a family.

Furthermore, it's important to be in a healthy and good mental state when preparing yourself to adopt a child. If your mental health has become compromised due to difficult circumstances around trying to conceive (such as being told that you're infertile), it may be a good idea to take a break and concentrate on your own recovery before adopting. That way, you can be in the healthiest condition to care for a new child. It's, therefore, imperative to seek out support options, such as sessions from a licensed individual with a masters in mental health counseling.

Regarding an adopted child, if they are at an older age when they are adopted, or if you choose to tell your child the truth about their adoption when they reach a certain age, this knowledge can affect their mental health. They may struggle emotionally trying to understand about their birth parents, or why they had to be put up for adoption. Or perhaps the truth may simply be something they struggle with mentally. It may even be the case that an adopted child suffered through difficult circumstance or even trauma, leading to the need for them to be adopted, and this could result in issues later in life.

Your child always has the option of receiving counseling at any age from someone with a masters in mental health counseling.

Mental Health and IVF Treatment

If you've chosen the IVF route, then firstly, it can be expensive, depending on how many attempts of the treatment you need. Therefore, you may experience stress and anxiety relating to your finances when trying to get pregnant through IVF. It's essential to manage your finances properly and plan for the cost of IVF treatment in advance, to have a better understanding and avoid any unwarranted stress.

Furthermore, IVF treatment is never guaranteed to work successfully. This can be extremely traumatic for those parents who had hoped the treatment would work for them. There are other options you can consider as an alternative if IVF treatment is not a success for you, or you can try again with the same treatment. Alongside this, support your mental health during this journey by seeking out services from someone with a masters in mental health counseling.

Mental Health and Your Growing Family

Mental health issues can arise at any time, at any age, in anyone. This means both for you as a parent, and for your growing child. You can never plan for how your child is going to behave, whether in their childhood years or as they develop. You can easily run into difficulty and negativity as a parent if you are worried about your child's behavior or if they are difficult.

Additionally, your child may develop mental health issues of their own as they age. It's important as a parent to know what to look out for in others regarding signs and symptoms of mental health issues such as depression.

In growing children, this could include:

  • Persistent low mood
  • Withdrawing from social situations
  • Disruptive or out-of-control behaviour
  • Speaking of negative or troublesome thoughts
  • Issues with behaviour and mood in other situations, such as school or out in public

There is always support available for parents struggling with their own mental health issues, such as from those with a masters in mental health counseling, or for parents with children who have mental health problems.

Mental Health and Suffering with a Miscarriage

While it is possible to heal and gain support from loved ones and professionals who can help through the process of miscarriage recovery, your own mental health and how you choose to handle the situation is what is most important. Nobody can tell a parent how to act when they have lost a child, and it's important for you to never keep it inside about what you are experiencing.

You may want to speak to other parents who have suffered through the same experience so that you can gain a better understanding and the support you need. Naturally, those who have never experienced the loss of a child will not be able to understand or support you fully — even if those people love you and care about your grief — so it can be very helpful to speak to other parents who know directly how it feels.

Physical, mental and emotional health can be severely impacted following the loss of a child, perhaps even for the rest of your life. The emotional distress and grief experienced by those who suffer from a miscarriage will undoubtedly mean that their mental health is compromised, and they may benefit from the services of a professional with a masters in mental health counseling.

It's important to understand that suffering a miscarriage does not mean that you can never try again for a family or that you will never be able to have a child. Still, it's also important to allow yourself enough time to understand, grieve and heal.

Understanding Postnatal Depression

You can never plan for postnatal depression, and you may think that it would never happen to you, but the truth is, it can arise in any parent following giving birth to their child. What's important to remember if suffering through postnatal depression that is — just with any mental health illness — it is not your fault, and it does not mean that you are any less of a loving parent. After all, having a baby is completely life-changing, which means it can trigger new and overwhelming responses in your mind and body when raising a new child.

The signs of postnatal depression include:

  • Feeling anxious and tearful. While this is natural after giving birth, if these symptoms persist for a long period, such as a month or longer after giving birth, it could be a sign of a large problem
  • Lack of energy and feeling tired
  • Loss of interest in anything
  • Withdrawing from other people, or different situations
  • Worrying thoughts involving your baby, including negative thoughts towards them

Strategies to cope with postnatal depression include:

  • Seeking professional help and support, such as from those with a masters in mental health counseling
  • Being prescribed medication, such as anti-depressants
  • Speaking with loved ones
  • Trying to keep up with a healthy routine, such as exercise and your diet choices
  • Trying to partake in activities which will help you to feel more positive, such as pastimes you've always enjoyed
  • All of the above

Take Away

While the experience of trying for, and raising, a family is rewarding and positive, it's undoubtedly one where many problems can be faced. These problems don't mean that raising a family isn't everything you'd hoped for or that it can't be a success, it simply means that better care and planning may be needed for problems which can arise.

Most importantly, it is your own emotional and mental wellbeing as a parent — as well as that of your child — which needs to be taken into consideration during this important time, and you can always seek support from those with masters in mental health counseling.

Clomid Use and Abuse

Photo of the medication clomid

Some women can't get pregnant because they don't secrete enough LH and FSH at the right time during the cycle and, as a result, they don't ovulate. For these women, the first drug doctors often prescribe is clomiphene citrate (Clomid, Serophene). This synthetic drug stimulates the hypothalamus to release more GnRH, which then prompts the pituitary to release more LH and FSH, and thus increases the stimulation of the ovary to begin to produce a mature egg.

Clomiphene is a good first choice drug when a woman's ovaries are capable of functioning normally and when her hypothalamus and pituitary are also capable of producing their hormones. In short, the woman's reproductive engine is in working order but needs some revving up.

Structurally like estrogen, clomiphene binds to the sites in the brain where estrogen normally attaches, called estrogen receptors. Once these receptor sites are filled up with clomiphene, they can't bind with natural estrogen circulating in the blood and they are fooled into thinking that the amount of estrogen in the blood is too low. In response, the hypothalamus releases more GnRH, causing the pituitary to pump out more FSH, which then causes a follicle to grow to produce more estrogen and start maturing an egg to prepare for ovulation. Typically, a woman taking clomiphene produces double or triple the amount of estrogen in that cycle compared to pretreatment cycles

If a woman is menstruating, even if irregularly, clomiphene is usually effective, particularly if she develops follicles that aren't reaching normal size. Usually, a mature follicle is about 20 millimeters in diameter, or about the size of a small grape, just before it ruptures and releases its egg. Clomiphene may help small, immature follicles grow to maturity.

A low estradiol level in a woman's blood correlates with an inadequately stimulated, small follicle. A woman having a spontaneous ovulation cycle (that is, ovulating without the aid of fertility drugs) generally has peak estradiol levels ranging from 100 to 300 picograms (one trillionth of a gram)/ml. A woman may have enough hormones to produce an egg, but if her estradiol production by the follicles is low (less than 100 pg/ml), she may not adequately stimulate her cervix to produce fertile mucus or stimulate her endometrium to get ready to accept a fertilized egg for implantation. Clomiphene could boost the weak signals from the hypothalamus to the pituitary to the ovaries.

"A woman who ovulates infrequently, say at six-week intervals or less often, is also a good candidate for clomiphene therapy, since clomiphene will induce ovulation more frequently. The more a woman ovulates, the more opportunities her mature eggs have to be exposed to her husband's sperm and, therefore, the greater her chance to become pregnant.

Clomiphene is also often effective for a woman with a luteal phase defect (LPD). A woman with LPD may begin the ovulation process properly, but her ovarian function becomes disrupted, resulting in low production of the hormone progesterone in the luteal phase of the menstrual cycle. Following ovulation, the ovary produces progesterone, the hormone needed to prepare the uterine lining for implantation of the fertilized egg, which has divided and entered the uterine cavity. A fall in progesterone levels in the blood during this critical time can interfere with early embryo implantation or, even if a fertilized egg has already implanted, cause a woman to menstruate too early and end a pregnancy within a few days after implantation.

Using an LH-urine detector kit or keeping a basal body temperature (BBT) chart can help a woman taking clomiphene determine whether the luteal phase of her cycle is shorter than the normal fourteen days. The luteal phase of the cycle, the length of time from ovulation until she menstruates, has a normal range of thirteen to fifteen days. Clomiphene can often "tune up" the hypothalamus and pituitary so they keep producing the hormones the ovary needs to manufacture progesterone throughout the luteal phase.

"Of women whose only fertility problem is irregular or no ovulation at all, about 80 percent will ovulate and about 50 percent will become pregnant within six months of clomiphene treatments. About three percent of women on clomiphene have multiple pregnancies, usually twins, compared with about one percent in the general population.

If a woman responds to clomiphene and develops a mature follicle (determined by adequate estrogen production and ultrasound examination), but has no LH surge by cycle day 15, then injection of the hormone human chorionic gonadotropin (HCG), which acts like LH, can be given to stimulate final egg maturation and follicle rupture, releasing the egg. The woman tends to ovulate about 36 hours after the LH surge or HCG injection, which can be confirmed by further ultrasound scans.

"Clomiphene is a relatively inexpensive drug, and is taken orally for only five days each month. The doctor attempts to initiate clomiphene therapy so that the woman ovulates on or around day 14 of a regular 28-day cycle. The simplest, most widely used dose starts with one daily 50 mg. tablet for five days starting on cycle day three or five. If a woman ovulates at this dose, there is no advantage to her increasing the dosage. In other words, more of the drug isn't necessarily better. In fact, more may be worse, producing multiple ovulation, causing side effects such as an ovarian cyst or hot flashes, and most commonly, interfering with her fertile mucus production.

If a woman doesn't ovulate after taking one clomiphene tablet for five days, then her doctor will usually double the daily dose to two tablets (100 mg) in her next cycle, and if she still doesn't respond, then triple the daily dose to 150 mg, or add another fertility medication such as human menopausal gonadotropin (Pergonal) in the next cycle. Some doctors increase the dose up to 250 mg. a day, but this is NOT recommended by either of the drug's two manufacturers. Women tend to have side effects much more frequently at higher doses.

If the dose of clomiphene is too high, the uterine lining may not respond completely to estrogen and progesterone stimulation, and may not develop properly. As a result, a woman's fertilized egg may not be able to implant in her uterus.

Side Effects

Because Clomiphene binds to estrogen receptors, including the estrogen receptors in the cervix, it can interfere with the ability of the cervical mucus glands to be stimulated by estrogen to produce fertile mucus. Only "hostile" or dry cervical mucus may develop in the days preceding ovulation. If this occurs, adding a small amount of estrogen beginning on cycle day 10 and continuing until the LH surge may enhance cervical mucus production.

Some women taking clomiphene experience hot flashes and premenstrual-type symptoms, such as migraines and breast discomfort (particularly if they have fibrocystic disease of the breasts). Visual symptoms such as spots, flashes or blurry vision are less common and indicate that treatment should stop.

Clomiphene is a very safe medication with relatively few contraindications. Preexisting liver disease is one contraindication since clomiphene is metabolized by the liver. Enlarged ovaries are also a contraindication since clomiphene may occasionally produce hyperstimulation of the ovaries.

The hot flashes are just like the hot flashes women experience at menopause when the level of estrogen circulating in the blood is low. The clomiphene fools the brain into thinking that blood estrogen levels are low.

Clomiphene Abuse

Too often, doctors give clomiphene to women with unexplained infertility before the couple has a fertility workup, or even after they have a workup, but there is no evidence of an ovulation disorder. This empiric therapy may create new problems, such as interfering with fertile mucus production and often delays further evaluation that can lead to a specific diagnosis and proper treatment.

For a woman who has normal, spontaneous ovulation, driving the pituitary harder with clomiphene won't make ovulation any more normal. If a woman has taken clomiphene for several cycles without becoming pregnant, then she and her fertility specialist should investigate other conditions that may be preventing her pregnancy.

After noting a good postcoital test (PCT) during a fertility workup, some doctors fail to repeat the test after placing a woman on clomiphene. A PCT needs to be repeated to check the quality of the woman's cervical mucus while she is on clomiphene, since 25 percent or more of women who take the drug develop cervical mucus problems. It's important for a woman to monitor her cervical mucus production during every cycle while trying to become pregnant, including her cycles while taking clomiphene.


The Male Reproductive System: Sperm Analysis

Sperm Analysis

Take this mini course on the Male Reproductive System and test your anatomy knowledge at the same time.

Laura E. A. Cook, M.D., Jan A. Enabore, and
William E. Roudebush, Ph.D, HCLD

Department of Biomedical Sciences
University of South Carolina School of Medicine Greenville
Greenville, SC, USA

The male reproductive system structures give men the ability to reproduce by fertilizing a woman’s egg. There are a number of organs that make up the male reproductive system.
Although infertility is commonly felt to be a female condition, a male factor often plays a significant role. Certain risk factors place a male at higher risk of having infertility including any abnormalities or issues with the testicles themselves, prior treatment for cancer, hormonal disorders, prior scrotal surgery, or even infections such a sexually transmitted disease.


The Infertility Evaluation: Basic Testing with a Reproductive Endocrinologist By INCIID Advisors

Basic Infertility Evaluation - Fertility Tests

This article is a basic overview or review of an infertility evaluation for those individuals and couples struggling with infertility and trying to conceive or carry a pregnancy to term and delivery.

The American Society of Reproductive Medicine (ASRM) revised the definition of infertility to encourage earlier evaluation and treatment in the highest risk group. Infertility has traditionally
been defined as the inability to conceive after twelve months of regular, unprotected intercourse

INCIID suggests seeking evaluation early with a reproductive endocrinologist (RE). Seeking help from a specialist (RE) is
particularly important if you are 30 or over and/or have experienced
more than one spontaneous abortion (miscarriage).

The following experiences suggest seeking specialized help from a reproductive endocrinologist.

·       Regular unprotected intercourse with no pregnancy for a year

·       Trying 6 months when 30 years of age or older

·       Irregular menstrual cycles

·       A history of pelvic pain or other problems such as infection or abdominal or reproductive surgery

·       DES Exposure

·       Two or more miscarriages (under 30) and one if 30 or older

·       Male reproductive problems that may alert you to a problem may include:

  • Reproductive surgery
  • Low sperm count and./or problems with morphology etc.
  • prostatitis
  • Urinary infections

Reproductive Endocrinology and Infertility (REI): Why seeing an RE is important.


The reproductive endocrinology specialist is usually an Obstetrician-Gynecologist with advanced education, research and professional skills in the field of Reproductive Endocrinology and Infertility (REI). Reproductive endocrinology is a surgical subspecialty of obstetrics and gynecology that trains physicians in reproductive medicine addressing hormonal functioning as it pertains to reproduction as well as the issue of infertility and multiple pregnancy loss.

Generally, OB/GYN enter into a 3-year fellowship or training program leading to board certification in Reproductive Endocrinology and Infertility by the American Board of Obstetrics and Gynecology. These fellowships provide clinical training in reproductive endocrinology, reproductive surgery, assisted reproductive technology (i.e. IVF and other ART procedures), genetics, embryology, and andrology. The programs are rigorous with comprehensive requirements. The physicians in the program are also required to pass a written examination and an oral exam by a team of REI experts. Once passed the physicians are sub-specialty board certified.

INCIID is often asked, “who is the best”. The most important first decision is seeing a specialist. Seeing an RE is the consummate “gold standard”. OB/GYNs will have some basic knowledge about infertility but that information and practice are minimal. The research required during an REI fellowship will support improved clinical outcomes and fewer clinical errors. This sub-specialty also requires updating physician knowledge to continue to provide evidence-based practice.

When looking for a board-certified reproductive endocrinologist check the Society of Reproductive Endocrinology and Infertility (SREI)website. The SREI required board certification in Obstetrics and Gynecology as well as the RE subspecialty. INCIID also offers a biographical overview including the specialty of physician members who support INCIID’s mission. Search the directory by zip code or state.

Patients should not be shy about asking their fertility doctor if they are “Sub-specialty” board certified as a reproductive endocrinologist.

Many patients are reluctant to switch from their OB/GYN. Some sight the expense. But the business of Obstetrics and Gynecology concentrates on routine gynecological care and delivering babies for their bread and butter. While evaluation of a fertility problem can be expensive, to stay with an OB/GYN can waste valuable time and actually become more expensive.

INCIID stresses the importance of seeking early care with qualified practitioners and outlines the criteria for moving to a specialist.

Having a family is an individual or couples’ decision. Whatever your situation, partners are in this together.

Basic Infertility Evaluation

Please note that every reproductive endocrinologist (RE) has his or her own standard protocol, and the following is intended to be a helpful basic guideline. Patients should be in a partnership with their physician and feel comfortable asking questions about any test or procedure. 

FIRST APPOINTMENT: History and Physical Exam

At the first appointment, most REs also do a routine screening of both partners such as HIV, hepatitis, etc. Medical histories for both partners will be taken. Try to keep track of the length of your menstrual cycles for several months beforehand. Charting Basal Body Temps (BBTs) for several months will also give your doctor some insights---as will using home Ovulation Predictor Tests (OPTs) and recording the results. A semen analysis will be scheduled. Some doctors will accept your medical records for review prior to your appointment. If not, bring your medical records with you.

The doctor will generally start with some type of comprehensive questionnaire providing an overview of reproductive history for both partners. He or she may also ask questions about the reproductive history. Some of those questions may include information about:

  • Previous pregnancies (if any)
  • Irregular periods or menstrual cycles
  • Pre-existing conditions or diagnosis such as polycystic ovary syndrome, pelvic inflammatory disease, tubal pregnancy, endometriosis
  • Problems with ovulation,
  • Male infertility issues, sperm count, motility, urinary or prostate issues

The physician may do a vaginal ultrasound. Consider scheduling the first consultation with the RE during the first or second day of the menstrual cycle. Why? Because during the exam, the doctor may be able to do several tests that are cycle-day specific. Instead of re-scheduling for another date, patients may be able to arrange for time-sensitive tests and move forward with evaluations and a plan more quickly.

Assessment of Ovarian Reserves

Human Ovary Antral Follicle Count (Guided Vaginal Ultrasound)

One test and a good predictor of ovarian reserve is the antral follicle count. The count is done of cycle days 2, 3, or 5 using guided vaginal ultrasound. Antral follicles are immature eggs. The number of immature follicles correlates with ovarian reserves.  that looks at the ovaries. Keep in mind that antral follicles vary from month to month.

A vaginal ultrasound can also discover abnormalities within the Pelvis. Infections in the pelvic region often go unnoticed but are a significant cause of infertility (i.e. blocked tubes, uterine scarring, tubal damage, endometriosis, fibroids, adhesions, etc.) 

 If the antral count is too low (generally less than 4 according to Dr. Richard Sherbahn) chances of a successful pregnancy and live birth are low, the higher antral counts can be indicative of PCOS (Poly Cystic Ovarian Syndrome)

Anti-Mullerian Hormone Testing of Ovarian Reserve (AMH) (Blood Test)

The human egg is "housed" inside a structure called the follicle. The follicle is comprised of specialized cells called granulosa cells. The granulosa cells produce a specific hormone directly and predictably linked to egg quality, and that hormone is called AMH. While other means of examining ovarian reserve may offer indirect, and possibly less accurate, less specific, and less predictive tests of egg quality (such as cycle day 3 FSH/estradiol levels and the Clomiphene Citrate Challenge Test), many reproductive endocrinologists believe women are better served by examining their AMH level -- a more direct, more accurate, more specific, and more predictive test of egg quality.

The AMH test has been found particularly useful in the following clinical situations:


Women who either need a Clomiphene Citrate Challenge Test (CCCT) or previously had a CCCT and want to confirm/refute the results;

·      Women of advanced reproductive age (35 years or older);

·      Any women with a diagnosis of "unexplained infertility";

·      Women who have shown a poor response to ovulation induction with either Clomid/Serophene or injectable fertility drugs;

·      Women who have been told they need IVF with donor eggs -- a normal AMH level may permit them to do IVF with their own eggs, while an abnormal AMH level may confirm the need for IVF with donor eggs

For more information on AMH testing, see the article by Scott Roseff, MD

Day 3 Follicle Stimulating Hormone (FSH) and Estradiol (E2) Testing (Blood Testing)

On the third day of the menstrual cycle, the clinic may draw blood and test the FSH levels. This test is not as reliable as other but can give an indication if a woman is closer to menopause (with low ovarian reserves). FSH is a hormone secreted by the anterior lobe of the pituitary and stimulates the maturing of the ovarian follicles in women. In men, the hormone is important in maintaining spermatogenesis.

Unfortunately, a high FSH is always bad but a good level may not mean there are egg reserves either.

Adding to the confusion is the fact that FSH bounces around quite a bit. One month the result may be a 7 and the next month it may be a 13. For a while, it was thought that waiting for a month to cycle may yield a better level and improve the odds that a given cycle would work. Unfortunately, the intermittent high FSH is as bad a prognostic sign in months where the FSH is normal as in months where the level is high.

For more information on FSH testing read the David Sable, MD article.

Other Blood Work May Be Ordered

Depending on the individual or couple’s needs, there may be other blood tests ordered. Blood tests that might be needed include:

Luteinizing hormone (LH): A pituitary hormone that stimulates the gonads. In the male LH is necessary for spermatogenesis (Sertoli cell function) and for the production of testosterone (Leydig cell function). In the woman LH is necessary for the production of estrogen. When estrogen reaches a critical peak, the pituitary releases a surge of LH (the LH spike), which releases the egg from the follicle.

LH controls the length and sequence of the female menstrual cycle, including ovulation, preparation of the uterus for implantation of a fertilized egg, and ovarian production of both estrogen and progesterone. Theca cells in the ovary respond to LH stimulation by secretion of testosterone, which is converted into estrogen by adjacent granulosa cells. In women, ovulation of mature follicles on the ovary is induced by a large burst of LH secretion - the preovulatory LH surge. Residual cells within ovulated follicles proliferate to form corpora lutea, which secrete the steroid hormones - progesterone and estradiol. Progesterone is necessary for the maintenance of pregnancy, and, in most mammals, LH is required for continued development and function of corpora lutea. For more information read this article.

Dr. Geoffrey Sher, “It is certainly time for us to reflect seriously on what and why e use specific protocols and drugs in IVF.” Dr. Sher thinks the focus might be better by optimizing ovogenesis rather than simply on how to increase the total egg yield.” He goes on to say he favors the use of FSHr-dominant, long pituitary down-regulation protocols that reduce LH. Dr. Sher is experienced in treating older women. Read more about LH regulation here.
Estradiol (E2), 

Prolactin is a hormone produced by the pituitary gland. The pituitary gland sits below the hypothalamus at the base of the brain.

Prolactin causes breasts to grow and develop. It also causes milk production in the breasts of a lactating or pregnant woman. Prolactin can be found in both males and females. A blood test will determine the prolactin levels and your doctor will have a normal or out of range level and recommend the best course of action.

During pregnancy prolactin levels increase. After the birth of a baby, a woman’s estrogen and progesterone levels drop and prolactin levels rise. These high levels of prolactin cause milk to “come in” or milk production to begin so a baby can be breastfed. In women who are not pregnant, prolactin is one of the hormones that regulate menstrual cycles.  In males, high levels of prolactin may be related to sperm production and sexual dysfunction. For more information on prolactin, read this article by Carolyn Coulam, MD.

Testosterone (T): The male hormone responsible for the formation of secondary sex characteristics and for supporting the sex drive. Testosterone is also necessary for spermatogenesis.

Progesterone (P4): The hormone produced by the corpus luteum during the second half of a woman's cycle. It thickens the lining of the uterus to prepare it to accept implantation of a fertilized egg. It is released in pulses, so the amount in the bloodstream is not constant.

17-hydroxyprogesterone (17-OHP) An over-secretion of androgen can cause elevated 17-OHP levels which can, in turn, interfere with ovulation. This is called congenital adrenal hyperplasia. Once this condition is found it can be corrected with medication to help patients ovulate normally.

Thyroid Releasing Hormone (TRH) and low levels of Thyroxine(T4) can also result in an excess of prolactin (normally produced by the pituitary gland to promote lactation) and TSH both of which can have a negative effect on fertility by preventing ovulation or result in irregular or absent periods.

Thyroid Stimulating Hormone (TSH): Women are far more likely and more often (than men) experience thyroid disease during their reproductive years. The most common test done to assess thyroid function is TSH (Thyroid Stimulating Hormone). TSH is produced by our pituitary gland. TSH stimulates the thyroid to produce the hormones T4 (thyroxine) that can interfere with ovulation. 

Different clinics and laboratories standardize testing in different ways. Below is an overview generally of the ranges for the different levels.

Luteinizing Hormone (LH)

·       Follicular Phase (day two or three): <7mIU/ml

·       Day of LH Surge: >15mIU/ml

Follicle Stimulating Hormone (FSH)

·       Follicular Phase: <13mIU/ml

·       Day of LH Surge: >15 mIU/ml


·       Day of LH Surge: >100 pg/ml

·       Mid Luteal Phase (seven days after O): >60 pg/ml


·       Day of LH Surge: <1.5 ng/ml

·       Mid Luteal Phase >15 ng/ml

Prolactin:<25 ng/ml 
Free T3: 1.4 to 4.4 pg/ml 
Free Thyroxine (T4): 0.8 to 2.0 ng/dl 
Total Testosterone: 6.0 to 89 ng/dl 
Free Testosterone: 0.7 to 3.6 pg/ml 
DHEAS: 35 to 430 ug/dl 
Androstenedione: 0.7 to 3.1 ng/ml

KEY: < = less than;
        >= greater than; mIU=milli International Units;




uIU=micro International Units;

dl=deciliter; ug=micrograms

Additional Testing

After the initial workup, many doctors continue with some of the following tests.


This test is used to examine a woman's uterus and fallopian tubes. It is essentially an x-ray procedure in which a radio-opaque dye is injected through the cervix into the uterus and fallopian tubes. This "dye" appears white on the x-ray, and allows the radiologist and your doctor to see if there are any abnormalities, such as an unusually shaped uterus, tumors, scar tissue or blockages in the fallopian tubes. If you are trying to get pregnant in the same cycle as an HSG, make sure to schedule the test PRIOR to ovulation so that there is no danger of "flushing out" a released egg or developing embryo. Although most women report only minor cramping and short-term discomfort during this procedure, some women, especially those who DO have blockages, report intense pain. Speak to your doctor about taking a pain medication about 30 minutes prior to the actual procedure.

Transabdominal Saline Contrast Sonohysterography

Although HSG is the standard screening test for the diagnosis of tubal infertility, there are studies that confirm a higher sensitivity, safety and acceptability of Transabdominal Saline Contrast Sonohysterography (compared to HSG) for the evaluation of tubal patency in infertile women.

This technique uses sound waves to produce pictures of the inside of a woman’s uterus and help diagnose unexplained vaginal bleeding. Hysterosonography is performed very much like a gynecologic exam and involves the insertion of the transducer into the vagina after you empty your bladder.

Using a small tube inserted into the vagina, your doctor will inject a small amount of sterile saline into the cavity of the uterus and study the lining of the uterus using the ultrasound transducer. This can also be injected into the fallopian tubes for evaluation of patency. Ultrasound does not use ionizing radiation, has no known harmful effects, and provides a clear picture of soft tissues that don’t show up well on x-ray images.

This technology is readily available, easy to interpret. It is not only safer and cheaper but it’s as accurate as HSG in evaluating the fallopian tubes and the uterine cavity in infertile patients. Some physicians advocate its use as a replacement. (Read more here.)


(Transabdominal Saline Contrast Sonohysterography can be also used in place of Hysteroscopy)

If a uterine abnormality is suspected after the HSG, your doctor may opt for this procedure, performed with a thin telescope mounted with a fiber optic light, called a hysteroscope. The hysteroscope is inserted through the cervix into the uterus and enables the doctor to see any uterine abnormalities or growths. "Photos" are taken for future reference. This procedure usually is performed in the early half of a woman's cycle so that the build-up of the endometrium does not obscure the doctor's view. However, if the doctor is planning to do an endometrial biopsy at the same time, it is done near the end of the cycle.


A narrow fiber optic telescope is inserted through a woman's abdomen to look at the uterus, fallopian tubes, and ovaries and to discern endometriosis or pelvic adhesions, and is the best diagnostic tool for evaluating the ovaries. This test is usually done two or three days before menstruation is expected, and only after an HCG beta blood test ensures the woman is not pregnant.


In the past, the endometrial biopsy was a routine part of the fertility evaluation, but currently, it is performed mainly on patients at risk for endometrial cancer or with repeated IVF failures. An endometrial biopsy is a simple office-based procedure that is performed just before the onset of a woman's menses.

Baseline tests for follicle stimulating hormone (FSH) and luteinizing hormone (LH) must be done on day three of your cycle. If your consultation should take place before that, you'll be instructed to come in for these tests on day three of your cycle. Additional tests will be conducted on the day of Luteinizing Hormone (LH) surge (mid-cycle), and again about seven days after ovulation.

Luteinizing Hormone (LH)

·       Follicular Phase (day two or three): <7mIU/ml

·       Day of LH Surge: >15mIU/ml

Follicle Stimulating Hormone (FSH)

·       Follicular Phase: <13mIU/ml

·       Day of LH Surge: >15 mIU/ml


·       Day of LH Surge: >100 pg/ml

·       Mid Luteal Phase (seven days after O): >60 pg/ml


·       Day of LH Surge: <1.5 ng/ml

·       Mid Luteal Phase >15 ng/ml

Prolactin:<25 ng/ml 
Free T3: 1.4 to 4.4 pg/ml 
Free Thyroxine (T4): 0.8 to 2.0 ng/dl 
Total Testosterone: 6.0 to 89 ng/dl 
Free Testosterone: 0.7 to 3.6 pg/ml 
DHEAS: 35 to 430 ug/dl 
Androstenedione: 0.7 to 3.1 ng/ml

KEY: <= less than; >= greater than; mIU=milli International Units; ml=milliliter; pg=picograms; ng=nanograms; uIU=micro International Units; dl=deciliter; ug=micrograms

Semen Analysis

A semen analysis is a  very important test and it should be done early in the evaluation. If there is a significant sperm problem, the female analysis may be modified to more basic tests and certainly, the analysis should be conducted before more invasive female surgical interventions are attempted.

About a quarter of infertility cases are due to a sperm defect. Almost half of the infertility patient cases will include a sperm deficit as a contributing factor in the causation of infertility. Take a closer look at the male reproductive system and the way sperm is analyzed here.

Multiple Miscarriages, Stillbirth and Pregnancy Loss

Until the last decade, there was little a couple could do if they suffered from recurrent pregnancy losses. Miscarriages that couldn't be attributed to chromosomal defects, hormonal problems or abnormalities of the uterus were labeled "unexplained," and couples would continue to get pregnant, only to suffer time and again as they lost their babies. New research, however, has provided information on the causes of the heretofore unexplained pregnancy losses allowing more effective treatment enabling women to carry their babies to term.
About 15-20% of all pregnancies result in miscarriage, and the risk of pregnancy loss increases with each successive pregnancy loss. For example, in a first pregnancy, the risk of miscarriage is 11-13 %. In a pregnancy immediately following that loss, the risk of miscarriage is 13-17 %. But the risk to a third pregnancy after two successive losses nearly triples to 38 %.

There are a number of tests for multiple pregnancy loss. Those patients with unexplained infertility may also want to read this article by Carolyn Coulam, MD and investigate immunological issues that may curtail or prevent pregnancy. (A list of tests can be found in the article.)

If you have questions about a basic fertility evaluation, please contact INCIID.


IVF Scholarships from INCIID

"From INCIID the Heart" IVF Scholarship

2019 Scholarships will be reviewed on a rolling basis as they are received each month.

The InterNational Council for Infertility Information Dissemination (INCIID -- pronounced “inside”) has the first and only national program designed to help individuals and couples -- From INCIID the Heart -- It provides an  In Vitro Fertilization (IVF) Scholarship to those in need through donations of funds and treatment from professional members, and consumers.    

 "Infertility care is sometimes portrayed as ‘wealthy couples creating designer babies. But nothing could be further from the truth".  The From INCIID the Heart is an important step in helping to eliminate the barrier preventing many couples from having children.

There are at least 6-7 million infertile couples in the U.S., and of those, approximately two million are unable to conceive without IVF treatment.  The majority have no insurance coverage for IVF and its associated medications, which can range in cost between $18,000 and $25,000 per couple. And  EMD Serono supports the program with donations of ovarian stimulation medications.
INCIID continues to gain support for the scholarship from a number of respected IVF clinics in the U.S. to donate their expertise and state-of-the-art facilities for patients who do not have the financial resources. Thes generous reproductive centers support the INCIID mission to help patients build families where they may not have the opportunity without help. The program will cover most of the basic expenses incurred during an IVF cycle.

Couples with financial and medical need may be eligible for participation in the program. The criteria are simple: No insurance covering IVF, Financial Need and Medical Infertility (as defined by the American Society for Reproductive Medicine - ASRM).  Final committee selections and decisions take cost-of-living in different regions of the country into account, applicants who may have student loan debt and a variety of other situations. Each application is processed based on an individual needs assessment.   INCIID required applicants provide copies of their most recent tax returns (2 years) and pay stubs (2 consecutive and most recent pay cycles), and supply a letter from their doctor recommending IVF as medically necessary. Selected recipients partner with INCIID in agreement to fundraise a small amount. 
Our goal is to give those without insurance coverage for IVF an opportunity to fulfill their dream of becoming parents.

For more information and to apply: READ the FAQ (Frequently Asked Questions) FIRST. Once you read the FAQ, download the application located at the end of the FAQ.

* All recipient/finalist cycles are subject to a final medical review and determination on whether the donated treatment is appropriate for the recipient. INCIID  may make changes in policies, procedures, offerings, and requirements at any time. The fundraising agreement in no way guarantees a cycle of IVF.

The application process is on-going. If you want to be considered for the program, please read the FAQ first and then send us your application. Applications are reviewed throughout the year. Before you apply: Please get the latest version of Adobe Reader.

INCIID is grateful to EMD Serono. for their support of this program.

12th Edition of the EMD Serono Specialty Digest™ Now Available

Scott Filosi, Senior Vice President, Market Access & Customer Solutions, EMD Serono

Scott Filosi, Senior Vice President, Market Access & Customer Solutions, EMD Serono

Value of specialty medicines, appropriate clinical use identified as critical managed care challenges

ROCKLAND, Mass., May 9, 2016 /PRNewswire/ -- EMD Serono, the North America biopharmaceutical business of Merck KGaA, Darmstadt, Germany, announced the release of the 12th edition of the EMD Serono Specialty Digest™.  The Digest, which was featured last week at the Asembia Specialty Pharmacy Summit in Las Vegas, NV,  is an industry resource that provides market data on health plans' management of specialty pharmaceuticals in 2015 and identifies common trends occurring across plans. The Digest is available to those who request a copy at

"EMD Serono has a longstanding commitment to customers and patients to further the understanding of trends in the management of specialty pharmaceuticals and ultimately, improve patient outcomes," said Scott Filosi, Senior Vice President, Market Access & Customer Solutions, EMD Serono. "It is our hope that this year's Digest findings will help spur conversations around ways to ensure continued patient access to optimal care." 

The 12th edition of the EMD Serono Specialty Digest includes data from 58 commercial health plans across the country, representing more than 140 million covered lives. New to the Digest this year is an oncology-specific supplement that includes a deeper analysis into the therapeutic category, which continues to be a major focus for health plans.  The new oncology-specific supplement is scheduled to be available in June.

"The findings in the area of oncology shed light on new trends such as the adoption of clinical pathways as well as concerns around restricting product use and the cost of infusion site visits for payers," said Kevin Host, President, Artemetrx, who oversaw the development of this year's Digest. "Understanding these managed care challenges as they relate to oncology is an important step in better meeting the needs of patients."

Further findings from this year's Digest show that while alignment of pharmacy and medical benefits has improved, it still remains a major issue for some plans. Additionally, plans are more likely to select preferred products and to exclude non-preferred agents as a therapy class matures post-launch. 

The EMD Serono Specialty Digest was first developed in 2004 to provide a comprehensive reference for managed care decision makers regarding the management of specialty products. Over the past twelve years, health plans, Pharmacy Benefit Managers (PBMs), employers, specialty pharmacies, and pharmaceutical companies have relied on the Digest to identify current and future trends in the management of specialty pharmaceuticals.

About EMD Serono, Inc. 
EMD Serono is the North America biopharma business of Merck KGaA, Darmstadt, Germany - a leading science and technology company - focused exclusively on specialty care. For more than 40 years, the business has integrated cutting-edge science, innovative products and industry-leading patient support and access programs. EMD Serono has deep expertise in neurology, fertility and endocrinology, as well as a robust pipeline of potential therapies in oncology, immuno-oncology and immunology as R&D focus areas. Today, the business has more than 1,100 employees around the country with commercial, clinical and research operations based in the company's home state of Massachusetts.

About Merck KGaA, Darmstadt, Germany
All Merck KGaA, Darmstadt, Germany, press releases are distributed by e-mail at the same time they become available on the EMD Group Website. In case you are a resident of the USA or Canada please go to register again for your online subscription of this service as our newly introduced geo-targeting requires new links in the email. You may later change your selection or discontinue this service.

Merck KGaA, Darmstadt, Germany, is a leading science and technology company in healthcare, life science and performance materials. Around 50,000 employees work to further develop technologies that improve and enhance life – from biopharmaceutical therapies to treat cancer or multiple sclerosis, cutting-edge systems for scientific research and production, to liquid crystals for smartphones and LCD televisions. In 2015, Merck KGaA, Darmstadt, Germany, generated sales of € 12.8 billion in 66 countries.

Founded in 1668, Merck KGaA, Darmstadt, Germany, is the world's oldest pharmaceutical and chemical company. The founding family remains the majority owner of the publicly listed corporate group. Merck KGaA, Darmstadt, Germany, holds the global rights to the Merck KGaA, Darmstadt, Germany, name and brand. The only exceptions are the United States and Canada, where the company operates as EMD Serono, MilliporeSigma and EMD Performance Materials.

Your Contact
Melissa Manganello 1-781-681-2393

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IVF Market Size Projected to Reach USD 27 Billion by 2022: Grand View Research, Inc

SAN FRANCISCO, May 3, 2016 /PRNewswire/ --

Global In-Vitro Fertilization (IVF) market is expected to reach USD 27 billion by 2022, according to a new report by Grand View Research, Inc. The market is driven by the increasing incidence of infertility owing to, lifestyle changes, expansion of fertility procedures for treating male infertility such as ICSI, government initiatives to provide better reimbursement policies, and continuous efforts by the industry contributors. 

     (Logo: )

Moreover, the availability of genomic testing enabling the prevention of the transfer of genetic disease during IVF use is further expected to drive the market demand. The increase in the number of IVF treatment has led more insurance players to cover the IVF procedures. This has ultimately led to competitive pricing and has moderated the treatment costs as IVF has been a successfully practiced technology. This will most likely drive the market by introducing treatment standardization and automation. 

The behavioral shift in the society is a major factor contributing to the decreased Total Fertility Rate (TFR). These factors include an increasing number of women in the labor force, the increased age of the first birth, a shift from rural to urban societies, lower marriage rates, postponement of marriage, and greater levels of education for women. 

Obesity is another factor, which has led to an increase in infertility in the population. This is due to the fact that the fat deposited on women's abdomen prevents follicular stimulation and produces male hormones. In the case of males, the rising fat decreases testosterone levels causing a problem in sperm production. Doctors have started recommending weight loss in men prior to fertility treatments along with proper Body Mass Index (BMI) maintenance. The U.S. Endocrine Society has established the use of Letrozole to increase the testosterone levels in obese patients. 

Browse full research report with TOC on "In-Vitro Fertilization (IVF) Market Analysis by Procedures (Intracytoplasmic Sperm Injection (ICSI), Frozen Embryo Replacement (FER), Pre-implantation Genetic Diagnosis (PGD)), By Types of Cycles (Fresh Donor, Frozen Donor, Fresh Non-donor, Frozen Non-donor), By Instruments (IVD Disposable Devices, Culture Media, Capital Equipment), And Segment Forecasts to 2022" at:

Further key findings from the report suggest:  

  • Intracytoplasmic Sperm Injection (ICSI) dominated the market in 2014.ICSI was introduced in the year 1992 and boosted the fertility rates from 50% to 80%, according to the American Society for Reproductive Medicine. In April 2016, Nigeria recorded its first successful delivery from a frozen egg. Bridge Clinic has stored the eggs using the flash-freezing technique. With this birth, Nigeria has put itself on the global map as it now offers IVF through frozen eggs. The eggs were then fertilized using the ICSI technique. 
  • Frozen Embryo Replacement (FER) technique is expected to witness a rapid rise in demand. Conventionally, most embryos were transferred through fresh cycles. However, with technology refinement, the number of frozen embryo transfers and the success rates have increased. Moreover, the policy of freezing the embryos has also reduced the chances of ovarian hyper-stimulation. The frozen embryo transfers enable single egg transfer, thus, giving enough time for the endometrial layer to heal from the medicine stimulation effect. This ensures higher success rates. 
  • Culture media dominated the overall market in terms of revenue in 2014. With the increasing government funding and industrial support for employees for egg/sperm freezing, the demand for cryopreservation and the needed media for it is expected to witness growth. There has been an increase in the research activities undertaken to improve the culture media and to procure maximum boar sperms or eggs, spurring market growth. Moreover, the increasing number of egg/sperm donor banks is expected to drive the demand for sperm, egg, and embryo processing media during the forecast period. 
  • Europe dominated the IVF market in 2014. High quality of treatment offered at the most economical price, and the adherence to medical standards have contributed to its market leadership. In Europe, the NHS covers three IVF cycles and has also started providing coverage for gametes freezing. Moreover, the region is an attraction for international clients as countries, such as Spain, have the highest number of egg donors. The clinics also provide sex identification and other IVF treatments, which are not offered in North America. 
  • North America also accounted for a significant share of the market in 2014. The standardization of procedures through automation, regulatory reforms, government funding for egg/sperm storage, and industry players introducing more IVF treatments are some contributing factors for North Americadominating the IVF market. 
  • The presence of favorable reimbursement framework (implementation of USD 50 million 5-year plans by the U.S Department of Defense for sperm/egg freezing coverage) is also expected to drive regional market growth over the next six years. The increasing number of clinics undertaking newer industrial techniques to offer better fertility success rates is also expected to boost the regional market demand. 
  • The demand for IVF treatment is expected to boom in APAC owing to fertility tourism, increasing foreign industries trying to penetrate the economically developing countries and the changing regulatory landscape. 
  • The Asia Pacific Initiative on Reproduction (ASPIRE), the task force of clinicians and scientists is involved in the monitoring and management of fertility and Assisted Reproductive Technology (ART). Such initiatives promote awareness levels thereby, driving growth. 
  • Industry contributors are introducing newer automation to shift the IVF treatment from invasive to a minimally invasive or non-invasive procedure. The industry players are also trying technologies, which can enable older women to have enhanced fertility rates. For instance, in August 2015, OvaScience announced the results of its first published analysis comparing AUGMENT fertility treatment with a standard IVF. The results showed a significantly higher rate of selection and transfer of embryos as compared to the standard treatment. 
  • Some key players in this market includeEMD Serono Inc., Boston IVF, OvaScience, Thermo Fisher Scientific Inc., Vitrolife AB, Irvine Scientific, CooperSurgical, Inc., Cook Medical Inc., Genea Biomedx and Progyny Inc. 

Grand View Research has segmented the In-Vitro Fertilization (IVF) market on the basis of procedures, type of cycles, instruments, end-use, and regions:  

  • Global In-Vitro Fertilization (IVF) Procedures Outlook (Revenue, USD Million, 2012 - 2022) 
    • Intracytoplasmic Sperm Injection (ICSI)
    • Frozen Embryo Replacement (FER)
    • Pre-implantation Genetic Diagnosis (PGD)
    • Others
  • Global In-Vitro Fertilization (IVF) Types of Cycles Outlook (Revenue, USD Million, 2012 - 2022) 
    • Fresh Donor
    • Frozen Donor
    • Fresh Non-donor
    • Frozen Non-donor
  • Global In-Vitro Fertilization (IVF) Instruments Outlook (Revenue, USD Million, 2012 - 2022) 
    • IVD Disposable Devices
    • Culture Media
    • Capital Equipment
  • In-Vitro Fertilization (IVF) Regional Outlook (Revenue, USD Million, 2012 - 2022) 
    • North America
      • U.S.
      • Canada
    • Europe
      • UK
      • Germany
      • France
      • Rest of Europe
    • Asia Pacific
      • India
      • Japan
      • China
      • Rest of Asia Pacific
    • Latin America
      • Brazil
      • Mexico
      • Rest of Latin America
    • MEA
      • South Africa
      • Rest of MEA 



Fertility Research Survey


Fertility research:  Acceptance and mindfulness among couples dealing with infertility.

[Note:Questions? Contact information is at the end of the article.] 
Anastasiia Kuliapina, provisional psychologist  and Dr Lisa Abel from the School of Psychology at Bond University, Australia, seek to understand your individual experiences related to infertility. We would like to learn from your experiences. Our goal with this research is to replace despair with hope and isolation with meaningful engagement in valued living and strong loving relationships. The research is conducted to contribute to the development of helpful fertility related psychological support programs.

Research has shown that infertility and its treatment include stressors that strain but also strengthen couples’ relationships (Lebow, 2014). Randall and Bodenmann (2009) showed that stress is correlated with a number of adverse relationship outcomes. For example, stress can impact communication (Bodenmann et al., 2008) and decrease marital relationship quality (Allen et al., 2010). Distressed couples typically lose their ability to discuss difficulties and are also more likely to report feelings of sadness, grief, and hopelessness (Leifker, 2015).  Behavior such as self-disclosure and support provision facilitate the development and maintenance of the relationship bond; these behaviours also facilitate mutual understanding, closeness, and affection (Leifker, 2015). According to Martins (2014), support from different sources (e.g. partner, family and friends, psychotherapy) can affect the way persons deal with the challenge of infertility.

Studies show that individuals experience psychological distress because they are unable to accept their infertility (Galhardo et al., 2011, Galhardo et al., 2013). The acceptance interventions offer a holistic approach to increase quality of life and foster important protective factors against realities of the uncertainty and losses. Active acceptance of adversity has been shown to increase a person’s sense of self-efficacy and psychological flexibility in difficult circumstances, as well as facilitate relationship satisfaction among couples facing chronic illness (Pakenham & Samios, 2012).

Mindfulness as a skill could be applied to painful internal and external experiences, bodily sensations, thoughts and feelings related to the past or to the future in a form of noticing without trying to suppress or modify them. Greater mindfulness is related to better adjustment and lower psychological distress. Mindfulness practice has also been shown to facilitate relationship satisfaction, due to its capacity to reduce emotional reactivity (Barnes et al., 2007; Wachs & Cordova, 2007). Given this, acceptance and mindfulness may be of benefit to couples facing the challenge of infertility (Galhardo, Cunha, & Pinto-Gouveia, 2013).

The aim of our research is to investigate the role of acceptance and mindfulness in relation to dyadic adjustment in couples facing fertility difficulties. The study has been approved by Bond University Human Research Ethics Committee (BUHREC) (Ethics Approval Code: RO 1951; please feel free to contact BUHREC if you have any questions or concerns regarding this research:

The research questionnaire takes approximately 45 minutes to complete and can be accessed online at your own pace and in a comfortable place here:

In recognition of the participation in this research, all participants are eligible to win a $100 gift card. The draw for this will take place at the completion of data collection.

Currently we have received positive feedback and gathered information from 45 participants living in Australia, New Zealand, USA, Canada, UK, Denmark, Saudi Arabia, Trinidad, and Jamaica. We hope to obtain 120 completed questionnaires, as this is the minimum number of responses that is necessary to answer our research question.

We invite both partners to complete the online survey here:


However, in instances where both partners cannot contribute, individual partner participation is also valuable and precious.

If you are able to share information about this research project, that would be much appreciated.


Anastasiia Kuliapina

Provisional Psychologist, MAPS, BPsych (Hons), MPsych (Clinical) Candidate

Bond University School of Psychology




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