However, at the Massachusetts General Hospital Fertility Center, we know that infertility is about more than just statistics. While no one has better results than our program, we understand the profound emotional impact infertility has on a couple. That’s why we work as a team to provide couples with not only expert medical care but also psychological and emotional support throughout their journey to become parents.

 Learn more from John C. Petrozza, MD 
Chief, MGH Fertility Center

What Causes Infertility?
About one-third of all infertility problems are caused by female factors, including recurrent pregnancy loss. An equal number are caused by factors in the male. In the remaining cases, the cause is unknown or due to problems with both partners.

Successful conception is a complex process, and infertility can be the result of a problem at any one of these steps: First, an egg must be released from the woman's ovaries (ovulation). The egg must then travel to the fallopian tubes and be fertilized by the man's sperm. If the egg is fertilized (conception), it then moves from the fallopian tubes to the uterus. It secures itself into the wall of the uterus and continues its 40-week period of fetal growth.

Female Infertility
Most cases of female infertility are due either to problems with ovulation, decreased egg quality or problems with blocked or damaged fallopian tubes.

• Problems with Ovulation
  If the egg is not released, it is not possible to conceive. Up to 40 percent of cases of female infertility are due to ovulation problems. Some factors that can cause problems with ovulation are:
  
  • Polycystic ovarian syndrome
  • Other hormonal disorders
    
• Decreased Egg Quality
  Decreased egg quality or ovarian reserve is a major source of decreased fertility in older women. Reduced egg quality may be caused by:
  
  • Age
  • Smoking
  • Prior chemotherapy or radiation therapy
  • Premature ovarian failure
    
• Problems with Fallopian Tubes
  If the fallopian tubes are damaged or blocked, it is difficult for the egg to be fertilized or to travel to the uterus. Problems with fallopian tubes can be caused by:
  
  • Pelvic inflammatory disease
  • Sexually transmitted diseases
  • Endometriosis
  • Surgeries
  • Ectopic pregnancies
  • Congenital anomalies
• Endometriosis
  Endometriosis is a frequent cause of pelvic pain and infertility. It is typically a progressive disease, caused by cells from the uterine lining, found outside of the uterus, where they do not belong. They may be on organs in the abdomen, pelvis or elsewhere. These cells, because they came from the uterus, are triggered by hormonal changes in the woman's body, and grow and proliferate prior to menstruation, just as if they were in the uterus, trying to form a lining. The tissue swells, breaks down, and bleeds but cannot pass out of the body the way the normal uterine lining does. The result can be scar tissue, inflammation in surrounding tissue, pain and trouble with fertility.
  
  Epidemiologic studies suggest that 68 percent of women have endometriosis, with approximately 5 million affected women in the United States. In women with cyclic pelvic pain, up to 75 percent of women have endometriosis. Many of these women have difficulty conceiving. Symptoms of endometriosis can range from mild to severe, including cramping, pain during sex, pain associated with periods, heavy periods, and low back pain.
  
  Treatment of endometriosis is often based on the patient's ultimate goals: relieving pelvic pain, removing an ovarian cyst, relieving the complications of scar tissue, or conceiving. If pelvic pain is the primary issue, treatment may involve medical regimens, all of which induce a hormonal state that prevents a woman from conceiving while it tries to shrink the endometriosis. Surgery is often reserved for women who fail medical treatment, have large ovarian cysts filled with endometriosis, have complication from scar tissue caused by the endometriosis, or who may be trying to conceive (especially if they have significant pain). For women who have blocked tubes or a significant amount of scar tissue due to endometriosis, in vitro fertilization may be the best option to consider as they try to conceive.
  
  While the cause of endometriosis is not yet known, the Vincent has received several research grants to study the role of genetics, environmental, and hormonal triggers, growth factors that allow the disease to implant and grow, and is investigating several treatment regimens, including surgery, medications and the use of hormones.

Male Infertility
Problems with male infertility exist on a continuum, ranging from men who have no sperm (azoospermic) and, therefore, sterile, to men who have some sperm (oligospermic). The causes of sperm production problems vary, but it is not only numbers of sperm that matter. Also important is the percentage of motile (moving) sperm that are traveling at the right speed and in the right direction. Several methods used at the Vincent, including in vitro fertilization and sperm injection are viable treatment options for couples with male infertility problems.

What Are The Treatments Of Infertility
Treatment options vary depending on the cause of infertility.

Learn more from Jan L. Shifren, MD
Director, Vincent Menopause Program

• Lifestyle Changes
  Often lifestyle issues can affect fertility. You may be first asked to make lifestyle changes such as:

• Lose or gain weight
• Stop smoking
• Avoid caffeine and alcohol
• Avoid excessive exercise
• Plan sexual activity according to ovulation
  
• Medication
  You may be given medications or hormonal therapies to correct imbalances and induce ovulation. For women who do not ovulate on their own, medications can be taken by pill or injection. They cause the ovaries to produce eggs to allow for pregnancy. These medications also may be taken by women who ovulate regularly in order to increase the production of eggs each month. This increases the chance for conception. The risk of multiple births increases with these medications.
  
• Assisted Reproductive Technologies (ART)
  ART involves manipulating human sperm and eggs or embryos in a laboratory to help with conception. In rare cases, when no healthy sperm or eggs are present, these may need to be provided by a known or anonymous donor. Our goal with ART is to achieve the safest, not the highest, rate of pregnancy. Methods include:
  
  • Intrauterine Insemination (IUI): Semen is collected and processed in a lab and then inserted directly into the woman's cervix or uterus.
  • In Vitro Fertilization (IVF): Eggs are removed from the woman's body and fertilized with sperm in a laboratory. The fertilized embryos are then placed in an incubator. Two to five days later a predetermined number of embryos are transferred to the uterus.
  • Intracytoplasmic sperm induction (ICSI): This is a micromanipulation process to assist fertilization. In the laboratory, a single sperm is injected into a single egg. The fertilized embryo is then transferred into the uterus.
  • Single embryo transfer: Most IVF transfers occur three days after fertilization, when a predetermined number of embryos are placed in the woman’s uterus. It is possible that more than one embryo will implant, resulting in multiple births. To reduce multiple births, your doctor may recommend single embryo transfer. When the embryo becomes a blastocyst (five days after fertilization), it is possible to identify which blastocysts are most likely to result in a pregnancy. We then transfer only one embryo, eliminating the possibility of multiple births. Note that method is not appropriate for all patients.
  • Assisted embryo hatching: At the appropriate stage of embryo development (usually on the morning of transfer) an embryologist in the laboratory uses a micro-needle to create a small opening in the shell of the fertilized egg to assist the embryo in attaching to the lining of the uterus for implantation.
  • Embryo cryopreservation: Embryo cryopreservation is the process of freezing embryos so that they can be used at a later date. Viable embryos that are not transferred during an IVF procedure may be frozen for future transfer into the uterus. At the Vincent, advanced methods of freezing blastocysts (5-day old embryos) are contributing to the new protocol of single embryo transfers for certain patients.

  Learn more from Thomas Toth, MD
  Director, Vincent IVF Program
  

  • Preimplantation genetic diagnosis (PGD): Preimplantation genetic diagnosis (PGD) is a procedure used to detect and prevent the development of possible lethal genetic defects in offspring before the initiation of pregnancy. This procedure is appropriate for couples already known to have identified genetic abnormalities.

Learn more from Irene Souter, MD
Director, Preimplantation Genetic Diagnosis Program

Virtually any disease can be detected for which the genetic defect has been identified. Some of the more common diseases include:

• Beta Thalassemia
• Cystic Fibrosis
• Tay Sachs Disease
• Down Syndrome
• Achondroplasia
• Franconi’s Anemia
• Huntington’s Disease


• Minimally Invasive Surgery
  The Massachusetts General Hospital Fertility Center has developed advanced techniques for minimally invasive surgery ensuring safe and swift recovery for women undergoing complex procedures for a wide-range of conditions. Working closely with the MGH Center for the Integration of Medicine and Innovative Technology in the MGH Operating Room of the Future, Massachusetts General Hospital surgeons use advanced laparoscopic surgery to treat endometriosis, pelvic adhesions and tubal disease, including opening blocked fallopian tubes. Minimally invasive surgery is also used to repair problems with the uterus or to remove cysts, fibroids, and scar tissue.
  
  
• Sperm & Egg Donation and Surrogate Programs
  Using donated sperm, eggs, embryos, or a gestational carrier are alternative paths to parenthood for some couples. These are grouped together because they necessitate the involvement of a third person. All of these methods bring with them complex emotional and ethical considerations. The Massachusetts General Hospital Fertility Center staff is well trained to help you along this path.
  
  
  • Sperm donation: The woman is inseminated with previously frozen sperm from a man other than her husband or partner. Sperm can be donated by a known donor or obtained anonymously from sperm banks
  • Egg donation: Advances in assisted reproductive technologies such as IVF now make it possible for a woman to receive an egg that has been removed from another woman and fertilized in a laboratory. Donated eggs are generally fertilized with the recipient's partner's sperm. Therefore, any babies that may result from this treatment would carry the genetic material of the father and the biological mother but not of the recipient mother who carries the baby to term.
  • Gestational carrier: An embryo can be created using the egg of a woman and the sperm of her husband or male partner. This embryo can then be transferred into a “carrier” uterus. The gestational carrier then gives birth to a baby for the couple.