The definition of infertility by the World Health Organization (WHO): the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.

There are many reasons on why infertility may occur and is possible in both men and women. In general, the probability of female-caused infertility is about 40%, the probability of male-causes infertility is also about 40%, and the probability of both female and male-causes infertility is almost 20%.

Ovulation injections will not cause early menopause. In humans, the pituitary gland secretes FSH that nourishes only one egg to grow and mature per month so there is only one egg for ovulation every month. With the use of ovulation injections (with high FSH content), eggs that would otherwise not get enough nourishment will be able to grow and mature, resulting in more eggs available for ovulation. You can think of this as a “resource recovery” that will not exhaust the original stock of eggs, nor cause early menopause.

Many patients consulting with infertility clinics often ask: How long should sexual abstinence be to achieve optimal fertility? According to the recommendations of the World Health Organization (WHO), 3 to 7 days of sexual abstinence is enough to achieve the maximum quality of sperm. Exceeding the 10-day abstinence duration will compromise the quality of the sperm.

In Women:

  • 1) Advanced maternal age
  • 2) Uterine fibroids and adenomyosis
  • 3) Polycystic ovary syndrome
  • 4) Chocolate cysts of the ovary
  • 5) Fallopian tube obstruction or adhesions
  • 6) Ovulation dysfunction
  • 7) Hyperprolactinemia
  • 8) Endometrial adhesions

In Men:

  • 1) Low sperm count
  • 2) Low sperm motility
  • 3) Azoospermia
  • 4) Abnormal sperm morphology
  • 5) Unable to complete sexual intercourse

The probability of miscarriage in pregnancies achieved by IVF and that of a natural pregnancy is similar, about 10%-20%. Advanced maternal age carries a higher risk of miscarriage rate. When pregnancy is achieved after IVF treatment, close follow-up with ultrasound or blood tests can detect the possibility of miscarriage.

The most common cause of a miscarriage is usually the abnormality of the embryo itself, with the largest factor being accounted for by chromosomal abnormalities. Other factors may include fetal structural abnormalities, uterine malformations, or a deficiency in luteinizing hormone.

In general, early miscarriage may be complete and will not require further intervention. When a miscarriage occurs at around 12 weeks gestation, heavy bleeding may occur and miscarriage may be incomplete so that further intervention may be required such as “Dilatation and curettage” to completely clean the products of conception.

Usually, there is only one mature egg for ovulation per menstrual cycle. In order to increase the chance of assisted reproduction, it is sometimes necessary to use ovulation drugs to increase the number of mature eggs. In general, ovulation drugs do not cause any side effects, but there are still a few patients who might have some complications. The most serious condition is “ovarian hyperstimulation syndrome (OHSS).” Most cases of ovarian hyperstimulation syndrome will resolve on its own, but there may be severe cases that will require hospitalization for observation and treatment.

The ovaries also secrete substances that increase the permeability of the blood vessels, causing the outflow of water, electrolytes, proteins, and more from blood vessels. These may collect in the abdominal cavity called ascites or in the chest cavity called pleural effusion. If this happens, the replacement of water, electrolytes, and proteins should be done in moderation either orally or by intravenous infusion.

Most patients recover in 7-10 days, but for those who recover slowly or are pregnant, the condition may last for several weeks. When there is ovarian hyperstimulation syndrome, daily urine output should be at least 500cc; if the amount of urine excreted is less than 500cc or other symptoms are more severe, your physician will advise hospitalization as the case requires. Severe symptoms may even require termination of pregnancy. The incidence of severe ovarian hyperstimulation syndrome is 0.5% to 5%, and in these cases, although rare, stroke, renal failure, adult respiratory distress syndrome, and even death may occur.

Women receiving ovarian stimulation for infertility treatment have a slightly higher chance of developing ectopic pregnancy than that of normal pregnant women. The reason for this may be that people who receive infertility treatment have problems with the fallopian tubes so the probability of an ectopic pregnancy occurring is higher than the average person. Therefore, it is necessary to follow up closely with ultrasound and blood tests during the process.