The Role of Progesterone for a Successful Pregnancy

Progesterone a hormone produced by the ovaries helps prepare the uterus for pregnancy. It is first produced by the corpus luteum in the ovaries and later is maintained by the placenta. Healthy progesterone levels can help to maintain healthy estrogen levels, which are also crucial for achieving and maintaining pregnancy. Referred to as the pregnancy hormone, progesterone production is necessary for the safe maintenance of pregnancy. Progesterone supports pregnancy throughout the first trimester. In some women, a lack of progesterone may cause a spontaneous abortion

During pregnancy, progesterone is required for the following reasons:
• To keep the endometrium in a thickened condition for egg implantation

• To prevent the onset of uterine contractions

• To stimulate the growth of breast tissue and prevent lactation until after the birth

• To create a mucous plug that prevents bacteria from entering the uterus

After the egg is implanted in the endometrium, the growing embryo receives nourishment from progesterone produced by the ovaries. Around 8 weeks after implantation, the placenta takes over the production of progesterone and estrogen from the ovaries, producing substantial levels of progesterone to maintain a healthy pregnancy.

The failure of the corpus luteum to adequately support the pregnancy with progesterone can sometimes result in an early pregnancy loss. Progesterone levels may be monitored in such cases. In order to maintain a high progesterone level, injections, oral supplements and vaginal suppositories may be prescribed.

Progesterone in Fertility Treatment

Women who seek fertility treatment will most likely need to take a progesterone test. This test is also recommended for women with a history of miscarriages, stillbirth, unexplained infertility, and/or abnormal uterine bleeding.

Women facing infertility issues producing low levels of progesterone require progesterone supplementation to bring them into the safe levels. The type of fertility treatment used will determine the type of supplemental progesterone used. Progesterone is prescribed with in vitro fertilization (IVF) treatments and other assisted reproductive technology (ART) treatments. To prepare the lining of the uterus for implantation of the fertilized egg, most women undergoing IVF will be given progesterone after the retrieval of her eggs. In an IVF cycle the progesterone needs to be replaced in the form of injections and/or vaginal suppositories. A complete progesterone supplementation may be necessary in most frozen embryo transfer protocols. Progesterone levels in the blood are monitored by blood draws and supplemental doses adjusted accordingly.

Progesterone is a vital component for a successful pregnancy and low levels of this hormone have been found in many women who have suffered recurrent miscarriages or who are unable to get pregnant. It is important that these women meet a fertility expert and discuss the possibility of progesterone hormone therapy to increase their chances of sustaining a healthy pregnancy.

East Bay fertility Center Dublin California, specializes in the comprehensive evaluation and treatment of infertility, providing a complete mind-body experience for fertility couples. East Bay’s experienced medical staff is headed by Dr. Ellen U. Snowden, Medical Director and physician. Dr Snowden is Board Certified in Obstetric, Gynecology, and Reproductive Endocrinology with advanced Fellowship training in the treatment of infertility, recurrent miscarriages and hormonal disorders in women. With the right type of treatment and intervention, the Center assists couples who have been having problems conceiving to overcome those difficulties in the shortest possible time in order to realize their dreams of having a healthy baby. Call 925.828.9235 for a free initial consultation.

How Therapeutic Donor Insemination Works

Therapeutic donor insemination (TDI) helps couples facing significant sperm abnormality to conceive through IUI procedures. In this process, screened sperm from an anonymous donor is used instead of the male partner’s sperm thus making it a treatment of choice for those suffering from severe, untreatable male factor infertility or for males carrying a hereditary disease that may be dangerous to pass on to offspring. However, success rates of TDI decrease with increasing female age.

Who can benefit from TDI?

This procedure is recommended for couples who are experiencing male fertility problems such as:
• Azoospermia (absence of sperm)
• Poor sperm count and motility
• Erectile dysfunction
• Failed ICSI
• Residual effects from chemotherapy or radiation therapy
• Single women who wish to become pregnant
The TDI Process

In Therapeutic Donor Insemination, donor sperm that are thoroughly screened and frozen are inserted through a small catheter (tube) into the uterus at the time of ovulation. After the insemination is complete, the woman has to remain lying down for ten minutes or so. In two weeks a pregnancy test is conducted. Once pregnancy occurs, it is no different than one that occurs naturally with the same rate of complications as natural pregnancies.

Sometimes, couples undergoing IVF treatment fertilize the eggs with the help of donor sperm. Most couples try to find a donor who has a similar cultural background and religion.

Donor sperm specimens are frozen and quarantined for six months to ensure that the donor still tests negative for infectious diseases such as HIV and hepatitis after initial testing. This is necessary to make the specimen as safe as medically possible. The female is required to have a pelvic exam and is tested for sexually transmitted diseases and other diseases before undergoing TDI.

Infertility counseling is important for couples or women who consider TDI as a conception option in order to understand fully the immediate and long term psychological, emotional and social implication of using donor sperm.
East Bay Fertility Center offers TDI as an infertility treatment option, adhering to the guidelines of the American Society of Reproductive Medicine (ASRM) regarding the use of donor sperm. Before proceeding with TDI, a complete examination and basic lab tests are performed. Thorough screening of donor sperm is carried out as well.

East Bay’s experienced medical staff is headed by Dr. Ellen U. Snowden, Medical Director and physician. Dr Snowden is Board Certified in Obstetric, Gynecology, and Reproductive Endocrinology with advanced Fellowship training in the treatment of infertility, recurrent miscarriages and hormonal disorders in women. Call 925.828.9235 for a free initial consultation.

Uterine Malformation as a Hindrance to Conception

A small percentage of women face difficulties in conceiving due to a malformation in the uterus. A congenital uterine malformation is a deviation in the shape of the uterus that may occur during a woman's prenatal development. Some uterine malformations are present from birth, while others develop during the woman’s adult life.

Specific uterine malformations include septate uterus, bicornuate uterus, unicornuate uterus, arcuate uterus, didelphic uterus, or T-shaped uterus. The septate uterus seems to be the most frequent anomaly accounting for 30 to 50% of all cases, followed by the bicornuate uterus and unicornuate uterus.

A bicornuate uterus is a condition where the uterus, instead of being pear-shaped, is formed like a heart. This gives the embryo less space to grow than in a normally shaped uterus. Surgery may be performed to create a larger uterine cavity and to correct this condition. However unicornuate uterus and didelphic uterus cannot be surgically corrected.

Diagnosis of a Uterine Malfunction
The physician uses imaging techniques to analyze the character of the malformation in the uterus and they are generally revealed at the time of the first sonographic examination in early pregnancy. When the diagnosis is made at the beginning of pregnancy, preventive treatment such as taking rest, and periodic sonographic monitoring of the fetal growth are recommended.

However, unicornuate uterus is difficult to locate as also discrete forms of septate and bicornuate uterus. 3D ultrasonography seems the ideal method of imaging for uterine malformations. An evaluation of the uterine malformations should be accompanied by a renal investigation as there can be a direct association between the malformation and the kidneys.

Uterine Malfunction and Infertility
Patients with uterine malformations have higher rates of reproductive loss, preterm delivery, breech presentation and complications that increase obstetric intervention. The risk of breech or transverse presentation is higher, since normal rotation of the fetus in the uterine cavity is impeded.

It is seen that pregnancy outcome is poorer in the bicornuate and arcuate uterus groups. The incidence of miscarriages seems to be highest in the case of septate uterus. Early abortions can also be traced to uterine malformations.
However, uterine malformations are not the only factor responsible for infertility; this condition can increase the risk of endometriosis. Uterine problems are but one of the causes of infertility which can be revealed in the course of basic infertility tests.

Treatment of Uterine Malformation
Surgical intervention differs from case to case and depends on the extent of the specific problem. For a septate uterus, surgery is performed to remove the septum (wall). The procedure is performed either through hysteroscopy or laparoscopy. Once this corrective surgery is done, chances of conceiving are good.

At East Bay Fertility Center, California, couples dealing with infertility get access to the latest technology and comprehensive consultation with a reproductive endocrinologist and fertility specialists. East Bay specializes in providing infertility treatments such as in-vitro fertilization, insemination, Intracytoplasmic sperm injection, egg donation and gestational surrogacy. Call 925.828.9235 for a free initial consultation.

Infertility as a Result of Adhesions

Sometimes, infertility can be traced to pelvic scarring and adhesions. Infertility is caused when abdominal adhesions prevent the fertilized egg from reaching the uterus. Adhesions around the fallopian tubes can also make it difficult for sperm to reach the ovum. Tubal ectopic pregnancy is very often traced to adhesions in or around the fallopian tubes. Surgical intervention is needed to remove the adhesions which may be causing infertility.

What are Adhesions?
Adhesions or injuries are a type of scar tissue that may form between organs and tissues after a surgical procedure. Adhesions that form after surgery in the pelvic area and after surgeries to remove fibroids are among the leading causes of post-operative infertility. The main cause of intrauterine adhesions is trauma to the uterine cavity following a D&C procedure, prolonged use of an intrauterine device (IUD), endometritis and removal of fibroids in the uterus.

These injuries are typically caused by cauterization, suturing, and abrading tissues and organs during surgery. This internal trauma may lead to infertility and other issues. Once formed, adhesions need to be surgically removed. This means that adhesions that form in one surgery may require future surgery to cut through them to correct infertility or other complications.

Diagnosing Adhesions

Intrauterine adhesions may be diagnosed using an x-ray procedure called hysterosalpingography (HSG). Hysteroscopy is also another method of diagnosis where a hysteroscope (a thin telescope-like instrument) is inserted through the cervix to allow direct visualization of the uterine cavity. Both HSG and hysteroscopy can be performed without general anesthesia.

How are Adhesions removed?

Generally, trauma caused by intrauterine adhesions is removed with hysteroscopic guidance using instruments such as a laser, electrocautery device, or scissors. They are inserted through small incisions. Pelvic adhesions may sometimes be treated by laparoscopy. A laparoscopy is conducted under general anesthesia where the laparoscope is inserted into the pelvic cavity through a tiny incision made just below the woman's navel. After the adhesions are removed, surgeons recommend placing a device such as a plastic catheter temporarily inside the uterus to prevent the adhesions from forming again. Hormonal treatment with progestins estrogens and non-steroidal anti-inflammatory medications are prescribed post surgery to lessen the chance of adhesion reformation.

Conception Chances

After treatment it is seen that patients with mild to moderate adhesions have full-term pregnancy rates of around 70 to 80 percent. Patients with severe adhesions may only have full-term pregnancy rates in the 20 to 40 percent range after treatment. In-vitro fertilization (IVF) is ideally suited for women with blocked fallopian tubes or pelvic adhesions.

East Bay Fertility Center specializes in the comprehensive evaluation and treatment of infertility providing a complete mind-body experience for fertility couples. The Center performs extensive tests to find out the cause of infertility that also includes investigating suspected adhesions in the uterine cavity. Call 925.828.9235 for a free initial consultation.

Testosterone Testing during Infertility Treatment

Testosterone levels are an important factor in fertility. When infertility is suspected, testosterone testing may be recommended for both partners. It involves a blood test and in the male, the test primarily looks for a lower than normal level of testosterone since sufficient testosterone is absolutely critical for normal sperm production. A testosterone test may be used to see whether a problem with the testicles or pituitary gland is preventing a man from being able to father a child. If the testosterone level is abnormal that could also be the reason for erectile dysfunction. Low testosterone may be caused by an underlying hormonal problem such as a pituitary problem, a disease affecting the testes, or physical damage to the testes. Damage may be caused by physical injury, chronic alcohol abuse or a history of mumps.

Testosterone Testing in Women
Testosterone was once considered an exclusively male hormone; but research over the past decade has shown that this hormone also plays a crucial role in women's physical and psychological health. Endocrine abnormalities like increased testosterone levels are factors that affect female fertility.

A blood test to determine testosterone levels is recommended if a woman has irregular periods or none at all. Most of the testosterone in the blood is bound to a protein called sex hormone binding globulin (SHBG). Obesity or hyperthyroidism could lead to increased SHBG levels and therefore, "Free" testosterone may be checked when such conditions are present.

Testosterone and Infertility
Testosterone has an indirect impact on female fertility and female testosterone levels can be an indication for certain conditions that can cause female infertility. High testosterone caused by low estrogen or by ovarian cancer in females may be the root cause for many infertility related issues. Polycystic ovarian syndrome (PCOS) is another possible cause. Another symptom is anovulation (not producing mature egg cells), which leads to infertility. High testosterone does not cause infertility, but testosterone levels can rise in women because of tumors that develop in the ovaries or PCOS.

East Bay Fertility Center California, offers a wide range of infertility treatments along with expert medical counseling to couples facing difficulty in conceiving. Under the guidance of Dr. Ellen U. Snowden, Medical Director and Reproductive Endocrinologist, medical staff at East Bay provides dedicated treatment for infertility and reproductive endocrine issues. With the right type of treatment and intervention, the Center assists couples who have been having problems conceiving to overcome those difficulties in the shortest possible time in order to realize their dreams of having a healthy baby. Call 925.828.9235 for a free initial consultation.

Endometrial Biopsy during Infertility Investigation

In the course of infertility assessment, an endometrial biopsy is one diagnostic tool used to investigate hormonal imbalances that can lead to irregular cycles, frequent miscarriages, or even irregular uterine bleeding. It is indicated when diseases of the endometrium are suspected to be the cause of the infertility and also to find out how ready the endometrium is to accept the implantation of an embryo. The test analyzes whether the lining of a woman’s uterus can support a pregnancy. During an endometrial biopsy a soft, straw-like device (pipelle) or any other pliable instrument is used to suction a small sample of lining from the uterus. The endometrial lining is then analyzed in a lab for abnormal cells.

Problems with the endometrium are called “luteal phase defect", which is a hormonal disorder. An endometrial biopsy checks to see if the endometrium can support implantation and growth of a fertilized egg. The entire procedure takes less than 10 minutes and is far less invasive than a hysteroscopic procedure. The biopsy is usually done about three days before the start of the period. Prior to the biopsy, if a pregnancy is suspected, a pregnancy test must be done to rule out this possibility.

Endometrial biopsy and Infertility
In women with infertility issues, it is very important to know what causes this infertility. The outcome of an endometrial biopsy may determine whether there exists a progesterone deficiency, an estrogen deficiency, or a luteinizing hormone (LH) deficiency. Depending on the hormonal imbalance, a hormone supplement or a prescription drug may be recommended. The test can also be used to check for infection and if this is discovered, a D&C may be needed and/or treatment with antibiotics.

Thus an endometrial biopsy is sometimes necessary to determine the cause of infertility and in some cases the infertility can be reversed. This is a useful tool to detect hormone imbalance that may be the cause of infertility and the doctor will usually prescribe progesterone to relieve it. Thus by performing the simple endometrial biopsy for infertility, a couple may have well taken the first step towards having a child.

East Bay fertility clinic specializes in the comprehensive evaluation and treatment of infertility. Their experienced medical staff is headed by Dr. Ellen U. Snowden, Medical Director and physician. Dr Snowden is Board Certified in Obstetric, Gynecology, and Reproductive Endocrinology with advanced Fellowship training in the treatment of infertility, recurrent miscarriages and hormonal disorders in women. A former infertility patient herself, Dr. Snowden brings to her patients a rare and valuable firsthand empathy for the personal pain and emotional stress of dealing with infertility. Call 925.828.9235 for a free initial consultation.

Dealing with High-FSH levels and Pregnancy

Follicle Stimulating Hormone (FSH) stimulates the female ovaries to produce a mature egg for fertilization. By measuring a woman's FSH levels, doctors get an indication of the quantity of the woman’s eggs remaining as well as her chances of having a successful pregnancy. Eggs are not replaceable as a woman is born with all of the eggs she will ever have. As she ages, the quality and quantity of the eggs decreases.

Declining ovarian function is indicated by an elevation of FSH levels. Increased levels are seen in primary or premature ovarian failure, sometimes referred to as early menopause. FSH levels are usually checked around cycle day three. The tests may show a rise or fall in FSH levels over a couple of months. A rise is an indication of a problem with a woman’s ovarian egg supply, leading to difficulties in treating infertility. This however does not mean that a woman with high FSH levels cannot get pregnant. Checking FSH levels assists in deciding upon treatment options. Along with FSH level, Estradiol levels are also tested since they are indicators of ovarian reserve.

By measuring the amount of FSH, doctors can suggest specific treatments (such as in-vitro fertilization or intrauterine insemination) that could maximize the chances of becoming pregnant. Assisted hatching in IVF is also an option for women with elevated basal FSH levels who may also have a thickened wall around the egg called the zona.

Can FSH Levels be lowered?

FSH can be artificially suppressed by taking birth control pills or synthetic estrogen. However there are mixed reports whether these options are really beneficial. Research is currently underway to find a way of using stem cells to either create egg cells or to fabricate eggs using donated egg material and the woman’s DNA.

High FSH Levels – What they could mean

High FSH levels correlate with poor pregnancy rates. A normal FSH level is usually under 10, whereas an abnormal level is anything above 25. Measurements between 10 and 25 are generally considered to be borderline cases. FSH levels vary a bit across laboratories depending on which assay system is used. It’s best to retest the FSH in the new RE’s lab so that there is no confusion.

High FSH levels warrant an immediate treatment regimen since even a short delay in treatment could mean the difference between conceiving and not conceiving. This condition is also a case for considering using an egg donor.

For women, in their 20s or early 30s, high FSH may be due to immune abnormalities or an undetected infection. Sometimes the level returns to normalcy on its own. However the high FSH levels that occur in women age 38 and older are unlikely to be reversible.

East Bay fertility Center Dublin California, specializes in the comprehensive evaluation and treatment of infertility providing a complete mind-body experience for fertility couples. East Bay’s experienced medical staff is headed by Dr. Ellen U. Snowden, Medical Director and physician. Dr Snowden is Board Certified in Obstetric, Gynecology, and Reproductive Endocrinology with advanced Fellowship training in the treatment of infertility, recurrent miscarriages and hormonal disorders in women. East Bay Fertility Center conducts FSH tests in the course of infertility tests to check the ovarian egg supply and recommends the best possible course of treatment.

Call 925.828.9235 for a free initial consultation.