Intracytoplasmic Sperm Injection:
Intracytoplasmic sperm injection (ICSI) involves the direct injection of sperm
into eggs obtained from in vitro fertilization (IVF).
How is ICSI performed?
There are basically five simple steps to ICSI which include the following:
1. The mature egg is held with a specialized pipette.
2. A very delicate, sharp, and hollow needle is used to immobilize and
pick up a single sperm.
3. The needle is then carefully inserted through the shell of the egg and
into the cytoplasm of the egg.
4. The sperm is injected into the cytoplasm, and the needle is carefully
5. The eggs are checked the following day for evidence of normal
Once the steps of ICSI are complete and fertilization is successful, the
embrto transfer procedure is used to physically place the embryo in the
woman’s uterus. Then it is a matter of watching for early pregnancy
symptoms. The fertility specialist may use a blood test or ultrasound to
determine if implantation and pregnancy has occurred.
Are there specific situations where ICSI might be recommended?
ICSI may be recommended when there is a reason to suspect that achieving
fertilization may be difficult. ICSI is most often used with couples who are
dealing with male infertility factors. Male infertility factors can include any of
the following: low sperm counts, poor motility or movement of the sperm,
poor sperm quality, sperm that lack the ability to penetrate
an egg or azoospermia.
Azoospermia is a condition where there is no sperm in the male’s
ejaculation. There are two types of azoospermia: obstructive and non-
obstructive. Obstructive azoospermia may be caused by any of the following:
Congenital absence of vas
Scarring from prior infections
Non-obstructive azoospermia occurs when a defective testicle is not
How is sperm retrieved for use in ICSI?
For men who have low sperm count or sperm with low mobility, the sperm
may be collected through normal ejaculation. If the man has had a
vasectomy, the microsurgical vasectomy reversal is the most cost-effective
option for restoring fertility.
Needle aspiration or microsurgical sperm retrieval are good alternatives
when a competent microsurgical vasectomy reversal has failed, or when the
man refuses surgery. Needle aspiration allows physicians to easily and
quickly obtain adequate numbers of sperm for the ICSI procedure. A tiny
needle is used to extract sperm directly from the testis.
Needle aspiration is a simple procedure performed under sedation with
minimal discomfort; however, there is the potential for pain and swelling
afterwards. The sperm obtained from testis is only appropriate for ICSI
procedures when testicular sperm is not able to penetrate an egg by itself.
What health concerns are there when considering ICSI?
There have been studies indicating that developing babies from pregnancies
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achieved through artificial insemination, and particularly ICSI, may face an
increased risk for some birth defects, such as imprinting defects. Imprinting
refers to the phenomenon in which certain genes function differently
depending on whether they involve a particular chromosome passed on by
the father or by the mother. Reproductive researchers are concerned that
manipulation of either gametes or zygotes may affect the imprinting process
or the subsequent release. Other researchers believe that the incidence of
these birth defects occurring is similar to those achieving pregnancy without
ART procedures and therefore should not be a deterrent in using them. The
potential risks or complications from doing ICSI is something that you should
discuss with your reproductive specialist at length about.
Gamete Intrafallopian Transfer:
What is gamete intrafallopian tube transfer (GIFT)?
GIFT is an assisted reproductive procedure which involves removing a
woman’s eggs, mixing them with sperm and immediately placing them into a
fallopian tube. One of the main differences between this procedure and the
in vitro fertilization (IVF) and zygote intrafallopian transfer (ZIFT) procedures
is that the fertilization process takes place inside the fallopian tube rather
than in a laboratory. However, healthy tubes are necessary for GIFT to work.
How is GIFT performed?
GIFT is an assisted reproductive procedure that involves the following:
A woman’s ovaries are stimulated with medications to increase the
probability of producing multiple eggs.
Eggs are collected through an aspiration procedure.
The best quality eggs are immediately mixed with mobile sperm and
placed in a special catheter.
The mixture of eggs and sperm are transferred to the woman through a
laparoscopic procedure by placing a catheter in the fallopian tube and
injecting the egg/sperm mixture.
The last step is to watch for early pregnancy symptoms. Your fertility
specialist will probably use a blood test to determine if pregnancy has
Who should be treated with GIFT?
GIFT is an assisted reproductive procedure that is a possible solution for any
infertility problem except the following:
Significant tubal damage
An anatomic problem with the uterus, such as severe intrauterine
In general, in vitro fertilization (IVF) is preferable for couples with male factor
GIFT is commonly chosen by couples who have failed to conceive after
trying at least one year and who have failed five to six cycles of ovarian
stimulation with intrauterine insemination.
What are the differences between GIFT and in vitro fertilization
GIFT tends to be favored by women who have tried getting pregnant
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through other means but have not been successful, whereas IVF is
preferable for women with more severe infertility concerns.
Since GIFT does not involve embryo culture, patients are able to
pursue additional fertility treatments without having to address ethical
concerns related to the creation or transfer of embryos.
IVF provides the physician with the opportunity to select the best
quality embryos on day 3 or day 5 for transfer. In contrast, GIFT places
unfertilized eggs and sperm in the tubes.
In the GIFT procedure, the transfer of gametes into the tube requires
an extra surgical procedure called laparoscopy.
Using Illegal Drugs DuringPregnancy
When you are pregnant, it is important that you watch what you put into your body. Consumption of illegal drugs is not safe for the unborn baby or for the mother. Studies have shown that consumption of illegal drugs during pregnancy can result in miscarriage, low birth weight, premature labor, placental abruption, fetal death, and even maternal death. The following information can help you understand these drugs and their effects.
Common slang names: pot, weed, grass and reefer What happens when a pregnant woman smokes marijuana?
Marijuana crosses the placenta to your baby. Marijuana, like cigarette smoke, contains toxins that keep your baby from getting the proper supply of oxygen that he or she needs to grow. How can marijuana affect the baby? Studies of marijuana in pregnancy are inconclusive because many women who smoke marijuana also use tobacco and alcohol. Smoking marijuana increases the levels of carbon monoxide and carbon dioxide in the blood, which reduces the oxygen supply to the baby. Smoking marijuana during pregnancy can increase the chance of miscarriage, low birth weight, premature births, developmental delays, and behavioral and learning
What if I smoked marijuana before I knew I was pregnant? According to Dr. Richard S. Abram, author of Will it Hurt the Baby, “occasional use of marijuana during the first trimester is unlikely to cause birth defects.” Once you are aware you are pregnant, you should stop smoking. Doing this will decrease the chance of harming your baby.
Common slang names: bump, toot, C, coke, crack, flake, snow, and candy What happens when a pregnant woman consumes cocaine? Cocaine crosses the placenta and enters your baby’s circulation. The elimination of cocaine is slower in a fetus than in an adult. This means that cocaine remains in the baby’s body much longer than it does in your body. How can cocaine affect my baby? According to the Organization of Teratology Information Services (OTIS), during the early months of pregnancy cocaine exposure may increase the risk of miscarriage. Later in pregnancy, cocaine use can cause placental abruption. Placental abruption can lead to severe bleeding, preterm birth, and fetal death. OTIS also states that the risk of birth defects appears to be greater when the mother has used cocaine frequently during pregnancy. According to the American Congress of Obstetricians and Gynecology (ACOG), women who use cocaine during their pregnancy have a 25 % increased chance of premature labor. Babies born to mothers who use cocaine throughout their pregnancy may also have a smaller head and be growth restricted. Babies who are exposed to cocaine later in pregnancy may be born dependent and suffer from withdrawal symptoms such as tremors, sleeplessness, muscle spasms, and feeding difficulties. Some experts believe that learning difficulties may result as the child gets older. Defects of the genitals, kidneys, and brain are also possible.
What if I consumed cocaine before I knew I was pregnant? There have not been any conclusive studies done on single doses of cocaine during pregnancy. Birth defects and other side effects are usually a result of prolonged use, but because studies are inconclusive, it is best to avoid cocaine altogether. Cocaine is a very addictive drug and experimentation often leads to abuse of the drug.
Common slang names: horse, smack, junk, and H-stuff What happens when a pregnant woman uses heroin? Heroin is a very addictive drug that crosses the placenta to the baby. Because this drug is so addictive, the unborn baby can become dependent on the drug. How can heroin affect my baby? Using heroin during pregnancy increases the chance of premature birth, low birth weight, breathing difficulties, low blood sugar (hypoglycemia), bleeding within the brain (intracranial hemorrhage), and infant death. Babies can also be born addicted to heroin and can suffer from withdrawal symptoms. Withdrawal symptoms include irritability, convulsions, diarrhea, fever, sleep abnormalities, and joint stiffness. Mothers who inject narcotics are more susceptible to HIV , which can be passed to their unborn children. What if I am addicted to heroin and I am pregnant? Treating an addiction to heroin can be complicated, especially when you are pregnant. Your health care provider may prescribe methadone as a form of treatment. It is best that you communicate with your health care provider, so he or she can provide the best treatment for you and your baby. PCP & LSD:
What happens when a pregnant woman takes PCP and LSD? PCP and LSD are hallucinogens. Both PCP and LSD users can behave violently, which may harm the baby if the mother hurts herself. How can PCP and LSD affect my baby? PCP use during pregnancy can lead to low birth weight, poor muscle control, brain damage, and withdrawal syndrome if used frequently. Withdrawal symptoms include lethargy, alternating with tremors. LSD can lead to birth defects if used frequently. What if I experimented with LSD or PCP before I knew I was pregnant? No conclusive studies have been done on one time use effects of these drugs on the fetus. It is best not to experiment if you are trying to get pregnant or think you might be pregnant.
Common slang names: meth, speed, crystal, glass, and crank What happens when a pregnant woman takes methamphetamine? Methamphetamine is chemically related to amphetamine, which causes the heart rate of the mother and baby to increase. How can methamphetamine affect my baby: Taking methamphetamine during pregnancy can result in problems similar to those seen with the use of cocaine in pregnancy. The use of speed can cause the baby to get less oxygen, which can lead to low birth weight. Methamphetamine can also increase the likelihood of premature labor, miscarriage, and placental abruption. Babies can be born addicted to methamphetamine and suffer withdrawal symptoms that include tremors, sleeplessness, muscle spasms, and feeding difficulties. Some experts believe that learning difficulties may result as the child gets older.
What if I experimented with methamphetamine before I knew I was pregnant? There have not been any significant studies done on the effect of one time use of methamphetamine during pregnancy. It is best not to experiment if you are trying to get pregnant or think you might be pregnant. What does the law say?
Currently there are no states that holds prenatal substance abuse as a criminal act of child abuse and neglect. But many have expanded their civil child-welfare requirements to include substance abuse during pregnancy as grounds for terminating parental rights in relation to child abuse and neglect.
The laws that address prenatal substance abuse are as follows:
Iowa, Minnesota, and North Dakota’s health care providers are required to test for and report prenatal drug exposure. Kentucky health
care providers are only required to test. Alaska, Arizona, Illinois, Louisiana, Massachusetts, Michigan, Montana, Oklahoma, Utah, Rhode Island and Virginia’s, health care providers are required to report prenatal drug exposure. Reporting and testing can be evidence used in child welfare proceedings. Some states consider prenatal substance abuse as part of their child welfare laws. Therefore prenatal drug exposure can provide grounds for terminating parental rights because of child abuse or neglect. These states include: Arkansas, Colorado, Florida, Illinois, Indiana, Iowa, Louisiana, Minnesota, Nevada, Rhode Island, South Carolina, South Dakota, Texas, Virginia, and Wisconsin. Some states have policies that enforce admission to an inpatient treatment program for pregnant women who use drugs. These states include: Minnesota, South Dakota, and Wisconsin. In 2004, Texas made it a felony to smoke marijuana while pregnant, resulting in a prison sentence of 2-20 years.
How can I get help?
You can get help from counseling, support groups, and treatment programs. Popular groups include the 12 step program. Numbers that can help you locate a treatment center include:
National Drug Help Hotline 1-800-662-4357 National Alcohol and Drug Dependence Hopeline 1-800-622-2255
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The Home Birth of Archer Lux Guimbellot
March 11, 2014
From the moment I learned I was pregnant I knew I wanted a home birth. I hate hospitals and being around people when I’m not feeling well, so I couldn’t imagine trying to accomplish a natural birth in the presence of strangers and with the pressures of intervention.
As soon as we met with Nanci for our consultation we knew she was the one. Her experience, confidence and calm demeanor were the qualities I was looking for in a midwife. She was always quick to answer my first-time-mom questions and reassuring of my concerns.
My husband was well prepared to coach me and Nanci was excellent in supporting us both throughout the labor. Knowing I had two experienced professionals caring for my baby and me allowed me to be completely present and give birth with intention.
Labor pains began around 7 am and by 4pm things were serious. Contractions got closer together and more intense. I got into the birthing pool and was really able to relax between contractions. I pushed a few times but did not feel comfortable enough to continue in the water. We moved into the bedroom where I laid on the bed and, hands behind my knees, I continued pushing. About 20 minutes later he crowned. Nanci took my hand and placed it on his head. It was a huge encouragement to feel that progress! Another few pushes and his head was out. Another push and his whole body shot right out! Josh and Nanci caught him and placed him on my chest. He was tiny and purple and mad. He was perfect. He weighed 7 pounds and 1 ounce, was 20.5 inches long. Josh cut the umbilical cord and we were a family.
I write this summary of my experience. No one’s story is the same. Some women have pleasant memories of giving birth. Some women do not. I am of the latter. For me, this was a traumatic experience. I had no complications, no real issues, but it was inexplicably difficult. It was painful. I’d read birth stories, natural birth books, watched home births…nothing could have prepared me for the intensity of the birth of my son. It is something I could not think on for some time after. It is also something I would never take back.
Thank you, Nanci, for helping us to introduce our sweet baby into the world. Our lives are forever changed.
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Trying to Conceive after Age 35
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Many women today find themselves trying to conceive after the age of 35. This opportunity can be full of joys and riddled with new questions. Despite the challenges, many women in their thirties and forties successfully conceive.
What are some of the challenges when trying to conceiving after age 35?
The most common cause of age-related decline in fertility is less frequent ovulation. As women age, they begin to have occasional cycles where an egg is never released. Egg quality and quantity also declines in a woman’s 30s and 40s. Other reasons conceiving after 35 may be more difficult include:
- Infection or surgery that caused scar tissue around the fallopian tubes or cervix
- Fibroids or uterine disorders
- Decrease in cervical fluid
- Chronic health problems such as high blood pressure or diabetes
Miscarriage is also more common in women over 35. This is often caused by increased incidence of chromosomal abnormalities. Women aged 35-45 have a 20-35% chance of miscarriage.
How can I increase my chances when trying to conceive after 35?
Trying to conceive after 35 may seem overwhelming, but there are many things you can do to make getting pregnant easier. Here are some things to remember:
- Schedule a pre-conception appointment. You and your health care provider can review your medical history, current medications and overall lifestyle. This gives you the opportunity to address any concerns about trying to conceive after age 35.
- Women over age 35 take longer to conceive. The average time it takes a couple over 35 to conceive is 1-2 years, so try to remain positive if you do not become pregnant immediately.
- A woman who is physically, mentally and emotionally healthy is more likely to conceive. Alcohol, smoking and caffeine can negatively affect fertility. Being overweight or underweight can also affect fertility by interfering with hormone function.
- Observing your fertility signs can tell you a lot about your body. Recording your basal body temperature and cervical fluid can help you pinpoint the best time to have intercourse while trying to conceive. These fertility signs can also reveal if you are ovulating regularly. Becoming familiar with your fertility will also help you discern between pending signs and symptoms of pregnancy.
- Consider taking an at home fertility screening test.. There are over-the-counter tests that help screen for key elements either male or female fertility. This often gives couples a peace of mind as they move through the journey to conceive.
- Visit your health care provider if you haven’t conceived after 6 months of purposeful intercourse. If you have not conceived after 6 months, contact your health care provider to discuss the possibility of fertility testing. You may decide to consult a fertility specialist at this time.
Preconception Health for Women
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Pregnancy should not be considered only a 9 month journey but as a year long journey. Knowing that the first few weeks of pregnancy are the most vital to the development of the baby, a mother should be healthy and avoid any harmful activities and substances near the time of conception. Some habits are harder to break, and some health issues take longer to address. Preconception health for women will be beneficial to you and your baby. Following these simple guidelines can help you prepare for pregnancy.
Before you become pregnant you want to make sure that you cut out any habits that are harmful for your baby. These habits include:
Smoking – Smoking during pregnancy is estimated to account for 20 to 30 percent of low-birth weight babies, up to 14 percent of preterm deliveries, and about 10 percent of all infant deaths according to the American Lung Association.
Drinking Alcohol – There is no safe amount of alcohol to consume while you are pregnant.
Recreational drug use – For example, smoking marijuana during pregnancy can increase the chance of miscarriage, low birth-weight, premature births, developmental delays, and behavioral and learning problems.
Prescription drugs – There are many prescription drugs that are teratogenic (cause birth defects). Talk with your healthcare provider about any and all prescription drugs you are taking.
Hazardous chemicals – There are some chemicals that can also be teratogenic. For example, most studies show that the greatest risk of exposure to pesticides is during the first three to eight weeks of the first trimester when the neural tube development is occurring. This is often before a woman knows she is pregnant.
Stress – Stress has been linked to delayed or missed periods which can cause difficulty tracking ovulation and getting pregnant. Limit your amount of stress as much as possible. You may find it helpful to employ relaxation techniques or yoga to help calm things down.
Herbs – Most herbs and herbal remedies are not mandated by the FDA, and therefore, there is little to no research on the effect they have on pregnancy. Discuss any herbs with your healthcare provider.
Caffeine – Some studies have shown a link between high levels of caffeine consumption and delayed conception. A few studies have shown that there may be an increase in miscarriages among women who consume more than 200 mg (one 12oz cup of coffee) a day versus those who do not consume any caffeine.
You should replace these old habits with new healthy habits. These healthy habits include:
- Exercise – Start exercising now. Set goals for what you want to achieve. Ask yourself if you want to lose weight, gain weight, build muscle, or improve lung capacity. Some good exercise options include walking, swimming, bicycling, and aerobics. Yoga is an excellent choice for exercise because it incorporates posture, breathing, and concentration which will be beneficial for you during labor. Talk with your healthcare provider about what is best for you.
- Read – Read books on pregnancy and child birth. It is important that you are educated and prepared.
- Track your menstrual cycle – This is very important. Your doctor will ask you about your menstrual cycle, so you need to be prepared. Keeping track of your cycle will also help you track your ovulation and increase your chance of pregnancy.
- Practice relaxation techniques – Relaxation can help minimize stress, and as you have already read, stress is not a woman’s best friend. Try Yoga or listening to soft relaxing music in a warm bath.
- Get lots of sleep – If you are not receiving 8 hours of sleep a night, you should start. Adequate amounts of sleep can also help relieve stress and tension.
- Eat healthy – Nutrition is vital to your health. The healthier you are the easier the pregnancy will be for you. You might start on some supplements to make sure you are getting all the nutrients you need. Just make sure to tell your health care provider about any supplements you are taking.
You are what you eat, and so is your baby. Make sure that you are getting lots of vitamins in your diet, and start taking folic acid now. Studies have shown that folic acid (300-400mcg a day) can help reduce the risk of neural tube defects when taken before conception.
For more information on the suggested amount of vitamins to consume during pregnancy (which is the same for preconception) look at our chart on Essential Nutrients & Vitamins.
Maintain an ideal weight
Your weight can play a significant role during conception and pregnancy. When planning to conceive you want to avoid being over or under weight.
Underweight (10% below normal range)
- Exercise to build muscle
- Increase energy intake
- Eat at least three meals a day
- Eat more food at each meal
- Eat more snacks
- Drink juices and milk
Overweight (20% above normal range)
- Choose a realistic eating plan
- Make sure your eating plan includes nutritional adequacy
- Drink adequate amounts of water
- Combine your eating plan with exercise
Discuss any plans for weight loss or gain with your healthcare provider.
Make an appointment with your Midwife or Doctor
It is important that you see your healthcare provider before you become pregnant. There are medical conditions that you may not be aware of that can affect your pregnancy. Some of the most common conditions include:
- Diabetes – If you are diabetic you should get your diabetes under control. Pregnancy increases the chances of diabetes, and it can make it hard for a mother who is already suffering from diabetes.
- High blood pressure – If you have high blood pressure before pregnancy, you must closely monitor your blood pressure during pregnancy.
- Anemia – A complete blood count (CBC) can measure your hemoglobin, red & white blood cell count, and the appearance of your platelets. Anemia can cause weakness and fatigue during pregnancy.
- Thyroid problems – The test to check for thryoid issues consists of a blood test which measures your thyroid-stimulating hormone (TSH). Hyperthyroidism (overactive) can lead to premature birth and low birth weight if left untreated. Hypothyroidism (underactive) can lead to infertility or miscarriage when left untreated.
- STDs – It is best to know if you have an STD before getting pregnant, since some STD’s can cause pregnancy compliations. For example, ectopic pregnancy is a risk for a woman who has chlamydia. If chlamydia is left untreated, it can also lead to Pelvic Inflammatory Disease (PID) which can cause infertility.
Other testing and screening that is common during a preconception health check up are:
- Pap Smear – A pap smear can check for cervical dysplasia.
- Breast exam – If over the age of 35, you may receive a mammogram.
- Blood type – If you are RH negative you will have to be desensitized prior to labor.
- Immunity to Rubella (measles) – The March of Dimes recommends that all women be tested for immunity to rubella before they become pregnant and that they consider being vaccinated at that time if they are not immune. The Centers for Disease Control and Prevention (CDC) recommends that a woman wait at least 4 weeks after receiving the vaccination before trying to conceive.
- Immunity to Varicella (chicken pox) – As with rubella it is recommended that all women be tested for immunity to varicella before they become pregnant and that they consider being vaccinated at that time if they are not immune. The CDC recommends that a woman wait at least 4 weeks before trying to conceive after receiving the vaccination.
At your appointment you will also be asked for your medical and family history.
Medical history may include:
- Medications you take
- Past pregnancies
- Medical conditions
Family history may include:
- High blood pressure
- Seizure disorders
- Mental retardation
Some couples may also need to seek Genetic Counseling. For the majority of couples, genetic counseling is not necessary .