The Fertility Guide: A Couples Handbook for When You Want to Have a Baby (More Than Anything Else)

November 7, 2011

By John C. Jarrett, M.D. and Deidra T. Rausch, Ph.D.

Infertility is a term that strikes fear in the hearts of every couple who worries it may, or learns it does, apply to them. 10-15% of all couples hear this diagnosis and must begin the frustrating and sometimes arduous journey of receiving medical help and undergoing treatment to achieve what should be one of life's most basic and simple accomplishments having a baby.

But for these couples, there is hope and the news is getting better all the time. In the last ten years our understanding of human conception, and our ability to assist couples who have difficulty conceiving, has grown exponentially. Not only can the vast majority of couples with infertility now conceive, but they can do so with less testing and fewer invasive procedures than previously. The treatment of infertility can be less expensive, take less time, and be tremendously more successful than ever before.

Table of Contents

part one: Understanding the Emotional Aspects of Infertility
Chapter 1: Navigating the Emotional Journey
Denial - Anger - Why Me?- Blame and Guilt - Isolation - Maintaining Relationship Cohesion - Intimacy - Grief - Depression - Resolution

Chapter 2: Evaluating the Alternatives
Adoption - Donor Gametes - Child Free Living - Single Child Parenting

Chapter 3: Pregnancy after Infertility

Part two: Understanding the Medical Aspects of Infertility: The Physical "Nuts and Bolts"
chapter 4: Nature's Way
The Male and the Sperm - The Female and the Eggs - Female Anatomy - Timing is Everything - When Should We Worry?

chapter 5: Getting Started
Evaluating the Male - Semen Analysis - Other Tests - Evaluating the Female : Prolactin Level, Chlamydia Titer, and TSH - Ovulation - The Post-Coital Test - Evaluating the Fallopian Tubes - Laparoscopy

chapter 6: Chances Are
Age and Duration of Attempts - Medical Considerations - Work Stress Levels - Geography - Cost - Deciding on a Treatment - Reaching Resolution

chapter 7: The Male
Semen Analysis - Obtaining and Delivering the Sample - Interpreting Semen Reports - Other Tests of Sperm Function - Causes of Abnormal Sperm Counts - Treatment Options for Sperm - Problems - Schedule Wisely - Urologist Evaluation - Medical Therapies - The Male Algorithm - Post-Coital Test - Alternatives

chapter 8: The Female
Overview: Tubo-Peritoneal Evaluation - Causes of Tubal Problems: Scar Tissue, Infections - Methods of Evaluating Tubal Problems - Chlamydia Antibody Titer - Hysterosalpingogram - Usefulness of HSGs -
Proximal Tube Disease - Laparoscopy - Uses of Laparoscopy - Evaluating Degrees of Tubal Damage and Assessing Treatments - Tubal Ligation - Office Laparoscopy - Saline Infusion Sono-Hysterography

chapter 9: Endometriosis
Overview - Diagnosing Endometriosis - Medical Therapies - Pseudo-Pregnancy - Pseudo-Menopause - Suppressing Ovary Function - Suppressing Pituitary Production - Precautions in Using Suppressive Therapy - Surgical Treatments - Scarring and Associated Pain - Laparoscopy - Lasers - Infertility

chapter 10: Female Cervix and Uterus
Overview: the Cervix - Evaluation: The Post-Coital Test - Causes of Cervical Mucus Problems - Treatment of Cervical Problems - Overview: the Uterus - Anatomic Problems of the Uterus - Anomalies: Fibroids, Polyps, Scarring - Treatment of Uterine Problems - Functional Uterine Problems - Luteal Phase Defect - Thin Endometrium - Integrins

chapter 11: The Female and Ovulation
Functioning of the Ovaries - The Ovarian Cycle: Follicular Phase, Luteal Phase - Ovarian Reserves - Personal Strategies to Strengthen Ovarian Function - Evaluation of Ovarian Function - Basal Body Temperatures (BBTs) - Progesterone Levels - Endometrial Biopsy - Pelvic Ultrasounds - Measuring a Day - Three FSH - Clomiphene Citrate Challenge Test - TSH Levels - Treating Ovulation Disorders - Clomiphene Citrate - Side Effects of Clomiphene - Progesterone - hCG - The Gonadotropins: Pergonal, Metrodin, Humegon, Fertinex, Follistim and Gonal-F - Monitoring Gonadotropins - Risk Factors of Gonadotropins - GnRH Agonists - Parodel and Dostinex - Luteal Phase Insufficiency - Hyperstimulation - Polycystic Ovaries

chapter 12: Unexplained Infertility
Overview - Diagnosis - Treatment - Hysterosalpingogram - Clomiphene - Gonadotropins

chapter 13: The ART Procedures
Inducing Ovulation - Retrieving the Eggs - Art Procedures: IVF, GIFT, ZIFT, ICSI - Cryopreservation of Eggs - Success Rates - A Summary and Perspective

chapter 14: Donor Gametes
Donor Sperm - Donor Inseminations - Donor Eggs

Chapter 15: Pregnancy Loss
Early Pregnancy Monitoring - Early Obstetrical Ultrasound - Miscarriage - Causes of Recurrent Pregnancy Loss: Genetic, Abnormalities, Auto Immune Disorders, Alloimmune Disorders - Evaluating Recurrent Pregnancy Loss - Ectopic Pregnancy

Chapter 16: The Future

Part Three: Monitoring your Course
Male Evaluation - One-Month Basal Body Temperature Record - Female Evaluation - Ovulation Induction Attempts - Art Procedures

"The Fertility Guide is written clearly and concisely. It offers couples an easy guide for the complicated road that infertility presents. Drs. Rausch and Jarrett present a realistic picture of what is involved in infertility treatment as well as the feelings that accompany the diagnosis and procedures. The Fertility Guide is a good companion to accompany any couple on their journey to achieve a pregnancy."

Andrea Mechanick Braverman, Ph.D.
Director of Psychological Services
Pennsylvania Reproductive Associates

"This Guide provides a concise, sensible, appropriately scientific, but yet easily understood approach to modern fertility diagnosis and treatment. Dr. Jarrett and Dr. Rausch have translated their vast and highly successful clinical experience into a "must" for the couple who "want to have a baby more than anything else." The most important contribution of this book is that it translates the "high tech" into common sense and fills an important void in the specialty."