Fertility & Reproductive Endocrinology Basics

Fertility is a complex subject, and for those facing challenges in family building, understanding some of the basic concepts can make the process less overwhelming. At Boston IVF, reproductive endocrinologists work with patients from all walks of life, offering a range of treatments to address fertility issues and support diverse family-building journeys. Below, we explore some key topics related to fertility, reproductive endocrinology, and family building based on insights from Boston IVF experts Drs. Nina Resetkova, Sandy Li, Denis Vaughan, Kristen Wright, and Rita Sneeringer.

Causes of Infertility
Infertility is often misunderstood as being equally divided between male and female causes, but the reality is more nuanced. Female factors account for at least 50% of infertility cases, with issues like ovulation dysfunction, tubal blockages, or uterine factors (such as fibroids) being common causes. Male infertility accounts for 30-50%, and subtle factors on both sides can compound the difficulty in conception. For many couples, it is a combination of both male and female factors that leads to infertility​.

The Role of Ovarian Reserve
One of the key factors in female fertility is ovarian reserve, which refers to the quantity (but not necessarily the quality) of eggs left in the ovaries. This reserve naturally declines with age, with a significant drop-off in fertility rates in the late 30s and early 40s. Several factors, including genetics, medical interventions, and environmental exposures, can affect ovarian reserve​. Testing for ovarian reserve can help guide fertility treatment decisions, but it is important to remember that even individuals with diminished ovarian reserve can still conceive​.

Understanding Embryo Development
After fertilization, embryos go through several stages before implantation. By Day 3, embryos typically reach the cleavage stage, with around 6-8 cells. By Day 5-7, they develop into blastocysts, which have more than 100 cells and consist of two distinct cell groups: the trophectoderm, which will become the placenta, and the inner cell mass, which develops into the baby. This process is monitored closely during IVF to ensure that the highest-quality embryos are selected for transfer.

Treatment Options for LGBTQ+ Couples
Boston IVF is proud to support LGBTQ+ individuals and couples in their family-building journeys. For lesbian couples, options like intrauterine insemination (IUI) with donor sperm or reciprocal IVF, where one partner donates eggs and the other carries the pregnancy, are available. For gay male couples, family building often involves an egg donor and a gestational carrier (surrogate). Transgender and non-binary individuals also have a range of fertility preservation and family-building options, including sperm or egg freezing before gender-affirming treatments.

Genetic Carrier Screening
Before pursuing fertility treatments, genetic carrier screening is recommended for all individuals, ideally before pregnancy. This screening identifies whether either partner carries genetic conditions that could be passed on to their children. Depending on the results, couples can choose from several options, including natural conception with prenatal testing, IVF with preimplantation genetic testing (PGT) to screen embryos before transfer, or using donor eggs or sperm to avoid passing on specific genetic conditions​.

Fertility Preservation
For individuals facing medical treatments like chemotherapy, which can affect fertility, or those wishing to delay childbearing, fertility preservation through egg, sperm, or embryo freezing is an effective option. Fertility preservation allows patients to store their eggs or sperm before undergoing treatments that could reduce their fertility in the future​.

Conclusion
Fertility and family-building journeys are deeply personal, and the path forward depends on each individual’s unique circumstances. Whether you are exploring IVF, fertility preservation, or LGBTQ+ family-building options, the specialists at Boston IVF are here to help. With advanced technologies and a compassionate, personalized approach, Boston IVF supports a wide range of patients in achieving their dreams of building a family.