Author: Stephan Krotz

Covid-19 Vaccine Article Image

When can I get the Covid-19 Vaccine?

The approval of the Pfizer and Moderna vaccines has been a major step forward in fighting Coronavirus.  Now the main question seems to be:

When will I be able to get the vaccine? 

Even though it may seem that creating an order or line to get the vaccine is not completely fair, there are a lot more people and professions included in the initial groups than you might have initially thought.  The Advisory Committee on Immunization Practice (ACIP) developed this system of vaccine allocation to maximize benefits and minimize harms, promote justice, and lessen health inequities present in society.  In other words, they are trying to make it as fair and helpful to society as possible.

Initially, on December 1, the Advisory Committee on Immunization Practices (ACIP) recommended that 1) health care personnel and 2) residents of long-term care facilities be offered COVID-19 vaccination first as part of Phase 1a of the vaccination program

On December 20, 2020, ACIP recommended, as indicated on the CDC website, that in:

-In Phase 1b, the vaccine should be offered to persons aged ≥75 years and frontline essential workers (non–health care workers) which includes 49 Million people.

-Frontline essential workers are at the highest risk for work-related exposure to SARS-CoV-2, the virus that causes COVID-19, because their work-related duties must be performed on-site and involve being in close proximity (<6 feet) to the public or to coworkers.><6 feet) to the public or to their coworkers.

-The ACIP defines frontline essential workers as First responders (e.g., firefighters and police officers), corrections officers, food and agricultural workers, U.S. Postal Service workers, manufacturing workers, grocery store workers, public transit workers, and those who work in the education sector (teachers and support staff members) as well as child care workers.

In Phase 1c:

Persons aged 65–74 years, persons aged 16–64 years with medical conditions that increase the risk for severe Covid-19, and essential workers not recommended for vaccination in Phase 1a or 1b should be offered the vaccine.  The Phase 1c group includes 129 Million people.

-The risk for COVID-19–associated hospitalization increases with the number of high-risk medical conditions, from 2.5 times the risk for hospitalization for persons with one condition to 5 times the risk for those with three or more conditions.

-Essential worker sectors recommended for vaccination in Phase 1c include those in transportation and logistics, water and wastewater, food service, shelter and housing (e.g., construction), finance (e.g., bank tellers), information technology and communications, energy, legal, media, public safety (e.g., engineers), and public health workers.

Phase 2 will include:

Everyone that is 16 years of age or older who has not already received the vaccine or who does not fall into one of the groups mentioned in Phase 1A, 1B, or 1C.  There are still ongoing trials for children and adolescents to determine when they will be able to receive the vaccine.

For further information you may refer to:

“The Advisory Committee on Immunization Practices’ Updated Interim Recommendation for Allocation of COVID-19 Vaccine — United States, December 2020”

How Can a Same Sex Female Couple Have a Baby? The Ultimate Guide

Getting married and having children is something many of us look forward to from the time we ourselves are children. We play with baby dolls and cuddle relatives’ babies, dreaming of the day we can have our own. But if you are in a same-sex female relationship, you may find yourself asking the question, “How can a same-sex female couple have a baby?”

Thanks to the miracle of modern medicine, lesbian couples can now not only adopt children but give birth to their own. Read on to learn more about the different options available for lesbian couples looking to become parents.

Pregnancy vs. Adoption

Before we dive into the different ways lesbian couples can have a baby, let’s talk a little about the pregnancy vs. adoption question. Adoption is an obvious solution for same-sex couples looking to have a baby and in many cases, adoption is a win-win situation; the couple gets to raise a child, and a child who needed a good home and parents gets an amazing family.

Most couples however will want to have a baby that is genetically their own or want the experience of pregnancy and delivery. In these cases, it is possible for same-sex female couples to have a baby that is related to one of the partners.  As we will discuss more later, it may someday be possible for same-sex couples to have a baby that is genetically both of theirs.

Selecting a Sperm Donor

Most of the options for same-sex female couples to have a baby involve intrauterine insemination using a sperm donor.  During this process, couples will select a sperm donor from a donor sperm bank with the assistance of a fertility clinic.  Once the donor sperm is selected, the sperm will be sent to the fertility clinic.  The sperm donor, usually anonymous, will serve as your baby’s biological father.

You can also ask for a sperm donation from close friends if you feel comfortable doing so although involving someone you know is not as easy as it may at first seem.  Some same-sex male couples are even interested in serving as sperm donors in a co-parenting situation, which we’ll discuss later.

Donor Intrauterine Insemination

Donor intrauterine insemination happens in a fertility clinic under the direction of the physician. Be sure to talk to your doctor about what you can do before the appointment to give things the best chance to go right.  These procedures often involve taking medication such as Clomid to stimulate your ovaries and involve close monitoring by your doctor.  When your doctor determines that you are ready, the intrauterine insemination will be performed which is relatively painless.  In this procedure, a catheter is inserted through your cervix and the donor sperm gets injected directly into your uterus. This increases the chance of your becoming pregnant (compared to normal intercourse), especially since it bypasses the issue of poor cervical mucus.

In Vitro Fertilization 

In vitro fertilization is one of the most popular options for same-sex couples looking to have a baby. This process is more involved and costly than intrauterine insemination with donor insemination. However, it can triple your chance of becoming pregnant and lessen the risk of twin or triplet pregnancies which is safer for your health.

During in vitro fertilization, a doctor will harvest eggs directly from your ovaries after giving you fertility medication to promote egg development. They will then inject sperm directly into the eggs or will allow them to interact and fertilize in a lab. These embryos will be incubated for 5 days and then frozen for transfer back to your uterus in the following 6-8 weeks.  The freezing process results in higher pregnancy rates and allows your embryos to be genetically tested, if you desire, prior to returning them to your uterus.

Reciprocal IVF and Surrogacy

Some same-sex couples opt to use a procedure called reciprocal IVF to have a baby. Rather than one partner donating the eggs and carrying the baby, one partner will donate the eggs which will be implanted into the other partner’s uterus. This is a good option for couples who want both parents involved in the pregnancy and birth process.

In some cases, same-sex couples may also choose to have a surrogate carry their baby. This is most commonly done when one or both partners have problems with their uterus or if it not safe for either of them to become pregnant due to medical reasons.  The donated egg from one partner may be implanted into another person who will carry the baby for them. However, this process can be very costly and can have some tricky legal ramifications, so it requires some careful forethought.

Co-Parenting

In some cases, same-sex female couples may choose to arrange a co-parenting situation with a same-sex male couple. Both couples want children and cannot have them through traditional methods, so they team up and form a close-knit parenting team.

In a co-parenting situation, one of the partners from the same-sex male couple provides the sperm donation for the artificial insemination procedure. One of the partners in the same-sex female couple carries the baby and gives birth.  All four parents then work together to raise the child.

Co-parenting can be an amazing option for those who want their child to know their biological father, but it can be complicated from a legal and practical standpoint. If you and your partner plan to go this route, you will need to have extended discussions with your co-parents about how you will handle everything from living situations and custody to schooling, discipline, and finances.

Transgender Partners

If one partner in a same-sex female couple is a transgender woman, you may be able to have a child that is genetically connected to both of you. If that partner is pre-transition, their body will still be producing sperm. Depending on their medical situation, that sperm may be healthy enough to fertilize the other partner’s egg or frozen for later use during intrauterine insemination (IUI) or In Vitro Fertilization (IVF) treatment cycles.  In this situation, you have more options for conceiving. You will need to consult with a doctor to figure out what the best option is for you and your partner.

Adoption 

Of course, adoption can always be a wonderful option for same-sex female couples interested in having a baby. At any given time, there are more than 125,000 children in the foster care system who are eligible for adoption. You can give these children a loving home with your partner.

If you decide to adopt, be aware that you may fight some lingering bias against same-sex couples in the system. Some social workers may want to make extra demands or try to give you only “problem” children. Know your rights and be prepared to stand up for them during the adoption process – you have just as much right to adopt as anyone else.

Ongoing Research

There is some ongoing research that may one day make it possible for same-sex couples to have a child that is biologically connected to both of them. In 2018, a scientist at the University of Cambridge announced that their lab had a mouse pup that was born to two fathers. It may be possible to use stem cells from one parent to create a sperm with a woman’s DNA in it.

This research is ongoing, and it will be a long time before this procedure is medically approved for human use. Mice are much less complex than humans, and a lot more experimentation will be necessary. But someday, same-sex couples may be able to have a baby that is biologically both of their children.

Deciding on the Best Method for You

There is no one right answer to what the right way to have a baby is. Which method you choose will depend on your and your partner’s wishes and on each of your medical situations. There are a lot of factors that will impact your decision.

Start by sitting down and having a conversation with your partner about what you both want from your parenting experience. Discuss your financial resources and what you know of your reproductive health, then make an appointment with your doctor to discuss the best medical options for both of you.

Answer, “How Can a Same-Sex Female Couple Have a Baby?” 

There are many right answers to the question, “How can a same-sex female couple have a baby?” From intrauterine insemination to adoption to co-parenting, you have a lot of options available to you. Which one you choose will be a personal discussion you and your partner will need to have.

If you’d like to get started on your parenthood journey, check out the rest of our site at Inovi Fertility and Genetics Institute. We’re committed to achieving the highest success rates while providing personalized care to our patients. Schedule an appointment today and take the first step in your journey towards becoming

Intracytoplasmic Sperm Injection Procedure

What is Intracytoplasmic Sperm Injection (ICSI)?

Getting pregnant can be more challenging than it seems, with recent studies suggesting that about 1 in every 7 couples have difficulty conceiving.

Before a sperm can fertilize an egg, the head of the sperm has to attach to the outer layer of the egg. It then pushes through the outer layer into the cytoplasm of the egg and moves towards its center (nucleus) where fertilization takes place. However, sometimes the sperm may fail to penetrate the egg’s outer layer for several reasons discussed below.

But there’s still hope for couples with who have trouble conceiving naturally or with intrauterine insemination  – intracytoplasmic sperm injection (ICSI). This medical procedure involves the direct injection of a sperm cell into an egg outside the woman’s body.

Read on to learn more about the ICSI procedure.

Why is ICSI Performed?

There are several reasons for ICFI, including:

Low Sperm Count

Also known as oligospermia, low sperm count means that the semen ejaculated during intercourse contains fewer sperm cells than normal. When the semen contains zero sperm cells, the condition is known as azoospermia.

There a range of causes of low sperm count such as:

  • Depression
  • Excessive alcohol and drug use
  • Infections
  • Varicocele
  • Ejaculation problems
  • Hormone imbalances
  • Undescended testicles
  • Overheating of the testicles

If a man’s sperm count is less than 15 million sperms per milliliter of semen, it’s considered lower than average.

Low sperm counts significantly reduce the chances of a sperm cell fertilizing the egg and therefore lessens the chance of pregnancy. Fortunately, during ICSI sperm is directly injected into the eggs, increasing the odds of fertilization and pregnancy.

Abnormal Sperm Morphology

Sperm morphology is the shape and size of the sperm, and it’s one of the top factors used to evaluate fertility in men. Healthy sperm have oval heads with long tails. Abnormally shaped sperms have head and/or tail defects that reduce their effectiveness.

For example, a sperm cell may have a double or crooked tail or a misshapen head. These morphological defects affect the sperm’s ability to reach, penetrate, and fertilize the egg.

Low Sperm Motility

Sperm motility is the ability of sperm to swim efficiently to the egg. Good motility is a crucial factor in the fertilization process.

There are two main types of sperm motility – progressive motility and non-progressive motility.

Progressive motility means that the sperms are mostly moving in a straight line or large circles.

Non-progressive sperm motility, on the other hand, means that the sperm don’t swim in a straight line. For sperm to swim through the woman’s reproductive tract and fertilize the egg, it needs to have progressive motility of at least 25 micrometers per second.

Men whose semen analysis demonstrates a lot of non-progressively motile sperm have asthenozoospermia, the inability of the sperm to swim efficiently to the egg.

Unsuccessful IVF Procedures

In Vitro Fertilization (IVF) is an egg fertilization process where the egg is incubated with many sperm cells outside the woman’s body to allow fertilization to occur.

If a couple has had standard IVF procedures before and none of the eggs were fertilized, ICSI may be a viable option for them.  ICSI is a procedure that is added to the IVF procedure so that sperm are injected into the eggs instead of just being placed next to the eggs.

Vasectomy Reversal Failure

For men who previously had a vasectomy but later changed their mind, vasectomy reversal is a cost-effective option to regain fertility. This procedure reconnects the vas deferens, tubes that carry sperm from the testicles to the man’s prostate where they enter the semen.

After the procedure, a man can get his partner pregnant. However, pregnancy rates after vasectomy reversal can be as low as 30 percent. If a couple is unable to get pregnant after a vasectomy reversal, surgically collected sperm (testicular or epididymal) can be harvested and directly injected into the egg for fertilization.

Blocked Tubes

Apart from a failed vasectomy reversal, the surgical collection of sperm may be necessary if there’s a blockage that prevents sperm from reaching the semen. This can be due to injury, disease, a genetic disorder (e.g. Cystic Fibrosis), or even an extremely low sperm count.

How is ICSI performed?

An intracytoplasmic injection is when the sperm gets injected into the cytoplasm of a mature egg with a tiny needle known as a micropipette. This helps eliminate the need for the sperm to penetrate the egg’s outer layer. ICSI is done as part of the IVF cycle.

Once fertilization takes place, the fertilized egg (embryo) grows in the IVF laboratory for about five days.  It can be transferred into the woman’s uterus at that time or a later date if genetic tests are to be performed.

The ICSI technique was first used on human eggs in 1988. It was mostly used for cases where the standard IVF procedures failed. However, it was until 1992 when the first ICSI pregnancies succeeded.

ICSI’s capacity to permit almost all types of sperms to fertilize the egg has made it one of the most reliable treatments for male infertility.

How is the Egg Retrieved for ICSI?

The egg retrieval is a surgical procedure done under sedation. The ovarian follicles are aspirated using a tiny needle with the help of transvaginal ultrasonography.

A trained embryologist will scan the follicular fluids to find the best available eggs. The retrieved eggs are then stored and cultured in a specific IVF media in the lab until fertilization.

How is Sperm Retrieved for ICSI?

For men with low sperm motility and/or low sperm count, the collection of sperm cells can occur through normal ejaculation.

For cases where vasectomy reversal fails, needle aspiration or surgical sperm retrieval is an excellent alternative to surgery. This process allows physicians to get an adequate amount of sperm for the ICSI procedure, using a tiny needle that extracts sperm from the testicles. It’s performed under sedation with little to no discomfort.

ICSI vs. IVF vs. IUI: What’s the Difference?

ICSI is usually confused with IVF and IUI. However, these procedures are all different.

IUI (Intrauterine Insemination) is a procedure where sperm from the man is “washed” so that only the best sperm cells remain. The “good” sperm then gets inserted into the uterus through the cervix with a catheter. This procedure is suitable for men with slightly low sperm counts or motility since the sperm doesn’t have to travel far to reach the egg. It’s also the least invasive of the three options.

In IVF (In Vitro Fertilization), the eggs are taken out of the woman’s body and are placed with motile sperm.  Fertilization of the egg occurs naturally but in order to increase the odds of fertilization, a large amount of healthy sperm is required.  Hence, this may not be the right choice for men with low sperm count.  After fertilization, the fertilized egg (embryo) will be transferred into the woman’s uterus.

What is the Success Rate for ICSI?

The use of ICSI as a solution to male infertility in the U.S. has increased significantly since its inception.

In 2016, IVF with ICSI comprised more than 66 percent of all assisted reproductive technology procedures.  The ICSI procedure fertilizes a higher percentage of eggs than IVF alone.  This can result in more embryos and increase a couple’s chance of conceiving by giving them more embryos to transfer, although many factors are involved in determining clinical pregnancy rates.

What are some of the Risks of ICSI IVF?

While the fertilization rates of IVF with ICSI may be high, not all fertilized eggs develop into healthy embryos. Factors such as the woman’s age, egg and sperm quality, and condition of the eggs all affect pregnancy rates.  Birth defects associated with ICSI specifically are rare with a 1 percent chance of occurrence. Some of the defects that can occur with ICSI IVF include sex chromosome abnormalities, hypospadias, Angelman syndrome,  and Beckwith-Wiedemann syndrome, and can be associated with the fact that male partner has fertility issues.  For example, a male child conceived through ICSI may have the same infertility complications as their fathers. Compared to natural fertilization, there’s also a slight risk that ICSI may allow unhealthy sperm to fertilize the egg, potentially leading to a defective embryo that fails to develop.

Keep in mind that even with regular fertilization, there’s a 3-4 percent chance of birth defects which is similar to the general population that does not have fertility issues.

Another risk of IVF or IVF with ICSI is the increased chance of multiple or higher-order births (twins, triplets, or higher). Controlling the number of embryos that are transferred into the woman’s uterus can substantially lower this risk. Like naturally conceived children, children that are from twin or higher-order multiple pregnancies may be prone to birth defects or developmental problems.  The goal of most good clinics is to transfer one or two high-quality embryos per attempt.

Final Thoughts on Intracytoplasmic Sperm Injection (ICSI)

Patients should understand the potential risks and complications of Intracytoplasmic Sperm Injection before the procedure is undertaken.  It is essential to do your research and find an expert. At Inovi Fertility & Genetics Institute, we are committed to providing the best IVF, ICSI & Personalized care in the Houston fertility market.

 

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