Human Reproduction 

The Female Reproductive System

A woman’s reproductive organs include the vagina, uterus, two fallopian tubes and two ovaries. The female reproductive cycle (menstrual cycle) is a highly coordinated process involving hormones produced by the hypothalamus and pituitary gland (in the brain) and by the ovaries.
 
Women are born with more than one million eggs, which are stored in the ovaries. These eggs will be depleted over the course of a woman’s reproductive life span. To mature an egg, a woman’s hypothalamus releases a hormone called gonadotropin-releasing hormone (GnRH). GnRH stimulates the release of two other hormones – follicle stimulating hormone (FSH) and luteinizing hormone (LH) – from the pituitary gland. These hormones, in turn, stimulate the woman’s ovary to produce a follicle. The follicle is a fluid-filled sac that contains an egg (oocyte). The follicle also produces estrogen, which helps to regulate the release of FSH and LH and stimulates the lining of the uterus (the endometrium) to thicken to prepare to receive an embryo.
 
A follicle matures and reaches a point where it is ready to release the egg at about day 14 of a woman’s ovulatory cycle. A surge of LH from the pituitary gland causes the follicle to release the egg in a process known as ovulation. When this occurs, the egg is released from the ovary and travels down one of the fallopian tubes. The egg is now in position to be fertilized by a man’s sperm following intercourse. The hormone progesterone is made by the ovary after ovulation to provide the proper environment for implantation and to support an early pregnancy. If an egg is fertilized, it must travel down the fallopian tube to the uterus where it will implant itself in the endometrium about six days later. If the egg is not fertilized, the uterus sheds the endometrium about two weeks later and a woman menstruates.
 

The Male Reproductive System

In contrast to a woman’s monthly egg production cycle, men continuously produce sperm in the testes after puberty. Testosterone is also produced in the testes. The same hormones that regulate a woman’s reproductive cycle, LH and FSH, stimulate production of both testosterone and sperm in the man. The sperm leave the seminiferous tubules of the testis and travel through a tube called the epididymis, and then to the vas deferens where they mature. During ejaculation, they move to the ejaculatory duct, where the sperm mix with nutrient-rich fluids from the seminal vesicles and prostate gland. The combination of sperm and fluids is called semen. The semen provides a vehicle that allows sperm to travel outside the body. To fertilize an egg, a man needs to have sufficient amounts of normal sperm that are capable of traveling up through the woman’s uterus to the fallopian tubes.
 

The Menstrual Cycle and Pregnancy 

A woman’s menstrual cycle is the number of days from the start of one period to the start of the next period. The average menstrual cycle for most women is 28 days. But for many women, a normal range can be anywhere from 21-35 days. It is also normal for the number of days in a woman’s ovulatory cycle to vary from month to month. In fact, one study of 2,700 women found that only one woman had consistent 28-day cycles over the course of a full year.
 
The best way to determine your average cycle length is to keep a log indicating the start date for each period. The first day of a period is the first day you experience full flow, not spotting. This information can help doctors to assess your ovarian function with greater precision. A woman is fertile for only a short window of time each month – around ovulation. Keeping track of your menstrual cycle can also help you to identify the period during your cycle when you are most likely to ovulate.
 
Doctors generally recommend that couples have intercourse starting three to four days prior to expected ovulation and up to two days after expected ovulation. This represents the period during the ovulatory cycle when a woman is most likely to get pregnant. Most fertility experts recommend that a couple have intercourse at least every 48 hours around the time that ovulation may occur to maximize the chances of achieving a pregnancy. More frequent intercourse during this period may increase a couple’s chances of getting pregnant.
 

ART

The medical team at RMANJ is skilled in using all of the most advanced and effective assisted reproductive technologies. In vitro fertilization is the basis of all ART procedures at RMANJ. The first successful IVF procedure was performed nearly 30 years ago. This procedure is now the most commonly performed ART in the world and has been responsible for helping over a million couples with many forms of infertility to have a baby. With IVF, a woman’s egg (oocyte) and a man’s sperm are combined and fertilization occurs in the laboratory. The resulting embryo is placed in a woman’s uterus where it can implant and grow into a healthy fetus.
 

Screening & Diagnosis

Before we recommend and perform any ART procedures at RMANJ, we complete a thorough evaluation of the couple to determine the causes of their fertility problem and whether there are any health factors that could have an adverse affect on treatment or pregnancy. This testing is designed to identify certain infectious diseases and genetic conditions, to evaluate the woman’s ovaries and uterus, and to evaluate the man’s semen. When needed, we may perform special additional medical tests for couples with a history of unique health conditions. The medical team then uses this information to develop a treatment plan that is specially tailored for each couple.