Fertility 101
What is infertility?
Infertility is defined as the inability to become pregnant after one year of trying for women less than 35 years of age or after six months of trying for women over 35. Women who are able to become pregnant but cannot stay pregnant may also be infertile. About 10 percent of women ages 15-44 in the United States have difficulty getting pregnant or staying pregnant, according to the CDC. Approximately 15% of American women of childbearing age receive care for infertility each year.
Both women and men can have problems that cause infertility. About one-third of infertility cases involve problems with the female, one-third are due to problems with the male, and the other cases are due to a mixture of male and female problems or unknown problems.
What causes infertility in women?
Ovulation dysfunction is the most common cause of female infertility. Without ovulation (release of an egg from the ovary), there are no eggs to be fertilized. Some indications that a woman may not be ovulating normally include irregular or absent menstruation.
Polycystic ovarian syndrome (PCOS) is a common cause of female infertility. PCOS is a hormone imbalance problem that can interfere with ovulation. Ovarian insufficiency is another cause of ovulation problems. Ovarian insufficiency occurs when a women’s ovaries stop working normally before age 40.
Other causes of female infertility include:
- Blocked fallopian tubes due to pelvic inflammatory disease, endometriosis, or surgery for an ectopic pregnancy
- Uterine or cervical anomalies, which include problems with the cervical mucus, the opening of the cervix, or abnormalities in the shape of the uterus
- Uterine fibroids which are benign tumors in the wall of the uterus and can interfere with implantation of the fertilized egg
- Endometriosis, a condition in which endometrial tissue (the cells that line the uterus) grows outside the uterus and can affect the function of the ovaries, fallopian tubes, and uterus
- Pelvic adhesions, bands of scar tissue that can cause organs to bind together after abdominal or pelvic surgery , pelvic infection, or appendicitis
- Thyroid disorders
- Cancer and its treatment
What causes infertility in men?
- Azospermia (no sperm cells) or oligospermia (few sperm cells) are the most common male infertility factors
- Malformed sperm cells or sperm cells that die before they can reach the egg
- Varicocele, enlarged veins in the testes that increase the blood flow and heat, affecting the number and shape of sperm
- Medical conditions such as diabetes, cystic fibrosis, and infection
- Trauma
- Unhealthy habits such as smoking, excessive alcohol use, testosterone supplementation, anabolic steroid use, and drug use
- Environmental toxins
- Cancer and its treatment
What are risk factors that contribute to infertility?
- Age – fertility declines with age
- Tobacco use
- Alcohol use
- Being overweight
- Being underweight
- Exercise – not enough exercise or too strenuous or too intense exercise
How is infertility treated?
85 to 90 percent of infertility cases are treated with conventional therapies, such as drug treatment or surgical repair of reproductive organs. Although IVF is usually every couple’s best chance for pregnancy, most couples do not need it. The majority of infertile couples who achieve pregnancy do so without employing the most expensive, most “high tech” interventions.
What will happen at my first visit?
Your provider will thoroughly review your medical, family, and social history. You should bring all pertinent medical records, including any previous reproductive treatment you have received.
Beginning the infertility investigation with a new patient is much like opening a mystery novel.It is most effective to begin with the simple evaluation methods and move to the more complex. Because of the myriad causes of and contributing factors to infertility, it is important to use a process of elimination, determining what the problems are not in order to better understand what they are.
Specific fertility tests will be recommended and may include:
- Hormone testing to determine whether you’re ovulating, as well as thyroid and pituitary hormones that control reproductive processes.
- A complete pelvic exam for the female.
- Semen analysis for the male to determine the number and quality of sperm present. If subfertile sperm parameters are discovered, referral for urological consultation will be made.
- Imaging tests. Transvaginal ultrasound looks for ovarian cysts and uterine or fallopian tube disease. A saline enhanced ultrasound, or sonohysterogram, is used to evaluate the uterine cavity and rule out abnormal masses that could interfere with conception.
- Hysterosalpingogram is an outpatient procedure in the Radiology Department of a hospital that helps to determine if the fallopian tubes are open.
- Laparoscopy and hysteroscopy. In some patients, especially those who have pelvic pain or recurrent pregnancy loss, this outpatient surgery is a preferable method of evaluating the uterus and tubes. Laser technology allows the surgeon to address the problems caused by scar tissue, adhesions and endometriosis. During the same procedure, valuable information can be obtained about the uterus, tubes and ovaries that will guide recommendations for the future therapies.
Although there are common approaches to the evaluation of infertility, each woman and her partner are unique in their specific situation and deserve individualized care. We believe that our patients are in partnership with us to seek the most thorough explanation of “why” successful pregnancy has not occurred and to formulate a plan that will have the greatest potential to help them in their quest for a child.
