Infertility

Infertility is defined as an inability to conceive after one year.  This is based on the fact that 50% of couples without fertility issues will have conceived in three months, 75% in six months, and 90% by one year.  If after one year of attempting to conceive the couple is unable to, this is the time to be evaluated by your physician.

Causes and Treatments of Infertility

There are many different causes for infertility, each with their own evaluations and treatments. Causes of infertility include (a) anovulation, (b) pelvic or fallopian tube factors, (c) sperm issues, and (d) various other factors.

(a)     Anovulation

Anovulation results in about 20% of couples experiencing infertility.  Anovulation refers to the ovary not releasing an egg.  Ovulation usually occurs on a monthly basis (range 28-32 days).  Having a regular, monthly period can sometimes be an indicator that ovulation is occurring.  However, you can have regular periods without ovulation and you can also have irregular periods with ovulation.  There are several ways to determine if a woman is ovulating. This can be done with basal body temperatures or with ovulation predictor kits, which can be bought over the counter in many stores. Both approaches can be explained to you at your initial evaluation. Various factors can interfere with ovulation such as thyroid disorders, high prolactin hormone levels, and most commonly Polycystic Ovarian Syndrome or PCOS.

Hormone levels in the blood can be checked and corrected if needed.  New advances in treating PCOS have greatly improved fertility rates, and include diabetes medications such as Metformin and ovulation stimulators like Clomid.

(b)     Pelvic or Fallopian Tube Factors 

Another 30-40% of infertility is related to pelvic or fallopian tube factors.  This includes endometriosis that can be diagnosed by medical history as well as with a minimally invasive surgery called laparoscopy.  Pelvic infections can lead to scarring of the fallopian tubes which are necessary to transport the egg towards the uterus and the sperm towards the egg.  Most fertilization happens in the fallopian tubes, and therefore their health is of vital importance.  Whether the fallopian tubes are open or not can be assessed with a procedure called a hysterosalpingogram or HSG.  This is a procedure where dye is injected through the cervix into the uterus, while taking X-ray pictures, to see if the dye leaks out of the end of the tubes.  This can be done quickly and with minimal discomfort. If a blockage is diagnosed, a laparoscopy can be done in some cases, to help open the tubes.  Some blockages cannot be repaired and In-vitro fertilization with a reproductive specialist may be necessary.

(c)     Sperm Issues 

An additional 30-40% of infertility is related to the male partner.  Low sperm counts, low sperm motility, low volume, and inability of the sperm to penetrate the cervical mucous may all be contributing factors.  Obtaining a semen analysis is an easy and non-invasive step in analyzing causes of infertility.  Most ob/gyn physician offices can assist the male partner with the steps necessary to diagnose the problem.  The specimen can usually be collected in the office or at home and brought promptly to the laboratory. If a problem is found, a referral to a Urologist for further evaluation may be needed. Some issues, such as an inability of the sperm to penetrate the cervical mucous, can be bypassed with insemination. Insemination involves the partner or chosen donor’s sperm being placed into the woman’s uterus directly by means of a thin plastic catheter. This is easily done in the doctor’s office with almost no discomfort.

(d)     Other Factors

Unfortunately, approximately 25% of infertility cannot be easily explained.  When this is the case your gynecologist may refer you to a reproductive endocrinology/infertility specialist for further testing or treatments. Injectable medication to induce ovulation, some fallopian tube or pelvic surgery, or in-vitro fertilization are potential treatments  the infertility specialist may recommend.

Conclusion

If you find yourself wondering and worrying about infertility remember one thing:  The monthly pregnancy rate is only 20%.  So if it has been a couple of months and you are not pregnant yet, do not panic!  90% of you will be pregnant within the first year.  If you’re not pregnant, then come in for a consultation and we will help you figure out how to proceed.