Infertility
Infertility is defined as a couples inability to conceive after one year of unprotected relationship. In women over 35, the time frame is shortened to six months.
A recent survey reported that 14% of American couples (28 million) have documented Infertility. Approximately half of these patients seek treatment and, most importantly, 85% will conceive with the appropriate treatment.
The etiologies of infertility are complex and patients need to be evaluated by a reproductive endocrinologists, who is sub-specialize in evaluation and treatment of infertility. A thorough evaluation of both partners are required. Common causes of infertility include male factor 30%, ovulation and egg quality disorders 35%, pelvic adhesive disorders, endometriosis, fallopian tube disorders and uterine anomalies (25%), combined male and female causes (10%), and in 10% of infertile couples have unexplained etiologies.
Most infertility evaluation tests must be done at particular times during the menstrual cycle. Treatment is seldom employed until the investigation is complete because it is necessary to rule out all potential causes. For example, it does no good to treat the female if there is an undiagnosed male problem.
What are the requirements for normal fertility?
The male must produce a sufficient number of normal sperm which are released from the male organ as an ejaculate. The sperm must be deposited in the female organ at the appropriate time during the menstrual cycle, when they can penetrate the cervical mucus, ascend through the uterus and fallopian tubes, and fertilize the egg.
The female must produce a healthy, mature egg which is released from the ovary. After release, the egg must travel down the fallopian tube so that it may be fertilized by the sperm. The fertilized egg then travels into the uterus and implants in the endometrium (the uterine lining) which will nourish its further development.
Disruption in any of these processes can lead to infertility. Egg development and ovulation are under the control of complex hormonal interactions including FSH, LH, Estradiol, Progesterone and others. Diseases of the thyroid, adrenal, pituitary, or hypothalamus glands can lead to ovulatory dysfunction. Additionally, conditions such as polycystic ovarian syndrome(PCOS) cause irregular or absent ovulation.
Blockage of the fallopian tubes can occur as a result of serious infection, congenital abnormalities, scarring from previous surgery, or endometriosis. Patients with significant tubal damage usually have the best chance of achieving pregnancy with IVF.
Endometriosis is a major cause of infertility and may be present with no symptoms. Some studies indicate that endometriosis decreases pregnancy rates even though there may be little visible organ damage.
IVF or other advanced reproductive technologies are not always the treatments of first choice. Timed Intrauterine insemination (IUI) after Ovulation Induction with gonadotropins is also very effective. However, these therapies are best administered by a reproductive endocrinologist with advanced training in the use of fertility medications.
Our infertility specialists offer care for all levels of infertility from the initial diagnosis to advanced reproductive technologies. We understand the importance of personalized care and deliver our services in a compassionate environment.