What is Infertility?
Approximately 85% of women will become pregnant within one year of trying. Only an additional 7% of couples will conceive in the second year. Based on these results, infertility is defined as the inability to conceive within 12 months.
The most common causes of Infertility
Advancing Maternal Age: As women age, the number of eggs they produce and the egg quality decreases at a rapid rate.
Ovulation disorders: Normal and regular ovulation (the release of a mature egg) is essential for women to conceive naturally. There are many disorders that may impact the ability for a woman to ovulate normally. The most common disorders impacting ovulation include PCOS (link to past written PCOS article). Ovulation can be detected by keeping a menstrual calendar or using an ovulation predictor kit.
Uterine Fibroids: There are three types of fibroids and 40% of women have them. However, only submucosal fibroids reduce a woman’s pregnancy rate. Submucosal fibroids can cause heavy periods, or bleeding between periods
Endometriosis: It causes infertility by producing inflammation and scarring in the uterine cavity. This can result in pelvic pain and affect eggs, sperm or developing embryos.
Unknown: About 15% of couples can never pinpoint the cause of their infertility.
Luckily there are fertility treatments to help overcome infertility.
- Clomid, Tamoxifen, Letrozole (pill form) or Gonadotropins (Injectable): These medications help induce egg development and ovulation
- Insemination: Intrauterine Insemination (IUI) is the process where sperm is washed and prepared for placement into the uterine cavity, bypassing the cervix and bringing the sperm closer to the tubes and ovulated egg
- In Vitro Fertilization (IVF): IVF is the process where the woman’s eggs are collected and then fertilized by sperm outside the body in a laboratory
When a couple decides to seek the help of a fertility specialist they will have a fertility evaluation.
During this process the following steps will be conducted.
- Medical and Fertility History
- Transvaginal Ultrasound: An ultrasound is an important tool in evaluating the structure of the uterus, tubes, and ovaries. It can also detect any abnormalities like fibroids or ovarian cysts. Additionally, transvaginal ultrasound offers the opportunity for your doctor to assess the estimated number of available eggs (i.e your ovarian reserve).
- Laboratory testing: Blood work is conducted to measure blood levels of hormones like Estradiol, FSH and AMH (anti-Mullerian hormone), (related to ovarian function and overall egg numbers), TSH (assesses thyroid function) and Prolactin (hormone that can affect menstrual function if elevated), and Vitamin D.
- Hysterosalpingogram (HSG): This test is important in evaluating fallopian tubal patency, uterine filling defects such as fibroids and polyps, and scarring of the uterine cavity (Asherman syndrome). Many uterine and tubal abnormalities detected by the HSG can be surgically corrected. We have been performing HSG at our facility since 2009, and Dr Sharara has performed over 1000 HSGs.
- Semen analysis: The semen analysis is the main test to evaluate the male partner fertility concerns. There are many factors analyzed including:
- semen volume
- sperm concentration
- sperm motility (movement)
- morphology (shape)
- WBC count
If you are having trouble conceiving or have already been diagnosed with infertility and are in the process of selecting a fertility clinic contact VCRM today to start fertility treatment.