Infertility
Infertility FAQs:
Definition:
The American College of Obstetricians and Gynecologists (ACOG) defines infertility as not having become pregnant after 1 year of having regular sexual intercourse without the use of birth control.
Prevalence:
About 15 % of couples in the United States are infertile.
Prognosis:
Most infertile couples achieve a healthy pregnancy, whether or not a diagnosis is reached or treatment is undertaken.
Workup:
Your evaluation may include charting of cycles, blood work, and imaging studies and take place over several cycles.
Diagnosis:
The causes of infertility are many, coming from women about 1/3 of the time, men1/3 of the time, both 15% of the time and unknown 20% of the time.
Treatments:
Treatments depend entirely on the cause and may range from watchful waiting, hormone therapy, surgery to assisted reproductive technologies (ART).
Gray's Anatomy 1918
More depth:
Fertility can be of male or female origin. Male infertility is diagnosed by a simple semen analysis and is usually treated by a Urologist. Female infertility is evaluated and treated by Ob/Gyns and Reproductive Endocrinologists.
Workup of Infertility:
In considering the evaluation for infertility, consider the process:
Sperm must swim up the cervical canal into the uterus, generally meeting the egg in the midsection of the tube. The egg must erupt from the surface of the ovary and be swept up by the end of the undulating tube and be able to be pushed down the tube to meet the sperm. The egg is propelled passively by tiny hairs within the tube, while the sperm must have healthy tails to swim to their destination. The sperm must also have a properly formed head to penetrate the egg. Already you can see that a number of different problems could be in play. What if the woman has trouble releasing eggs (ovulating ) or if the man has poor sperm count or quality? When if adhesions (scar tissue ) from infection or endometriosis in the pelvis damage the tubes to make the tubes dysfunctional or blocked? I remember medical school at the time when we were studying infertility. We were all overwhelmed with how many ways reproduction could go wrong. At the end of the unit, we all wondered how pregnancy ever worked correctly. But it does the majority of the time.
Assuming a semen analysis is normal, attention is turned toward the woman. Any proper medical workup includes a history and a physical. From there, if there are clues, such as a history of multiple pelvic infections, they are followed. If there are no particular clues to the reasons behind her infertility, the order of inquiry typically goes like this:
1. Checking ovulation - For this, the cycles are assessed. ( Have a look at Menstrual Cycle 101 for a good knowledge base.) Indirect evidence of ovulation shows up in an elevated basal body temperature in the phase of the cycle after ovulation. This can be charted on a Basal Body temperature chart ( BBTC). Urine test strips can detect the hormone that prompts the egg to release, Leutenizing Hormone (LH). Finally, progesterone levels increase after ovulation and can be measured in the blood as more evidence of ovulation.
2. Checking for tubal patency, or if the tubes are open - This can be done a couple of ways. Special dye can be instilled into the uterus and out into the tubes, and while this is being done, fluoroscopic photos can be taken to confirm dye spillage out the end of the tube. Similarly, at the time of laparoscopy, colored dye can be injected through the cervix, which observers watch from inside the abdomen for dye spillage from each side. Checking the tubes is especially useful if the patient's history contains circumstances which might have produced scarring near the tubes. If there is considerable concern for scarring in the pelvis because of prior infection or surgery, then laparoscopy will probably be chosen so a full assessment of the pelvic organs can be made.
Treatments for Infertility:
1. Ovulation problems - These can be caused from hormone problems of various kinds, such as thyroid issues, or more commonly from a condition called Chronic Estrogenized Anovulation (CEA). If you are interested in this, one of the most common forms of infertility, read here. The treatments for ovulatory dysfunction often involve hormone management or ovulation induction and monitoring. However they almost always also include a tune up of nutrition and fitness. Nutrition and fitness are very important to reproductive health.
2. Tubal scarring - This is generally treated surgically. When we have laparoscopic access to the pelvis, we can open or reconstruct tubes with some success. We can also simply release bands of scar tissue which may be distorting anatomy. If endometriosis is present, it can be addressed. However, oftentimes, endometriosis requires both surgical and hormonal therapy. For more information on endometriosis, click HERE.
If such treatments are unsuccessful, Assisted Reproductive Technologies (ART) may become necessary. According to the American College of Obstetricians and Gynecologists (ACOG),
ART includes all fertility treatments in which both eggs and sperm are handled. ART usually involves in vitro fertilization (IVF). In IVF, sperm is combined with the egg in a lab, and the embryo is transferred to the uterus. IVF is done for the following causes of infertility:
· Damaged or blocked fallopian tubes that cannot be treated with surgery
· Some male infertility factors
· Severe endometriosis
· Premature ovarian failure
· Unexplained infertility
References on Infertility :