Fertility

What is Infertility?

The medical definition of infertility is the inability to become pregnant and conceive an offspring. Women with recurrent pregnancy loss (2 or more spontaneous miscarriages) would also be considered infertile. Women with these issues are recommended to make an appointment with a reproductive endocrinologist, also called a fertility specialist.

How common is Infertility?

Six percent of married women 15-44 years of age in the United States are unable to get pregnant after one year.

Twelve percent of women 15-44 years of age in the United States have difficulty getting pregnant or carrying a pregnancy to term.

Is it the male or the female’s fault?

Infertility is not limited to women, men as well can contribute to the inability to conceive or carry an infant to term.

A study conducted in 2002 by the National Survey of Family Growth found that 7.5% of all sexually experienced men younger than age 45 reported seeing a fertility doctor during his lifetime. 18% of those men were diagnosed with a male related infertility problem.

What are the causes of infertility in women?

There are three organs women need in order to become pregnant and they are as follows: ovaries, fallopian tubes and uterus. Any condition affecting any one or more of these can contribute to infertility.

Ovarian Function (ovaries)
Women with irregular periods are likely not preparing an egg for fertilization, also known as ovulating. Potential causes of not ovulating include:

• Polycystic ovary syndrome (PCOS): PCOS is a hormone imbalance problem that can interfere with normal ovulation.
• Functional hypothalamic amenorrhea (FHA): FHA relates to excessive physical or emotional stress that results in amenorrhea (absent periods)
• Diminished ovarian reserve (DOR): This occurs when the ability of the ovary to produce eggs is reduced because of congenital, medical, surgical or unexplained causes
• Premature ovarian insufficiency (POI): This occurs when ovaries fail before the age of 40
• Menopause: It is natural decline in ovarian function occurs around the age of 50. It is associated with hot flashes and irregular periods

Tubal Patency (Fallopian tubes)
What are risk factors for blocked fallopian tubes?

• History of pelvic infection
• History of ruptured appendicitis
• History of gonorrhea or chlamydia
• Known endometriosis
• History of abdominal surgery

When the fallopian tubes are blocked it can prevent the eggs from travelling towards uterus and becoming fertilized. There are several tests your doctor can do to determine normal functionality of the fallopian tubes.

Uterine Contour (Uterus)
The uterus must not have any anatomical abnormalities. In some women, fibroids can develop and this could contribute to infertility. Doctors can do special tests based on the symptoms of a woman if fibroids exist.

What are the risk factors that contribute to a woman’s infertility?

1. Age: Aging decreases a woman’s chances of having a baby and increases a woman’s chance of having a miscarriage. Man women are waiting until their 30s and 40s to have children. In the United States, 20% of women have their first child after the age of 35
   • Why is age a problem?
     • Ovaries become less functional
     • There are certain number of eggs that women have, as you get older, that number decreases
     • More likely to have health problems as you get older that can contribute to infertility
     • Higher risk of having a miscarriage
2. Smoking
3. Excessive alcohol use
4. Extreme weight gain or weight loss
5. Excessive physical or emotional stress that results in absent periods (amenorrhea)

How do doctors treat infertility?
The treatment of infertility will depend on the cause of the issue. It will be based on the patient’s medical conditions and medical history. The three main ways infertility can be treated is through medications, intra uterine insemination or assisted reproductive technology.

What are the medications used to treat infertility in women?

1. Clomiphene citrate (Clomid): this is a medication that causes ovulation by acting on the pituatry gland. This medication is used in women who have polycystic ovarian syndrome (PCOS) or other problems with ovulation
2. Human menopausal gonadotropin or hMG (Repronex; Pergonal): These are medications that work for women who do not ovulate because of issues with their pituitary gland. hMG acts directly on the ovaries to stimulate ovulation
3. Follicle-stimulating hormone or FSH (Gonal-F; Follistim): These are medications that work similarly to hMG. It causes the ovaries to begin the process of ovulation
4. Gonadotropin-releasing hormone (Gn-RH analogs: medications that are often used for women who do not ovulate regularly. It is also effective in women who ovulate before the egg is mature. These medications work on the pituitary gland to make ovulation more consistent
5. Metformin: a medication is commonly used in diabetes. This medication is also effective in women who have polycystic ovarian syndrome (PCOS). It mainly works by lowering the high levels of male hormones in women with these conditions, which helps the body ovulate.
6. Bromocriptine (Parlodel): A medication that is sued for women with ovulation problems due to high levels of prolactin. Prolactin is a hormone that plays a role in reproduction and breast milk production.

When should women call their doctors?

Experts suggest women (<35 years of age) to try for one year and women (≥ 35 years of age) should try for 6 months before visiting their healthcare provider. A woman’s chances of having a baby decrease rapidly every year after the age of 30.

How do doctors know what the problem is?

Doctors will first begin by collecting your medical and sexual history. Then three evaluations are done which includes: semen analysis, tubal evaluation and ovarian reserve testing