What is it?

Infertility is defined as one year of unprotected intercourse without conceiving a desired pregnancy. Women over 35 should consult their doctor when they desire conception, as waiting one year may not be advisable in the woman over 35. A work-up for causes of infertility should be instituted sooner when the woman is over 35.

What causes infertility?

• Male factor infertility – Abnormalities in semen
• Ovulatory factor – Ovulatory disorders
• Tubal/Peritoneal factor – Tubal injury, blockage, paratubal adhesions, endometriosis
• Cervical factor – Abnormalities in cervical mucus and sperm interaction
• Tubal/Peritoneal factor – Tubal injury, blockage, paratubal adhesions, endometriosis
• Uterine abnormalities
• Immunologic problems
• Infections
• Unexplained infertility

How is infertility diagnosed?

• Semen analysis – Look for ejaculate volume, concentration, motility (ability to move spontaneously), morphology (form and structure)
• Documentation of ovulation – Ovulation predictor kits, serum progesterones
• Postcoital test
• Evaluation of tubal patency (openness)
  There are several techniques to evaluate the fallopian tubes. The hysterosalpingogram (HSG) is an indirect x-ray dye test where a dye that is visible on x-ray is injected through the cervix. If the tubes are open, the dye will be seen to spill from the fallopian tubes on x-ray. Multiple authors have compared HSG to laparoscopy and generally consider HSG to be a good predictor of tubal patency, but a poor predictor of scar tissue and endometriosis. Laparoscopy is still considered the gold standard for pelvic evaluation, but it is expensive because it requires hospitalization. It is also more painful because of the need for incisions.

  There are several techniques to There are 2 other modalities that have been used to evaluate the patency of the fallopian tubes, Sonohysterography and THL.

• Sonohysterography – In this procedure, a small balloon tip catheter is placed in the uterus and under ultrasound visualization, fluid is inserted into the uterine cavity. Ultrasound can detect the spillage of fluid in the pelvis. The procedure can be performed in the office. It is no more painful than an HSG, but does not expose the woman to x-rays.
• THL – Transvaginal hydrolaparoscopy is close in accuracy to standard abdominal laparoscopy and more accurate than HSG. THL can be performed in the office with minimal oral sedation (no IV is necessary). Pelvic anatomic problems can be diagnosed more accurately than with HSG. The Advanced Women’s Health Institute feels that office THL is the most cost-effective approach to evaluate pelvic problems that cause infertility.

How many women have infertility problems?

Infertility affects 10-15% of reproductive age couples in U.S. The number of couples experiencing this problem continues to grow over the years.