What is infertility?
Infertility is defined as one year of unprotected intercourse without conceiving a desired pregnancy. Women over 35 should consult their doctor if not pregnant after six months of trying because of age related decline in pregnancy rates.
What causes infertility?
There are a number of reasons why you may be having trouble conceiving. Here are the most common causes of infertility we see at Advanced Women’s Health Institute:
- Male factor infertility: Abnormalities in your partner’s sperm.
- Ovulatory factor: Problems with ovulation.
- Tubal/Peritoneal factor: A blockage, infection, or injury or condition in your fallopian tubes. Sometimes also caused by endometriosis.
- Cervical factor: Abnormalities in the interaction between sperm and your cervical mucus.
- Uterine abnormalities: Fibroids, polyps, intrauterine adhesions.
- Immunologic problems: Antibodies accidentally working against sperm or placental tissues.
- Unexplained infertility: No cause is found after testing
How is infertility diagnosed?
At Advanced Women’s Health Institute, we have several tried-and-true methods for providing you with an accurate diagnosis for your infertility. These methods include:
- Semen analysis: Is the sperm count normal or are there low numbers? A low sperm count is associated with a lower monthly pregnancy rate. If the sperm count is high but all the sperm are somehow abnormal, this may also affect your pregnancy rate.
- Ovulation evaluation: Cycles longer than 35 days indicate an ovulation problem and a lower chance of pregnancy. Low progesterone production by the ovary after ovulation is called a luteal phase defect and is associated with lower pregnancy rates. Ovulation predictor kits are used to tell the woman she is about to ovulate. Our team will make sure you are ovulating using ultrasound, then schedule serum progesterone levels to see if you have a luteal phase defect.
- Postcoital test: After having sex close to the time of ovulation, there should be a lot of sperm moving around in the cervical mucus. Dead sperm or very few motile sperm indicates this may be the reason for not conceiving.
- Tubal evaluation: There are several techniques to evaluate the fallopian tubes. The hysterosalpingogram (HSG) is considered the gold standard and involves an indirect x-ray test where a fluid that is visible on x-ray is injected through the cervix. If the tubes are open, the fluid will be seen to spill from the fallopian tubes on x-ray. This option can be more painful and expensive than others. Sonohysterography (SHG) is another option in which ultrasound can detect the spillage of fluid in the pelvis. Finally, transvaginal hydroLaparoscopy (THL) is close in accuracy to standard abdominal laparoscopy and more accurate than HSG.
Transvaginal hydroLaparoscopy can be performed in the office with oral pain meds(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 anatomic infertility.
How many women have infertility problems?
Infertility affects approximately 15% of reproductive-age couples in the US. The likelihood of infertility increases with age. The number of couples experiencing this problem continues to grow over the years as more women delay their decision to start a family.
What is the best treatment for infertility?
The Advanced Women’s Health Institute is proud to offer a number of treatments for infertility, depending on the diagnosed cause.
- IUI (intrauterine insemination): At the time of ovulation, the semen is collected by masturbation, like for a sperm count. In the lab, the semen is added to a physiologic wash solution and the sperm are separated from the rest of the semen. Pure sperm are inserted by catheter through the cervical canal and into the uterine cavity. Far more sperm get out to the tubes than would with intercourse.
- IVF (In-vitro fertilization): When the sperm count is extremely low it is possible to fertilize an egg with a single sperm. The process is called intracytoplasmic sperm injection.
- Donor insemination: If your partner does not have viable sperm, you’re starting a family without a partner who has sperm, you may choose to select a suitable sperm donor.
- Clomiphene and Letrozole: Oral medications used to improve ovarian function. There are different causes of ovarian dysfunction including luteal phase defect, stress and polycystic ovarian syndrome. Oral meds and IUI are also used to treat unexplained infertility.
- Gonadotropins: Injection medications that stimulate the ovaries when oral meds are not indicated.
- Minimally invasive laparoscopic procedures: Can free up the fallopian tubes in cases of adhesions. Ovarian cysts can be removed laparoscopically almost all the time, and treatment of endometriosis improved pregnancy rates by 75% after 9 months in a Canadian multi-center study.
- IUI (intrauterine insemination): Bypasses a cervical mucus problem.
- IUI (intrauterine insemination): Can help bypass any anti-sperm antibodies present, including after a vasectomy removal.
- IVF (In-vitro fertilization): Sometimes the necessary procedure if IUI does not succeed.
- Low-dose aspirin and heparin: May improve pregnancy rates in patients ant anti-phospholipid immunologic problems which interfere with implantation and can cause miscarriage.