Wright State Physicians Health Center
725 University Blvd.
Fairborn, OH 45324
Infertility is defined as the inability to achieve pregnancy after one year of unprotected intercourse. Because age can have a significant impact on fertility, women who are 35 years or older should see a reproductive specialist after six months of trying to conceive without success. Other reasons for seeking a fertility evaluation may include:
- Irregular menstrual cycles (less often than every 25 days or more often than 35 days), which may suggest that a woman is not ovulating
- Previous pelvic surgery or infection(s), which may suggest fallopian tube disease
- Painful periods, which may suggest endometriosis
- Recurrent pregnancy loss
If you or your partner have a known reason that may complicate the ability to conceive, we understand that not being able to conceive on your own in a timely fashion can be stressful. You may experience feelings of anxiety, frustration, guilt and insecurity. That is why we developed our Fertility Program. These feelings are perfectly normal and our expert staff understands what you are going through. However, after your initial visit and evaluation, we think your mind will be eased upon learning that simple infertility treatments are available, and if a more complex treatment is needed, you have come to the right place.
For conception to happen, the following steps must occur:
- A woman must first release an egg (ovulate) that enters into a fallopian tube
- Sperm must enter the cervix and travel through the uterus and into the fallopian tube
- Fertilization must take place in the fallopian tube within 24-48 hours of ovulation
- The fertilized egg, or embryo, must travel through the fallopian tube down to the uterus, where it can implant in the uterine lining and develop
Infertility results when a problem develops in any part of this complex process. One of eight couples have trouble conceiving. The first step in overcoming infertility is to seek out an experienced reproductive endocrinologist who will make an accurate diagnosis and develop a treatment plan.
A single female factor is the cause of infertility in 40 percent of the cases. Interestingly, a single male factor is the culprit in another 40 percent of the cases. Both male and female factors occur in 10 percent of the cases. In the remaining 10 percent of cases, diagnostic tests do not tell us the cause. This is called unexplained infertility. There is scientific data that suggests that many couples who have unexplained infertility may in fact have a fertilization problem. The good news is that in-vitro fertilization (IVF) with intra-cytoplasmic sperm injection (ICSI) often overcomes this problem.
Age is a major factor in female fertility. As a woman approaches her mid-30s, her fertility begins to decline. This decline in fertility is because there are fewer eggs in the ovaries and the quality of the eggs diminish as a woman gets older. Not only does age affect a woman’s ability to get pregnant and carry the pregnancy to term, age can also affect the pregnancy itself by increasing the risk of genetic abnormalities in the embryo.
Age is not as much of a factor for a male as reduction in fertility generally does not occur until his mid-50s. Men are able to produce sperm throughout their lifetime, though problems can affect sperm quantity and quality regardless of a man’s age.
Infertility: Female Factors
There are several factors that contribute to female infertility. These include anovulation, tubal and cervical-uterine issues.
Problems with ovulation are a common cause of infertility, accounting for approximately 25 percent of all female infertility cases. In order to conceive, a woman must ovulate (release an egg from the ovary into the fallopian tube). Ovulation is connected to a woman’s menstrual cycle, or period, which takes place every 28-34 days depending on the individual. Women who experience a menstrual cycle of more than 35 days, or do not experience periods at all, are probably ovulating infrequently or not ovulating at all.
The causes of ovulatory problems can include:
- Thyroid conditions
- High prolactin levels (which can cause a milky breast discharge in some women)
- Polycystic Ovarian Syndrome (PCOS) which is also associated with excessive facial and body hair growth (hirsuitism), acne and obesity (in 50 percent of those with this disorder)
Whether and when ovulation is occurring can be determined through charting, over-the-counter ovulation predictor kits or through additional hormonal testing.
If a woman is not ovulating or is ovulating irregularly, Dr. Lindheim may prescribe fertility medications to stimulate ovulation.
Open (patent) and functioning fallopian tubes are necessary for conception to occur. Certain risk factors can affect tubal function and account for 35 percent of female infertility, including:
- Previous pelvic infections
- Previous pelvic-abdominal surgery
The test that is typically performed to assess tubal patency, or whether the fallopian tubes are open, is referred to as a hysterosalpingogram (HSG). An HSG is an X-ray picture of the pelvis. A thin tube-like instrument is passed into the cervix, and then an X-ray dye is injected into the uterus. As the dye enters the uterus and fallopian tubes, an assessment can be done to look at the uterine and fallopian tube anatomy.
The cervix is located in the lower part of the uterus. Conditions of the cervix can affect fertility but are rarely the sole cause of infertility. The following might contribute to cervical health and are important to discuss with Dr. Lindheim if they have occurred:
- Abnormal pap smear(s)
- Prior cervical biopsies
- Cervical surgery-cone biopsy
- “Freezing” and/or laser treatment of the cervix
- Having a mother who took DES (diethylstilbestrol) while she was pregnant
Cervical problems are generally treated with antibiotics, fertility medications or by intrauterine insemination (IUI).
The uterus (womb) is where the fertilized egg implants and develops. Uterine abnormalities can account for 20 percent of female infertility and can include:
- Uterine scar tissue (Asherman’s Syndrome)
- Polyps (bunched-up pieces of the endometrial lining)
- Abnormally shaped uterine cavity
Problems within your uterus may interfere with implantation of the embryo or may increase the incidence of miscarriage. The test(s) typically performed to assess the uterine cavity include a hysterosalpingogram (HSG) or sonohysterogram (SHG or SIS). Similar to the HSG, a thin tube-like instrument is passed into the cervix. Small amounts of saline are injected into the uterus under ultrasound guidance to assess the uterine cavity. This the preferred test for uterine abnormalities.
Surgery may be required to further evaluate and possibly correct uterine cavity abnormalities.
Infertility: Male Factors
The male partner is either the sole or a contributing cause of infertility in 40 percent of couples who are having problems conceiving. Evaluation of the male involves a detailed sperm analysis. This can determine the volume (amount), motility (movement) and morphology (shape) of the sperm.
The cause of abnormal sperm can be:
- Varicocele (dilated or varicose veins in the scrotum)
- Duct obstruction
- Hormonal issues
- Infectious disease
Additional testing, including blood, semen cultures and a comprehensive examination with a urologist, can help identify the cause.
Treatment for male factor infertility may include:
- Surgical correction of a varicocele (dilated or varicose veins in the scrotum) or duct obstruction
- Hormonal medications to improve sperm production
- Antibiotic therapy for infection
In many cases, no direct treatment for decreased sperm counts is effective, and IVF with ICSI may be recommended.
For approximately 10 percent of infertile couples, no identifiable abnormality can be found in spite of all testing. Fortunately, unexplained infertility can often be treated successfully with prescribed fertility medications and IUI or IVF with ICSI. A leading theory suggests that many couples with unexplained infertility may have a fertilization defect whereby the sperm cannot penetrate the egg after intercourse. This may explain why IVF with ICSI is so successful in these couples.
Recurrent Pregnancy Loss
Miscarriage is one of the most devastating experiences that can happen to a woman. It is estimated that approximately two of every 10 pregnancies result in a miscarriage. After having one miscarriage, most women will go on to have a healthy pregnancy.
Women are considered to have recurrent pregnancy loss when they have two or three miscarriages in a row. Only about 1 percent of women will have three consecutive miscarriages or more. In about two out of three cases, we are able to determine the cause of recurrent pregnancy loss.
The causes of recurrent pregnancy loss include:
- Genetic-chromosomal defects
- Uterine abnormalities
- Incompetent cervix
- Hormonal defects
- Autoimmune disorders
- Clotting disorders
Treatments vary depending on the cause of recurrent pregnancy, including hormonal-anticoagulant medications, surgery, IVF and PGS-PGS.