Infertility: A guide to the basics
By Isela Molina Robertshaw, MD, FACOG
If you have been trying to get pregnant for six months to a year without success, it may be time for you and your partner to think about getting a complete fertility evaluation. But what can you expect in your first visit, and what does fertility treatment even entail?
Let’s break down the basics!
Q: What is infertility?
The simplest definition of infertility: An inability to conceive after having unprotected sex for a certain period of time. How long is that period? It often depends on age. For women younger than 35 years old, it’s 12 months of unprotected sex. For women above 35 years old, it’s six months.
Q: How common is infertility?
Up to 15% of couples in the United States are affected by infertility, according to the Mayo Clinic.
Q: What are some of the common causes of infertility?
About half of infertility cases are caused by male infertility factors—most notably, low sperm count due to genetic, hormonal or anatomic issues.
Common female-factor causes of infertility include:
- A “tubal factor,” caused by blocked or inflamed fallopian tubes. “Tubal factors” account for about 40% of female infertility cases.
- “Ovulatory dysfunction,” which is irregularities in menstrual cycles. It also accounts for about 40% of female infertility cases.
- Another 10-15% of female infertility cases are due to “uterine factors,” which include growths or abnormalities in female reproductive organs.
Q: What early-stage tests can physicians run to test infertility in male and female patients?
The most important first step in evaluating a couple experiencing infertility is to consult a reproductive specialist, such as the Bethesda Fertility Center team. There, you’ll discuss—in detail—medical histories, including menstrual cycle; medications; surgeries; allergies; family histories and environmental exposures.
Once that consultation is complete, we perform the following tests for a thorough evaluation:
- Blood work to evaluate female hormone levels. This helps us look for signs of ovulatory dysfunction.
- Pelvic ultrasound to see if there are any uterine factors.
- Hysterosalpingo-contrast sonography (or HSG) to check for tubal factors.
- Semen analysis to evaluate male factors.
Q: What are the most common infertility treatment options for patients?
For ovulatory dysfunction:
- First, we address any irregularities in hormones to improve ovulation response. Typical irregularities are often related to thyroid disorders and hyperprolactinemia.
- The most common treatment for ovulatory dysfunction is ovulation induction. This treatment involves taking an oral medicine to stimulate egg development/maturation and time its release (ovulation). Making ovulation more predictable helps ensure that intercourse or insemination is timed appropriately.
For tubal factor:
- Management of tubal infertility should always be tailored to the individual patient, as there are many different approaches depending on the type of tubal dysfunction and its severity. Among the elements to consider:
- Type of dysfunction
- Age of the patient
- Patient’s ovarian reserve
- Whether or not there’s a male infertility factor present
For uterine factors:
- Uterine factors are also managed by individual characteristics. Most commonly, though, treatment will involve minimally invasive corrective surgery.
For male factor:
- After getting the initial consultation results, the next step in treatment is typically a referral to a urologist for a more focused evaluation. Treatment may involve medications or surgery depending on the issue identified combined with other factors such as age. If minimally invasive surgery or medications do not improve the identified problems, then intrauterine inseminations (IUIs) or in-vitro fertilization (IVF) will be considered for the next step in treatment.
If you have concerns about your fertility, please call our office at 513-865-1675 or 1-800-634-1222 to speak with one of our staff. You do not need a physician referral to schedule a consultation.