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FEMALE INFERTILITY

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Overcoming Female Infertility and Starting a Family

When you have experienced negative pregnancy tests and months of disappointment, you want answers.

  1. Why can’t I get pregnant?
  2. What fertility tests should I have to determine the cause of female infertility?
  3. When can I get started with Fertility Treatment, IUI or IVF?

Dreamflower IVF Centre specializes in the care and treatment of infertility, with many years of experience in helping couples and individuals get pregnant. Our board certified reproductive endocrinologists will clearly define a path to getting pregnant, resolving even the most complex causes of female infertility.

Fertility Testing to Identify Causes of Female Infertility

Testing for female infertility begins with a conversation about your health history, and progresses from fertility blood tests and sonograms, to non-surgical tests such as hysterosalpingogram (HSG) and, possibly, minimally invasive fertility surgery. While we are testing you for female causes, your fertility doctor will order a semen analysis for your partner to rule out male factors.

Female infertility testing usually takes one menstrual cycle to complete.

It’s important to begin this process by focusing on the positive. Most cases of infertility will be resolved with fertility treatment and only a small percentage of women will need advanced reproductive technologies such as in vitro fertilization, IVF. Our website details the many options you have for overcoming female infertility, with fertility treatments to address ovulation factors, blocked tubes, endometriosis, recurrent miscarriage and unexplained infertility.

When to Seek Treatment for Female Infertility

Your age and symptoms will determine the ideal time to call a fertility specialist. If you have a history of pelvic disease, irregular or painful periods or uterine factors (fibroids or polyps), arrange for a fertility workup with Dreamflower IVF Centre. We also follow the American Society for Reproductive Medicine’s recommendation that women over 35 enlist a fertility specialist after six months of timed intercourse.

Female Infertility is a reproductive disorder which can have many causes.

Some causes are not easily — or even able — to be changed. However, lifestyle choices can have a profound impact on your fertility and pregnancy health.

It is clear that tobacco abuse, weight issues, alcohol, and caffeine use can all impact fertility, pregnancy, and fetal outcomes. It is ideal to address these factors before pregnancy takes place.

Tobacco Use and Fertility

The chemicals in cigarette smoke can cause the ovaries to age faster, leading to a higher change of infertility, miscarriage, and menopause at an early age. Much of this impact appears to be irreversible. Cigarette smoking can also increase the chance of pregnancy complications, including preterm labor and delivery, underweight newborn, placental problems, and ectopic pregnancy. There can also be adverse effects on the health of children who grow up around smoking parents.

Alcohol and Fertility

Alcohol consumption has been shown, in general, to have a detrimental impact on female and male fertility. Higher levels of consumption (more than 2 alcoholic drinks a day) are best avoided when attempting pregnancy. In women, a more conservative amount is generally accepted. Once ovulation occurs and a possible pregnancy is germinating, there is no safe level of alcohol exposure. There are a variety of birth defects related to alcohol intake during pregnancy; these can range from mild growth retardation and neurobehavioral effects to the full fetal alcohol syndrome.

Unprotected Intercourse, STDs and Infertility

Chlamydia and gonorrhea are sexually transmitted infections which can have a profound impact on fertility. Untreated, approximately 40% of women will go on to develop pelvic inflammatory disease (PID). A critical issue is that many women with chlamydia or gonorrhea may have no recognizable symptoms. The same can be true of the male partner. It is important for women and men who desire future fertility to take steps toward reducing infection exposure during intercourse. This can be accomplished by limiting sexual partners and/or using condoms.

Caffeine and Fertility

Caffeine exposure has been linked to both infertility and miscarriage. One study has shown a 50% increase in infertility in those who consume excessive (500 mg or more) caffeine intake daily. An even smaller amount (more than 200-300 mg) daily may still increase the risk of miscarriage. It is reasonable to minimize caffeine prior to and during pregnancy to optimize reproductive outcome.

Other: Though there is limited research, illicit drug use can have a detrimental impact on both fertility and pregnancy outcome.

There are many Female Fertility Risk Factors that can lead to a decreased chance for pregnancy

Infertility is a disease affecting the reproductive systems of men and women that can lead to an inability to have children. It is a disease which affects many people – recent estimates are that about 6-7 million people in India are affected by infertility. In contrast to many unavoidable diseases, there are steps that people can take to optimize their current and future fertility.

Factors which can significantly influence female fertility include the following:

  1. Age: A woman’s age has a strong impact on her ability to conceive.
  2. Stress: There is some evidence that stress and depression may impact the hormones that regulate reproduction.
  3. Smoking: In addition to its other health risks, smoking can prematurely age the ovaries in women and reduce sperm production in men.
  4. Alcohol: Fertility problems can be encountered with even relatively modest amounts of alcohol intake in both men and women.
  5. Unprotected intercourse: Sexually transmitted infections can cause fertility problems for both men and women.
  6. Weight and Exercise: Women whose weight is either above average (10-15% above normal) or below average (10-15% below normal) may encounter hormonal abnormalities affecting reproduction.
  7. Environmental factors: Certain chemicals, radiation, and high temperatures may impact fertility in both men and women.

Protecting Your Fertility: Now and for Future Pregnancy

To many couples, one of the most important events in their lives is the birth of their child. While the ability to conceive a pregnancy is often safely taken for granted, one in seven couples will struggle with infertility. For those couples, this basic desire to have a family may become a challenge that can ultimately strain their relationships and become an overwhelming issue that consumes their lives.

Although most couples spend their early years focusing on how not to get pregnant, there are some basic tips for each stage of life that, if followed, will significantly lessen the likelihood that they will ultimately face infertility.

Singles Can Safeguard Their Future Fertility

Many behavioral choices made early in life can significantly affect one’s subsequent fertility. For example, certain lifestyle choices – such as smoking, risky sexual behavior, and diet and exercise – can ultimately impair or enhance the ability to conceive.

Although everyone knows that cigarette smoking increases the risk of developing cancer, heart disease, and lung disease, few people know that smoking can also lead to early menopause and infertility. In fact, smokers have a 66 percent higher chance of infertility and, if they do conceive, they have a 70 percent increased risk of having a miscarriage. While most smokers say that they will quit smoking as soon as they conceive, for many the damage has already been done. Even second-hand smoke can negatively affect fertility, so it’s very important that young adults – and even parents and grandparents – either avoid becoming smokers or quit immediately.

Other habits, such as illicit drug use and alcohol abuse, can also negatively impact one’s fertility. Marijuana can interfere with ovulation and sperm production, and – contrary to popular belief – it can also adversely affect sexual performance. Cocaine can alter blood flow to the uterus, potentially affecting implantation. Common street drugs such as crystal methamphetamine, ecstasy, and oxycontin can cause lower sperm counts, decreased libido, and problems with ovulation. Even certain prescription drugs, when abused, can lead to infertility. Alcohol abuse can also adversely affect hormone production and metabolism, leading to potential problems with ovulation and sperm production.

Drug and alcohol abuse may also impair one’s otherwise good judgment and lower inhibitions leading to risky sexual behavior. Unprotected sexual intercourse – whether promiscuous OR ISOLATED – significantly increases the risk of infection with a sexually transmitted disease (STD). Although many young adults believe that oral contraceptives or spermicides protect against STD transmission, in fact, only latex condoms provide such protection – and then only when used correctly. Some contraceptives, such as the IUD or using spermicides alone, may actually increase the risk of STD transmission. These infections, specifically gonorrhea and chlamydia, can do irreversible damage to the fallopian tubes, markedly increasing the risk of infertility.

While there is no diet that will ensure normal fertility, experts agree that all women should follow a well balanced diet as well as a regular exercise regimen to optimize their overall health. In addition, all women should consider taking a daily multivitamin. Over-the-counter prenatal vitamins are an excellent choice, as they provide a cost-effective, enhanced combination of supplements in one daily pill that exceeds that found in many more expensive, multi-pill regimens. In addition, when one is ready to pursue pregnancy, the higher levels of folic acid found in prenatal vitamins can protect against the development of fetal malformations such as spina bifida.

Fertility Considerations for Married Couples

One of the last things on newlyweds’ minds, appropriately so, is fertility. However, it is important to at least broach the subject of conception early in marriage. With many couples choosing to get married at later ages, an early conversation about fertility is even more important. While it is fact that a woman’s fertility declines as she ages, it is important to separate the hype from the reality.

MYTHS:

  1. Women can easily conceive into their early to mid-40s.
  2. Infertility is a female problem.
  3. If we just keep trying we’ll get pregnant

FACTS:

1. Women are born with all of the eggs that they will ever have, approximately 6-7 million.
2. At puberty, a woman has 300,000-500,000 eggs.
3. By age 40, only 10,000 eggs remain.
4. Infertility is due to male problems in 40-50 percent of cases, so men should also be evaluated by a fertility doctor.
5. Couples who fail to conceive after one year of unprotected intercourse (six months if the woman is over 35) should see a specialist.

Fertility rates remain high throughout one’s twenties and early thirties, so for most couples, there is no need to rush into pregnancy.

It’s Time: You’ve Decided to Get Pregnant!

When a couple decides that they are ready to pursue pregnancy, there are several things that they should consider. Typically it is fine to attempt conception as soon as one stops using contraception. The “old wives’ tale” about needing to be off of birth control pills for three months before conception was never true. Similarly, one needs to wait only one cycle after having an IUD removed before trying to conceive.

There are certain tests that couples may choose to undergo before attempting pregnancy. These “preconceptual tests” can evaluate one’s chromosomes for the presence of over 100 genetic diseases that are potentially preventable with today’s technology. Examples include Tay Sach’s disease, Canavan’s disease, and sickle cell anemia. A simple saliva or blood test can identify whether either partner is a “carrier” of these genetic conditions. As both partners need to be carriers for a child to be affected with most genetic diseases, if one partner tests negative, there is no need to worry that an affected child will be conceived. In cases in which both partners test positive for the same condition, advanced fertility treatments can diagnose the presence of disease in an embryo prior to the time of implantation. Then, if the couple so chooses, a fertility specialist can transfer only those embryos that do not carry the disease.

Once you are ready to attempt conception, a few basic tips can help shorten the process and make it more successful. Couples should have sex every other day mid-cycle; women should consider buying an over-the-counter ovulation prediction kit to let them know both if and when during their cycle they are ovulating; and couples who have not conceived after 12 months of trying should seek care from a fertility specialist. This last recommendation has been modified to six months if the woman is 35 or older. In addition, couples should seek care sooner if they already know that they may have a problem. For example, if either partner has previously had an STD, if the woman has irregular cycles or she has had abdominal or pelvic surgery, or if either partner has a chronic medical condition such as diabetes, hypertension, or cancer, they should consult a fertility specialist right away.

Prepare to welcome the next generation

Infertility affects one in seven couples in the India, or approximately 7.3 million couples. Although the overwhelming majority of affected couples can be successfully treated, taking simple steps before one is even ready for pregnancy can preserve your fertility and enable most couples to easily conceive whenever the time is right for them.

Obesity & Reproduction

Obesity is an increasing problem in the India; women/men of a reproductive age are not excluded from this problem. Many people are aware of the problems that obesity can cause – but many are not aware of the reproductive consequences.

Infertility in obese women is often (but not always) caused by ovulation problems – ovulation may be occurring very infrequently or not at all. Thus, women may have increasingly irregular/erratic menstrual cycles or no menstrual cycles at all. However, there is some evidence that this is not the only way that fertility can be affected. Although it is not known for sure, some research suggests that elevated levels of insulin (the hormone that allows the body to use glucose effectively) in overweight/obese women may be another factor which reduces fertility.

Studies done on women who have undergone IVF have, in general, shown there to be an adverse effect of carrying extra weight on the success of treatment. These studies also indicate a higher risk of early pregnancy loss for overweight or obese women undergoing IVF.

What is known for sure is that obesity increases the risk of many complications of pregnancy: pre-eclampsia, gestational diabetes, and need for c-section. The risk increases with the BMI (body mass index). Also, obesity has been linked to an increased risk of birth defects. In addition, there are concerns about the impact that maternal obesity may have on the subsequent development and health of the child.

Some providers believe that women should achieve a BMI of less than 35-40 (ideally 19-25) before pregnancy to minimize risks. However, women who are older may have to balance the benefits of postponing pregnancy to achieve weight loss with the risk of further fertility decline over time.

Long story short…there are many reasons (fertility included) to try to maintain a healthy weight. In contrast to many aspects of infertility that you may not have control over (e.g. decreased ovarian reserve or fallopian tube blockage), you CAN take charge of your general health. It is optimal to achieve a BMI of 19-25 prior to pregnancy; however, even small changes in the right direction can have a large impact. Don’t be discouraged by thinking that you have to achieve a large amount of weight loss all at once – every little bit helps.

If you are wondering what your BMI is, ask your nurse (who can calculate it from your height/weight). Or consider looking on the internet for a ‘BMI calculator’ which will give you the answer. If your number is not where you would like it, consider it a potential aspect of health/fertility that you can take charge of!

If your general health and potential pregnancy health are not strong enough motivators, realize that it takes longer for women who are overweight/obese to achieve pregnancy – and they may require higher doses of more expensive medications and treatments to get there. You may be able to significantly save on the costs of fertility treatment by getting your weight in a good range

Certainly, lifestyle changes involving a diet/exercise program are the 1st-line treatment for obesity. If you have questions about where to start, consider asking your doctor (or PCP) for strategies. For those women (or men) with a BMI > 30 who are not achieving results with lifestyle changes alone, some medications may be helpful in enhancing weight loss. For women (or men) who have a BMI >40 (or over 35 with serious co-existing medical problems), weight loss surgery may be a better and more efficacious option.

Addressing weight issues is never easy. Many folks may have already tried weight loss in the past with mixed results. However, the potential benefits for reproductive health are significant. Now is the time to make changes for a healthier you and a healthier pregnancy!

We see Age as the number one reason for Female Infertility.

Many women are delaying childbearing. It is estimated that approximately 20% of women are waiting until after the age of 35 to start a family. This can be due to many factors, including the availability of effective birth control options, the desire to succeed professionally prior to beginning a family, and the fact that women are marrying at an older age. There are many stories in the media which can suggest that fertility treatments can help to overcome this delay in childbearing successfully. However, successful fertility treatments depend upon a reasonable amount of ovarian function — which may or may not be available for women who choose to wait to begin a family.

It is important to remember that the decrease in fertility with age becomes more pronounced after the age of 35.

Even with the advances of modern medicine and the fact that many women are healthier and taking better care of themselves, this does not offset the natural decline in fertility with age. This is because women are born with all the eggs they will ever have and are unable to make any new ones. Even before puberty occurs, they have lost all but approximately 500,000 eggs. Though a woman ovulates (releases) approximately 300 eggs during her reproductive life, many more are lost through the natural aging process of atresia. The eggs that are remaining in the later 30s and early 40s are older eggs and have a higher chance of having developed genetic mistakes. This can lead to a decreased risk of pregnancy and an increased risk of miscarriage if pregnancy does occur.

An option for women whose ovarian function has significantly deteriorated is donor egg IVF. The chances of a successful pregnancy can be very high using an egg from a donor in her 20s or early 30s, and the miscarriage rate is very low. The high success with egg donation confirms that the egg quality is a significant barrier to pregnancy in older women.

Though we know that fertility naturally declines as women get older — when and how quickly the decline occurs varies significantly. It is important to seek help with appropriate testing and treatment to maximize the chances for successful pregnancy.

A common complaint for patients presenting with infertility is stress

Stress and infertility is often multifactorial in nature. The emotional challenges of infertility can be compounded by other personal, professional, and familial issues. If this stress becomes chronic, it can lead to depression, changes in sleep habits, weight gain/loss, and susceptibility to illness.

Many patients wonder if stress is causing infertility. There is no definitive proof that stress causes infertility, unless a woman is experiencing irregular or absent menstrual cycles as a result of stress.

It is well known that infertility can compound and exacerbate stress. It can be difficult for a couple to realize that the road to parenthood is not happening for them, in spite of having many family members or friends who appear to have no difficulty. It can be very isolating for a patient to feel as if there is something wrong with her body. Though patients are more open than in the past about infertility struggles, it is not uncommon for a woman to feel as if she is alone in her infertility experience.

Infertility tests and treatments can be physically, emotionally, and financially taxing. Infertility can lead to such stress that a couple grows apart, further increasing stress levels. During fertility treatment, it can be difficult for many patients and partners to miss work or other activities for multiple doctors’ appointments.

Though stress may not directly lead to infertility, it certainly does not feel good and it can make the process of treating infertility much more challenging. It is important to find ways to reduce stress. This is accomplished in different ways for different people, but reaching out to others can be a helpful start. It is critical to maintain communication within the couple. Some couples find it helpful to seek counseling advice to address and discuss their thoughts and feelings. Other patients may find support groups in person or online helpful.

Physically, it is helpful to learn stress reduction techniques, such as meditation, yoga, or acupuncture. Reducing caffeine intake can be helpful for improving fertility, reducing miscarriage, and lowering stress. Regular exercise can optimize physical and mental health.

It is also important to communicate with your doctor so that you are well-educated about treatment options and predicted success rates as well as the financial and time responsibilities inherent in these options. It is helpful to have your partner aware of these issues as well so that you can support each other through the emotional highs/lows of infertility.

Diagnosing & Treating Infertility caused by Ovulatory Dysfunction and Premature Ovarian Failure

Ovulatory dysfunction is comprised of a variety of different conditions that each result in the same outcome – either irregular ovulation or the total lack of ovulation. The major symptom of ovulatory dysfunction is a history of irregular menstrual cycles. Most ovulatory menstrual cycles are regular, occurring every 27-30 days or so, and are accompanied by some mild uterine cramping. Most ovulatory patients also experience some breast swelling and/or tenderness in the few days leading up to the onset of menstrual bleeding, and many patients may also have some mid-cycle discomfort (“mittleschmertz”) that occurs around the time of ovulation. Women with ovulatory dysfunction, on the other hand, frequently have very irregular cycles, ranging from 30-90+ days in length, rare menstrual cramping, and no mid-cycle discomfort. They may have other symptoms as well, such as a milky breast discharge and/or an increase in hair growth – predominantly on their face, chest, or back.

A patient’s clinical presentation and laboratory evaluation will help the physician determine the cause of the ovulation disorder. The initial workup of ovulatory dysfunction includes an evaluation of thyroid function and a measurement of the pituitary hormone prolactin. It is important that the prolactin determination be performed on a blood sample obtained early in the morning while fasting. The most common ovulation disorders include hyperprolactinemia, hypothyroidism, polycystic ovarian syndrome, hypothalamic dysfunction, and impending ovarian failure.

Women who have elevated prolactin levels leading to ovulatory dysfunction initially need an evaluation of the pituitary gland to exclude a tumor as the source of the excess prolactin production. Pituitary tumors responsible for excessive prolactin production are essentially always benign, and they are usually treated with a category of medications called dopamine agonists. The most common medications are bromocriptine (ParlodelTM) and cabergoline (DostinexTM). Patients with thyroid disorders – most commonly hypothyroidism – are typically treated with thyroid replacement therapy.

Hypothalamic dysfunction or hypothalamic amenorrhea is an uncommon cause of ovulatory dysfunction. Oftentimes women with this condition are thin with a low percentage of body fat and have almost complete absence of menses when not on hormonal contraception or replacement. This can be due to excessive exercise or conditions such as anorexia nervosa, but is often present without an obvious cause. The evaluation of women with hypothalamic amenorrhea includes laboratory testing for the pituitary hormones FSH and LH, which are either in the normal range or low, as well as a serum estradiol level which is typically less than 10 pg/ml. On ultrasound evaluation, women with hypothalamic amenorrhea often have a very thin uterine lining and their ovaries may be small as well. Women with hypothalamic amenorrhea who are given progesterone to induce menses typically will not experience a period due to the absence of an estrogen-primed uterine lining. Women with hypothalamic amenorrhea will occasionally respond to clomiphene citrate for ovulation induction, but often need treatment with human menopausal gonadotropins

Impending ovarian failure or premature ovarian failure has most recently been called primary ovarian insufficiency. Please refer to the appropriate section on our website for a complete discussion of this disorder.

Approximately 40% of the patients seen at the Dreamflower IVF Centre have ovulatory dysfunction. Fortunately, this is one of the most easily treated conditions in our practice, and the overwhelming majority of patients with this disorder eventually do successfully conceive.

Endometriosis: Causes, Symptoms, & Diagnosis

Endometriosis is a common condition affecting women who are in their reproductive years. It occurs when the lining of the uterus (the endometrium) develops and grows in abnormal locations (e.g. on the ovaries or the lining of the pelvic cavity). When these cells are found in abnormal locations, endometriosis can lead to problems specifically including pelvic pain and infertility. Endometriosis is thought to develop when cells that shed during a menstrual period flow backward into the pelvic cavity rather than forward into the vagina – a process known as “retrograde menstruation”. Although retrograde menstruation is very common, occurring in up to 95% of women of reproductive age, it is not clear why some women are more susceptible to developing endometriosis than others.

The Symptoms of Endometriosis

It is estimated that up to 10% of all women of reproductive age have endometriosis, compared to 25-50% of women with infertility. Classic symptoms of endometriosis include severe menstrual cramps (“dysmenorrhea”), painful intercourse (“dyspareunia”), and chronic pelvic pain. Endometriosis is thought to be the cause of 20% of cases of chronic pelvic pain, however many women with endometriosis may have relatively mild or even no symptoms whatsoever. In our practice, infertility is the only symptom that many women have.

Symptoms alone cannot reliably be used to make a definitive diagnosis of endometriosis. Your physician may suspect that you have endometriosis based on certain physical exam or ultrasound findings. A family history of endometriosis, infertility, and/or chronic pelvic pain may further increase suspicion.

Using Laparoscopy to Diagnose Endometriosis

Often, the only way to diagnose endometriosis with certainty is laparoscopy. This is an outpatient surgical procedure that enables your doctor to evaluate your pelvic organs by using an operative telescope and other surgical instruments that are passed into your abdomen through 1-3 small incisions. General anesthesia is required for this procedure, which typically takes 1-2 hours to perform. If endometriosis is found, it can be treated during the same procedure – typically by vaporizing it with a laser. The goals of laparoscopy are to remove or destroy as much endometriosis as possible, while restoring the normal arrangement of the pelvic organs. This can help to minimize pelvic pain as well as to improve fertility.

Endometriosis can have a variety of appearances when viewed through a laparoscope. Endometrial implants can appear in small patches that can be clear, white, red, brown, or blue. They can also create filmy or dense scar tissue which can cause pelvic organs to stick together. A cyst of endometriosis – sometimes called an endometrioma or “chocolate cyst” is a more severe form of endometriosis which can sometimes be found in one or both ovaries.

Endometriosis is classified as stage I (mild)-IV (severe) depending on the extent and location of the implants, as well as the presence and extent of scar tissue and/or endometriomas. Though most women have stage I (minimal) or II (mild) endometriosis, they can still have significant pelvic pain and/or infertility, as the extent of endometriosis does not always correlate well with the amount of symptoms.

Tubal Abnormalities: Damaged and Blocked Fallopian Tubes Both Cause Infertility

A woman’s fallopian tubes serve as the pathway that connects her ovaries (where eggs are stored and develop) to her uterus (where an embryo implants). In a lot of ways, the fallopian tube is like a natural petri dish in which conception occurs.

Blocked fallopian tubes prevent an ovulated egg from interacting with sperm, thereby inhibiting fertilization. They also prevent a fertilized egg from traveling to the uterus, preventing implantation.

Many problems, including infection, endometriosis, pelvic adhesions, and even normal menstrual flow can cause a tube to be blocked.

Tubal occlusion is quite common, as evidenced by the fact that approximately 15-20% of the patients seen at Dreamflower IVF Centre suffer from this condition. All too often, they don’t even know that they have it.

Any fallopian tube disease – even without complete obstruction – increases the risk of having a tubal pregnancy. The risk is increased from 1% in the general female population to approximately 20% for women who have fallopian tube disease.

Fortunately, many patients with tubal disease have several treatment options available to them – all of which can lead to successful conception and delivery of a healthy baby.

Causes and Symptoms of Blocked Fallopian Tubes

Your Dreamflower fertility specialist will look for indications of blocked tubes in your health history, and will specifically look for common causes, including:

1. Endometriosis
2. Pelvic inflammatory disease
3. Sexually transmitted disease
4. Unexplained infertility

If you have a history of increasingly severe pain or cramping with your periods or with intercourse, previous abdominal or pelvic surgery, or a history of any pelvic infection, we will most likely recommend a laparoscopy to further evaluate your fallopian tubes.

Uterine Abnormalities: Uterine Septums, Scarring and Structural Causes of Infertility

Uterine abnormalities caused by both abnormalities of the uterus from birth and those that occur after birth, can affect fertility and the chance for conception. Both congential and aquired uterine abnormalities are significant causes of both infertility and recurrent pregnancy loss.

Congenital Uterine Abnormalities

Typically congenital abnormalities , present from birth and referred to as Mullerian anomalies, occir when the uterus is forming in the fetus. The uterus develops from a specialized type of tissue called Mullerian tissue. During embryonic development, a female fetus actually starts out with two small uteri (plural of uterus) – one near each kidney. As the fetus develops, each uterus migrates down toward the tissue that ultimately becomes the vagina, and toward the middle of the patient’s body where it fuses with the uterus from the other side.

Under normal circumstances, the wall where the two uteri join reabsorbs completely – from the bottom of the uterus to the top – resulting in a triangular shaped uterine cavity.Any alteration of this development can lead to a Mullerian anomaly.

The most common Mullerian abnormalies include:

1. septate uterus
2. bicornuate uterus
3. unicornuate uterus
4. uterine didelphys

Aquired Uterine Abnormalities

In addition to the congenital uterine abnormalities described above, there are a variety of other uterine abnormalities that can develop after birth. These are referred to as “acquired abnormalities”. Examples include endometrial polyps, intrauterine adhesions, and uterine fibroids.

These conditions frequently cause symptoms – such as increasingly severe menstrual cramps, heavier or irregular vaginal bleeding, or changes in bowel or bladder function. On some occasions, patients are unaware that they have these conditions and they are only discovered as part of a fertility evaluation. Typically large fibroids can be detected during a pelvic examination, however smaller fibroids, fibroids within the uterine cavity, polyps, and adhesions can only be detected by some sort of imaging technique – either a sonogram, an HSG, or a sonohysterogram.

Evaluation for Unexplained Infertility

Infertility is generally defined as the inability of a couple of reproductive age to conceive despite having sexual intercourse regularly without using contraception (unprotected) for a year or longer. In general, 50% of couples will conceive by three months, 75% by six months, and 85% by twelve months of having regular unprotected intercourse. Those couples who have not conceived after a year or more of trying have infertility and should seek evaluation from a Fertility Specialist physician.

During your infertility evaluation, we will thoroughly look for causes for why you have not been able to conceive naturally. We will test to see if you ovulate an egg(s) from your ovaries regularly, that your uterus is structurally normal and that your fallopian tubes are structurally normal and open, and if your partner has adequate numbers of moving sperm. We also will evaluate to see if your ovaries may be prematurely aged compared to your biological age, a condition commonly referred to as “diminished ovarian reserve.” Fertility is usually reduced in women in their late thirties and early forties and women with premature ovarian aging may have reduce fertility at younger ages.

Some patients will also undergo an outpatient surgical procedure under anesthesia, laparoscopy, to evaluate the abdominal and pelvic cavities for abnormalities such as endometriosis that may be contributing to your difficulty conceiving.

During this evaluation for infertility we will usually we will find a cause or causes that help explain your infertility. When we have done a complete evaluation and there is no cause found, we use the term “Unexplained Infertility” to describe the couples who have normal tests but still have infertility.

Unexplained infertility is a frustrating condition, as, while on the surface everything appears to be normal, the couples are still unable to get pregnant naturally. Approximately one in four infertile couples will have unexplained infertility. The good news is that there are effective treatments for unexplained infertility that can help you conceive the child you have been waiting for.

Secondary Infertility, more common than Primary Infertility can be successfully treated.

Although most people think of infertility as a condition that affects couples who have never had children, in fact, even if you’ve successfully conceived before, you might have fertility issues later in life. Secondary infertility (the inability to conceive or carry a pregnancy to term after the birth of one or more children) is even more common statistically than primary infertility. According to the National Survey of Family Growth, more than 1 million couples struggle with secondary infertility.

Secondary infertility is often a “hidden” issue, as couples experiencing secondary infertility often find it difficult to gain understanding or sympathy from family, friends and relatives. Since they already have one child, most people assume that the couple will have no problem having another. Patients with primary infertility may resent couples who have a baby and believe their own pain would disappear if only they too could bear one child. Couples who are victims of secondary infertility are caught between two worlds, fertile and infertile — and can be excluded from both!

Causes of Secondary Infertility

Common scenarios for secondary infertility can include new relationships in which one partner experienced no problems with fertility previously or cases in which one or both members of the couple have developed fertility problems since the birth of their last child.

For women, this can include

1. disorders of ovulation
2. progression of endometriosis
3. growths in the uterus
4. or most commonly, an increase in age

Men can also experience a decline in fertility with age, although it is typically much milder than in women.

There can be many emotions involved in the diagnosis of secondary infertility. Some couples are shocked to find that they are unable to conceive a second child, especially if the first conception was very easy. Those couples who have had problems with infertility may feel significant anxiety and pressure initiating fertility treatments. Other couples may feel guilty about not being able to provide a sibling for their child or fear that they have waited until it’s ‘too late’.

Though couples who have had a previous pregnancy often think of themselves as ‘fertile’, this isn’t always the case. It is important to initiate a workup as soon as a couple is experiencing difficulty conceiving.

The workup for secondary infertility is the same as for primary infertility. A thorough history and physical examination, and evaluation of the uterine, ovarian, fallopian tube, and sperm status are critical. Your doctor can help you to make the right choice regarding further steps. As with primary infertility, treatments for secondary infertility are successful in most cases.

Recurrent Miscarriage: Causes & Diagnosis with our Fertility Experts

Recurrent pregnancy loss is defined by the American Society of Reproductive Medicine as two or more pregnancy losses that occur before the 28th week of pregnancy. In the India, approximately 25% of all pregnancies are lost at some point during gestation. Only 5% of women experience two or more pregnancy losses and less than 1% of women experience three or more pregnancy losses. Although this condition can be very frustrating and emotionally challenging, the overwhelming majority of patients with recurrent pregnancy loss eventually will successfully deliver a healthy child.

Causes of Recurrent Pregnancy Loss

1. Anatomic 22%
2. Genetic 3%
3. Infectious 6%
4. Hematologic or immunologic 25%
5. Hormonal 20%
6. Unknown 40%

As you can see from the table, these numbers total more than 100%, indicating that some patients have multiple causes for their miscarriages. Unfortunately, following the completion of a thorough evaluation for recurrent pregnancy loss, 40% of couples with recurrent pregnancy loss will still not have a definitive diagnosis for their problem.

The Effect of Maternal Age on Recurrent Pregnancy Loss

As women age, their risk of spontaneous miscarriage increases. At age 20, the risk ranges from 9 to 17%; it rises to 20% in women by age 35, 40% at age 40, and 80% in women 45 and over. Most specialists believe that this age-related increase is most likely due to chromosomal abnormalities within the egg.

Anatomic Causes of Recurrent Pregnancy Loss

All healthy pregnancies attach to and grow within the uterine cavity. Unfortunately, some women are born with a uterus that not been formed normally. It appears that approximately 5% of fertile women have uterine anomalies. In other words, despite their abnormally shaped uterus, they were still able to successfully conceive and deliver a child. On the other hand, approximately 15% of patients with recurrent pregnancy loss have an abnormal uterus.

Uterine Development, Structural Causes of Recurrent Pregnancy Loss

When a woman is a fetus developing in her mother’s uterus, she initially has two separate uteruses (“uteri”), each originating near the corresponding kidney. As the female fetus develops, these two early uteruses migrate towards each other and eventually fuse. In the normal situation, the wall between the two separate uteruses reabsorbs, resulting in a normal, single, triangular shaped uterine cavity. Anatomical abnormalities result when this sequence of events does not occur or fails to occur completely.

The most common uterine abnormality is the septate uterus. In a large study from Yale, 85% of patients with a septate uterus either failed to conceive or miscarried repeatedly. Following repair of this abnormality, 88% of patients went on to deliver successfully while only 12% continued to have difficulty – either they failed to conceive or they continued to miscarry. Other uterine abnormalities include the bicornuate uterus (2 separate uterine cavities sharing a single cervix), the unicornuate uterus (a situation where only one of the fetal uteri develops), or a complete uterine duplication (2 uterine cavities, each with its own cervix). These are far less common and surgical correction does not appear to improve the prognosis in these patients.

Another uterine abnormality that can interfere with successful conception is the presence of scar tissue within the uterine cavity. This typically results following a D&C if too much uterine lining tissue is removed – the walls of the uterus can subsequently stick together, making the cavity small and irregular. Additional anatomic abnormalities that are associated with recurrent pregnancy loss include uterine fibroids or endometrial polyps. Fibroids are benign tumors caused by an overgrowth of uterine muscular tissue. They can occur inside the uterine cavity, in the muscular wall of the uterus, or on the outside of the uterus. Polyps are an overgrowth of glandular tissue within the uterus. Either of these conditions can cause abnormal uterine bleeding or they may be asymptomatic. Fibroids may also cause a significant increase in menstrual cramps, pelvic pressure, or pelvic pain.

Genetic Causes

Genetic abnormalities are one of the most common causes of recurrent pregnancy loss. It is thought that the more severe the embryonic genetic abnormality, the earlier the pregnancy is lost. Studies have shown that 60% of normal appearing day three embryos from 35-year-old women are chromosomally abnormal. This percentage rises to 90% in 40-year-old women. These abnormalities usually result from problems within the egg – either the egg’s chromosomes are abnormal or the structure responsible for chromosome separation as each cell divides is abnormal. Research suggests that, although problems in the sperm can lead to chromosomal abnormalities as well, this occurs much less frequently. Typically, if sperm are not chromosomally normal, either they fail to fertilize the egg or the fertilized egg fails to divide, resulting in loss of the pregnancy.

Despite the fact that genetic abnormalities in miscarried embryos are common, genetic abnormalities in parents are very rare. Even when patients have lost several pregnancies that were known to be chromosomally abnormal, only 2% to 3% of patients or their partners turn out to have a genetic abnormality themselves. Genetic translocations (where parts of two different chromosomes change places) represent the most common parental cause of genetic abnormalities.

Infectious Causes Of Recurrent Miscarriage

Although many studies suggest that infections such as gonorrhea, chlamydia, mycoplasma, and ureaplasma are associated with recurrent pregnancy loss, this still remains somewhat controversial. Regardless, a thorough evaluation of recurrent pregnancy loss includes the performance of cervical cultures designed to detect the presence of these conditions. Regardless of the culture results, each member of the couple is subsequently treated with antibiotics for at least 10-14 days, as cervical cultures have been demonstrated to be accurate less than 70% of the time.

Hematologic or Immunologic Causes

When a pregnancy attaches to the uterine wall, it gets nourishment and oxygen from the mother by way of the placenta. This circulatory connection is critical to the survival and growth of the baby. Some miscarriages are caused by blood clots that form in the small vessels of the placenta, as these clots prevent the transfer of either nutrition or oxygen to the fetus. These clots may be caused by abnormalities in the normal blood clotting mechanism.

This category of miscarriage is referred to as “hematologic or immunologic”, and consists of three basic causes. The first is antiphospholipid antibody syndrome (APAS). APAS has been reported to occur in 3%-15% of women with recurrent pregnancy loss. Although many blood tests can detect the presence of APAS, the only test that has been demonstrated to correlate with recurrent pregnancy loss is the anti-cardiolipin antibody test. This simple blood test effectively confirms the presence or absence of APAS.

The second major hematolgic cause of recurrent pregnancy loss is lupus anticoagulant. While this condition unfortunately shares the same name as the chronic disease commonly referred to as “lupus”, the two conditions have little in common with each other. Like APAS, lupus anticoagulant is a disorder in which blood clots occur within the small vessels of the placenta. As with APAS, a simple blood test can detect the presence of lupus anticoagulant.

The final category of hematologic causes of recurrent pregnancy loss is a group of disorders called thrombophilias. This category includes such conditions as deficiencies of factor V Leiden, protein C, protein S, and methyl-tetrahydrofolate reductase (MTHFR). It remains controversial as to whether thrombophilias cause recurrent pregnancy loss and, in fact, the American Society for Reproductive Medicine in their August, 2008 practice committee report, stated that there is no evidence that it is beneficial to either diagnosis or treat these conditions. Therefore, many fertility specialists no longer test patients with recurrent pregnancy loss for thrombophilias.

Hormonal Causes

The evidence supporting a hormonal cause of recurrent pregnancy loss is also somewhat limited. This condition, called “luteal phase inadequacy”, is thought to result from inadequate progesterone production, leading to a disorder in which the development of the uterine lining is not synchronized with the development of the embryo. Therefore when the embryo tries to attach to the uterine wall, an unstable attachment may occur which may lead to miscarriage. This condition is classically diagnosed by performing an endometrial biopsy – a procedure where a small piece of uterine tissue is removed and subsequently evaluated under a microscope. This test is somewhat uncomfortable and, as even normal women can occasionally have an abnormal biopsy, the biopsy should actually be performed twice (preferably in consecutive cycles) in order to confirm the presence of the abnormality. If luteal phase inadequacy is diagnosed, it is treated with either progesterone or Clomid. Due to the discomfort caused by the biopsy, many fertility specialists will initiate treatment without a repeat biopsy. Other hormonal etiologies that have been associated with luteal phase inadequacy include thyroid disease and hyperprolactinemia.

Luteal Phase Defect can be associated with Recurrent Miscarriage

Luteal phase defect is a condition that is associated with recurrent miscarriage and possibly with infertility as well.

An ovulatory cycle is divided into two phases…

Follicular Phase: The part of the cycle prior to ovulation is called the follicular phase. During this time, the follicle (the fluid filled sac within the ovary that contains the oocyte) develops in preparation for release of the oocyte. The developing follicle produces a type of estrogen (“estradiol”), that stimulates growth or thickening of the uterine lining (the “endometrium”).

This estrogen production is also responsible for increasing the cervical mucous production and changing its characteristics to make it more favorable for sperm penetration. When release of the egg occurs (“ovulation”), the cells remaining in the follicle undergo changes that allow them to produce another hormone called progesterone. This process is called “luteinization”, and it is triggered by the release of a hormone called luteinizing hormone, or LH.

Luteal Phase: Following this LH surge, the follicle changes names and it becomes the “corpus luteum”. This event is the beginning of the luteal phase, which makes up the second half of a woman’s cycle. The progesterone made by the corpus luteum causes changes to occur within the endometrium that make it more favorable for embryo attachment (“implantation”).

If progesterone production is weaker than normal, the endometrium may not develop sufficiently for an embryo to implant. This situation is called a luteal phase defect. The developing endometrium is dependent on adequate progesterone production from the ovary.

The Importance of Progesterone in the Luteal Phase

Although many physicians focus on the blood progesterone level, it is actually more important that progesterone production be of a sufficient quantity for an appropriate number of days. The absolute serum level of the hormone is not as important.

Therefore, simply measuring the serum level may be misleading. It is more accurate to evaluate the effect of progesterone on the endometrium over time. This is accomplished by examining a piece of uterine lining tissue under a microscope, a procedure call an endometrial biopsy. This biopsy is obtained close to the end of the luteal phase, which is the most accurate time to evaluate the luteal phase. Another acceptable (and far less uncomfortable) way of evaluating the luteal phase is to count the number of days from the time of ovulation until the woman begins her next menses. A normal luteal phase needs to be at least 12 days.

Treatment for Luteal Phase Defects, includes Progesterone Supplementation

The most common treatment for a short luteal phase is to give the woman extra progesterone.

Progesterone supplementation can effectively prevent the loss of a pregnancy when given to women with a luteal phase defect. Usually, progesterone supplementation is begun three days following ovulation. It is therefore important to accurately document the day of ovulation, as starting progesterone too soon may increase the risk of a tubal pregnancy. It is common for women to use a urinary ovulation predictor kits to determine the day of ovulation. As the LH surge typically precedes ovulation by 18-30 hours, progesterone supplementation is begun four days after the initial detection of the LH surge.

Types of Progesterone Supplementation

Supplemental progesterone is given to all women undergoing in vitro fertilization. In the past, intramuscular progesterone was utilized exclusively for IVF supplementation. Recent data, including one of the largest studies on this topic – performed at Dreamflower – suggest that other methods of progesterone supplementation, such as a vaginal gel, are just as effective, if not more so.

Oral progesterone is not as effective because of its short half life, and also because it may be broken down by stomach acid. When a medication has a short half life, it needs to be given more frequently to maintain adequate levels in the circulation.

Luteal phase defect is a significant cause of recurrent miscarriage – and possible infertility as well – that, once diagnosed, is easily treatable.

Fertility evaluations for conditions such as PCOS, Endometriosis, Male Factor, and more.

Identifying the cause of infertility, the roadblock that stands between you and a baby, is the critical first step in devising a fertility treatment plan. Your Dreamflower IVF Centre evaluation will begin with a consultation. At this time, one of our renowned fertility specialists will determine a course of action to diagnose and overcome infertility,unexplained infertility, or secondary infertility. As infertility is a medical condition that affects the couple, we always recommend that both partners fully participate in the evaluation.

Dreamflower IVF Centre favors an organic, straightforward approach to diagnosis. For some couples, treatment will simply involve timing intercourse to maximize the chances for conception. For women diagnosed with more involved conditions such as endometriosis, pelvic adhesions, or ovulatory problems including polycystic ovarian syndrome, we will proceed with evidence-based, targeted treatments.

Precise Infertility Evaluation to pinpoint Fertility Treatment

1. Initial Consultation
2. Male Fertility Evaluation
3. Surgical Evaluation
4. Follow-Up Consultation
5. Recurrent Miscarriage Evaluation (Special Testing)

Initial Consultation

Another important component of the initial consultation is to educate the couple about normal reproductive function. All too often, the last exposure that many couples had to any formal instruction was during high school sex education classes, and much of their current knowledge may not be based on fact. Often times, there are many myths and misperceptions that have to be addressed and corrected in order to help a couple understand normal reproductive physiology. This also helps the couple better understand normal statistics regarding fertility, the various causes of infertility, and the rationale for treatment. Preconception counseling regarding lifestyle and health factors including smoking, alcohol consumption and exercise are also addressed at this time. Once the initial consultation has taken place, the physician will establish a plan for a diagnostic evaluation.

The goal of the fertility evaluation is to identify a specific cause or causes of infertility, and to then recommend appropriate targeted treatments. The most common cause of female infertility is a disorder in ovulation. Significant information can be obtained from a menstrual history including cycle length and variability, as well as duration of menstrual flow and age of menarche (your first period). There are several ways to determine if ovulation occurs normally, including basal body temperature charting, ovulation predictor kits, and serial ultrasonography.

The evaluation of ovarian reserve, which refers to the number and quality of oocytes remaining in a woman’s ovary, is often performed as part of the ovulation assessment. Ovarian reserve testing typically involves measurement of the hormones follicle stimulating hormone (FSH) and estradiol (E2) on cycle day two, three, or four, as well as an ultrasound evaluation of the number of follicles within the ovaries early in the menstrual cycle. The final part of the evaluation of ovulation is a determination of the length of the post ovulatory, or luteal, phase. This time frame, which includes the time from ovulation until the onset of the next menstrual bleed, should be 12-14 days in length.

The next component of the female infertility evaluation is an assessment of the uterus and the fallopian tubes. This is most commonly accomplished with a procedure called a hysterosalpingogram (HSG), which involves a radiologic evaluation performed after a woman’s flow has ceased, but prior to ovulation. The HSG involves placement of a small catheter through the opening of the cervix in order to pass dye into the uterus and the fallopian tubes. In addition to determining whether the tubes are open (patent) and normal, the HSG can also diagnose any type of structural abnormalities of the uterus, such as congenital anomalies (birth defects), polyps or fibroids.

In specific situations, such as when a woman has a history of severe or worsening menstrual cramping or a strong family history of endometriosis, your physician may recommend an outpatient surgical procedure known as laparoscopy for further evaluation of the pelvic anatomy.

Male Factor Infertility Evaluations

As with the female, the goal of the male fertility evaluation is to identify a specific cause or causes of infertility, and to then recommend appropriate targeted treatment. The basic evaluation consists of a history – during which time previous fertility, medical conditions, surgeries, sexually transmitted diseases, and lifestyle issues will be discussed. A family history, looking for infertility, miscarriages, or other diseases will also be evaluated. The primary test of male fertility is the semen analysis. This test is critical, as it evaluates the sperm concentration as well as motility (the percent of sperm that are alive and swimming) and morphology (shape). If the semen analysis is abnormal, or if there is something in the male’s history that suggests an anatomic abnormality, then we will probably refer him to a urologist for a physical examination. We may also recommend a blood test to check the hormone levels that influence sperm production, including FSH, LH, and testosterone.

In some cases, male factor infertility is the cause of the problem.. After taking a comprehensive medical history and reviewing all previous medical testing on your partner, we may recommend additional testing as well as a consultation with a urologist for a more advanced evaluation.

Surgical Evaluation

An integral part of the female fertility evaluation is an assessment of the reproductive anatomy – specifically the fallopian tubes, the uterus, and the ovaries. If an abnormality is discovered, it is usually correctable through the performance of a relatively minor surgical procedure, such as laparoscopy or hysteroscopy

If we determine that you need surgery, we will refer you to our surgical coordinator whose sole job is to handle all of the details involved in scheduling your procedure – answering your questions as well as coordinating the scheduling of the surgery between your physician, the surgery center or hospital, and your insurance company. The surgical coordinator will also arrange for a preoperative evaluation with your physician who will thoroughly discuss your procedure with you in detail, including the risks of the procedure, the expected outcome, and what you can expect following surgery. Our nursing staff calls every surgery patient following surgery to ensure that you are recovering as expected, to review the intraoperative findings with you, and to answer any additional questions that you may have. At that time, they will also schedule a postoperative visit with your physician.

Follow-Up Consultation

Once the diagnostic portion of the fertility evaluation has been completed, the physician will typically schedule a meeting with you and your partner to review all of the results of the testing and to discuss treatment recommendations. This is another opportunity for you to discuss the success rates and risks of any recommended treatment, as well as the costs and time commitment required for each. Following your consultation, a treatment plan will be established and you will begin your fertility journey.

Fertility Tests Uncover the Causes of Infertility in Both Men and Women

Fertility Tests

Prior to deciding upon a treatment plan, it is important to do some basic fertility testing to uncover any issues that should be addressed before treatment. For the woman, it is important to evaluate the uterus, ovaries, and fallopian tubes. As well, there may be some recommended genetic testing to see if either patient or partner may carry a hidden genetic mistake that may increase the chance for a child with a genetic abnormality.

Common Blood Tests

Bloodwork is an integral part of fertility testing and treatment. The most basic fertility evaluation for the woman often includes testing for ovarian function (FSH and estradiol) as well as a few other hormones (TSH and prolactin). Other scenarios (e.g. PCOS or recurrent pregnancy loss) may warrant other types of bloodwork to be analyzed. Also, any couple pursuing intrauterine insemination (IUI) or in vitro fertilization (IVF) is required to have infectious disease screening prior to treatment. Your physician will individualize the type of bloodwork to be ordered based upon your very specific situation.

Genetic Screening

Before proceeding with pregnancy, your physician may offer you the opportunity to screen for one or more genetic disorders. Even if you and your partner are perfectly healthy and have no history of genetic disorders in your or his family, either of you may still carry a ‘silent’ genetic mistake – which could increase the chance of a baby with a genetic disorder. The American College of Obstetrics & Gynecology (ACOG) has recently recommended that “preconception and prenatal cystic fibrosis (CF) carrier screening should be made available to all women of reproductive age as a routine part of obstetric care.” You doctor can discuss with you any other genetic tests that may be considered depending upon your family history and/or your ethnic background.

Ultrasound Examination

An important aspect of fertility evaluation is looking at the womb – the uterus. An internal ultrasound is done as part of the basic testing to look closely at the shape and size of the uterus as well as to evaluate the uterine lining and any other abnormality (e.g. fibroid, polyp, or septum). As other specialties may not look at the uterus the same way that we do, even if you have had a previous ultrasound elsewhere, your physician will want to repeat the ultrasound. The ultrasound also gives us important information about the ovaries – how they look and where they are located. Usually, fallopian tubes are not seen on ultrasound, so a separate test (called an HSG) is usually required to look at them more closely. Hysterosalpingogram (HSG)

Since the ultrasound generally gives no information about the patency of fallopian tubes, it is important to look at them through a test called an HSG. This test is done by a radiologist and involves placing a thin catheter into the uterus and injecting dye into the cavity of the uterus (where a pregnancy would grow). This dye shows up on x-ray, and pictures are taken during this test to determine if both fallopian tubes are open. This test can also give more information about the inside of the uterus. This test is generally short (about 15-20 minutes usually), but it can cause cramping. Consider talking to your nurse about taking extra pain medication (e.g. ibuprofen) 30-60 minutes before the procedure. Even though it is not a comfortable test, it can be very informative for evaluation of anatomy – there also appears to be a mild fertility boost for some couples in the first few months following this test.

Surgical Evaluation

Some patients may benefit from having their physician perform a laparoscopy and/or a hysteroscopy. Laparoscopy involves placing a thin camera through the belly button. A laparoscopy can be used to evaluate and treat endometriosis, scar tissue, and certain fibroids. Alternatively, a hysteroscopy involves placing a thin camera inside the uterus. It is helpful for diagnosing and treating such things like a uterine septum, polyps, or certain fibroids. Both of these procedures are outpatient and can be done concurrently if necessary.

A thorough evaluation of infertility or recurrent miscarriage often includes specific testing designed to evaluate abnormalities uncovered during the initial medical history and physical examination. These tests help your physician determine the cause or causes of your condition.

Semen analysis

As sperm problems affect around 30% of couples with infertility, it is important to do a semen analysis to identify any issues. After 2-5 days of abstinence, the male partner can provide a semen sample into a sterile cup. This can be done at home if the couple lives within an hour of the clinic. Alternatively, a collection room can be available. Usually collection is done via masturbation; however, a ‘collection condom’ can be used to collect sperm during intercourse. The semen analysis will give information about sperm numbers, the percentage of sperm moving, and the percentage of sperm that look ‘normal’. Certain treatments are not successful with low numbers of moving sperm, so this is important information for your fertility specialist to have.

The above tests are commonly done for couples having problems with fertility. Your doctor will let you know if there are further tests to consider for your specific situation. After basic testing, the next step will typically be a consult visit with your doctor to determine the best approach to get you closer to your goal of growing your family!