Thyroid, Breast, Endocrine & Cancer Surgeon
Obstetrician, Gynecologist & Laparoscopic Surgeon
For most couples trying to have a baby, getting pregnant takes an average of six months. After having frequent, unprotected (without using birth control) intercourse for one year, about 10 percent to 15 percent of couples in their 20s and early 30s have difficulty getting pregnant-difficulty getting pregnant jumps to 40-50% in women in their late 30s and 40s. When this happens, the couple most likely has a problem with infertility.
For many couples trying to conceive, something may go wrong in one or several of these complex processes, thus causing infertility. A couple is usually considered to be infertile when pregnancy has not occurred after one year of unprotected intercourse. Since most couples are able to conceive within this time frame, it is recommend that couples who are not able to do so be assessed, and if needed, be treated for fertility problems.
You may have fertility problems if you haven't been able to get pregnant after trying for at least 1 year. It doesn't necessarily mean you will never get pregnant. Often, couples conceive without help in their second year of trying. Some don't succeed. But medical treatments do help many couples.
Age is an important factor if you are trying to decide whether to get testing and treatment for fertility problems. A woman is most fertile in her late 20s. After age 35, fertility decreases and the risk of miscarriage goes up.
⇒ If you are younger than 35, you may want to give yourself more time to get pregnant.
⇒ If you are 35 or older, you may want to get help soon.
In cases of fertility problems
⇒ About 50 out of 100 are caused by a problem with the woman's reproductive system. These may be problems with her fallopian tubes or uterus or her ability to ovulate (release an egg).
⇒ About 35 out of 100 are caused by a problem with the man's reproductive system. The most common is low sperm count.
⇒ In about 10 out of 100, no cause can be found in spite of testing.
⇒ About 5 out of 100 are caused by an uncommon problem.
Before you have fertility tests, try fertility awareness. A woman can learn when she is likely to ovulate and be fertile by charting her basal body temperature and using home tests. Some couples find that they simply have been missing their most fertile days when trying to conceive.
⇒ A standard fertility evaluation includes physical exams and medical and sexual histories of both partners. Men undergo a semen analysis that evaluates sperm count and sperm movement.
⇒ For women, doctors first check to see whether ovulation is occurring. This can be determined and monitored through blood tests that detect hormones, ultrasound exams of the ovaries, or an ovulation home test kit.
⇒ If a woman is ovulating, we then move to test patency of your fallopian tubes known as HSG( hysterosalpingogram).
Once the initial work-up is complete and test results are reviewed, a diagnosis can be pinpointed and a treatment plan begun. We will educate you thoroughly about your particular diagnosis, but we have provided an overview below. We believe it is essential for our patients to understand what is happening to them every step of the way.
A surgical procedure called hysteroscopy(looking inside the womb)and laparoscopy also allows doctors to examine the ovaries, uterus, fallopian tubes, and abdominal cavity. We may begun to assess the ovarian reserve by measuring hormone levels and seeing how the ovaries respond to various fertility treatments.
Semen analysis refers to looking at semen under a microscope to identify any signs of abnormality. This analysis is an essential part of any fertility work-up since problems with male sperm account for about 40% of all infertility experienced by couples.
Men must refrain from ejaculation for 48-96 hours prior to giving a specimen for evaluation. The sample is usually collected by masturbating and ejaculating into a sterile specimen cup, which our clinic will provide at the time the appointment, is made. The specimen may also be collected at home and brought to our offices within one hour of collection.
Ovulatory disorders are the most common form of infertility in women. Affecting nearly 40% of women in child-bearing age, ovulatory disorders directly affect the ovaries' ability to release the egg. Symptoms may include the absence of regular periods (anovulation) or irregular menses due to a hormonal imbalance, severe stress, high endurance or excessive exercising, or extreme weight loss (both over and under), thyroid dysfunction, insulin resistance and eating disorders. Anovulation is a condition in which a woman's eggs fail to develop properly and/or are not released from the egg sacs (follicular cysts or follicles) of the ovaries.
Treatment of ovulatory disorders focuses on the underlying cause of the specific disorder. When no clear cause of is found, a physician can treat the patient with ovulation-inducing medications - this results in an excellent chance for pregnancy.
Hysterosalpingogram, a type of X-ray of the fallopian tubes and uterus. This test involves placing a radiographic dye solution into the uterine cavity. Multiple X-rays are taken. If the fallopian tubes are open, the dye will flow through the tubes and be visible in the abdominal cavity. If the fallopian tubes are blocked, the dye will be retained in the uterus or fallopian tubes, depending on the location of the blockage.
Laproscopy This involves inserting a fiber-optic telescope into the abdomen. One advantage of laparoscopy is that it allows doctors to both diagnose and treat conditions such as endometriosis. This occurs when uterine cells attach to tissue outside of the uterus. Adhesions, abnormal attachments between two surfaces inside the body, can also be treated in this way.
⇒ How common is infertility?
The most recent estimates indicate that infertility affects nearly 10 -15 percent of the population in their childbearing years.
⇒ Does a diagnosis of infertility mean I am sterile?
Infertility and sterility are two different problems. Just about 90 percent of all diagnosed infertility cases can be traced to specific causes, which allows the majority of couples to receive proper treatment to achieve pregnancy.
⇒ Does infertility only happen to women?
While many people associate infertility with women, it actually occurs evenly among both women and men.
⇒ How often should we have intercourse while trying to conceive?
A man's sperm can live between 48 and 72 hours in his partner's reproductive tract and can fertilize an egg at any time during that period of time. Sexual intercourse is appropriate every two to three days around the time of ovulation i.e. 10th to 20th day of menses if she menstruate monthly.
⇒ What affects the ability of sperm to fertilize an egg?
A man's semen quality and quantity may impact the ability of sperm to effectively fertilize a women's egg. While the movement of sperm plays an important role in fertilization, men with a low sperm count may have highly mobile sperm that may be fertile. Obesity, smoking, excessive alcohol consumption, wearing tight undergarments may affect semen parameters.
⇒ Do all infertility treatments involve "high-tech" or experimental procedures?
No. Most couples who undergo treatment for infertility use simple or "low-tech" procedures. Less then five percent of all couples that seek infertility treatment will undergo assisted reproductive technologies (ART), and most of the major ART procedures, like in vitro fertilization (IVF), are common medical treatments.
⇒ How successful are treatments for infertility?
Advances in treatments have made pregnancy a reality for a majority of couples that are pursuing treatment for infertility. The success rate for couples who need assisted reproductive technology had dramatically improved over the years. In fact, the pregnancy rate for an ART series may surpass the monthly fertility rate for a majority of couples trying to conceive. While success rates vary from case to case, you should talk with your doctor more about treatment for your specific case.
⇒ Are there side effects associated with the use of hormonal therapies?
Studies have shown that hormonal therapies are effective and safe. Like any other prescribed medication, you may encounter some possible side effects. You should discuss with us the prescribed treatment and what, if any, side effects you may encounter. It is important to report all symptoms to us as they will observe your response to the treatment.
For ovulation study we perform USG transvaginally with a specifically designed probe called the vaginal transducer. Transvaginal imaging utilizes a higher frequency imaging, which gives better resolution of the ovaries, uterus and endometrium (the fallopian tubes are generally not seen unless distended), but is limited to depth of image penetration, whereas larger lesions reaching into the abdomen are better seen transabdominally. The procedure is regarded as not painful and non invasive.
It is started on day 2 or 3 of periods with a baseline ultrasound to see the baseline status of the ovaries prior to starting stimulation of the ovaries for IUI or IVF. Then a series of USG's are done every few days to monitor the growth of the eggs. Folliculometry ends around day 12 to day 17 with the documentationn of ovulation. This is an entirely painless procedure.
⇒ Is there any risk in getting ultrasounds done regularly?
As currently applied in the medical field, properly performed ultrasound poses no known risks to the patient. Sonography is generally described as a "safe test" because it does not use mutagenic ionizing radiation, which can pose hazards such as chromosome breakage and cancer development
IUI treatment uses a catheter to put washed, prepared sperm at the top of the cavity of the womb around the time of ovulation to increase the chance of getting pregnant. IUI is more successful if it is done in combination with daily FSH (follicle stimulating hormone) injections to stimulate egg production and accurate timing of insemination to coincide with egg release. A combination of tablets and injections are used to stimulate the woman's ovaries to produce one or two eggs using very low doses of FSH injections. Once one or two follicles (fluid-filled sacs) have reached 16-18mm across, the eggs inside the follicle will be mature and egg release (ovulation) is triggered with a different injection. Insemination takes place 36 – 40 hours after the trigger injection.
IUI is one of the assisted conception treatments that is used to treat unexplained or mild male factor infertility. It may also be used if you have irregular periods but have not fallen pregnant with clomifene (tablet medication). IUI is only recommended if your fallopian tubes are normal and 5 million or more forward-moving sperm are present after the sperm preparation process.IUI is less invasive than IVF and currently forms pathway for some couples before moving on to IVF treatment.
