Infertility Specialist

What is infertility?

• Infertility is the inability of a couple to become pregnant after 1 year of unprotected intercourse
• 10-15% of reproductive-aged couples will experience infertility
• Infertility is age-related in women and occurs with 11% of 34-year-old women, 33% of 40-year-old women and 87% of 45-year-old women.
• Therefore, an infertility workup can be initiated after 6 months of unprotected intercourse for women over 35 years of age as opposed to 12 months for women under 35 years of age.

What causes infertility?

• For spontaneous conception to occur, eggs, sperm, fallopian tubes and a uterus are necessary.  Damage to any of these components can cause infertility
• Problems with ovulation, the process by which an egg is released from the ovaries, make up 27% of infertility cases
• Ovulation can be affected by the polycystic ovarian syndrome, ovarian cysts, primary ovarian insufficiency, thyroid disease, hormone imbalance or pituitary disorders.
• Scarring or damage to the fallopian tubes causes 22% of infertility cases
• This can occur in patients with a history of endometriosis, pelvic inflammatory disease, chlamydia infections, abdominal surgery, ruptured appendicitis, or diverticulitis
• Problems with sperm make up 25% of infertility cases
  • Sperm development takes 90 days so high temperatures such as a hot tub or fever in the last 3 months can cause damage
  • Sperm can also be damaged by testicular trauma, a varicocele, infections such as mumps or STDs, and certain medications

• 9% of infertility cases are due to other cases including uterine factors such as fibroids or scarring from prior surgeries.
• 17% of infertility cases remain unexplained

What can be done by the patient to increase fertility?

• Optimizing health is the first step
  • Cigarettes, from smoking or secondhand smoke, contain toxins that cause ovaries to lose eggs more quickly than is natural
  • These toxins also cause mutations in the genes within the eggs which increases the risk of miscarriage
  • Just 5-8 drinks per week decrease the chance of pregnancy
  • Marijuana suppresses the pathway between the brain and ovaries
• Early studies also indicate it may decrease male fertility as well
• Maintain a healthy weight
• Quit smoking
• Decrease alcohol use
• Avoid marijuana
• Keep a menstrual calendar
• Ovulation occurs 2 weeks before menses begins
• The best time to have intercourse is the 5 days leading up to ovulation and the day of ovulation

Use ovulation predictor kits to help time intercourse.

What would an infertility work up mean for you?

• Complete history including:
• Medical history to ensure there are no medical conditions that should be optimized prior to attempting pregnancy including.  Also screening for a history of infections that could be the cause for infertility
• Surgical history to determine if there is a possibility of scar tissue in the abdomen or uterus
• Family history to screen for genetic disorders that could be passed on to children
• Social history to screen for behaviors that could be decreasing fertility
• Lab work can be done to ensure hormones are appropriate for the patient’s age
• If history indicates a potential problem with the sperm, a semen analysis can evaluate the number, quality, and motility of sperm
• An ultrasound is often used to evaluate the overall shape of the uterus and count the number of follicles, eggs waiting to develop, on the ovaries
• A procedure known as a hysterosalpingogram, or HSG, can be used to assess the shape and size of the uterus and to ensure that the fallopian tubes are open allowing ovulated eggs to reach the uterus.
• If necessary laparoscopic surgery can be done to look inside the patient’s abdomen to assess for and remove scar tissue

How is infertility treated?

• Ovulation dysfunction
  • First eggs are removed from the ovaries. 
  • The eggs are then combined with sperm in a lab
  • The resulting embryo is placed into the uterus where it will hopefully implant and develop into a successful pregnancy
• If the ovaries contain eggs that are just not being released properly there are medications and a surgical procedure that can help stimulate the ovaries to ovulate properly
• If following this the ovaries are still not ovulating properly, in vitro fertilization (IVF) can be done
• Tubal factor infertility
• If the tubes are closed and eggs are not making it to the uterus, sometimes a procedure can be completed to reopen the tubes.
• If there is scar tissue within the abdomen involving the tubes, this scar tissue can be removed surgically
• If the tubes are severely damaged sometimes the best treatment is to remove the tubes and proceed with IVF
• Uterine factor infertility
• If there is scar tissue or a fibroid within the uterus a surgical procedure can be done to look inside the uterus with a camera and remove the scar tissue or fibroid
• Male factor infertility
  • Placing the sperm in closer proximity to the eggs can help if motility is a problem
• There are some medications available that can boost sperm count
• Intrauterine insemination (IUI) involves taking a semen sample, concentrating the sperm and gently injecting the sperm into the uterus
• If the number of sperm is very low or motility is severely restricted, IVF can be done to directly combine the sperm with the egg