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Infertility

There are many reasons why a couple might be infertile: dysfunction of a woman’s ovaries, a woman being over age 35, issues with the fallopian tubes or uterus and sperm disorders are some of the leading causes.

Before beginning infertility evaluation and testing, most individuals or couples fit into one of these categories:

  • They are under 35, and have tried for one year to conceive
  • The woman is over 35 and has not gotten pregnant, despite six months of unprotected sex
  • The woman has had irregular periods or pelvic surgery

Additionally, some individuals and couples who want a child seek consultation from their gynecologist for other reasons, such as:

  • The individual does not have a spouse or partner
  • The couple is of the same sex
  • The woman is in her 20s to 30s and is considering freezing her eggs

Things to Consider
Pursuing fertility treatment requires you and your partner to have a very strong desire to start a family. That is because the process can be both physically and emotionally demanding as you try to achieve your goal of becoming pregnant and having a baby.

Prior to moving forward with infertility testing and treatment, your gynecologist will discuss the possible causes of infertility, and explain whether they can be treated medically and if so, the options, risks and possible side effects associated with them.

Common Causes of Female Infertility

  • Being over age 35
  • Dysfunction of the ovaries
  • Fallopian tube blockages

Common Causes of Male Infertility

  • Sperm count or issues with the sperm’s motility
  • Shape of the sperm
  • PH factor and semen volume

The Testing Process
Most gynecologists follow a straightforward process to determine the cause of infertility that includes testing the eggs, testing the sperm and finally conducting other tests to see if the egg and sperm are compatible.

Egg Testing

  • Your gynecologist will give you a blood test to check your progesterone levels, usually about a week prior to the start of your next menstrual period.
  • If you are over 35, you will also be tested for your “ovarian reserve,” which simply means the supply of eggs you have available

Semen Testing

  • An ejaculated semen specimen from your partner or your donor will be tested for sperm concentration, volume, the number of active sperm and the number of normal forms

Compatibility

  • If individual egg and sperm tests show no abnormalities, your gynecologist may suggest a hysterosalpingogram (HSG), which is a type of x-ray
  • During an HSG, liquid is inserted into your uterus using a small flexible catheter. X-rays are then taken and the outline of the uterine cavity and fallopian tubes is visible on the x-ray film. This can confirm that the uterine cavity is normal and that the fallopian tubes are open.

Other Tests

  • Your gynecologist may monitor your menstrual cycle to gain more insight into the possible cause of your infertility
  • If you are not ovulating properly, you may be given a hormonal evaluation
  • Infectious disease testing will also likely be conducted for you and your partner. Basic tests usually include HIV I and II, Hepatitis B Surface Antigen, HTLV I, Hepatitis C Antibody and Rapid Plasma Reagent (RPR).
  • Surgical evaluation may be needed to determine the cause of some infertility issues.

Types of Treatments

Ovulation Induction 
If the quality of your existing eggs is considered good and you have no other infertility issues, your gynecologist may prescribe a medication that will induce ovulation. These include both oral and injectable medications.

Sperm Washing and Intrauterine Insemination (IUI)
The goal of sperm washing and intrauterine insemination (IUI) is to increase the chance of fertilization by increasing the number of sperm that reach the fallopian tubes.

  • IUI: Is the process of placing this “washed” sperm inside the uterus. To do this, a gynecologist will prepare the area and use a sterile, flexible catheter to place the sperm in the cervix or higher in the uterus.
  • Semen Washing: This process prepares a semen sample for IUI by "washing" it the laboratory. The process involves separating the sperm from the other components of the semen and concentrating it in a small volume.

In Vitro Fertilization (IVF)
In vitro fertilization, IVF, can help women with blocked fallopian tubes. This treatment involves retrieving a woman's eggs and fertilizing them with sperm in a laboratory dish. One or more of the fertilized eggs (embryos) are then transferred into the woman's uterus, where it is hoped they will implant and produce a pregnancy.

Although IVF has helped couples to become pregnant, there are some potential risks from fertility medications and procedures used, as well as an increased rate of becoming pregnant with twins or triplets. There are also a number of possible side effects of treatment, such as abdominal swelling and discomfort. Your gynecologist will consult with you on these matters.

The IVF process happens over a period of weeks, and often this cycle must be repeated before pregnancy occurs.

  • Ovarian Stimulation
    • Your gynecologist will prescribe fertility medications to increase the number of eggs and control the time of ovulation. For several weeks before beginning IVF, you will take a birth control pill in order to prevent your body from releasing hormones that stimulate natural ovulation.
    • You will begin giving yourself injections of a medication that helps prevent your body from releasing hormones that could stimulate ovulation or allow premature ovulation. You will need to contact your gynecologist on the first or second day of menstrual bleeding to schedule blood tests and an ultrasound.
    • A few days later, you may have a pelvic ultrasound to evaluate your ovaries and blood testing to measure hormone levels. If these tests are positive, your gynecologist will tell you when to begin giving yourself injections to stimulate the growth of egg follicles.
    • After a few days of injections, you will have a pelvic ultrasound to measure follicle growth and a blood test to measure hormone levels.
       
  • Egg Retrieval Procedure
    • You likely will be sedated during this procedure and you should arrange for someone to drive you home afterwards.
    • To retrieve the eggs, your gynecologist inserts an ultrasound probe into your vagina and then uses a needle to extract an egg from each follicle. You will go to a recovery room and rest for several hours.
       
  • Fertilization Procedure
    • The retrieved eggs (called “oocytes”) are combined with sperm in a laboratory dish to fertilize. Typically, about 50 percent of oocytes become fertilized.
       
  • Embryo Transfer Procedure
    • Several days after retrieval, one or more fertilized eggs (embryos) are placed your uterus.
    • To perform this procedure, your gynecologist will insert a thin, flexible catheter through your cervix. The catheter is inserted gently and anesthesia is usually not needed.
    • After transfer, your gynecologist may prescribe a hormonal medication that can improve the chances that the embryo will implant and you will become pregnant.