Fertility Evaluation

Infertility is generally defined as the failure to conceive within 1 year of attempting pregnancy if less than 35 years old or 6 months  of attempting pregnancy if 35 years old or older.

It is a couples issue and we always want to evaluate both partners.

Sixty percent of infertility is caused by the medical problems with the female partner and 40% of the time it is male infertility that is the main issue. But 40% of couples have problems with both partners that overlap.

The chance for conception with couples who have normal fertility is about 20% each month but depends significantly on age.  When fertility is normal, 70% of couples will conceive within 6 months.  The American Society of Reproductive Medicine recommends initiating infertility testing after 1 year of attempting pregnancy in women under age 35 and after 6 months of attempting pregnancy in women over 35 years of age.  Exceptions to this might be women who have the following medical conditions:  complete absence of monthly menstrual cycles, or quite irregular cycles, since that is an obvious sign of failure of ovulation; a history of pelvic infection; a history of endometriosis.  In these cases, seeing a fertility specialist for testing immediately is appropriate and you should not wait 6 or 12 months.  Natural fertility potential in the female is age-dependent with peak fertility being in the age of 20-25 years old, a decrease in fertility into the early 30’s and then a sharp decrease in fertility potential after age 35.  It is important to understand that even with state-of-the-art fertility treatment, the effect of age on fertility potential cannot be changed.  In the process of aging of the ovaries the problem is the gradual depletion in number and, more importantly, quality of remaining of eggs.

Forty percent of infertility in the female is due to ovulation dysfunction.  Complete absence of monthly menses or highly irregular menses are obvious signs of ovulation problems.  Polycystic ovary syndrome is a very common cause of ovulation dysfunction (the most common problem patients come to see us for) and usually easily corrected with appropriate therapy.  Other hormonal causes may be identified.  Forty percent of infertility in the female is due to distortion of normal pelvic anatomy by: endometriosis, previous pelvic infection, adhesions/scarring from previous surgery.  Each of these conditions can be addressed and corrected to some degree.  Some patients with extreme abnormalities in these areas end up benefiting from in vitro fertilization. Many patients with blocked fallopian tubes will benefit from minimally invasive surgery, called laparoscopy and hysteroscopy to correct problems.  Other less common causes include: damage to the lining of the inside of the uterus by previous surgery or infection; disruption of the normal uterine anatomy by uterine fibroids or polyps.  Both of these conditions can be corrected by appropriate surgery.  Uterine or vaginal developmental (congenital) anomalies can cause infertility and pregnancy loss.  Appropriate testing with ultrasound and imaging studies by an MRI establish a diagnosis and appropriate treatment.  Ten to twenty percent of infertility is of undetermined cause.  The good news of female infertility is that in almost all conditions there is effective therapy available. We just have to understand why and we can usually correct most problems.

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