Understanding Infertility

Infertility Dallas and Fort Worth

If you and your partner have been unable to have a baby on your own, it is important to realize that you are not alone - at least one in seven couples has trouble conceiving.  Infertility is defined as the inability to achieve pregnancy after one year of unprotected intercourse.  If you have been trying to conceive for a year or longer, you should consider an infertility evaluation.  However, if you are 35 years or older, you should begin the infertility evaluation after about six months of unprotected intercourse (rather than a year) and not delay potentially needed treatment.  In addition, if you have a known fertility problem (such as very irregular menses suggesting you are not ovulating), you should probably not wait an entire year before seeking treatment.  Since at least 25% of infertile couples have more than one factor causing infertility, it is important to evaluate all factors that may affect both you and your partner. 

Problems with ovulation are common causes of infertility, accounting for approximately 25% of all infertility cases.  If you have regular menstrual cycles, you are probably ovulating.  If you have a period every few months or not at all, you are probably not ovulating or ovulating infrequently.  If you are not ovulating, your physician may order tests to determine the reason and then prescribe certain medications, either oral or injectable, to induce ovulation.



Age and Fertility

Fertility begins to decline significantly in your mid 30s and accelerates in your late 30s; however, some women experience a decline in fertility at a younger age.  Overall, fertility declines with age because fewer eggs remain in your ovaries.  In addition, the quality of these eggs remaining is lower than when you were younger.  The tests commonly used to determine your ovarian reserve (potential eggs remaining in your ovaries) include a transvaginal ultrasound to evaluate the size and appearance of your ovaries and two blood tests, a follicle-stimulating hormone (FSH) with an estradiol level and antimullerian hormone (AMH).  The FSH and estradiol level should be drawn during days 2 through 4 of your menstrual cycle.  An elevated FSH and/or a low AMH is suggestive of a decreased ovarian reserve.  This does not mean you have no chance of conception, but it may indicate more aggressive treatment options are warranted for improved success rates.

Functional fallopian tubes are necessary for conception because fertilization, the process where the sperm joins the egg, takes place in the fallopian tube.  Therefore, tests to determine tubal openness (patency) are an important part of the evaluation.  Tubal factors account for approximately 35% of all infertility problems.  A hysterosalpingogram (HSG) is a special x-ray that we can perform in our office to evaluate your fallopian tubes.  This test takes only a few minutes to perform allowing us to provide the results immediately.  If your tubes are found to be blocked or damaged, surgery can sometimes correct the problem.  In cases where the fallopian tubes are severely damaged and not amendable to surgery, in-vitro fertilization offers the best success for pregnancy.  It is important to realize the HSG may not detect scar tissue and endometriosis affecting the fallopian tubes.  Depending on your personal history, your physician may recommend further evaluation of your fallopian tubes and pelvic structures with surgery.

Problems with your uterus (womb) may interfere with implantation of the embryo or increase the risk of miscarriage.  Possible uterine factors include polyps, fibroids, scar tissue and an abnormally shaped uterine cavity.  Uterine cavity evaluation is possible with transvaginal ultrasound and HSG imaging.  Many uterine cavity problems can be fixed with surgery.

Male Factor

In approximately 40% of infertile couples, the male partner is either the sole or contributing cause of infertility.  Therefore, a semen analysis is an important part of the work-up for infertility.  In preparation for a semen analysis, your partner will be asked to refrain from ejaculation for 48 to 72 hours.  Our andrologists perform semen analyses in our office and the results are available in approximately one hour.  Two treatment options to overcome male factor infertility include intrauterine insemination (IUI) and in-vitro fertilization with intracytoplasmic sperm injection (ICSI).  IUI is the placement of sperm through the cervix and into the top of the uterine cavity using a small catheter at the time of ovulation.  ICSI is a part of the in-vitro fertilization process where a single sperm is directly injected into each egg to assist with fertilization.



Unexplained Infertility

In approximately 10% of couples trying to conceive, there is no identifiable cause for infertility and this is referred to as “unexplained” infertility.  Fertility treatments, including fertility drugs with IUI or IVF, still remain as treatment options for these patients.

Infertility can cause someone to experience stress and mixed emotions.  This is a common feeling among our patients, so it is important to realize you are not alone.  CARE Fertility’s team is unique in that it includes a psychologist specializing in infertility and staff eager to support you through this process.

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For more information on infertility, contact CARE Fertility