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Fertility Evaluation

Basic Fertility - In my practice-RELAX! I will help you throught some basic testing and head you towards some basic treatments and guidelines.  If you and your husband want “high –tech” fertility or have multiple factors-I will refer you to an appropriate subspecialist.

Definition: If getting pregnant has been a challenge for you and your partner, you're not alone. Ten to 15 percent of couples in the United States are infertile. Infertility is defined as not being able to get pregnant despite having frequent, unprotected sex for at least a year — or for at least six months if the woman is age 35 or older.

Infertility may be due to a single cause in either you or your partner, or a combination of factors that may prevent a pregnancy from occurring or continuing. Fortunately, there are many safe and effective therapies for overcoming infertility. These treatments significantly improve your chances of becoming pregnant. Most couples achieve pregnancy within the first six months of trying. Overall, after 12 months of unprotected intercourse, approximately 90 percent of couples will become pregnant. The majority of the remaining couples will eventually conceive, with or without treatment. The main sign of infertility is the inability for a couple to get pregnant. There may be no other obvious symptoms. In some cases, an infertile woman may have abnormal menstrual periods. An infertile man may have some signs of hormonal problems, such as changes in hair growth or sexual function.

When to see a doctor
In general, don't be too concerned about infertility unless you and your partner have been trying regularly to conceive for at least one year. Talk with your doctor earlier, however, if you're a woman and:

  • You're age 34 or older and have been trying to conceive for six months or longer
  • You menstruate irregularly or not at all
  • Your periods are very painful
  • You have been diagnosed with endometriosis or pelvic inflammatory disease (PID)
  • You've had more than one miscarriage

If you're a man, talk with your doctor if you have: Low sperm count, a history of testicular, prostate or sexual problems.

Causes of female infertility

  • Fallopian tube damage or blockage
  • Endometriosis.
  • Ovulation disorders, which can prevent the ovaries from releasing eggs (anovulation). Underlying causes may include injury, tumors, excessive exercise and starvation. In addition, some medications can be associated with ovulation disorders.
  • Elevated prolactin
  • Polycystic ovary syndrome (PCOS), a condition in which your body produces too much of the hormone androgen causing ovulation problems. PCOS is also associated with insulin resistance and obesity.
  • Early menopause, which is the absence of menstruation and the early depletion of ovarian follicles before age 40. Although the cause is often unknown, certain conditions are associated with early menopause, including immune system diseases, radiation or chemotherapy treatment, and smoking.
  • Uterine fibroids, which are benign tumors in the wall of the uterus and are common in women in their 30s and 40s. Rarely, they may cause infertility by blocking the fallopian tubes. More often, fibroids interfere with proper implantation of the fertilized egg.
  • Pelvic adhesions, bands of scar tissue that bind organs after pelvic infection, appendicitis, or abdominal or pelvic surgery. This scar tissue formation may impair fertility. Medications. Temporary infertility may occur with the use of certain medications. In most cases, fertility is restored when the medication is stpped. Thyroid problems. Disorders of the thyroid glandcan interrupt the menstrual cycle and cause infertility. Cancer and its treatment. Certain cancers — particularly female reproductive cancers — often severely impair female fertility. Other medical conditions. Medical conditions associated with delayed puberty or amenorrhea, such as Cushing's disease, sickle cell disease, kidney disease and diabetes, can affect a woman's fertility.

Tests for women Not everyone needs to undergo all, or even many, of these tests before the cause of infertility is found. Which tests are used and their sequence depend on discussion and review of your individual case.

  • Ovulation testing. A blood test is sometimes performed to measure hormone levels to determine whether you are ovulating.
  • Hysterosalpingography. This test evaluates the condition of your uterus and fallopian tubes. Fluid is injected into your uterus, and an X-ray is taken to determine if the cavity is normal and ensure the fluid progresses through your fallopian tubes. Blockage or problems often can be located and may be corrected with surgery.
  • Laparoscopy. Performed under general anesthesia, this procedure involves making a small incision (8 to 10 millimeters) beneath your navel and inserting a thin viewing device to examine your fallopian tubes, ovaries and uterus. The most common problems identified by laparoscopy are endometriosis and scarring. Your doctor can also detect blockages or irregularities of the fallopian tubes and uterus. Laparoscopy generally is done on an outpatient basis.
  • Hormone testing. Hormone tests may be done to check levels of ovulatory hormones as well as thyroid and pituitary hormones. Ovarian reserve testing. Testing may be done to determine the potential effectiveness of the eggs after ovulation. This approach often begins with hormone testing early in a woman's menstrual cycle.
  • Genetic testing. Genetic testing may be done to determine whether there's a genetic defect causing infertility.
  • Pelvic ultrasound. Pelvic ultrasound may be done to look for uterine or fallopian tube disease.

Treatment for women Fertility drugs are the main treatment for women who are infertile due to ovulation disorders. These medications regulate or induce ovulation. In general, they work like natural hormones — such as follicle-stimulating hormone (FSH) and luteinizing hormone (LH) — to trigger ovulation. Commonly used fertility drugs include: Clomiphene citrate (Clomid, Serophene). This drug is taken orally and stimulates ovulation in women who have polycystic ovary syndrome (PCOS) or other ovulatory disorders. It causes the pituitary gland to release more FSH /LH, which stimulate the growth of an ovarian follicle containing an egg.

Please go to www.mayoclinic.com for ideas on coping and support and prevention.

 

© Copyright 2012, Mary J. Kotob, MD, FACOG. All rights reserved.
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