Infertility

Overview

Infertility affects nearly 10 percent of couples. About half of all infertility cases are due to female factors alone, 20 percent are due to male factors alone, 20 percent are due to both female and male factors, and 10 percent have unexplained causes.

Advances in infertility treatment, such as prenatal genetic diagnosis (PGD), have helped many patients with genetic disorders or recurrent pregnancy loss with the dream of having healthy children.

University Reproductive Care offers many exciting technologies to help overcome infertility conditions for both women and men. These technologies can also be applied to building a family for single parents, same-sex couples, and alternative couples. University Reproductive Care also offers highly specialized fertility-sparing surgeries for endometriosis, fibroids, tubal blockage or ligation, and uterine anomalies or scarring. When fertility is a concern, these procedures are best performed by a reproductive endocrinologist.

For men who do not have sperm in their ejaculate, microsurgical sperm retrieval is a highly-specialized procedure to obtain sperm directly from the testes while minimizing the amount of testicular tissue being removed.

Symptoms

For couples in which the female partner is younger than 35, an infertility diagnosis is made if pregnancy does not occur during one year of having unprotected intercourse. In women older than 35, six months is the critical time period. In other situations, a consultation with a reproductive endocrinology and infertility specialist is advised before attempting pregnancy to identify prenatal risk factors and to maximize the likelihood of a healthy pregnancy.

Causes

Female infertility can be caused by: Male infertility can be caused by:
  • Poor semen characteristics
  • Azoospermia (no sperm in the ejaculate), the cause is either obstructive or nonobstructive. Obstructive azoospermia results from vasectomy, congenital absence of the semen outflow tract or previous scrotal surgery or trauma. In the case of nonobstructive azoospermia, the outflow tract is normal, but sperm production is severely diminished or completely absent.
  • Genetic causes
  • Unknown causes

Risk Factors

In females, previous pelvic infection or surgeries, fibroids or polyps can disrupt the reproductive tract, making it difficult for the sperm to reach the egg, or for the embryo to be transported to the uterine cavity. Endometriosis, or a history of pelvic pain suggesting endometriosis, coexists with possible anatomic, ovarian, and implantation dysfunction.

A history of chemotherapy or radiation often predisposes a woman to diminished ovarian reserve. While not infertile per se, recurrent pregnancy loss also renders a couple childless.

In males, scrotal infections or surgeries also can disrupt the reproductive tract and the outflow of sperm. Exposure to chemotherapy or radiation to the pelvis, testosterone, or anabolic steroids can inhibit sperm production. Medical conditions including diabetes, high prolactin levels, and low testosterone levels are associated with abnormal sperm production. A history of erectile dysfunction or inability to ejaculate can be a sign of poor testicular function, which can lead to male infertility.

Diagnosis

The evaluation for a cause of infertility includes a complete history and physical by a physician specifically trained in reproductive endocrinology and infertility. Medical conditions, medications, menstrual patterns, sexual practices, and toxic exposures are important aspects of the history. A full physical exam can reveal important signs of conditions leading to infertility.
In the case of a couple, it is critical to evaluate both the female and male partner simultaneously to understand causes of infertility and to choose the best treatment option.

Our infertility evaluation process complies with recommendations from American Society of Reproductive Medicine, but is individualized to each patient.

Important components include:
  • A full female and male history and examination
  • Ovarian reserve testing to determine baseline ovarian function and select the best infertility treatment option
  • Hysterosalpingogram to visualize the uterine cavity and fallopian tubes
  • Luteal phase progesterone to ascertain ovulation
  • Complete semen analysis to determine sperm count, motility, shape of the sperm, and other important chemical characteristics
  • Baseline laboratory testing for infectious diseases and to ensure immune protection against common illnesses such as chickenpox
  • Referral for genetic counseling or preconception counseling with high-risk obstetricians and other specialists, as needed
  • Once a diagnosis is made, a consultation with the physician will clarify the diagnosis and tailor the treatments. In the case of couples-related infertility, the focus should be on both partners.

Complications

Some conditions related to infertility, such as endometriosis, can continue to cause pelvic pain and scarring unless treated. In other cases, where menstrual cycles are irregular or scant, low estrogen levels could lead to poor bone health and a higher risk for bone fractures.

In men with low testicular function and infertility, overall energy levels and libido can be affected.

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