Definition of infertility
12 months or more of unprotected intercourse without pregnancy
Primary infertility: Infertility without any previous pregnancy.
Secondary infertility: Fertility problems occurring in a couple that has conceived on their own and had a child in the past.
Sterility: When there is no chance for a pregnancy. This is different from infertility which generally represents a reduced potential for pregnancy.
When to see a fertility specialist?
In general, it is appropriate to see a doctor for medical assistance after 12 months of trying to get pregnant on your own.
Many couples will start the infertility workup process with their general gynecologist, while others prefer to go straight to a fertility specialist. Either option is appropriate.
It is advised to see a specialist sooner if the female partner is over 35 years old.It is not needed to wait for one year to visit a doctor if you have a known risk factor for fertility, such as irregular menstrual cycles, endometriosis, previous tubal pregnancy, PCOS - polycystic ovary syndrome, previous pelvic inflammatory disease (PID).
However,it is recommended to seek medical help after only 6 months of trying if the female age is 35 or older.
For couples with a female partner age 40 or older, it is appropriate to see a fertility specialist if not pregnant by 3-4 months of trying to conceive.This women mostly have egg quality problems related to age.
The best fertility advice in terms of frequency of intercourse is every day or every other day "around ovulation".
Ovulation is usually on day 14 - if the menstrual cycle length (from day 1 to day 1) is 28 days, or on day 16 if periods are 30 days apart.
In other words, ovulation usually occurs 14 days before the next period comes.
The egg only lives about 12-24 hours, while the sperm (if normal) will live in the female's reproductive tract for up to 2-5 days - while maintaining the ability to fertilize an egg.
What are the reasons of infertility
Egg quantity and quality problems and Female age
How to treat infertility
Intrauterine Insemination - IUI
In vitro fertilization - IVF or ICSI
Surgery- Laparoscopy and Histeroscopy
The absence of ovulation. A common cause of anovulation is polycystic ovarian syndrome, PCOS..Polycystic ovarian syndrome is a very common cause of anovulation or and infertility.In general, cumulative pregnancy success rates are high with treatment from a fertility specialist when the fertility issue is an ovulation problem.
Tubal factor infertility
Tubal factor infertility statistics are about 20-25% of all cases of infertility. Tubal factor infertility is often caused by pelvic infection, such as pelvic inflammatory disease (PID), or endometriosis or after pelvic surgery. Testing for tubal infertility is possible through Hysterosalpingography or Laparoscopy.
Male Infertility and Sperm Problems
About 40-50% of infertility cases have a sperm defect as the main cause. Part of the problem is just numbers. But we know that men with low sperm counts can sometimes have children and some men with normal sperm counts can be infertile. The other cause might be sperm motility.
A normal uterine cavity and endometrial lining are necessary in order to conceive and maintain a pregnancy. There are several conditions related to the cavity or the lining that can cause problems such as Uterine Polyps, Uterine Fibroids (Myoma or Leiomyoma), Intrauterine Adhesions (scar tissue within the uterine cavity, also called Asherman's Syndrome), Congenital Uterine Malformations, such as a bicornuate uterus, a T-shaped uterus, or a uterine septum, Luteal Phase Defect –(an uncommon condition that involves inadequate development of the microscopic and cellular changes in the endometrial lining of the uterus after ovulation and exposure to the hormone progesterone).
Hysteroscopy is a surgical procedure that involves insertion of a narrow telescope-like instrument through the vagina and cervix into the cavity of the uterus (endometrial cavity). The cavity is then distended with fluid and can be visualized through the scope. This procedure allows us to see any defects inside the cavity.
Ultrasound is a very useful tool for evaluating the pelvis and the uterus and its lining, or endometrium. 3D ultrasound, a newer technology, is particularly good at helping doctors to characterize the shape of the uterine cavity.
The endometrium is the tissue that lines the inside of the uterine cavity. Endometriosis is a disease state in which some of this tissue has spread elsewhere - such as to the ovaries, or elsewhere in the abdominal cavity.Endometriosis causes pelvic pain during menstruation or sexual intercourse in some women and can also cause infertility.5-10% of all women have endometriosis. 30-40% of infertile women have endometriosis.In some cases the eggs in the ovaries can be damaged, resulting in decreased ovarian reserve and reduced egg quantity and quality.
Treatment for mild endometriosis
Medical (drug) treatment can suppress endometriosis and relieve the associated pain in many women. Surgical removal of lesions by laparoscopy might also reduce the pain temporarily. For treatment of the infertility associated with mild to moderate endometriosis, controlled ovarian hyperstimulation with intrauterine insemination may be recommended. If IUI is not successful by about 2 or 3 cycles, in vitro fertilization should be considered.
Treatment for severe endometriosis
Several studies have shown that medical treatment for severe endometriosis does not improve pregnancy rates for infertile women.Some studies have shown that surgical treatment of severe endometriosis does improve the chances for pregnancy as compared to no treatment. This is one of the issues regarding endometriosis for which there is not universal agreement among infertility specialists.If the pelvic anatomy is very distorted, artificial insemination is unlikely to be successful. These women often require in vitro fertilization in order to conceive.
In Vitro Fertilization (IVF)
The IVF process involves:
Stimulating multiple follicles and eggs to develop
Egg retrieval to get the eggs under general anesthesia
Fertilizing the eggs in the laboratory ( IVF or ICSI )
Embryo transfer to the uterus on 3. or 5. day after egg collection
Who should be treated with in vitro fertilization?
Blocked fallopian tubes due to pelvic adhesions with distorted pelvic anatomy because of endometriosis, pelvic inflammatory disease, tubal ligation or congenital agenesis of the tubes.
Male factor infertility (low sperm count or low motility or abnormal morphology ). ICSI is an IVF procedure that can fertilize eggs even with poor sperm quality.Failed intrauterine inseminations.
Advanced female age - over about 38 years of age. In vitro fertilization and advanced maternal age is discussed in detail on the female age page.
Reduced ovarian reserve, which means lower quantity of eggs. A day 3 FSH and Estradiol test, antral follicle counts and AMH hormone levels are often done as screening tests for egg quantity. Severe EndometriosisUnexplained infertility (when inseminations have failed IVF must be considered)
Unexplained infertility means standard fertility tests have not found the cause of the infertility.