Infertility affects 10-15% of couples trying to conceive. So, do not think that you are alone in this sojourn. These are some well-established facts about infertility that should be known:
- Infertility increases with woman’s age; reproductive aging differences appear to exist in all racial and ethnic groups and is much more pronounced for women than for men.
- Infertility increases with maternal age because the ovarian reserve decreases but also egg quality suffers. This also results in an increased risk of miscarriages and chromosomal anomalies of embryos.
- There is a high incidence of male factor infertility; and fewer men than women utilize reproductive services in the USA.
- Believe it or not (because all your friends and relatives seem to get pregnant in a heartbeat) pregnancy is a rare event! It is estimated that the normal monthly fecundity rate is around 20%, that is, 1 in 5 couples will statistically conceive in each month of trying (natural conception).
- BUT HERE IS THE GOOD NEWS: with adequate diagnostic work up and subsequent directed and individualized therapies, two thirds of couples will achieve a pregnancy!!!
When analyzing the reasons for infertility, these are the main problems:
- Female causes are present in 40% of couples.
- Male causes are present in 40% of couples.
- Combined female and male causes are identified in other 10% of cases.
- Failure to establish a cause (unexplained infertility) occurs in 10% of couples.
The most frequent female causes are:
- Ovulatory dysfunctions (irregular ovulation, anovulation). The presence of regular menstrual cycles usually, but not always, indicates ovulatory status. Check for signs of ovulation at mid-cycle: vaginal mucus discharge, ovulatory pain, and even better test for basal temperature and monitory urinary LH surge with accurate over-the-counter kits. The ¨timing¨ of sexual intercourse in relation to ovulation is critical for success.
- Low ovarian reserve. This can happen at any age, but it is obviously more frequent as maternal age advances. Test ovarian reserve with transvaginal ultrasound to investigate the basal antral follicular count, and check serum AMH and cycle day 3 FSH/LH/estradiol levels. It follows that time-to-pregnancy (or lack of…) is very important to consider: while women under 35 years of age should try for a year and then consult, women over 35 should seek help after 6 months of attempting pregnancy, to try to diminish the impact of the declining “ovarian clock”.
- Tubal issues (blocked and/or damaged tubes secondary to infection/inflammation), to be tested with an X-ray (HSG or hysterosalpingogram).
- Uterine problems, such as presence of congenital anomalies (developmental issues), fibroids, polyps and others. These can be identified with HSG and transvaginal ultrasound.
- Endometriosis can be suspected based on symptoms (painful periods and pain with intercourse), by vaginal ultrasound of ovaries, by inflammatory changes seen in an endometrial biopsy, but can typically only be confirmed by laparoscopy, that is not always needed.
- Other less prevalent but important factor to consider are systemic, including thyroid issues, autoimmune problems, thrombophilia (coagulation defects) among others.
And keep in mind that for successful reproduction: “it takes two to tango”. So that a semen analysis is a mandatory test for the male partner!
At the Sher Fertility Institute, New York, we will help you achieve your goal of starting a family. For further information please Request An Appointment or call us at (646) 792-7476.