Infertility is a disease or medical condition of the reproductive system. Typically, 40% of infertility problems can be traced to the female partner, another 40% to the male, 10% to both individuals, and the remaining 10% are classified as unexplained.
Female infertility is primarily due to abnormal ovulation, fallopian tube dysfunction or uterine or pelvic pathologies. Male factor problems may be related to inadequate or abnormal sperm production and delivery, anatomical problems, previous testicular injuries or hormonal imbalances.
Both you and your partner will be evaluated simultaneously, first with a complete history and physical examination and then with the more specific testing appropriate to your presenting complaints and referral diagnoses.
The infertility evaluation will focus on four basic questions during the initial assessment of each couple:
- Is there a problem with ovulation?
- Is there a problem with sperm production or function?
- Can fertilization of the egg and sperm occur?
- Can implantation occur and be maintained?
The Infertility Workup
Finding the cause of your inability to get or stay pregnant is the first step in finding the treatment right for you.
Both female and male partners will be evaluated, though the female will undergo the buik of the testing regardless of whether a male factor problem is causing the couple’s infertility.
For most couples, doctors can determine an infertility diagnosis. For about ten percent of them, however, a diagnosis of “unexplained infertility” will require more extensive testing. Whatever the outcome, a thorough evaluation is necessary to gather all the facts required to chart the proper course of action.
Male infertility may be related to sperm production, the anatomy or structure of the male reproductive system, or to the immune system.
Sperm production problems can relate to the number, shape or motility of the sperm and can be caused by genetic defects, infection, hormonal imbalance, testicular trauma or exposure to radiation and certain medications.
Either ovulation does not occur (amenorrhea) or occurs very sporadically so that it is hard to gauge the ideal time of the month in which to get pregnant.
Scar tissue forms adhesions that bind organs together, which interferes with pregnancy.
Endometriosis is a condition in which endometrial tissue is found in places other than the lining of the uterus, usually within the reproductive tract, but also has been found elsewhere in the body.
These are tissue masses that can grow inside the wall of the uterine cavity, within the uterine cavity, or outside the uterine cavity. They usually are non-cancerous and don’t need treatment unless they are symptomatic with pelvic pain or bleeding. But they do cause infertility, depending on their location.
Tubal disease is a disorder in which the fallopian tubes are blocked or damaged. It can be caused from scar tissue from endometriosis, abdominal or gynecological surgery, or ectopic pregnancies. It can block the egg from entering or traveling down the fallopian tubes and meeting the sperm or prevent the embryo from implanting in the uterus.
Polycystic Ovarian Syndrome (PCOS)
A group of symptoms characterized by cystic ovaries, an excessive level of testosterone, weight gain and facial hair that can infertility.
Premature Ovarian Failure
Early menopause in women in their 20's and 30's.
Excessive secretion of prolactin, a hormone stimulating breast milk production, can interfere with ovulation because it fools the body into thinking the woman is nursing.
Since women are born with a finite number of eggs in their ovaries; a woman’s age is an extremely important factor in determining fertility.
Three or more consecutive miscarriages or pregnancy losses.