Infertility
Infertility is a common condition affecting approximately 11% of couples at some point in their reproductive lives. A reproductively healthy couple generally has about a 25 percent chance of conceiving during any one month of unprotected intercourse. In females, the incidence of infertility increases with advancing age. As more and more women delay child bearing, this life altering condition has become more prevalent.
In females less than 35 years of age, infertility is defined as the inability to conceive after 12 months of unprotected intercourse. For women over 35, the definition changes to the inability to conceive after six months of unprotected intercourse.
Infertility is defined as either primary or secondary. The term "primary infertility" is used when no previous successful pregnancy has occurred. The term "secondary infertility" is when a first conception and delivery was successful but difficulty is encountered when trying to become pregnant again.
It is always best to consult a reproductive endocrinologist, like Dr. Kustin, early in the infertility evaluation. Obstetricians and gynecologists, although dedicated and well meaning, may not have the expertise and experience to deal with fertility issues, especially as time is of the essence for many patients. Treatment requires constant diligent review of progress and alterations in treatment strategies that are best managed by a specialist.
In women there are many conditions that warrant immediate consultation with a specialist and include:
Some conditions in the male that warrant immediate consultation with a specialist include:
- A history of undescended testicles
- A history of sexually transmitted disease
- Hernia repair
- Vasectomy reversal
- A known poor semen analysis
- A history of trauma to the testicles
Infertility affects men and women almost equally and is always a "couples" problem. It is important to realize that infertility can be treated and that greater than 80% of infertile couples succeed in having a baby. Consultation with an infertility specialist, such as Dr. Kustin, early in the evaluation often expedites a successful pregnancy. Often simple measures prescribed by an expert will result in excellent outcomes.
Treatment from an infertility specialist does not typically warrant advanced, expensive procedures such as IVF. Less than 10% of women receiving treatment for infertility require these advanced procedures. It is imperative that couples undergo a tailored infertility investigation in order to identify the deficiencies in the reproductive process resulting in infertility. Costly treatments without a plan rarely succeed and cause unwarranted anxiety and delay.
Oftentimes, women receive treatment with drugs such as clomiphene citrate (Clomid) before seeking specialized care, including a thorough infertility evaluation. Studies have shown that there is little advantage to administering Clomid for more than three ovulatory cycles and that continued use may be detrimental. Increasing the dose of clomiphene in a woman who is ovulating does not increase her chances of conception. Also, a woman who ovulates regularly (normal periods) is not a candidate for clomiphene. (Be sure and review the sections on male and female reproductive physiology)
Major Causes of Female Infertility
In general, there are five basic causes of female infertility:
- Tubal disease can be caused by previous
surgery, pelvic inflammatory disease, endometriosis,
or it can be congenital. Depending upon where the
tube is damaged (blocked) IVF is often the treatment
of choice.
- Ovarian disease is a common cause
of infertility especially in the older patient.
Ovulation is controlled by a complex interaction
between numerous endocrine hormones (see section
on physiology). Imbalance in this "feedback"
mechanism can prevent ovulation or cause it to be
irregular. Clomid is often used to treat anovulation
(lack of ovulation). If clomiphene does not produce
regular ovulation, injectable drugs such as gonadotropins
(FSH, Follistim and Repronex) are often indicated.
A specialist thoroughly trained in their use should
administer these products.
- Another condition, which can cause
anovulation, is hyperprolactinemia. This condition
is caused by a tumor (usually benign) located on
the pituitary gland. Treatment with the drug Parlodel
is often very effective in treating this condition.
- Uterine factor disease is a cause of infertility in a small number
of cases. The uterus can be damaged by pelvic inflammatory
disease; previous surgery, endometriosis, or some
women are born with a malformed uterus. In cases
of severe uterine damage, surrogacy (another female
who can carry the pregnancy) is the only treatment.
- Cervical disease occurs when the
cervical mucus is insufficient, too thick, or hostile
to sperm. When antisperm antibodies are present
in the cervical mucus, they can incapacitate or
destroy sperm. Antisperm antibodies can also rarely
be produced by a male to his own sperm. IUI is usually
the treatment of choice for female antisperm antibodies.
Numerous treatment options are available based upon each couple's diagnosis. Choose a link from the list below to learn more about each technique.
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