Infertility

Quick look at infertility

Infertility is when a woman can’t get or stay pregnant after having regular, unprotected sex for more than a year.

Causes can come from the male, the female or a combination of male and female factors that interfere with the woman becoming pregnant.

Testing for fertility involves both partners and begins with a thorough physical exam. It may also involve semen analysis for men. Laboratory tests and imaging studies may be ordered for the woman.

Treatment options for couples and individuals facing infertility may range from lifestyle changes to assisted reproductive techniques, such as medications, intrauterine insemination or in vitro fertilization (IVF).

Our team uses testing and therapy to determine what works best for an individual problem. We can treat patients and couples with complex and difficult issues such as cancer or major medical problems.

Our infertility diagnosis and treatment plans are individually based after discussion with the patients regarding the outcomes to be expected. We help patients determine the path forward for them, rather than fit them into a standardized approach. We are “up front” with our patients regarding their chances of success, but are willing to give patients with limited success an opportunity to try treatment if the benefits to be expected outweigh the risks.

Many infertile patients need support or benefit from counseling regarding infertility related decision making. Sometimes a referral for outside counseling or psychotherapy is needed and we can help with this as well.

What is infertility?

Infertility is defined as not being able to get pregnant despite having regular, unprotected sexual intercourse for at least 12 months (six months if the woman is older than 35). About 10-15 percent of couples in the United States experience infertility.

Both men and women can have factors that cause infertility, or a combination of male and female factors can cause it. Roughly one-third of the time, no explanation is found for infertility – this is called unexplained infertility.

Women’s infertility may be related to problems with ovulation, hormones or the reproductive organs. Men often see problems with the amount and health of their sperm.

Age can also play a role with infertility. Women are born with a set number of eggs and cannot make more during their lifetime. Each month one egg is used during the menstrual cycle.

Younger, healthier couples have a 20 percent chance of pregnancy during any single menstrual cycle. As a woman enters her 30s, that percentage starts to decline, and declines even more rapidly when a woman hits 37. Men’s fertility chances also decline with age, but not as predictably.

Lifestyle factors can affect infertility. For women, being overweight or underweight can play a role in infertility issues. Smoking tobacco or drinking alcohol, at a moderate or heavy level, also may make it difficult for a woman to get pregnant.

For men, obesity, smoking tobacco or marijuana, heavy drinking or use of anabolic steroids can reduce the sperm quantity and quality, leading to infertility. Some medical conditions can also affect fertility.

When to seek fertility testing

Our physicians help our patients assess their fertility. If needed, we can also refer patients to an infertility specialist, a reproductive endocrinology and infertility doctor. It is time to consider going to a doctor for an infertility evaluation if any of the below statements apply:

• After one year of regular sexual intercourse with no birth control the woman is not pregnant (six months if the woman is over age 35)
• Over age 40
• Irregular menstrual cycle
• Have experienced multiple miscarriages
• If either person has undergone treatment for cancer
• If the couple has known fertility problems
• The woman has been diagnosed with pelvic inflammatory disease or endometriosis
• The man’s testicles are small or there is swelling in the scrotum (varicocele).

Diagnosing infertility

During an infertility evaluation for a woman, the doctors at CU Medicine OB-GYN East Denver (Rocky Mountain) will try to pinpoint the cause of infertility, beginning with a medical history and a gynecological exam. Additional infertility testing may include:

Laboratory tests

• Basal body temperature charting is when a woman tracks her body temperature in order to determine whether ovulation has occurred. To perform this test, a woman will need to take her temperature by mouth every morning prior to getting out of bed.
• Ovulation predictor kits can be purchased over the counter. Women use these tools to help figure out when they will be ovulating.
• Progesterone testing involves a blood sample on the 21st day in the menstrual cycle. The test will measure the level of progesterone, an increased level showing that the woman has ovulated.
• Prolactin levels are tested through a blood sample. High levels of the hormone prolactin can disrupt ovulation.
• Thyroid function testing is completed through a blood test. Thyroid function problems have been linked to infertility issues.
• Urine testing can determine if/when a women is ovulating. The test detects luteinizing hormone (LH) in a woman’s urine. LH activates the release of an egg.

Imaging tests

• Hysterosalpingogram (HSG), also known as a tubogram, is a series of X-rays of the uterus and fallopian tubes that are taken after liquid dye is inserted through the vagina. This will help the physician determine if the fallopian tubes are blocked or if there are any defects in the uterus.
• Hysteroscopy gives the doctor a good view of possible problems by placing a thin, flexible tube with a camera on the end into the uterus. In addition to seeing any abnormalities, the doctor can also take samples of the tissue if needed, as well as correct certain problems.
• Laparoscopy is a minimally invasive surgery where a doctor will insert a thin viewing device and operating instruments through a small incision in the woman’s lower belly. This procedure can identify irregularities or blockage of the fallopian tubes, endometriosis, scaring or other problems with the uterus and ovaries. It can also correct those issues when appropriate.
• Transvaginal ultrasound is performed in the days following the end of the period. An OB-GYN will place a small ultrasound device into the vagina and bring it close to the pelvic organs. The sound waves of the ultrasound will provide images of the ovaries and uterus for the doctor to review. A physician can also decide to include a saline solution to the transvaginal ultrasound to increase image quality, which is called a sonohysterography (SHS).

In most cases, all the needed tests can be completed within a few menstrual cycles. An OB-GYN can also order a semen analysis for a man to evaluate his sperm.

If a cause is found, treatment options will be discussed. Not all infertility cases can be linked to a specific problem, which is defined as unexplained infertility, but patients still have treatment options.

Treatment options for infertility

Treatment options vary depending on multiple factors. Some of the treatments available for infertility are:

• Surgery to restore fertility, such as removing endometrial polyps or correcting anatomical problems
• Stimulating ovulation with fertility drugs, which is the most common treatment option for women who are infertile due to an ovulation disorder. These medications can come in a pill or a shot and help to regulate or induce ovulation.
• Intrauterine insemination (IUI) involves placing healthy sperm directly in the uterus around the time the woman’s ovary releases her egg
• IVF involves fertilizing eggs retrieved from the woman with a male’s sperm in a dish in a lab and implanting the resulting embryo(s) in the uterus
• Intracytoplasmic sperm injection (ICSI) during IVF injects sperm directly into a mature egg
• Donor eggs or sperm
• Gestational carrier or surrogate to carry a pregnancy.

OB-GYNs cannot perform advanced infertility treatments. If needed, we will provide a referral to see a reproductive endocrinologist and infertility specialist.

Infertility is common. Advanced Reproductive Medicine (ARM) offers a full range of fertility services. We combine research-based care with compassionate support to help you find a path to parenthood.

What We Believe

• We start with simple, effective treatments when possible.
• We tailor diagnosis and treatment to your needs.
• We give honest guidance about your chances and risks.
• We support single women and patients using donor eggs or sperm.
• We offer advanced care for patients with complex medical needs.

How We Support You

• We coordinate with specialists in cardiology, oncology, and maternal–fetal medicine.
• We partner with the Center for Integrative Medicine for acupuncture and related support.
• We provide emotional care through two Ph.D.-level psychologists.
• We refer to support groups or outside counselors when needed.

Our Core Fertility Services

Infertility Testing

• Semen analysis
• Ovarian reserve testing
• Uterus evaluation for fibroids and polyps
• HSG to assess fallopian tube health

In Vitro Fertilization (IVF)

• Egg fertilization in the lab and embryo transfer
• Assisted hatching for select embryos: This involves the use of mechanical or chemical thinning of the zona pellucida (outer shell) of the embryo. It is believed this outer shell becomes thicker and hardened with the aging of the oocyte. Assisted hatching is performed before transfer and may be beneficial for women older than 38, for women with thicker zona pellucidas, or for a couple with poor quality embryos. Assisted hatching may also be utilized for couples that have failed to achieve pregnancy after multiple IVF attempts.
• PGD for genetic testing
• ICSI for male-factor infertility

Donor Options

• Donor egg
• Donor sperm
• Donor embryos

Intrauterine Insemination (IUI)

• Sperm placed directly into the uterus
• Best for patients who are ovulating and have open fallopian tubes

Surgical & Retrieval Procedures

• Sperm retrieval and electroejaculation
• Microsurgery for reproductive issues

Ovulation Induction

• Fertility medication to help women ovulate on a regular schedule

Embryo Culture & Transfer

• Embryo growth to day-5 blastocyst stage
• Single embryo transfer for safer pregnancies

Hormonal & Reproductive Health Care

• Menopause and perimenopause evaluation
• Hormone therapy and integrative options
• Treatment for endometriosis and fibroids

Preconception Counseling

Before a woman starts trying to conceive, it is a good idea for her to speak to her health care provider about how to best facilitate a healthy pregnancy. Preconception care and counseling revolve around evaluating a woman’s overall health and wellness while addressing lifestyle changes that will promote conception and fetal development.

Preconception care may occur during a scheduled annual exam, but some patients prefer to make a separate appointment dedicated to addressing their questions and concerns. Additionally, women who are having difficulty trying to conceive, or suspect that they may be experiencing infertility, may wish to speak with their OB-GYN about underlying factors that may be contributing to their struggle.

Health and wellness evaluation before trying to conceive

The early stages of pregnancy are critical for a baby’s development. In many ways, these initial weeks lay the groundwork for the entire pregnancy. The baby’s organs and major systems will start to form during the first two months following conception. Because of this timeline, a woman should ensure that any chronic health issues and risk factors are treated, controlled and addressed before trying to conceive.

During a preconception care appointment, an OB-GYN will talk to the patient about her health history, including vaccination records, previous pregnancies and any pressing concerns the patient may have. Additionally, the provider will identify any chronic health issues and talk about strategies for treating and managing them before and during pregnancy.

Depending on the issues identified, a woman may need to see a primary care provider or, less commonly, a specialist. Underlying issues that may affect healthy conception and pregnancy include:

• Irregular menstrual cycles and periods
• High blood pressure
• Thyroid conditions
• Asthma
• Depression
• Obesity
• Diabetes
• Seizure disorders
• Substance abuse.

The presence of one or more of these conditions does not necessarily mean that a woman will have an unhealthy or complicated pregnancy. Rather, they are indicators that extra care and attention should be paid to managing these issues before and during her pregnancy to keep her and the baby safe, healthy and thriving.

Finally, some women may be identified as being at a higher risk for passing on certain birth defects or congenital disorders. If this is the case, an OB-GYN may discuss options for genetic testing of the mother and father.

Preconception care and lifestyle adjustments

Equally important to evaluating a woman’s overall health is addressing lifestyle factors that will contribute to her success when trying to conceive. Leading a healthy lifestyle can alleviate some of the chronic health issues listed in the previous section and lower the risk of complications such as miscarriage and birth defects. Before trying to get pregnant, a woman will be advised to:

• Stop using tobacco products
• Stop using all recreational drugs, including marijuana
• Moderate alcohol consumption while trying to conceive
• Stop drinking alcohol as soon as pregnancy is suspected
• Lose weight if necessary
• Limit or eliminate exposure to environmental toxins at home or in the workplace.

Toxoplasmosis, a parasite infection that is often spread by cat feces, poses a risk to an unborn fetus if the mother is infected. For this reason, pregnant women and women trying to conceive may be advised not to change cat litter. But if a woman has had toxoplasmosis in the past, she will be immune to the infection and will be at a very low risk of developing it during pregnancy and passing it on to the fetus.

Because toxoplasmosis often does not cause symptoms in adults, a blood test may be ordered to determine if a woman is immune. When in doubt, it is best for all pregnant women to err on the side of safety and avoid changing cat litter until after the baby is born.

Medications and prenatal vitamins

A woman should start taking a prenatal vitamin containing at least 400 micrograms (mcg) of folic acid around three months in advance of trying to get pregnant. Folic acid is a vitamin found naturally in certain foods.

It is added to common grocery items like cereals, pastas and breads due to federal regulations. Folic acid plays a key role in fetal development, and supplementation helps to prevent miscarriage and major birth defects such as spina bifida.

Certain prenatal vitamins cause unpleasant side effects in certain women. These may include nausea, loss of appetite and digestive issues. It can therefore be a process of trial and error to determine which prenatal supplement is the best fit.

Some prenatal supplements are only available via prescription and others are sold over the counter (OTC). Prescription supplements are not necessarily better than OTC options. A woman’s OB-GYN can help her determine which prenatal supplement(s) are best suited for her individual needs.

Lastly, women who are trying to conceive should follow the same advice that is given to pregnant women regarding all OTC medications. They should limit or eliminate their use of certain medications taken for common ailments such as allergies, colds and headaches. This includes commonly-used drugs such as aspirin and ibuprofen.

Why Choose CU Medicine

• Evidence-based treatment customized for each patient
• Experienced nurses, physicians, and lab staff
• Access to university-level medical resources
• Psychological support at every step

Emotional & Psychological Support

• Sessions with infertility-focused psychologists
• Support groups and community resources
• Referrals to outside therapists