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).

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.