Fertility is often a common concern for people in their reproductive years. These patients may have questions about diagnoses, treatments and causes of infertility. It is important for physicians to validate these concerns by finding answers if possible. Clinically, infertility is defined as the inability to achieve pregnancy after one year of having unprotected intercourse. However, that timeframe drops to six months for people ages 35 or older.
Gynecologists play an integral role in helping patients navigate the often confusing and emotional subject of infertility diagnosis and treatment, so it pays to be knowledgeable about these issues. Consulting with specialists in reproductive medicine may also be helpful.
Infertility Can Have Multiple Potential Causes
What causes infertility? In many cases, the specific cause of infertility is unknown, a condition called idiopathic infertility. In other cases, infertility can have multiple causes — and it can be just as likely to affect a male partner as a female one. While the factors influencing fertility can be far-ranging, common causes of infertility include:
- In women: Irregular menstruation, failure to ovulate, structural problems with the reproductive system and conditions such as endometriosis, uterine fibroids and polycystic ovarian syndrome
- In men: Conditions affecting sperm formation or transport
- In either: Age, weight, substance use, previous radiation or chemotherapy and possibly exposure to certain chemicals
For many couples, infertility may be the result of a combination of these infertility causes.
Uncovering and Diagnosing Infertility
Gynecologists and other health professionals typically begin the process of diagnosing infertility in women with a thorough medical history and physical exam. They may also use a variety of tests and exams, such as:
- Blood tests to evaluate levels of certain hormones, including progesterone, follicle-stimulating hormone and anti-Mullerian hormone
- X-ray hysterosalpingogram or laparoscopy to evaluate the fallopian tubes
- Transvaginal ultrasound, 3D HyCoSy or saline infusion ultrasound/sonohysterography to examine the uterus
3D saline infusion ultrasound - uterine polyps
Physicians usually evaluate male fertility through a medical history, a physical exam and various blood tests.
Treatment Options
Treatment for infertility depends on the cause. According to the American Society for Reproductive Medicine, in the vast majority of cases — about 85 to 90 percent — infertility is treatable with conventional medical approaches, such as medication or surgery. The overall likelihood of successful treatment is about 50 percent, with treatment for problems involving ovulation the most apt to be successful.
Female infertility treatment options may include:
- Medications to stimulate ovulation such as clomiphene, letrozole, gonadotropin and bromocriptine
- Surgery to repair damage to or remove blockages from the fallopian tubes
- Surgery to treat endometriosis, uterine fibroids, polyps or scarring
If infertility treatments have failed to address the problem, patients may wish to pursue assisted reproductive technologies such as intrauterine insemination, in vitro fertilization, sperm or egg donation or surrogacy.
