Infertility Diagnosis and Treatment
Women under 35 years of age who are not pregnant after intercourse for one year without birth control, or above 35 years of age and are not pregnant after 6 months under the same circumstances are likely to be infertile. Men of all ages who do not delivery quality sperm or enough quality sperm to impregnate his partner, may be infertile.
A physical exam and complete medical history is evaluated by Dr. Ricks, and your general health and frequency of intercourse will be reviewed. Periods, infections, surgeries, ectopic pregnancies, personal habits and endometriosis could hinder fertility in women. Genital infections, toxins or trauma could negatively affect fertility in men.
Dr. Ricks may order tests to find structural or endocrine disorders. It is important to note that in ten percent of people who have infertility, no cause is found.
How your infertility is treated depends on the cause, your age, how long you’ve been infertile and personal preferences. Although some women need just one or two therapies to restore fertility, it’s possible that several different types of treatment may be needed before you’re able to conceive.
Treatments can either attempt to restore fertility — by means of medication or surgery — or assist in reproduction with sophisticated techniques.
Fertility restoration: Stimulating ovulation with fertility drugs
Fertility drugs, which regulate or induce ovulation, are the main treatment for women who are infertile due to ovulation disorders. In general, they work like the natural hormones — follicle-stimulating hormone (FSH) and luteinizing hormone (LH) — to trigger ovulation.
Using fertility drugs carries some risks:
- Becoming pregnant with twins or other multiples. Oral medications carry a fairly low risk of multiples (less than 10 percent), but your chances increase to about 15 to 20 percent with injectable medications. Generally, the more fetuses you’re carrying, the greater the risk of premature labor, low birth weight and later developmental problems. Sometimes the amount or timing of the medications will be altered in an attempt to lower the risk of multiples. Treatment cycles may be canceled if your doctor detects the development of too many follicles, which could result in ovulation of more than one egg.
- Developing enlarged ovaries. Ovarian hyperstimulation syndrome (OHSS) is a condition that can result from the use of fertility drugs. In response to the medication, your ovaries become overstimulated. Besides developing enlarged ovaries, you might experience abdominal pain and distention, gastrointestinal problems and shortness of breath. Signs and symptoms can develop while you’re undergoing ovulation induction or during the early stages of pregnancy.
There are several fertility drugs for abnormal LH and FSH production. These drugs include:
Clomiphene citrate (Clomid, Serophene). This drug is taken orally and stimulates ovulation in women who have PCOS or other ovulation disorders. It causes the pituitary gland to release more FSH and LH, which stimulate the growth of an ovarian follicle containing an egg. Clomiphene citrate also improves fertility in normally ovulating women, and is often used as an initial treatment for unexplained infertility.
Gonadotropins. Instead of stimulating the pituitary gland to release more hormones, these treatments stimulate the ovary directly. Often, gonadotropin medications are used in combination with intrauterine insemination (IUI) — a procedure during which sperm is injected into your uterus via a thin tube (catheter) — to increase the odds of a pregnancy. Gonadotropin medications include:
- Human menopausal gonadotropin, or hMG, (Repronex, Menopur). This injected medication is for women who don’t ovulate on their own due to the failure of the pituitary gland to stimulate ovulation. HMG contains both FSH and LH, and directly stimulates the ovaries to ovulate.
- Follicle-stimulating hormone, or FSH, (Gonal-F, Follistim, Bravelle). FSH works by stimulating the ovaries to produce mature egg follicles.
- Human chorionic gonadotropin, or HCG, (Ovidrel, Pregnyl). Used in combination with clomiphene, hMG or FSH, this drug stimulates the follicle to release its egg (ovulate).
Metformin (Glucophage). This oral drug is used when insulin resistance is a known or suspected cause of infertility, usually in women with a diagnosis of PCOS. Metformin improves insulin resistance, normalizing the insulin level and making ovulation more likely to occur.
Letrozole (Femara). Letrozole belongs to a class of drugs known as aromatase inhibitors. Letrozole, also used to treat some breast cancers, may induce ovulation. However, the effect the medication has on early pregnancy isn’t yet known, so this medication isn’t used for ovulation induction as frequently as others.
Fertility restoration: Surgery
Several surgical procedures can correct problems or otherwise improve female fertility. They include:
- Tissue removal. This surgery removes endometrial tissue or pelvic adhesions with lasers or ablation, which can improve your chances of achieving pregnancy.
- Tubal reversal surgery (microscopic). After a woman has had her tubes tied for permanent contraception (tubal ligation), surgery may be done to reconnect them and restore fertility. Your doctor will determine whether you’re a good candidate for the surgery.
- Tubal surgeries. If your fallopian tubes are blocked or filled with fluid (called hydrosalpinx), tubal surgery may improve your chances of becoming pregnant. Laparoscopic surgery is performed to remove adhesions, dilate a tube or create a new tubal opening. Tubal surgery is more successful when the blocked or narrowed part of the tube is closer to the ovary than to the uterus. Tubal blockage close to your uterus may increase your risk of ectopic pregnancy. In these and other severe cases of blockage or hydrosalpinx, removal of your tubes (salpingectomy) can improve your chances of pregnancy with in vitro fertilization.
Reproductive assistance: In vitro fertilization
This effective technique involves retrieving mature eggs from a woman, fertilizing them with a man’s sperm in a dish in a laboratory and transferring the embryos in the uterus three to five days after fertilization. In vitro fertilization (IVF) often is recommended when both fallopian tubes are blocked. It’s also widely used for a number of other conditions, such as endometriosis, unexplained infertility, cervical factor infertility, male infertility and ovulation disorders. IVF increases your odds of having twins or other multiples if more than one embryo is transferred to your uterus. IVF requires frequent blood tests and daily hormone injections.
To schedule an appointment, please contact Dr. Jon T. Ricks’ office.