Infertility Overview

Overview of Infertility

Nearly 2.5 million American couples are infertile. The reproductive process is so intricate that even the most fertile couple has only a one in four chance of conceiving each month, naturally. The term infertility represents a reduced potential for pregnancy and is defined as 12 months of unprotected intercourse without pregnancy. Infertility without any previous pregnancy is termed primary infertility while infertility after a prior pregnancy is termed secondary infertility.

Since fertility naturally declines with age, a fertility evaluation is recommended for couples over the age of 30 who have not conceived after six months of unprotected intercourse. A younger patient may want to seek help in less than 12 months of trying or may opt to give it more time to conceive naturally. A high percentage of women over 40 will need help in order to conceive and may appropriately elect to see a fertility specialist if not pregnant after 3-6 months of trying.

There are several causes of infertility. Approximately one-third of infertility cases are due to male factors, about one-third are due to factors that affect women and in about one-third of infertile couples, infertility is caused by a combination of problems in both partners. Interestingly, in about 20 percent of couples no obvious cause can be found despite all investigations, in such situations we use the term unexplained infertility.

The most common causes of infertility in women include ovulation problems, age related factors, tubal causes, endometriosis and less common causes such as uterine causes (polyps, scar tissue, fibroids). Male causes of infertility include absence or decreased number of sperms, abnormal sperm quality, varicocoele and vas deferens blockage among others.

A comprehensive initial infertility evaluation is the first step to detect the cause of infertility. A thorough clinical history and physical evaluation is followed by a comprehensive sperm evaluation, tests to document evidence of ovulation (blood tests and ultrasound), endocrine studies to evaluate hormonal status, a dye test to evaluate tubal patency and an ultrasound series to evaluate uterine lining. We strive to complete these tests in one menstrual cycle. A consultation visit is scheduled to discuss these test results and an individualized treatment plan is formulated.

There are a wide range of treatment options depending on the cause of infertility. These include simple treatments of genital tract infection, management of problems related to ovulation, other hormonal problems, microsurgery, laser surgery, laparoscopic laser surgery, to the more complex treatments of In Vitro Fertilization (IVF) and Intracytoplasmic Sperm Injection (ICSI).

NOT EVERY PATIENT NEEDS TO UNDERGO IVF TO ACHIEVE A PREGNANCY.

Dr Pinto firmly believes that each patients needs are unique and he makes every effort to tailor a patient's treatment based on the history, physical exam, basic test results and each unique couples needs. At the ReproMed Fertility Center, we do not believe that all patients have to undergo laparoscopy or major surgery or even IVF procedures. Infertility can often be successfully treated by non-surgical means, and I will attempt these treatments first, except in cases where the necessity for surgery is obvious.