For many women and couples, there is no more heartfelt or important desire than to achieve pregnancy and have a child. For a gynecologist, there is no more rewarding event than to have helped a couple with infertility issues to achieve that dream.
It is a privilege to help if you have questions or are having problems. An initial consultation often identifies potentially solvable problems and provides the reassurance that many couples seeking advice will achieve a successful pregnancy.
Dr. Fortier is experienced in evaluating couples for infertility in a compassionate and respectful setting where their concerns are well heard. In many cases he can provide initial treatments that can be successful including induction of ovulation and counseling regarding coital timing.
How is infertility defined?
Infertility is defined as failure to achieve pregnancy within twelve months of regular unprotected intercourse. Most pregnancies will occur within the first six months of trying and many couples may become concerned and seek consultation at that interval, especially if they are over age 35 (see below).
How does age affect infertility?
Fertility declines with a women’s age. This starts gradually in the early to mid-thirties and is more troublesome after about age 37. Therefore, it is recommended to seek evaluation after six months of trying for women over 35 years old and immediately for women older than 40.
What are causes of infertility?
There are many potential causes of infertility that involve both the female and male. The most common causes in women are lack of regular ovulation (release of the egg from the ovary) and abnormalities of the fallopian tubes or uterus that prevent the sperm and egg from contact or a fertilized egg from implanting. Importantly, about 28-40% of infertility cases involve the male, usually due to abnormalities of the number or quality of sperm released.
Many other systemic disorders can cause or contribute to infertility. Patients and partners will be evaluated for these based on indications from a careful medical history and physical exam.
The initial infertility evaluation
An initial consultation and discussion regarding both partners will guide the course of the evaluation, which may then entail timed blood tests of female hormones and thyroid function and x-ray or ultrasound to assess the fallopian tubes and uterus. A semen analysis is usually ordered for the male partner.
The most basic goals are to evaluate whether there is timely ovulation, adequate supporting hormones, a patent system between the vagina and the released egg, and adequate good quality sperm provided. This initial information can usually be obtained within a few menstrual cycles.
Treatment examples
Treatment recommendations of course depend on the findings. For example, sometimes regular ovulation is not documented, but can be “induced” to occur on time with medication. Males may need to be referred to evaluate abnormal semen. Women with tubal abnormalities may be referred to subspecialists for evaluation for possible surgery or for assisted reproductive technology (ART) such as IVF.
We will find no known cause of infertility in about 30% of couples. Although this is frustrating, there are methods to proceed with medical ovulation enhancement and possible insemination with the partner’s sperm that can improve the chance of successful pregnancy for these couples. Some couples may also proceed to ART.
Summary
In every case, we will embark together with a thorough discussion and rational, well-explained evaluation. Then we will discuss the findings and options and use patient-doctor shared decision-making to choose a course. This may include some beneficial lifestyle and timing changes, some medication and/or office procedures, or referral to one of several top-notch advanced providers in our area for ART or a second opinion.
Please contact our office for more information or to schedule a consultation to discuss whether an initial evaluation is advisable. Call 919-916-3333 to schedule.
Note: The above is intended for information and as a basic introduction or orientation to a complex topic. It is far from exhaustive and cannot substitute for a thorough discussion and evaluation from a caring provider.
