Infertility

Table of contents

What is Infertility?

Infertility is a common problem in today's society affecting approximately 15% of couples. Infertility, which affects as many as 1 in 6 couples, is defined as the inability of a couple to conceive a child after one year of unprotected sex and is usually diagnosed through medical interviews and physical examinations of both partners.

Infertility can be caused by a wide variety of factors. One-third of the time the problem lies with the male, one-third of the time it lies with the female, and one-third of the time infertility is caused by problems with both the male and the female.

Causes of Infertility

There are multiple causes of infertility with the most common being problems with the male reproductive system (35%), and anatomic abnormalities or damage involving the female reproductive organs (35%).

Endometriosis is a major cause of damage to the female pelvic organs, especially the ovaries and fallopian tubes. If left untreated, endometriosis increases the risk of infertility and may decrease IVF success.

Abnormalities with ovulation account for about 15% of cases and another 10-15% of infertility is unexplained. Other causes such as autoimmune disorders, genetic abnormalities, and asymptomatic genital infections have also been implicated.

Causes of Male Infertility

In males infertility can be caused by a variety of problems. Some of the more common disorders are listed below.

Deficient Sperm Production: The production of sperm of low count, motility and increased abnormality commonly leads to infertility.
Varicocele: A varicose vein around one of the two spermatic cords can cause blood to pool in the testes, this, in turn, causes the temperature to increase in this area. Higher temperatures decrease sperm production and can lead to infertility.
Infections: Twenty-eight to seventy-one percent of infertile men show some signs of an infection of their reproductive organs. The presence of antisperm antibodies, which attack and destroy the sperm, are usually a good indicator that an infection is present.
Ductal Obstruction: Blockage or damage to the spermatic tubes.
Ejaculatory Dysfunction: These disorders are characterized by the failure to deliver sperm to the vagina.

Other factors that can cause male infertility include abnormal development or damage of the testes, genetic disorders such as a chromosomal abnormality and daily habits like smoking and alcohol.

Normal Sperm Parameters

The characteristics of a normal semen sample are mentioned in the table below:

Volume:	2.5-3ml
Concentration:	>20x10^6/ml
Mobility:	>50%
Morphology:	<85% (abnormal shapes)

Fertility Tests for Men

Sperm analysis to evaluate the volume of the ejaculate, acidity (Ph) of the semen, number of sperm, percentage of motile sperm, sperm morphology (sperm shape), and the number of round cells in the semen. In case of an abnormal first analysis, the patient is requested to repeat the test. Male factor infertility is only diagnosed after repeated abnormal semen analysis.
Blood tests for hormones such as FSH, LH, estradiol, and testosterone (if indicated)
Blood tests for transmissible diseases such as HIV, Hepatitis B and Hepatitis C
Other tests might be ordered depending on the patient’s history

Causes of Female Infertility

The main causes of female infertility are the following:

Hormonal Disorders that effect normal ovulation and the quality of the formed oocytes. The most common hormonal disorder in women is the polycystic ovarian disease/syndrome.
Age: After the age of 30 the quality of your eggs begins to diminish, and it becomes harder to become pregnant and carry a fetus to term. The older a woman is the more likely it is that her eggs will have chromosomal abnormalities. Read more: Age and Infertility
Endometriosis: This disorder occurs when the tissue that lines the uterus (the endometrium) grows into growths or lesions outside of the uterus (usually on the ovaries, fallopian tubes, the outer surface of the uterus, vagina, cervix).
Pelvic Adhesions: These are usually caused by surgery or infection, and occur when scar tissue forms between two or more internal organs. When this tissue affects the ovaries or fallopian tubes, infertility can result.
Immunological Infertility: This disorder occurs when the woman's system produces antisperm antibodies, which destroy her partner's sperm.
Genetic and Chromosomal Abnormalities
Pelvic Inflammatory Disease: This infection of the reproductive tract can lead to blocked or damaged fallopian tubes.
Daily habits: stress, alcohol and smoking

Fertility Tests for Women

Blood tests scheduled between days 2 and 5 of the menstrual cycle to measure hormones such as FSH, LH, estradiol, testosterone, prolactin and TSH.
Blood tests to detect transmissible diseases such as HIV, Hepatitis B, Hepatitis C, blood group and Rubella immunity.
An ultrasound scan of the uterus and ovaries scheduled between days 2 and 5 of the menstrual cycle.
A hysterosalpingogram (HSG) which involves taking an X-ray image of the uterus and fallopian tubes after injecting a small amount of dye through the cervix into the uterus to check for obstructions in the fallopian tubes. In the case of blocked tubes, the HSG will indicate the site of obstruction. The amount of radiation involved in performing an HSG is small and not harmful. The HSG will also show the shape and condition of the uterine cavity and is particularly useful in cases of repeated miscarriages. During the HSG, you may have some lower abdominal discomfort. If you have had a pelvic infection in the past, you will need to take antibiotics around the time your HSG has been scheduled. The HSG takes only a few minutes to perform and is an outpatient procedure; it should not be scheduled during menstruation or later than ten days in your cycle to avoid X-ray exposure to the fetus in case of a pregnancy.

When to Seek Help?

We encourage couples to seek fertility consultation after one year of unsuccessful attempts to become pregnant; however, you should seek help sooner if you have one or more of the following:

Irregular or no menstruation (suggesting ovulatory problem)
History of pelvic infections and / or burst appendix, previous abdominal surgeries (a possible tubal problem).
Increasing and severe pain during menstruation (suspected endometriosis)
2 or 3 previous miscarriages
history of sexually transmitted diseases such as Chlamydia or Gonorrhea in either partner
testicular surgery, injury, or history of childhood infections such as mumps
sexual problems such as premature ejaculation and/ or difficulty with erection
female partner is older than 35 years of age

The initial assessment may include organizing investigations and tests to evaluate and formulate the best treatment for you. Additional tests may be requested depending on the individual’s clinical profile. If you have had any if these tests within the past year, please forward the results before your first appointment for fertility consultation.

Infertility Treatment Options

Infertility treatment is based on the findings from a diagnostic workup, which can include various blood tests and imaging studies. Treatment may require instruction and behavior modification, hormonal therapy, or surgical intervention. Egg donation is also an effective treatment for infertility, especially in women older than 40.

Find out the cause of your infertility

Arrange for an initial free consultation with fertility specialist Dr. Thanos Paraschos.

Starting your Infertility Treatment

You're not alone. In the United States and Europe, roughly 6.1 million men and women, 10% of the reproductive-age population, are infertile. The causes are found equally among women and men, with nearly 35% cases of infertility caused by the woman, and 35% resulting from the man. (In 20% of infertility cases both partners have complications, and 10% of cases remain unexplained.)

The world of infertility treatments can be confusing and overwhelming to navigate, so we have created this step-by-step guide to help you understand how to get started and what to expect at every stage of an IVF treatment cycle at EmBIO Medical Center.

Initial Fertility Consultation: A Comprehensive Evaluation

Infertility can be a complicated thing. And, the causes are numerous. According to the Society of Assisted Reproductive Technology (SART), the most common female causes reported include tubal factor (which accounts for about 10% of all female related issues), ovulatory dysfunction (6%), diminished ovarian reserve (12%), endometriosis (5%), uterine factors (1%), and other factors (8%). In 11% of female infertility cases the causes are unknown.

While there are many causes of male factor infertility, some are seen more commonly than others. Those include blockage of sperm, infection (STD, mumps, etc.), chronic disease, erectile dysfunction (which occurs in 50% of men over 40), failure to produce sperm, exposure to harmful substances, injury, or varicocele (varicose veins in the testicle).

During your initial consultation we will complete a comprehensive fertility evaluation to help determine the cause of your infertility and the best treatment program for you. Though is not necessary, we recommend you schedule this appointment on day 2, 3, or 4 of your menstrual cycle just in case you can and wish to start right away, and because it will provide us the best picture into your fertility health.

The Fertility Consultation

During your first consultation with Dr Thanos Paraschos and your IVF coordinator (of your fertility care team), together you will discuss your medical and fertility history, any complications or issues you have been having, and your goals. Your fertility care team will also explain IVF, the treatment options, and potential solutions to why you may be having trouble conceiving naturally. Some causes that will be discussed include:

Ovulatory Dysfunction
Polycystic Ovarian Syndrome
Recurrent Miscarriage
Ectopic Pregnancy Tubal Disease
Pelvic Adhesion Disease
Hypothalamic Amenorrhea
Fibroids
Premature Ovarian Failure
Hyperprolactinemia

If we have suspicions about one of these conditions, tests to determine likelihood may be recommended. Some of those tests include Diagnostic laparoscopy, and an Endometrial/Endometriosis Biopsy.

Infectious Disease, Hormone, IVF Immune Testing, Genetic Testing

Once your consultation is complete, a nurse will draw blood for a variety of blood tests needed to determine your fertility health and possible treatment plans. These tests will check for various infectious diseases, immunities, hormone levels and genetic abnormalities that could affect your treatment as well as the health of your offspring. Our tests include the following:

Gonorrhea
Chlamydia
Cytomegalovirus (CMV)
Hepatitis B & C
Human Immunodeficiency Virus (HIV)
Human T-Cell Lymphocyte Virus Types 1 & 2
Syphilis Measles
German measles
Varicella
Chicken pox
Rubella Cystic Fibrosis
Sickle Cell Traits FSH
Estradiol
LH
Progesterone

Antral Follicle Count & Sonogram

Last, we will perform a transvaginal ultrasound (also called sonogram). This painless procedure is a small probe, much like a wand, which is inserted into your vagina. The probe emits information about your female reproductive system--your ovaries, follicles (where eggs are housed), uterus, etc. to a computer screen that both you and the doctor can see. Most women find it very interesting and informative.

Antral Follicle Count

This exam allows the doctor to count the number of antral follicles you have remaining. An antral follicle is a follicle in reserve, not ready to become mature or dominant in the month the exam is done. A follicle is the cell that contains an egg. This test gives us an idea of how much more time you have on your fertility clock & roughly a guess at the number of potential eggs you may get each cycle.

General Sonogram

Your doctor will also look for ovarian cysts and over hyper-stimulation syndrome (OHSS), and note the thickness of your endometrial lining (we hope for 7mm at the time of egg retrieval), & the overall health of your female reproductive system.

Semen Analysis

If you are a couple planning to conceive, we will also take a sample of his semen for an analysis of sperm count, motility (movement), morphology (shape), and an analysis of the ejaculate thickness and the sperms' ability to liquefy.

Follow-up Infertility Treatment Consultation

You may begin treatment immediately following your initial consultation, or you might return to discuss the results of your blood tests, initial sonogram, and semen analysis (if this was done), determine the best fertility care strategy based on your goals, and then begin treatment on day 3 of your next menstrual cycle.

Female Infertility Treatments & Male Infertility Treatments

If it is determined that you or your male partner need a reproductive treatment or surgery to repair a problem causing your infertility, those will most likely be done before an in vitro fertilization cycle begins.

Contact us to find out how you can start your fertility treatment at EmBIO and what stages you can do in your country!