Infertility & Women

Dr. Nicholas Kaloudis

Infertility is the inability of a sexually active couple, not using any birth control, to get pregnant after one year of trying. For pregnancy to occur, several things have to happen: an egg must develop in the woman’s ovary; the ovary must release an egg each month (ovulation). The egg must then be picked up by one of the fallopian tubes; a man’s sperm must travel through the uterus to the fallopian tube to meet and fertilize the egg; the fertilized egg must travel through the fallopian tube and implant in the lining of the uterus. If any of these events does not happen, infertility will result.

About 40% of infertility cases are due to female infertility, but just as many cases are due to male infertility. Therefore, before you have a lot of testing and treatment done, your partner should have a semen analysis done, to make sure his sperm is normal.

About 25% of women with infertility have infrequent or absent ovulation. These women usually have irregular periods or no periods at all. Ovulation can be disrupted by changes in the way certain hormones are released from the pituitary gland. These hormones FSH and LH signal an egg to develop and be released from the ovary. Problems that interfere with normal FSH and LH release include: Pituitary tumors; being too thin or too heavy; extreme exercise; extreme stress.

Other hormonal conditions that interfere with ovulation or affect fertility are: PCOS; an overactive or underactive thyroid; diabetes; early menopause; Cushing’s Disease.
A woman’s ability to get pregnant can be affected by her age, since the number and quality of her eggs gradually decreases beginning in the mid 30’s. Other factors include: problems with the reproductive tract, like blocked or damaged fallopian tubes, scarring of the uterine lining, polyps or fibroids in the uterus, and endometriosis; sexually transmitted diseases, like Chlamydia and gonorrhea that can cause tubal blockages; smoking, drinking alcohol, or using recreational drugs; medications like antidepressants, calcium channel blockers, and anti-cancer drugs; chronic medical conditions such as: kidney disease, liver disease, sickle cell disease, HIV/AIDS, and hepatitis B or C.

The proper diagnosis of infertility will begin with your endocrinologist obtaining a medical history about your menstrual cycle, past illnesses, STD’s, surgeries, and any medications you are taking. The next step is an ultrasound to make sure your reproductive tract is intact, and blood tests to measure your hormone levels. Depending on what these tests find, further testing including one to make sure your fallopian tubes are not blocked.

Treatment of infertility depends on the cause and your age. It falls into 2 main categories: one that helps fertility through medications or surgery, and the other uses assisted reproductive technologies. Fertility drugs are the main treatment for women with ovulation disorders. Sometimes doctors use drug treatment with intrauterine insemination, when sperm are released into the uterus through a catheter inserted through the vagina. IUI is done at the time of ovulation.

Surgery might help women with fibroids, uterine polyps, scarring, or endometriosis. Surgery may be an option for some women with blocked fallopian tubes, but it depends on your age, and the type of blockage. You should be aware that surgery to unblock a fallopian tube may increase the risk of ectopic pregnancy.

Assisted reproductive technology uses techniques such as mixing sperm with an egg outside the body (in vitro fertilization), or injecting a single sperm into an egg, then transferring the resulting embryo back into the uterus. Some women with very few remaining eggs in their ovaries choose IVF using a donor egg.