Common Fertility Issues

 Age & Fertility

In school and your early years, the worry was often about getting pregnant too soon. Now that you’re ready to have a family, it’s not happing as easily as you thought. We understand what you might be feeling. We can help.

The single biggest challenge to overcoming infertility is age or more technically speaking Advanced Maternal Age (AMA). Female fertility - basically the number of eggs you have in your ovaries and the quality of those eggs diminishes over time so that by your mid 30’s you have less than half of the eggs you had at puberty.

According to the American Society for Reproductive Medicine (ASRM), if you’re under 35 years and been trying to get pregnant or can’t stay pregnant after 1-year of trying, you should talk to a reproductive specialist. If you’re over 35 years and been trying to get pregnant or can’t stay pregnant after 6-months of trying, you should talk to a reproductive specialist.

Diminished Ovarian Reserve (DOR)

Diminished ovarian reserve or (DOR) occurs when a woman’s ovaries lose their reproductive potential, which refers to both the quantity and quality of eggs. At birth, women are born with all of the eggs (oocytes) that they will have in their lifetime – over 1 million. By their teenage years, that reserve or quantity of eggs has declined to 300,000 or less.

Although age is the primary cause of diminished ovarian reserve (DOR), other factors such as genetic abnormalities, injuries, and medical conditions, may have an effect as well on egg quantity and quality.

How is Diminished Ovarian Reserve diagnosed?
DOR is diagnosed by evaluating the follicle stimulating hormone (FSH), estradiol, and the anti-Mullerian hormone (AMH) levels in a woman’s blood, along with a transvaginal ultrasound. FSH and estradiol are markers of a woman’s response to ovulation or stimulation AMH correlates with the quantity of eggs left in a woman’s ovaries. Women with Diminished ovarian reserve (DOR) tends to show high FSH and low AMH levels.

What are the common misconceptions of Diminished Ovarian Reserve (DOR)?
Abnormal cycles always indicate that there is something wrong with your ovarian reserve. Although the average cycle length is 28 days, cycles can range anywhere from 21 to 35 days in adults. Shorter cycles do not always indicate DOR.

Diminished Ovarian Reserve (DOR) equates to a lower quality of eggs

DOR is diagnosed by evaluating the quantity of eggs left in a woman’s ovaries, whereas the quality of a woman’s eggs is primarily determined by age. Having DOR does not mean that you will not be able to get pregnant naturally or with Assisted Reproductive Treatment (ART).

Can IVF help DOR?
Although there are no treatments to decrease or slow down reproductive aging, there are treatments to help a woman conceive despite their DOR.

Embryos or eggs can be frozen and preserved earlier in life before a patient is ready to conceive. Medication can help increase the number of eggs produced per cycle (ovarian stimulation). A woman can achieve pregnancy with the use of donor eggs fertilized by a male’s sperm (her partner or donated sperm) and have the resulting embryo implanted into her uterus.

Endometriosis

What is Endometriosis?
Endometriosis a condition in which the endometrium (the tissue that lines the uterus) grows outside of the uterus, generally near the pelvic lining, ovaries, or fallopian tubes.

Normally, the endometrium thickens and sheds throughout the menstrual cycle and leaves the body during the period. However, any tissue that has grown outside of the uterus becomes trapped. In the tissue surrounding the ovaries, irritation may occur and cause cysts (called endometriomas) or scar tissue.

What are the symptoms of Endometriosis?

  • Difficulty getting or staying pregnant.
  • Moderate to severe pain and/or heavy flow during menstruation.
  • Discomfort with urination or bowel movements around the time of the period.
  • Pain during intercourse.
  • Bloating, cramping, nausea, constipation, and fatigue (especially during menstruation).

How does endometriosis affect fertility?

  • Endometriosis can impede the fertilization of an egg by blocking off the fallopian tube.
  • Endometriosis may also damage the egg and/or sperm and impact ovarian reserve.
  • About one third to one half of women with endometriosis have difficulty getting pregnant.

What can you do if you have Endometriosis and trying to get pregnant or stay pregnant?

  • If you have not been able to get pregnant after 6 to 12 months of actively trying, make an appointment with an infertility specialist to make a baseline assessment.
  • Talk with your OB/GYN or reproductive endocrinologist about your history and consider a treatment option like IVF.
  • During IVF, the egg is removed from the ovary and inseminated outside the body (in vitro), then placed back into the uterus for implantation. This prevents endometriosis from blocking the fertilization process or causing damage to the gametes (sperm or egg).
  • Options like Intrauterine Insemination (IUI) or treatment with oral medication can be considered for more moderate cases.
  • Try to maintain a healthy lifestyle with a balanced diet and enough exercise, as this can help reduce inflammation in the body.

Blocked Tubes

What Are the Fallopian Tubes?
The part of the female reproductive system responsible for carrying the egg from the ovary to the uterus. Site of fertilization – once the egg is fertilized by the sperm, it travels along the tube until it reaches the uterus to implant.

What does it mean for the Fallopian tubes to be "blocked" and how is it diagnosed?

Scar tissue, infection, pelvic adhesions, and/or other factors can cause an obstruction in one or both Fallopian tubes, which may:

Prevent the egg and sperm from uniting (fertilization)

Inhibit a fertilized egg from reaching the uterus

Tubal blockage may occur because of endometriosis, pelvic inflammatory disease (PID), sexually transmitted infections (STIs), fibroids, previous ectopic pregnancy (pregnancy outside of the uterus), and/or abdominal surgery. A blocked Fallopian tube can be assessed by a Hysterosalpingography (HSG), which is a radiologic procedure to assess the tubes.

How can blocked Fallopian tubes be treated?
Laparoscopic surgery can be performed to remove the blockage, although this may not be possible in severe cases. If one tube is open, medication can be taken to increase the number of mature eggs released per month, increasing the chances of an egg flowing through the open tube.

In Vitro Fertilization (IVF) can be used to bypass the blocked tube, retrieve the egg directly from the ovary, and fertilize it outside of the body. Once fertilized, the embryo can be placed directly inside the uterus.

Male Factor

In general, about 30% of infertility issues are related to poor sperm quality or quantity. Many men supper from varicocele (an enlargement of veins in the testicles) or azoospermia (lack of sperm). Anti-sperm antibodies, abnormalities in count or motility, volume, or sperm consistency can be the root cause