Causes of Infertility:
Polycystic Ovary Syndrome (PCOS) –1) infrequent or absent ovulation, 2) excessive hair growth on lips, chin, face, chest, or middle of abdomen, 3) Polycystic-appearing ovaries at transvaginal ultrasound (many small cyst-like “follicles”, each containing an oocyte/egg. Hypothyroidism, increased prolactin levels, congenital adrenal hyperplasia, and Cushing’s syndrome should be ruled out.
Diminished egg reserve – egg number and egg quality declines over time.
Hypothyroidism – low thyroid hormone (high TSH) can affect ovulation and decrease the chances of conception and increase the risk of miscarriage.
Hyperprolactinemia – increased prolactin levels can also affect ovulation.
Hypothalamic amenorrhea – women can have a lack of ovulation due to extreme weight loss, extreme exercise, or eating disorders such as anorexia/bulemia.
Blockage – fallopian tubes can be blocked due to previous infection, surgery, endometriosis, or even a ruptured appendix.
Endometrial polyps – these are growths in the uterine cavity and the cells are made of the lining of the uterus. Polyps are almost always benign, especially in women of reproductive age.
Uterine fibroids – these are growths in the muscle of the uterus that can sometimes grow into the uterine cavity and make it more difficult to conceive and can increase the risk of miscarriage.
Intrauterine scar/adhesions – these are bands of tissue that can result from a previous surgery or infection. Can decrease pregnancy rates and increase miscarriage rates.
Uterine anomalies – different shaped uterus may affect pregnancy rates and miscarriage rates, depending on the specific shape.
Cells that make the lining of the uterus can grow outside the uterus and be associated with difficulty conceiving.
Bands of tissue that can cause the uterus, fallopian tubes, ovaries, and intestines to attach to each other and can be associated with difficulty conceiving.
There are many reasons why semen analysis parameters may be low – if a reason is found, it may be due to hormones, anatomy, genetics, or environmental.
If all of the tests to evaluate fertility are normal and a cause for difficulty conceiving is not found, then the couple may have unexplained subfertility.
Tests to Evaluate Fertility:
FSH (follicle-stimulating hormone)/estradiol
TSH (thyroid-stimulating hormone)
Day 3 FSH (follicle-stimulating hormone)/estradiol
Anti-Mullerian Hormone (AMH)
Antral Follicle Count
Hysterosalpingogram (HSG): This is a test to check whether or not the fallopian tubes are open and is performed by a radiologist in a radiology suite. It involves injection of iodine contrast dye through a catheter and into the uterus and fallopian tubes.
Laparoscopy: Day surgery that performed to evaluate for endometriosis and/or adhesions, which can affect fertility; the fallopian tubes can be checked as well.
HSG: Checks the uterine cavity (the space where an embryo would potentially implant and grow) –to see whether or not the shape of the uterine cavity is normal.
Saline infusion sonogram (SIS): This is another test can check the uterine cavity. It involves a pelvic ultrasound in the office and injection of a small amount of saline into the uterine cavity.
Semen Analysis (for more information, please view the Male Fertility section of our website)
Ovulation Induction Treatment Options
Fertility-enhancing medications can be given to women who infrequently ovulate or who do not ovulate at all, such as those with Polycystic Ovary Syndrome (PCOS), and they are also given to subfertile women who have been ovulating monthly but have not achieved a successful pregnancy. These medications help grow follicles (follicles are fluid collections within the ovary that contain the eggs) and help to optimize hormone levels.
Clomiphene citrate (Clomid)
Gonadotropins -- FSH (Follicle-Stimulating Hormone) or FSH/LH (Follicle-Stimulating Hormone/Leutinizing Hormone)
Intrauterine Insemination (IUI)
IUI is a procedure which allows placement of the sperm high in the uterus, close to the fallopian tubes where fertilization occurs. The insemination is done near the time when ovulation or release of the egg from the ovary will occur. During the procedure, a thin, flexible catheter containing prepared sperm is inserted through the opening in the cervix into the uterine cavity.
In Vitro Fertilization (IVF)
IVF consists of:
•Ovarian Stimulation: Using medication to stimulate the ovaries to grow multiple follicles which contain eggs.
•Transvaginal ultrasound monitoring and hormone level checks.
•When the follicles are large enough and appropriate in number, Human Chorionic Gonadotropin (hCG) injections to mature the eggs.
•Egg retrieval at IVF laboratory.
•Egg fertilization by In Vitro Fertilization (placing the sperm and eggs together in the laboratory) or intracytoplasmic sperm injection (ICSI).
•Embryo Transfer three or five days after egg retrieval.
•Cryopreservation of surplus embryos 5-6 days after egg retrieval.
•Estrogen and progesterone supplementation until time for pregnancy test.
•Some indications for IVF include tubal factor infertility, male factor infertility, severe endometriosis and unexplained infertility. Each patient's IVF protocol is individualized based on age, ovarian reserve testing, and previous responses to fertility medication.
Assisted Reproductive Technologies offered by Austin Fertility & Reproductive Medicine:
In vitro fertilization (IVF) – fertilizing the female partner’s matured eggs by the male partner’s sperm in the IVF lab for transfer of embryo(s) into the uterus.
Intracytoplasmic Sperm Injection (ICSI) – in certain cases, it may be advisable to have a sperm injected into an egg for fertilization.
Assisted Hatching – opening the covering (zona pellucida) around the embryo in order to help it “hatch” and increase the chance of implantation; shown to be helpful in women 38 years of age and over.
Preimplantation Genetic Diagnosis – in certain cases, chromosome analysis of an embryo prior to embryo transfer.