Infertility is defined as the inability to conceive after one year of unprotected intercourse or the inability to carry a pregnancy to term. If you are a woman over 35, or have a history of painful periods, irregular cycles, pelvic inflammatory disease, miscarriages, or the male partner has a low sperm count then the time frame is reduced to six months.
The first step in overcoming infertility is an accurate diagnosis of the causes of infertility. In order to obtain a precise diagnosis, an in-depth study of each partner’s medical history and a thorough infertility work-up should be completed. Diagnostic testing can examine such things as hormonal patterns, ovulation cycle, anatomy of the uterus and fallopian tubes and sperm shape and motility. If a fertility problem is suspected, additional testing may be required and perhaps a urological consultation may be recommended for the male partner. The following testing can help diagnose more than 95% of infertility related problems.
Ovarian Function Tests, or egg quality tests, are assessed by blood tests and ultrasounds. These are markers of the number and quality of eggs that a woman has, typically referred to as “ovarian reserve.” Follicle Stimulating Hormone (FSH) and Estradiol is typically drawn on the second or third of woman’s menstrual cycle. This provides information on the potential quality of her egg(s). A newer blood test called Anti-Mullerian Hormone (AMH) can be done on any day of cycle. The AMH can give objective insight into the number of eggs the ovary has and how well ovaries will respond to fertility medications. An Ovarian Antral Follicle count by ultrasound also gives insight into the remaining number of eggs the ovary has.
Hormone Testing will help determine if a hormonal imbalance is affecting ovulation (release of eggs) and embryo implantation into the uterine wall. Hormone testing includes Prolactin and Thyroid Stimulating Hormone (TSH), among others.
Testing of a woman’s pelvic anatomy, which assesses for mechanical issues that may affect fertilization and implantation, is critical. A Pelvic Ultrasound may reveal such issues as fibroids or ovarian cysts, which could affect both infertility and pregnancy outcomes. The Sonohysterogram (SHG or SIS), a specialized ultrasound where small amounts of saline are injected into the uterus, allows for evaluation the uterine lining under ultrasound guidance. If the SHG is abnormal, surgery may be recommended to normalize the uterine cavity. Lastly, the Hysterosaalpingogram (HSG) essentially takes an x-ray of the pelvis. A thin tube-like instrument is passed into the cervix and then dye is injected into the uterus. As the dye enters the uterus and fallopian tubes, an assessment can be done to look at both the uterine and fallopian tube anatomy.
A semen analysis is a way of determining sperm counts, sperm motility and sperm morphology (shape). These results will help determine the probability of sperm being able to fertilize an egg.
Often overlooked are factors that may affect pregnancy or result in fetal complications. Preconception genetic disease testing should be considered based on your ethnic background. These include Cystic Fibrosis (Caucasian);Thalassemia (Southeast Asian) and ß- Thalassemia (Mediterranean);Tay Sachs, Canavans, Gaucher (Jewish) and Tay Sachs (French Canadian/Cajun) and Sickle Cell Anemia (African American). In addition, immunization status should be assessed. The testing should include Rubella (German measles) and Varicella (Chickenpox) which can have severe effects on a developing fetus, including blindness, heart defects, hearing defects, musculoskeletal defects, and mental retardation.
A balanced diet composed of fresh foods is one of the best things you can do for your future offspring – its gives them a distinct advantage in their intellectual capacity and ability to fight disease. It is recommended women who are pregnant or may become pregnant should not eat shark, swordfish, king mackerel or tilefish due to their high levels of mercury. Studies show pregnant women should limit coffee intake to two cups per day beginning in early pregnancy. A multi-vitamin containing folic acid (0.4-0.8 mg/day) is also a good addition to the diet.
For optimal fertility, women should try to maintain an ideal weight. Significantly overweight or underweight women can develop ovulation problems. Exercising regularly will help control weight gain and will keep the body strong enough to carry a pregnancy. Excessive exercise, which burns more than 2000 to 4000 calories per week can impair ovulation in some women. In addition, alternative therapies including acupuncture, yoga, and stress reduction technique have all been shown to augment infertility treatment outcomes.
Active smoking can significantly delay time to conception and is associated with failure to conceive. Exposure to passive smoke further increased the odds against a woman conceiving within six months. Smoking has been proven to impair blood flow and frequently results in low birth weight infants. We advise that both partners to discontinue smoking prior to attempting pregnancy.
Fetal alcohol syndrome has been known to occur in infants where mothers drink even moderately or lightly during their pregnancies. For this reason, it is advised to abstain from alcohol during pregnancy and while trying to conceive.
Infertility can be devastating emotionally, physically and financially. These simple diagnostic tests allow us to custom tailor treatments for the infertile couple. These range from lifestyle modification to surgical correction, to ovulation induction and in-vitro fertilization, where more than 75% of couples will achieve their dream.
(Editor’s Note: Steven Lindheim M.D., M.M.M. is the Medical Director at Arizona Reproductive Institute. He is board-certified in both Obstetrics and Gynecology and Reproductive Endocrinology and Infertility. His office can be reached at 222-8400.)