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Overview

Up to 12 percent of couples experience infertility, the failure to conceive after one year of regular intercourse. Women over the age of 35 are encouraged to seek treatment after only six months of trying, because female fertility can decline rapidly in the thirties. Some OB/GYNs initiate trial therapy with Clomid for approximately three to six months prior to referring. Studies clearly demonstrate that pregnancy is most likely to occur during the first three ovulatory cycles. Continued Clomid therapy is expensive, unlikely to work, and can cause detrimental side effects after this time period. 

There are many possible causes of infertility, so it’s important to see a specialist for proper diagnosis and appropriate treatment as soon as possible. The infertility specialists at Northwell Health Fertility have decades of combined experience and are all doubled board certified in reproductive endocrinology and OB/GYN.

Male infertility

Male infertility is present in up to half of all infertile couples. Prior to any female treatment, it’s important for the male partner to be evaluated early. Male infertility may have several causes. One common cause is temperature elevation in the testes. The scrotum functions to heat and cool the testes by moving them closer to or further away from the body; anything that interferes with this function can cause male infertility. For example, tightly fitting clothes elevate testicular temperature by not allowing the scrotum to move away from the body. Another example is a varicocele, a blockage of the veins in the scrotum responsible for controlling temperature by supplying cooled or warmed blood.

Female infertility

There are many possible causes of female infertility, including the following:

Ovulatory disorder

Any condition which interferes with normal hormonal events can lead to irregular or no ovulation, as well as infertility. These conditions include:

  • Polycystic ovarian syndrome (PCOS): PCOS causes elevated insulin levels and excess androgen (male hormones) production, leading to ovulatory failure. 
  • Hyperprolactinemia: This condition is defined by elevated levels of prolactin, which stimulates milk production in pregnant women. When levels are elevated in non-pregnant females, ovulatory disorders often result. Abnormal levels of other hormones, such as the thyroid hormones, can also lead to ovulatory failure.

Many hormonal conditions can be treated effectively with the appropriate fertility drug. 

Tubal factor

Once a woman’s eggs mature within her ovarian follicles, they are ovulated and must travel from the ovary to the uterus by passing through the fallopian tubes. Fertilization occurs at the distal end of the fallopian tube (end away from the ovary). Any condition which causes a narrowing or blockage of the tubes can lead to infertility. These abnormalities are usually seen during a hysterosalpingogram (HSG) test. Conditions that may affect the tubes include:

  • Tubal ligation: Some women who previously had their fallopian tubes tied for birth control wish to have the procedure reversed. (While pregnancy after tubal ligation is possible, this form of birth control should be considered permanent.) In vitro fertilization (IVF) is often the treatment of first choice for tubal blockage or to achieve pregnancy after a tubal ligation. Using IVF, the eggs are retrieved directly from the follicles and do not have to travel through the fallopian tubes. Per cycle success rates with IVF are higher than tubal reanastamosis.
  • Endometriosis: Endometriosis can attach to virtually any organ and grow, thus interfering with the organ’s normal function. Endometriosis can attach to and penetrate/block the fallopian tubes, making passage of the eggs impossible. Fortunately, endometriosis can often be treated by a skilled reproductive endocrinologist using laparoscopy. Depending on the extent and location of the endometrial implants, IVF may be the best treatment choice.

Cervical factor

Once the sperm are ejaculated into the vagina, they must swim in the cervical mucus to the uterus. The cervical mucus must be of the correct consistency and in sufficient quantity to support the sperm. Sometimes the female’s immune system mistakes sperm for invading pathogens, such as viruses and bacteria, and produces antibodies (known as anti-sperm antibodies) to destroy her partner’s sperm.

Intrauterine insemination (IUI) is usually the first choice treatment for cervical factor infertility.  Using IUI, the specially washed and prepared sperm are inserted directly into the uterus, thus bypassing the cervical mucus.

Uterine factor

The uterus must be free of large obstructions, such as polyps and fibroids, which can interfere with the implantation and growth of the embryo and fetus. Many times a skilled reproductive surgeon can remove fibroids and/or polyps using laparoscopy. Compared to other surgical procedures, laparoscopy greatly reduces pain after surgery, is less expensive, and shortens recovery time.

Also, some women may have scarring of the uterus as a result of pelvic inflammatory disease (severe infection), which can cause issues. There can also be congenital deformities of the uterus, such as the bicornuate (two horned) uterus, which can sometimes be treated surgically. 

Infertility counseling

If you're having difficulty achieving pregnancy, it can be emotionally challenging. The longer this pursuit goes unfulfilled, the greater the chance of developing anxiety, stress, and marital strife as a result of infertility. Many studies indicate that stress can reduce the chances of pregnancy even further, creating a vicious cycle.

At Northwell Health Fertility, we recognize the importance of paying close attention to our fertility patients' emotional well-being, in addition to their physical well-being. Our counseling staff, along with an expert team of fertility specialists, nurses and allied personnel, is trained to listen carefully to each patient. We then provide the individualized, compassionate support necessary to reduce the psychological impact of infertility treatments. 

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