Did you know that about 15 percent of couples in the United States are infertile? Both male and female factors contribute to infertility. Although a man’s fertility declines with age, it is not as predictable. A woman’s fertility gradually begins to drop at about age 32 and decreases more rapidly after age 37. You may wish to have an infertility evaluation if you’ve not been able to become pregnant after six months of trying to conceive.
Lifestyle factors can play a role in infertility. Women who are underweight or overweight or who exercise excessively may have a harder time getting pregnant. Drinking alcohol at moderate or heavy levels and smoking by either partner may reduce fertility. For men, using marijuana or anabolic steroids can reduce sperm count and movement as well.
First, the basic infertility evaluation is really quite simple and focused on the general health of the individuals involved, including hormone levels and structure of the uterus, tubes and ovaries. A semen analysis and an x-ray of the uterus may also be obtained early in the evaluation. Often there are obvious issues that can be addressed, for example, a low thyroid, a fibroid tumor, weak or absent ovulation. This may require a referral to specialists in urology or endocrinology.
Findings in the initial evaluation may indicate the need for surgery. For women, surgery may repair blocked or damaged fallopian tubes. It may also treat endometriosis, a condition in which tissue normally lining the uterus is found outside the uterus, usually on the ovaries, fallopian tubes and other pelvic structures. For men, surgery can treat some infertility problems such as varicocele (varicose veins in the scrotum).
If the above steps are not successful, it may be time to see a reproductive endocrinologist, if that specialist is not already involved. An endocrinologist performs procedures such as IUI (direct placement of sperm into the uterus). Some treatments are expensive and may not be covered by insurance. Examples of advanced evaluation and treatment include:
The most effective form of ART, IVF can be completed using your own eggs and your partner’s sperm. Or IVF may involve eggs, sperm or embryos from a donor. In some cases, a gestational carrier (a woman who has an embryo implanted in her uterus) might be used. If more than one embryo is implanted in your uterus, there is a risk of a multiple pregnancy.
…And don’t worry. We won’t limit the number of medical issues you can bring for evaluation at your appointment.