Infertility

Infertility Treatment at Lee Gynecology in Portland, OR

Initial infertility evaluation starts with a careful history and physical exam, laboratory testing and a pelvic ultrasound. Further basic testing involves an x-ray of the uterus and fallopian tubes and a semen analysis. All of this is done efficiently and safely.
– Michael J. Lee

Incidence and Risk Factors

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.

Common Causes of Infertility

  • Problems with ovulation
  • Problems with the fallopian tubes (such as blockage) that prevent a fertilized egg from moving through the tube to the uterus
  • Problems with the uterus that prevent a fertilized egg from attaching or growing normally as an embryo
  • Problems with the amount or health of sperm
  • Hormone disorders that affect reproductive function

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.

What are the Steps?

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.

When is Surgery Needed?

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).

When Should a Reproductive Endocrinologist Get Involved?

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:

  • Advanced Ovulation InductionIf ovulation does not occur within six cycles of using clomiphene (a fertility medication), drugs called gonadotropins may be used to induce ovulation. Blood tests and ultrasound exams track the maturation of the follicles (small sacs in which eggs develop). When test results show that the follicles have reached a certain size, another drug to trigger ovulation (called human chorionic gonadotropin or hCG), may be given.
  • Intrauterine InseminationHealthy sperm is placed in the uterus as close to the time of ovulation as possible. When the woman ovulates, either naturally or with ovulation drugs, sperm is placed in the uterus through a small tube. In most cases, the semen is prepared first in a lab. A multiple pregnancy is a risk of intrauterine insemination when ovulation drugs are used. If too many eggs develop, the insemination may be canceled.
  • Assisted Reproductive Technology (ART)ART includes all fertility treatments in which both eggs and sperm are handled. ART usually involves in vitro fertilization (IVF). In IVF, mature eggs are retrieved from your ovaries and fertilized by sperm in a lab.  Then the fertilized egg (embryo) or eggs are implanted in your uterus.  One cycle of IVF takes about two weeks, and more than one cycle may be needed to succeed.IVF is used for the following causes of infertility:
    • Damaged or blocked fallopian tubes that cannot be treated with surgery
    • Some male infertility factors
    • Severe endometriosis
    • Premature ovarian failure
    • Unexplained infertility

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.


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