Infertility Evaluation and Management

We define infertility as not being able to get pregnant after at least one year of trying. In addition, women who are over the age of 35 and having been trying for less than one year and women who are able to get pregnant but then have repeat miscarriages are are candidates for evaluation.

Pregnancy is the result of a complex chain of events in order to get pregnant.  Infertility can result from problems that interfere with any of these steps:

• A woman must release an egg from one of her ovaries (ovulation).

• The egg must go through a fallopian tube toward the uterus (womb).

• A man’s sperm must join with (fertilize) the egg along the way.

• The fertilized egg must attach to the inside of the uterus (implantation).

Problems with ovulation account for most cases of infertility. Without ovulation, there are no eggs to be fertilized. Irregular or absent menstrual periods are a sign of no ovulation (or infrequent ovulation). Less common causes of fertility problems in women include:

• Blocked fallopian tubes due to pelvic inflammatory disease, endometriosis, or surgery for an ectopic pregnancy

• Physical problems with the uterus

• Uterine fibroids

Many things can affect a woman’s ability to have a baby. These include: age, stress, diet, intense athletic training, being overweight or underweight, smoking, alcohol, sexually transmitted infections, hormone changes.

Sometimes we can find the cause of a couple’s infertility by doing a complete fertility evaluation. This process usually begins with physical exams and health and sexual histories. If there are no obvious problems, like poorly timed intercourse or absence of ovulation, further tests will be needed. Finding the cause of infertility is often a long, complex, and emotional process. It can take months for you and your doctor to complete all the needed exams and tests.

For a man, we usually begin by testing semen. We look at the number, shape, and movement of the sperm. For a woman, the first step in testing is to find out if she is ovulating each month.

Infertility can be treated with medicine, surgery, artificial insemination, or assisted reproductive technology. Many times these treatments are combined. About two-thirds of couples who are treated for infertility are able to have a baby. In most cases infertility is treated with drugs or surgery.

Many fertility drugs increase a woman’s chance of having twins, triplets, or other multiples. Women who are pregnant with multiple fetuses have more problems during pregnancy. Multiple fetuses have a high risk of being born too early (prematurely). Premature babies are at a higher risk of health and developmental problems.

Assisted reproductive technology (ART) is a term that describes several different methods used to help infertile couples. ART involves removing eggs from a woman’s body, mixing them with sperm in the laboratory, and putting the embryos back into a woman’s body.

At Tree of Life Medical we will perform a thorough evaluation of all the possible causes that are making it difficult for you to conceive.  We will prescribe some medications and make lifestyle recommendations to assist you in your attempt to conceive.  If more in-depth evaluation and management is needed, we will make sure you are referred to the appropriate specialists.  We will help coordinate your care and stand by you as you go through every step of the process.