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Tuesday, September 20, 2011

Infertility 101

One of the most heartbreaking situations for a gynecologist is to have a patient who strongly wants to have a baby but who has not been able to either conceive or to carry a pregnancy to term.  After a time of trying, desperation sets in and couples tend to seek the care of a physician.  They can begin with a consultation with a general gynecologist for the basic initial evaluation, but if no results are realized after a reasonable amount of effort with the simple measures, couples may need to step up to specialty care with a reproductive endocrinologist (RE).

Infertility is defined as the inability to conceive despite at least a year of concerted effort, but older couples (35 years and up) might not want to wait that long before getting some medical assistance.  There is a subcategory for women who actually can conceive but who cannot continue the pregnancy beyond a certain point (i.e. repetitive miscarriages).  About 10% of couples have some sort of fertility issue, and approx. 20% of the time, it is actually a problem with the male partner.  Female infertility is divided into multiple potential causes including tubal factor (i.e. the fallopian tubes become blocked because of infection or injury), ovulatory factor (the ovaries fail to produce  or eject a viable egg), cervical factor (sperm can't get past that point of entry) and unknown causes.  The latter is unfortunately a rather common diagnosis at all.

It is for the more difficult cases that assisted reproductive techniques are most helpful.  But first, the doctor will explore the general health of the partners.  Issues like smoking, excessive drinking and use of drugs clearly are contributing factors to infertility.  The female exam consists of a general physical, updated Pap test, cultures of the cervix for infection, and blood tests for thyroid function among other things.  Male factor infertility should also include a good general physical, but the one key test is a semen analysis.  Sperm can be less than optimal in number and quality, and the semen test will help sort that out and point the way to the appropriate treatment.

In any given menstrual cycle, women have about a 20% chance of conceiving, but those odds get worse as she ages beyond her early 30's.  So waiting too long to start trying to have a baby is one of the most common reasons that women don't get to realize their dream of having a family.

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The Mayo Clinic Infertility Page

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