If you are struggling to conceive (become pregnant), you are not alone. Infertility is common; in fact, infertility affects 10% to 15% of couples in the United States. The underlying problem may be traced to the woman (female factor), to the man (male factor), or due to a combination of male and female factors. At The Woman’s Health Pavilion, many of our patients are relieved to learn that the same providers they see for their gynecology care also provide fertility services. At our practice in Queens and Long Island, we have helped thousands of women navigate their struggles with fertility. We find it especially gratifying to help our patients achieve pregnancy, and then support them right through pregnancy and delivery.
If you have questions or concerns about infertility, request an appointment at one of our multiple offices in Queens and on Long Island. Our OB-GYN specialists see patients 7 days a week and offer same-day appointments for urgent conditions.
What qualifies as infertility?
The average healthy couple takes about 5 months to conceive. This average includes some couples who will achieve pregnancy during their first month of trying, and some who will take considerably longer. Up to a year of trying is considered “normal.” Infertility is defined as the inability to conceive after having unprotected intercourse for 12 months. In our office, we offer noninvasive testing before the 1-year mark for concerned couples, and we recommend initiating an infertility investigation within 6 months for women over age 35.
How does pregnancy begin?
Conception occurs when the male sperm penetrates the female egg. This process requires three elements:
- A healthy egg
- Healthy sperm
- A way for them to meet
When all goes right, sperm travel from the vagina, through the cervix and uterus, and into the fallopian tubes, where one lucky sperm fertilizes the egg. After a few days, the fertilized egg travels through the fallopian tube into the uterus, implants into the uterine lining (endometrium), and pregnancy begins. (See illustration.) Infertility occurs when one of these steps cannot take place.[Add this illustration (remove labels for uterine fundus and fimbriae: https://stock.adobe.com/images/female-reproductive-system-vector-esp10/269524603]
What are the main causes of infertility?
Infertility is not just a woman’s problem, it can be associated with the woman, man, or both. These problems are almost equally divided between men and women. In some cases, the cause is not found and considered unexplained infertility. (See chart.)
What causes female infertility?
Common causes of female infertility include problems with ovulation, eggs, fallopian tubes, and uterus.
In normal menstrual cycles, well-choreographed hormonal changes result in an egg maturing in the ovary and being released at the time of ovulation. At the same time, hormones cause the lining inside the uterus to thicken in order to receive the fertilized egg. Infertility can result if eggs are released infrequently (oligo-ovulation) or not at all (anovulation). This may occur, for example, as a result of polycystic ovarian syndrome or PCOS.
Common tests: At-home ovulation kit, day 21 progesterone level blood test
Unlike men, who produce new sperm well into old age, women are born with all of their eggs: Women have about 6 million eggs at birth, some of which will be lost to ovulation, and many of which simply degenerate over time. Some women will have issues with egg quality or egg quantity, especially over age 35: Because of issues of poor egg “reserve,” 70% of women over age 40 will experience problems with fertility.
Common blood tests: Follicle stimulating hormone (FSH), anti-muellerian hormone (AMH), and estradiol blood levels to determine egg quality and ovarian reserve.
Fallopian Tube & Uterus Problems
A woman’s fertility can be impacted by problems with her reproductive organs. The fallopian tubes may be blocked, preventing sperm from reaching the egg. This happens commonly after pelvic infections like chlamydia or pelvic inflammatory disease, which notoriously take their toll on the tubes. Occasionally, abnormalities of the uterus such as fibroids, polyps, and scar tissue can prevent a fertilized egg from implanting in the uterine lining.
Common tests: Pelvic ultrasound, saline sonogram, hysterosalpingogram (HSG), and sometimes laparoscopy to check for irregularities in the shape of the uterus, and to confirm that the fallopian tubes are open.
What are the main causes of male infertility?
Men have it easy: They submit a semen specimen in a cup, and it tells the whole story. Semen analysis is performed at an outside laboratory, and tells us:
- The number of sperm in the specimen (sperm count)
- How effectively they “swim” (motility)
- Whether they are normally shaped (sperm morphology)
Generally, male causes of infertility affect the sperm count, their motility, their morphology, or all three. Common causes of male infertility include:
- Varicoceles: Varicose veins in the scrotum that overheat the testicles and impair sperm production.
- Hormonal issues which impair sperm production
- Structural problems which obstruct the reproductive tract and prevent sperm release
What tests are done for male infertility?
The simplest test for male infertility is a semen analysis, during which a man’s ejaculate is examined under a microscope. For the best semen analysis possible, follow these guidelines:
- The sample must be fresh: Some laboratories provide a private space for men to produce a sample on site; other labs require a sample to be brought in immediately from home.
- Men have to “store up” first: Most labs recommend to no intercourse/release for 2 to 3 days prior to sample collection.
- Don’t “miss the cup”: The best part of the sample is the first part of the ejaculate.
How is female infertility treated?
Treatment for female infertility depends on the cause:
- Anovulation/Oligo-ovulation: Women who don’t ovulate or don’t ovulate consistently are probably the easiest to treat. Most can be treated through our offices with specialized medications which stimulate the ovaries. During treatment, we monitor each cycle to confirm that the medication is having the desired effect. Most women who respond to this treatment will be pregnant within 3 to 4 cycles.
- Tubal factor: Tubal obstruction may be diagnosed by hysterosalpingogram (or HSG, a specialized x-ray that shows whether the tubes are open); occasionally laparoscopy is required for confirmation. Generally, women with damaged tubes are referred for in vitro fertilization, a specialized technique which achieves conception by bypassing the tubes entirely.
- Egg quantity or quality: Sometimes medications may help to stimulate the ovaries. In some cases, women will require IVF with or without a donor egg.
- Uterine abnormalities: Fibroids, polyps, or scar tissue which affects the inner uterine cavity may be removed by hysteroscopy.
How is male infertility treated?
Treatment for male infertility are based on the results of the semen analysis, and evaluation by a reproductive endocrinologist and/or urologist. Issues with sperm quantity or quality may be treated by intrauterine insemination, which deposits fresh sperm right inside the uterus; some patients will require advanced reproductive techniques like in vitro fertilization or intracytoplasmic sperm injection (ICSI). Men with anatomic issues like varicocele may require a minor procedure to correct it.
We make referrals to local urologists and reproductive specialists to assist with male fertility treatments.
How can The Woman’s Health Pavilion help me have a baby?
We want our patients struggling with infertility to know they are never alone: Over the years, we have helped thousands of struggling patients to achieve pregnancy. Fortunately, with advancing knowledge and modern reproductive techniques, fertility is in reach for most women who want to conceive. If advanced reproductive technology like IVF is necessary, we have strong relationships with reproductive specialists in both Queens and Nassau, and we can make a referral for the best possible results. Providers at The Woman’s Health Pavilion should be your first resource for getting “plugged in” to the system.
May We Help You?
Would you like to find out more about our treatments and services? Are you looking for a second opinion on a diagnosis or treatment recommendation you received at another practice? The experienced team at The Woman’s Health Pavilion is happy to help. Just let us know how and when you’d like to hear from us.