Overcoming infertility​

What are the common causes of infertility?​

When a couple is struggling with infertility, the most pressing question in their minds is why. Infertility as a diagnosis is determined by the length of time you are trying to conceive. Primary infertility is the diagnosis in which a couple fails to conceive after a year of unprotected sex. Secondary infertility is when a couple is unable to conceive again after having one or two children before.

However, “infertility” is a broad concept, and in your case, answering the specific “cause” will require a deeper understanding of the underlying factors. There are many medical conditions and diseases that can affect fertility in both men and women. It’s important to know that you’re not alone. Fertility problems affect about one in six men and women of childbearing age. Contemporary infertility medicine has a good understanding of most of these conditions, and there are some very effective treatments and interventions that can help most couples eventually become pregnant 

The most common fertility problems faced by men​

While infertility has historically been considered a concern for women, we now know that up to one-third of cases involve male factor infertility. Most male infertility is caused by sperm problems, although physiological problems that affect the ejaculation process can also be an obstacle to conception. 

  • Azoospermia: Defined as the complete absence of sperm in semen/ejaculate, azoospermia is a condition that affects about 5% of infertile men. This can mean that sperm is not produced at all, but more often it is due to a blockage or blockage of the vas deferens, preventing sperm from reaching ejaculation.
  • Low sperm count: Also known as “low sperm count”, low sperm count means that very few sperm cells are found in the ejaculation. Again, this could mean that sperm produces sperm, or it can be caused by a partial blockage.
  • Congenital absence of the vas deferens: Sometimes the egg tubes that carry sperm to the penis for ejaculation fail to develop before birth. A man with this condition may produce sperm in his testicles, but since he has no way to ejaculate, pregnancy is avoided.
  • Varicose veins: These enlarged varicose veins in the scrotum can prevent normal function in a number of ways, affecting sperm production, quality, and transport.
  • Previous vasectomy: Many people who have had a vasectomy now want to get pregnant, and they need a reversal procedure. 
  • Age: A woman’s age has a huge impact on her ability to achieve a healthy and successful pregnancy. Some experts would consider this to be the most important determining factor. Around the age of 35, the quality and quantity of women’s eggs begin to decline rapidly. She may ovulate and menstruate regularly, but she may still be unable to conceive or remain pregnant.
  • Menstrual problems/irregular ovulation cycles can have a serious impact on a woman’s ability to get pregnant. Ovulation is the release of a mature egg from the ovaries, which must occur to have a chance of getting pregnant. The lower the frequency of ovulation, the less chance of getting pregnant.
  • Endometriosis: This painful chronic disease affects more than 5.5 million women in North America. Endometriosis is when the endometrial tissue lining the uterus grows outside the uterus. These endometrial growths grow and bleed with a woman’s menstrual cycle, causing pain and scarring. They are usually found in the ovaries, fallopian tubes, uterus, bowel, and bladder. Scar tissue formed in this condition can affect fertility by blocking the fallopian tubes, damaging the ovaries, or making it difficult for the body to maintain pregnancy.
  • Fallopian tube blockage/fallopian tube disease: This problem is usually the result of scarring. As mentioned earlier, conditions like endometriosis can cause this problem. It can also be caused by a pelvic infection or a sexually transmitted disease such as chlamydia, especially if the original infection is not properly treated. A history of ectopic pregnancy, or a history of surgery such as appendectomy or removal of an ovarian cyst may also be a factor.
  • Fibrous bodies or polyps: These are benign growths in the uterus. While they are generally harmless to a woman’s health, they may end up clogging the fallopian tubes. Fibrosis can also lead to infertility by making it difficult for embryos to implant in the uterus and can lead to recurrent miscarriages.
  • Polycystic ovary syndrome (PCOS): This common hormonal imbalance affects 5 million women in the United States. It affects the development and release of ovarian eggs and, if left untreated, can lead to irregular cycles and a lack of ovulation.
  • Premature Ovarian Failure (POF): This condition is diagnosed in women aged 40 or younger whose ovaries are no longer functioning properly. It can be caused by a chromosomal defect, certain cancer treatments, or an unknown cause. A woman who deals with POF is unable to ovulate/release eggs and may lose her fertility 

A common cause of infertility in women​

There are many possible factors that can lead to infertility in women, and some women may deal with more than one factor at the same time. The patient may have complete pregnancy problems or may be dealing with recurrent miscarriages. 

What should you do?​

If you’re worried about your ability to get pregnant, the best thing you can do is be aware of these risks and seek help as early as possible. An infertility specialist should be consulted immediately if:

  • If you are a woman under the age of 35 who has not been able to conceive after a year of unprotected sexual intercourse.
  • You are a woman over 35 years old and you have been trying to conceive for more than 6 months.
  • You’ve had two or more miscarriages.
  • You or your male partner have been diagnosed with the conditions listed above.

Being diagnosed with infertility can be devastating, but it’s only the first step in getting help and discovering what really happened. To get answers, it usually takes in-depth investigation and careful testing. Information is power. Once a potential problem is identified, there’s hope: your team will be able to use this information to create an action plan that will keep you moving towards your goal of bringing your child home. 

Male infertility: common causes and problems

Until recently, fertility problems were historically thought to have originated with a female partner’s problem, and early infertility treatments almost always revolved around women. Today, we know that male factor infertility is a problem for up to one-third of couples who struggle to conceive. Many of today’s modern assisted reproductive technologies (ART) can be used to help couples overcome these challenges.

What are the common causes of male infertility?

The underlying cause of male infertility may not be easy to identify. For up to 50% of men diagnosed with male factor infertility, the exact cause is unknown. In general, fertility problems in men are related to the quantity or quality of sperm, although ejaculation can also be problematic. While the cause of these problems is often unknown, most treatment options are the same, regardless of the underlying cause. Some of the more common causes include:

  • Pre-existing genetic conditions
  • Hormonal disorders
  • Injury to the groin area
  • Previous surgeries, such as hernia repair or vasectomy
  • Previous infections, particularly sexually transmitted diseases, urinary tract infections, or severe mumps infections after puberty.
  • Exposure to toxic chemicals or radiation (most commonly in cancer survivors).

There are also lifestyle choices that may affect a man’s fertility, such as wearing tight underwear or restrictive underwear, or smoking, drinking, or other drugs.

How is male infertility diagnosed?

The diagnostic process for men begins with a thorough physical examination, patient interview, and medical history, all of which may provide insight into the influencing factors. The next step is usually sperm analysis, where a sperm sample is tested in a laboratory. The lab will perform a sperm count, check the health, shape and movement of the sperm and can help determine the best course of action.

What are the most common infertility problems men face?

As mentioned earlier, male infertility usually manifests as problems with sperm or during ejaculation. These problems can take many forms, but the most common ones seen by fertility specialists include:

  • Azoospermia: This condition is defined as the complete absence of sperm in semen/ejaculation. Azoospermia affects about 5% of infertile men. This may be due to the body not producing any sperm, but more often than not, it is due to a blockage or blockage of the ejaculatory duct or vas deferens. This prevents any sperm from leaving the testicles and reaching the ejaculate site.
  • Low sperm count: Your doctor may refer to this as “low sperm count”. Low sperm count means that there are very few sperm cells in the ejaculation. Again, this can be caused by low sperm production or a blockage of part of the ejaculatory or vas deferens.
  • Congenital absence of the vas deferens: In some cases, the egg tubes that carry sperm to the penis at the time of ejaculation do not develop before birth. Patients with this condition may actually produce viable sperm in their testicles. However, without an access to ejaculation, pregnancy becomes impossible.
  • Ejaculatory duct obstruction (EDO) is a type of blockage of the ejaculatory ducts in men that can be caused by injury or infection, or it can be a congenital problem that has been present since birth.
  • Varicose veins: Some men develop enlarged varicose veins in the scrotum. This can affect reproductive function in a variety of ways, any of which can affect sperm production, quality, and transportation. 
  • Poor sperm motility or morphology: Sometimes a man produces a large amount of sperm, but there is a problem with how the sperm are formed (morphology) or how they move (motility). These problems can mean that it is difficult for sperm to reach or penetrate the egg.
  • Previous vasectomy: This is a direct cause of infertility, a man who has had a vasectomy in the early stages of his life now wishes to become pregnant.
  • Premature ejaculation: If a man continues to ejaculate before vaginal penetration (which can be caused by prostate health issues, mental health issues, and certain medications), then the chances of sperm encountering an egg are very low.
  • Erectile dysfunction: The ongoing difficulty of achieving or maintaining an erection, often due to a medical problem, can make it extremely difficult, if not impossible, to conceive naturally.

Which fertility treatment can help with male infertility?

Depending on the source of the problem, fertility clinics can treat male infertility in many ways. If there is a physical problem such as a previous vasectomy, blockage or varicocele, a surgical solution may be an answer.

  • Vasectomy reversal: Depending on the technique used when the vasectomy was originally performed, the surgeon can usually reattach the test tube (van). Reversal surgery is usually an outpatient procedure performed under spinal or general anesthesia. When the surgery is successful and performed within 10 years after vasectomy, the pregnancy rate is higher than 50%. Pregnancy is most likely to occur in the first 3 years after reversal.
  • Ejaculatory ductectomy: If a person’s catheter is blocked, it sometimes takes an hour of minor surgery to remove it. It is a day surgery performed under local or general anesthesia.
  • Varicocele Repair: Repairing a varicocele in the scrotum provides a better environment for sperm, helping to improve sperm count, motility, and mobility. Surgical repair is a small outpatient procedure. Its effectiveness has not yet been conclusively proven.

In addition to surgical treatment, in vitro fertilization (IVF) is often very effective in cases of male infertility, either alone or in combination with complementary ART treatments.

  • Intracytoplasmic Sperm Injection (ICSI): ICSI is a procedure that helps fertilize an egg in in vitro fertilization. A single high-quality sperm cell is injected directly into a single mature egg. This can be helpful in many cases, as the number of healthy sperm cells that can be used can be very limited. In severe cases of male infertility, ICSI can be a very effective treatment.
  • Sperm retrieval: If the patient does not seem to produce sperm during ejaculation, has an abnormally low sperm count, or does not ejaculate at all, the doctor can use one of three techniques to extract sperm from his body:
    • Percutaneous epididymal sperm aspiration (PESA)
    • Testicular sperm aspiration(TESA)
    • Testicular Sperm Extract (TESE)

For many couples who struggle to conceive, seeking help can feel hopeful and overwhelming. Making an appointment at a fertility clinic and starting to explore your options is an empowering move. This is an opportunity to start looking for answers to some of the questions that have been bothering you. Whatever the cause of a couple’s infertility, the path to pregnancy is a good diagnosis for one or both parties.  

Taking the first steps towards fertility treatment can be equally exciting and stressful. With so much hope focused on this decision, many patients arrive at their initial appointment with years of accumulated questions and anxiety behind them. Your first consultation with a fertility specialist is an opportunity to start looking for some answers. So, what should you expect and how should you prepare? Here’s everything you need to know about preparing for your first visit.

The main goal of the first date is to establish a roadmap of your fertility journey: where you’re coming from and where you’re going. During the consultation, you will have an in-depth assessment of your medical history with your doctor and nurse coordinator. Once the team has a solid understanding of your case, they can begin to outline the diagnosis and treatment plan. This initial visit can take anywhere from 30 to 90 minutes.

 

What to bring

  • Copies of medical records. Every piece of background information you provide can be an important part of the puzzle, so it’s important to have access to your most recent medical records. You can streamline this process by authorizing and arranging for each office to fax your records to the fertility clinic prior to your visit.
    • Your primary care physician
    • Your OBGYN
    • Any previous fertility assessment or treatment
  • Give your doctor a list of questions. It’s a good idea to print out your questions before you start your visit. Your fertility team will ask you a lot of questions, but you ask you questions. Having a list of questions on hand ensures that you don’t forget or miss the opportunity to ask them. See below for a list of suggested questions.
  • A notebook to write down any instructions or details. With so much to say on the first visit, and strong emotions that can arise around events, “information overload” is a common experience. Taking notes during your visit can help you process and remember important details.
  • Your partner, if you like. It is not necessary to take your partner to your first visit, but they are all invited and encouraged to attend. This visit is an opportunity to involve your partner in the process, and having them there may be helpful for you and your fertility team. They can provide emotional support or work with you to answer questions, providing your team with additional case insight. They can also ask their own questions, which can help them feel supported and eliminate any fears or concerns they may have about fertility treatments.

How to prepare

Your medical records will provide your fertility specialist with a lot of important information, but they are only part of the picture. Your own memories and facts are also very important. Before your visit, take the time to write down and organize the following information.

  • Make a list of any medications, vitamins, herbs or other supplements you take.
    • Don’t be afraid to get a detailed introduction here. Make a list of everything, no matter how trivial it may seem.
    • Include the dosage of each dose and how often you take them.
  • Make a list of key medical information.
    • Any medical conditions you or your partner may have.
    • Previous evaluation or treatment of infertility.
    • The age at which the first menstrual period occurred.
    • Details about your cycle. Is this normal? What is your average operating cycle? Is the flow particularly heavy/light? Do you suffer from PMS or particularly painful times?
  • Make a list of the details you are trying to conceive.
    • How long have you been actively trying to get pregnant.
    • Frequency of sexual intercourse.
    • This is very helpful if you’ve been recording basal body temperature, the results of the Ovulation Prediction Kit, or fertility charts.
  • Talk to relatives about a family history of infertility.
    • Check out both sides of the family. Until recently, infertility struggles were often kept very secret, so you may not know if your relative has experienced infertility unless you ask directly.
  • Check your infertility insurance coverage.
    • Speak with the HR representative at your job and discuss insurance options directly with your insurer.
    • If your insurance is close to an open enrollment window, you may be able to switch to a plan with more coverage.
    • Even without insurance, there are many ways to fund fertility treatment. You may want to prepare a financial specialist who consults with your clinic.

Management of tests. Multiple tests are a regular part of fertility treatment, allowing your team to monitor progress throughout the process. During the first consultation, these tests are done to help diagnose your fertility problems, establish a baseline for future tests, and screen out any issues that may interfere with fertility treatment. On your first visit, you may encounter the following tests:

  • For Women:
    • Ultrasound of the ovaries
    • Standard blood tests (to check an individual’s hormone levels), such as:
      • FSH (follicle-stimulating hormone)
      • Luteinizing hormone (luteinizing hormone)
      • TSH (Thyroid-stimulating Hormone)
      • PRL (Prolactin)
    • For Men:
      • Sperm samples
      • Infectious disease group before IUI (intrauterine insemination) or in vitro fertilization (in vitro fertilization).

Starting fertility treatment is a strong decision, and the first visit is an important moment. As you go through the process, remember that you are an equal partner and participant in your therapy, and you have the right to know and understand every stage and stage. Arriving ready for your initial consultation will give you a great start and allow you to start this journey with confidence. 

When patients first decide they need help to conceive, the range of fertility treatment options can seem overwhelming. When you start researching, every piece of information you find tends to raise more questions. How do you begin to decide which treatment is the right decision?

There is no one-size-fits-all solution for infertility, and the approach you take is unique to your specific situation, but there are some common starting points. Intrauterine insemination (IUI) and in vitro fertilization (IVF) are two of the most popular infertility treatments at the moment. Understanding what they are, their goals, and the success rate of both options will give you a place to start the conversation with your fertility specialist. Here’s what you need to know:

IUI and IVF: What is the difference?

While these treatments are often mentioned together, they have a number of significant differences.

  • Complexity. IUI refers to a process. When the patient ovulates, the prepared sperm is placed directly in her uterus to help fertilize. IUI can be synchronized with a woman’s natural cycle or timed to stimulate ovulation with fertility medications. In vitro fertilization, on the other hand, is a process consisting of several stages that require multiple processes: first ovarian stimulation using a series of fertility drugs, then the patient undergoes an egg retrieval procedure under gentle anesthesia, then the embryos are created and hatched in the laboratory, where they are placed directly in her uterus during the embryo transfer process. Even with the use of fertility drugs, passing IUI is less physically demanding than receiving in vitro fertilization.
  • The multiple of risk. IUI is associated with a significant risk of multiple pregnancies with fertility drugs, including high-order multiple births (triplets or more). A good clinic will carefully monitor your follicles to ensure that only a safe amount has matured before the IUI test, but they cannot completely eliminate the risk. Recent advances in in in vitro fertilization (including blastocyst transfer) have meant that most modern fertility clinics now only transfer one or two embryos per IVF cycle. As a result, in vitro fertilization patients have a much lower risk of developing multiple pregnancies than before.
  • Success. It is not easy to specify the success rate of a particular treatment because there are so many variables that affect individual cases, but statistically, the success rate of IUI is lower than that of IVF, and the gap widens as women age.
  • IUI combined fertility medicine (Clomid): The average success rate is 8% to 15% for patients under 35 years of age and 5% for patients over 40 years of age.
  • In vitro fertilization using a woman’s own eggs: the average success rate is 40% to 45% for patients under the age of 35 and 15% or less for women over the age of 42.
  • TimeWhen you weigh these two options, the factor of time decreases at the same time. IUI is much shorter than IVF, so if your first cycle is successful, it may be the quickest way to bring your baby home. However, due to the difference in success rates between these two treatments, some patients in their 30s to early 40s may be able to conceive faster by going straight to IVF instead of waiting until they have several failed IUI cycles.
  • The cost of a cost-effective IUI cycle is much lower than that of an IVF cycle, which is a serious consideration for many patients. However, depending on your diagnosis and your chances of getting pregnant through IUI, going straight into an IVF cycle may be more cost-effective than dealing with multiple failed IUI cycles before going straight to IVF.

When should I try IUI first?

Depending on the patient’s condition and diagnosis, IUI is a good first-line treatment for many patients. If you are a patient with:

  • Is at least one fallopian tube open
  • Being able to ovulate, maybe with the help of fertility drugs
  • Have a healthy ovarian reserve (which means having a large number of healthy eggs)
  • Is the uterine cavity normal

Then you might be a good candidate to try IUI. This treatment is often very effective for:

  • Cervical problems: Scarring or poor cervical mucus can hinder fertilization, and IUI provides a way to bypass these barriers.
  • Mild ovulation problems: When used in conjunction with fertility medications, IUI can help women with irregular cycles get pregnant “on time”.
  • Donor sperm: Patients or couples can use donor sperm with IUI to conceive.
  • Mild Male Factor Infertility: A lab-prepared sperm sample that concentrates the healthiest and most active sperm and places the sperm directly into the uterus can overcome sperm mobility problems or ejaculation problems.
  • After male fertility: Some men choose to freeze their sperm before cancer treatment or surgery, which may affect their fertility. After treatment, assuming that the female partner is a good candidate, IUI can be used to achieve pregnancy.
  • Same-sex couples: Female partners can use donor sperm, and male partners can use their own sperm and surrogacy.

If you meet one of these characteristics, your fertility team may agree that it makes sense to try IUI before considering IVF. Before you start IUI, it’s good to talk to your partner and doctor about how many cycles you want to try. Many limit three failed IUI cycles, but others may try as many as six before moving on.

Whether you end up opting for IUI or IVF, the first step is to find a Los Angeles fertility clinic that prioritizes your individual needs rather than a one-size-fits-all protocol. You need good information to make a good decision, which is why it’s so important to start with an in-depth medical investigation and diagnosis. Knowing exactly what problems may be causing your infertility will help you and your doctor develop a treatment plan that will give you the best chance of success.