How Can We Help?

No matter where or what type of fertility treatment you may have undergone, there are no qualifying criteria for enrollment at the UROGYN Infertility Program. The treatment undertaken by you previously and the result there after will be given due consideration by our experts before we proceed further. You are advised to inform the specialist all the details of previous treatment undertaken by you.

Couples are generally advised to seek medical help if they are unable to achieve pregnancy after an year of unprotected intercourse. If the woman is over the age of 35, a medical evaluation of both the male and female may be recommended after only six months.

Getting yourself into optimum condition prior to pregnancy involves the establishment of a healthy lifestyle and screening for disorders or genetic carrier state. Healthy lifestyle requires eliminating habits that may be detrimental such as cigarette smoking or excessive alcohol or caffeine intake. Proper diet and exercise are recommended as well. Women with diabetes or hypertension should see their medical doctors about getting these diseases in the best control possible before conceiving. Women who are obese should strongly consider weight loss prior to getting pregnant. Folic acid intake has been shown to reduce the risk of certain birth defects (neural tube defects). This may be accomplished by the daily intake of at least 400 micrograms of folic acid. Genetic screening may be recommended based on ethnicity.

A complete history and examination is usually the first thing that is done upon seeking assistance from a fertility specialist. Information about past pregnancies, menstrual cycles, prior gynecologic problems, medical disorders, prior surgery, and environmental exposures like tobacco and alcohol, are all critical in assessing the cause of infertility. Testing includes the semen analysis, hysterosalpingogram (HSG), and ovarian reserve testing (for women over 35).

Fertility declines with increasing female age, beginning as early as the late 20’s and early 30’s, and is most pronounced in women over 35. This is believed to be related to a decline in ovarian reserve and a higher incidence of oocyte (egg) abnormalities. The decline in fertility is accompanied by an increase in the rate of miscarriage. Evaluation and treatment of infertility should not be delayed in women over 35 who have attempted conception for over 6 months.

Semen specimens for analysis are usually collected on-site or locally, as they need to be evaluated within 1 hour of production, and not exposed to excessive heat or cold. It is usually recommended that specimens be collected after an abstinence from ejaculation for 2-5 days prior to providing the sample. Shorter or longer periods of abstinence may yield suboptimal semen specimens. Semen collection instructions usually recommend avoidance of use of any lubricants due to concerns about their effect on the sperm parameters. The semen analysis includes evaluation of the volume of the ejaculate, the concentration of the sperms (sperm count), the percentage of sperms that are moving (motility), and an assessment of the percentage of normal appearing sperms (morphology). Additionally, the presence of increased number of white blood cells may be an indication of infection in the male reproductive tract. The findings are compared to normal values determined by that laboratory. Sometimes, a second semen analysis will be requested if the initial one is abnormal to confirm that the findings are persistent. The finding of semen abnormality requires evaluation of male partner by a male infertility specialist (Urologist).

Anovulation may be caused by several endocrinologic disorders. Screening for abnormal thyroid function or elevations in the hormone prolactin is typically required. In these cases, specific treatment of those disorders is necessary. Many women who are anovulatory have polycystic ovarian syndrome (PCOS) which is diagnosed when there is evidence of elevation in androgen levels (like testosterone) and ultrasound finding of many small immature follicles in the ovaries. Women who don’t menstruate at all (amenorrhea) require investigation to assess the cause of the problem that may relate to abnormalities of the brain (hypothalamus and pituitary gland) or the ovaries. These women may require more involved treatments, like injectable fertility medications.

Recurrent pregnancy loss is a disease distinct from infertility defined by 2 or more failed clinical pregnancies (a visible gestational sac on ultrasound). Evaluations of RPL may include blood tests, uterine exams, and genetic screening. The purpose of the evaluation of recurrent pregnancy loss is to identify causes that may be treated prior to achieving another pregnancy. Specific causes are identified in approximately half of patients. The investigation usually includes several blood tests and an examination of the uterus. Genetic testing of both the male and female is performed in order to identify the presence of a chromosomal translocation. In such cases, a small piece of the chromosome in one of the parents is “broken off” and located on another chromosome. That parent is normal; however, when an egg or sperm is made it may contain the extra piece, which upon fertilization may result in an embryo with abnormal chromosome content. This can result in recurrent miscarriages. Future fertility treatment is possible with IVF and PGD. Evaluation for the antiphospholipid syndrome or for thrombophilia requires several blood tests. If any of these are abnormal, treatment may be necessary during pregnancy that may prevent further miscarriages. Testing of the uterine cavity is typically accomplished by a hysterosonogram (HSN) which is a simple office procedure requiring instillation of saline into the uterus with a catheter followed by an ultrasound. If a fibroid, polyp, or uterine anomaly is discovered, these may be surgically treated prior to further pregnancies.

After the initial infertility evaluation, if no specific cause is found, a lable of “unexplained infertility” is put up. Approximately, 20% of fertility patients are diagnosed with unexplained infertility. Treatments for unexplained infertility include intrauterine insemination (IUI) with or without either oral or injectable medications like clomiphene citrate (oral medication) or with (injectable) FSH stimulation, or in vitro fertilization (IVF). With unexplained infertility, the monthly conception rate without clinical treatment is low (under 5%). Fertility treatments are utilized to improve that rate. The chance of becoming pregnant after 3 or 4 treatment cycles of IUI with clomiphene is about 20 to 25%; with IUI with injectable FSH is about or 30 to 35%, and with IVF it can reach as high as 75 to 85% in young women. Age is important with regard to success rates. Usually, treatment begins with IUI with clomiphene for 3 to 4 cycles. If that is unsuccessful, either IUI with FSH or IVF is considered. This choice is made after weighing the costs, success rates, and especially multiple pregnancy rates, given the high risk involved. IVF may be chosen because of its higher success and lower risk for triplets. In addition, there is more control over multiple pregnancy risk since one may choose to transfer fewer embryos. With more liberal use of elective single embryo transfer, the multiple pregnancy rate with IVF will continue to diminish. The goal should be to arrive at a singleton pregnancy in the safest way possible and as quickly as is appropriate for that couple.

Infertility is defined as the inability to conceive after at least 1 year of unprotected sexual intercourse, World Health Organization (WHO) estimates that approximately 10-8% couples do experience some form of infertility, On a worldwide scale, this means that 50-80 million people are infertile. One out of 6 couples is affected by reduced fertility.

Couples are generally advised to seek medical help if they are unable to achieve pregnancy after an year of unprotected intercourse. If the woman is over the age of 35, a medical evaluation of both the male and female may be recommended as early as six months