Infertility is defined as the inability to conceive after one year of regular, unprotected intercourse (or six months for women over 35). An infertility work-up involves evaluating both partners to identify potential causes and develop a management plan.
Causes of Infertility
- Ovulatory Dysfunction: Irregular or absent ovulation due to hormonal imbalances (e.g., PCOS, thyroid issues).
- Tubal Blockage: Blockage in the fallopian tubes due to infection, endometriosis, or scarring.
- Male Factor Infertility: Low sperm count, poor motility, or abnormal sperm morphology.
- Endometriosis: Growth of uterine lining tissue outside the uterus, which can interfere with conception.
- Uterine Abnormalities: Fibroids, polyps, or structural issues in the uterus.
- Unexplained Infertility: No identifiable cause after a thorough evaluation.
Initial Work-Up for Infertility
- Medical History: Assessment of menstrual cycle regularity, past pregnancies, and sexual health.
- Physical Exam: Evaluation of overall health, pelvic exam, and assessment for structural abnormalities.
- Ovulation Testing: Blood tests to measure hormone levels and confirm ovulation.
- Semen Analysis: Evaluation of sperm count, motility, and morphology.
- Hysterosalpingogram (HSG): Imaging test to check for blockages in the fallopian tubes.
- Ultrasound: Exam to evaluate the ovaries, uterus, and endometrial lining.
Initial Management Strategies
- Lifestyle Modifications: Maintaining a healthy weight, quitting smoking, and managing stress.
- Ovulation Induction: Medications like Clomid or letrozole to stimulate ovulation.
- Intrauterine Insemination (IUI): Sperm is inserted directly into the uterus to increase chances of fertilization.
- Hormonal Therapy: Correcting hormonal imbalances with medications.
- Surgical Intervention: Correcting anatomical issues like fibroids or polyps through minimally invasive surgery.
- Referral to a Specialist: If initial management fails, referral to a reproductive endocrinologist for advanced treatments like IVF.
When to Seek Specialist Care
- Failure to conceive after one year of trying (or six months if over 35).
- Irregular or absent periods.
- History of pelvic infections or endometriosis.
- Male partner with known sperm issues.
- History of miscarriages or pregnancy complications.
Frequently Asked Questions
1. How long should we try to conceive before seeking help?
If you’re under 35, seek help after one year of trying. If you’re over 35, seek help after six months.
2. What are the most common causes of infertility?
Ovulation issues, tubal blockages, male factor infertility, endometriosis, and unexplained infertility are common causes.
3. Can stress affect fertility?
Yes, high levels of stress can disrupt hormonal balance and ovulation, reducing the chances of conception.
4. How is male infertility treated?
Treatment may include lifestyle changes, medications, surgical correction, or assisted reproductive techniques like IUI or IVF.
5. Is IVF the only solution for infertility?
No, IVF is usually considered after other treatments like ovulation induction and IUI have failed.
6. Can being overweight or underweight affect fertility?
Yes, maintaining a healthy weight helps regulate hormones and improves ovulation and sperm health.
7. Can infertility be prevented?
While some causes of infertility are unavoidable, maintaining a healthy lifestyle and addressing health conditions early can help improve fertility.