ARC^® Fertility Overview

Infertility is a highly personal and emotional subject and it’s a medical problem that is growing. In fact, six million American adults will be touched by infertility this year representing all ages, socioeconomic groups, and genders. Because of the personalized nature of infertility—the inability to conceive or take a baby to term—there is no one rule as to when to seek treatment but there are guidelines including:

• Couples over the age of 35 and six months of unprotected intercourse with no pregnancy;
• Couples under the age of 30 with one year of unprotected intercourse with no pregnancy,
• Known medical or health issues that could impact natural conception (i.e., cancer, diabetes, sterilization procedures, etc.) It’s important to note, however, that every couple is different and a consultation might in order much sooner. If nothing else than to provide peace of mind.

Infertility Evaluation Definition

The textbook definition of infertility is when a couple has difficulty achieving pregnancy after trying for one year. However, the work-up can be started earlier even if a couple has attempted pregnancy for a shorter period, especially if the female partner is older than 35. Some women have a known condition that will not allow a chance of conception without help and should get help without delay. In the female partner some of these conditions include blocked fallopian tubes from infections or tubal ligations, ovulation defects, and/or moderate to severe endometriosis. Very low sperm counts or no sperm in the male partner can also warrant immediate intervention or treatment.

Definition: Inability to get pregnant after one year of attempts (if the woman partner is under age 35) or after 6 months of attempts (if over age 35).
Incidence: Approximately 10-12% of couples are unable to conceive. The chance of a fertile couple to conceive is 20-25% each month, or 85% after 12 months of attempts.

Finding the right physician under any circumstances can be a daunting task. A patient who needs help with fertility may be faced with complicated medical decisions. Friends, family, and even the press and the Internet can provide contradictory information, making it extremely important that each patient find the most appropriate physician to advise her, support her and guide her through treatment. The reproductive endocrinologist will be responsible for directing medical testing and directing the appropriate treatment. Clearly, finding the right doctor to guide a patient through the process can be difficult.

After months of trying to get pregnant without success, “infertility” is never a word a couple wants to hear from their physician. Today, many couples are gaining hope from improvements for infertility diagnosis and treatment — making the dream of conceiving a child a real possibility.

Infertility is a common disease many couples face during their reproductive years. It occurs in about 15% of couples and is defined as the inability to conceive after twelve months of unprotected intercourse. Women over the age of 35 who are unable to conceive after six months and have irregular cycles, or men and women who have a past history of infertility can also fall under this definition.

Ovulation is perhaps the single most important factor when trying to conceive. Women who have infrequent, irregular, or no ovulation (anovulation) will find that conceiving is either very difficult or downright impossible.

Understanding Ovulation

Ovulation is when a mature egg is released from the ovary and makes it way through the fallopian tube in anticipation of fertilization. Hormones have already prepared the lining of the uterus for the potential pregnancy. If pregnancy does not occur, the egg and the lining of the uterus are expelled through menstruation and the ovulation process occurs again.

For many in our audience who are not familiar with the science of Reproductive Endocrinology and Infertility maybe you can provide a brief overview?

Reproductive Endocrinology and Infertility is a branch of medicine that identifies and treats infertility in both men and women. In the United States, 15 percent of all couples will face fertility issues, and many will be diagnosed with a reproductive disorder. Many infertile couples choose to see a reproductive endocrinologist when deciding upon fertility treatments. The reproductive endocrinologist will identify factors involved in a couple’s infertility and select the appropriate methods to treat these factors.

Fertility 101 Part 1 addresses the basic infertility work-up. This article will discuss specific causes and their evaluation.

Male Factor

The male factor is estimated to be significant in 40%-50% of couples. To determine the adequacy of the spermatozoa, the man must submit a semen sample for analysis after at least 2, but no more than 5 days of sexual abstinence. Sperm morphology has shown to be the most important semen parameter in predicting fertility rates and pregnancy outcome in assisted reproduction. Abnormal semen parameters can result from fluctuations in hormonal levels, from genetic or congenital abnormalities, and from drug use, infections, previous surgery, and exposure to occupational and environmental toxins.

Infertility is defined as a failure to conceive after 1 year of unprotected, appropriately timed intercourse without conception. The prevalence of infertility among couples in the United States is approximately 10%-15%. Possible contributing factors include advanced maternal age due to delay in child bearing and a decrease in sexual activity with increasing length of relationship. The natural fecundity rate (the percentage of fertile couples achieving a live birth) per month is estimated at 20%-25%. Life table analysis reveals that 64% of women with primary unexplained infertility (when all standard clinical tests yield normal results) and 79% with secondary infertility (when a previous pregnancy has occurred) will conceive within 9 years. Nevertheless, the decision to institute diagnostic tests and treatment should be made on an individual basis. This article will address the basic infertility work-up. Next month we will discuss specific causes and their evaluation.

The inability to give birth to a child when desired is a very personal and stressful life experience. Many myths surround this area of human life and though medical science has brought about a rapidly growing number of interventions and technologies to assist individuals toward pregnancy, much of it is misunderstood. It is helpful to separate some of the common myths from the truths regarding important subjects such as the causes and nature of infertility and the care of infertile couples.

Infertility is without a doubt a life altering experience. From your self-esteem, to your plans and dreams for the future, relationships with your friends, family and even your spouse can all be affected. Attention is primarily focused on the physical aspects of infertility, and the emotional aspects often go ignored and untreated. People aren’t aware of how emotionally challenging and overwhelming infertility can be.

As time goes by and your baby plans don’t unfold as expected, even the most harmless questions can seem overwhelming. Suddenly you feel like an A-list celebrity being stalked by the paparazzi, and the only thing everyone wants to know is, “Are you pregnant yet?” Whether you’ve been trying for two months, or two years, give some thought as to how much of your personal life you are comfortable sharing, and with whom.

As more women are delaying childbirth and more baby boomers are reaching midlife, the problem of diminished ovarian reserve (DOR) is increasing. This has several major medical consequences including infertility, decreased bone mass with risk of fracture, abnormal uterine bleeding from lack of regular ovulation, and hot flashes. This article will address ovarian reserve testing and its impact on treating infertility.

How many eggs is a woman born with? A woman is born with her entire life supply of eggs, approximately 1-2 million. At the time of her first menstrual period, the number of eggs has diminished to 300,000-400,000. Each cycle, hundreds of eggs undergo stimulation and usually only one is released during ovulation; the others are reabsorbed and are not functional.

Introduction
Numerous studies have repeatedly shown that women athletes who have a low body mass index, (‘BMI’), have a difficult time starting a family. We have found with our patient population that a number of female athletes have a low BMI. This low BMI often translates into fertility problems. In fact studies have shown that approximately12% of infertility cases are due to being underweight or having a low BMI.

Body fat plays a significant role in reproduction. Sex hormones are fat soluble and they are stored in the body’s fat layers. Women that have a low BMI produce a reduced amount of estrogen which can lead to an abnormal menstrual cycle. Amenorrhea, or the lack of a menstrual cycle, is a result of a low BMI.

Ovulatory dysfunction is one of the most common causes of reproductive failure in subfertile and infertile couples. Since the first clinical trial was published in 1961, clomiphene citrate (CC) has been the front-line therapy for ovulation induction. Its use quickly expanded to other empiric indications, such as luteal phase defect and the enhancement of fecundity in unexplained infertility. Failure to respond to CC occurs in up to 20% of cases, which may then require the use of injectable gonadotropins. The drawbacks of this approach are its high cost (both for the medication and the extensive monitoring it requires), risk of the potentially life-threatening ovarian hyperstimulation syndrome (OHSS), and, perhaps most importantly, the significant risk of high-order multiple gestations. Clearly, an inexpensive yet equally efficacious oral alternative would be ideal. Recent research has focused on the successful use of aromatase inhibitors, mainly letrozole, for ovulation induction. The medical team at Georgia Reproductive Specialists has begun incorporating letrozole into treatment plans for appropriately selected patients.