In the U.S. alone, around 11% of women and 9% of men suffer from reproductive health concerns that cause infertility. Infertility can take an emotional and physical toll on couples and individuals interested in having children. This may result in significant stress and frustration. Infertility is often not an isolated issue but can occur as a symptom of other underlying health conditions.
Christopher W. Lipari, a board-certified Reproductive Endocrinologist and Infertility specialist at the Jacksonville Center for Reproductive Medicine says, “In addition to improving fertility, improving someone’s health is important.” If you are suffering from infertility, here is how a reproductive healthcare specialist like Dr. Lipari and his team can diagnose and treat your condition.
What Is Infertility?
Dr. Lipari says, “Infertility is based on the time of conception. If people are attempting to conceive and they’re having regular unprotected intercourse for a year without conceiving, that basically is a diagnosis of infertility.”
The U.S. Centers for Disease Control & Prevention (CDC) suggests age 35 is an important milestone for those with infertility. Fertility declines with age and individuals 35 or older may have increased difficulty conceiving due to changes in their bodies related to age. Fertility rates decline and miscarriage risk rises with age. In addition, certain conditions can accelerate egg loss and thus negatively impact fertility. This is based on the fact that women are born with all the eggs they will ever have and these are lost naturally over time.
Dr. Lipari says, “Sometimes we think that if the female is under the age of 35 since age is important as a predictor of fertility potential, that year criterion is probably valid.” He points out that even if a couple “has no other signs of any reproductive problems, including no pelvic pain, pain with menses and no pain with intercourse,” there may still be underlying fertility concerns.
Contrary to popular belief, infertility does not only occur in women. Both the sperm and egg are important fertility factors and infertility can affect both sides of the equation. The conditions needed for a successful pregnancy include:
- A viable egg produced from a woman’s ovary
- The sperm must penetrate and fertilize the egg
- The fertilized egg or embryo must then travel through the fallopian tube to the uterus or womb
- The embryo must carefully implant on the side of the womb and begin to grow
Pregnancy is a delicate biological process and complications can occur at one or more of the steps involved in conception. Issues can also occur during the nine-month gestation period, even after the embryo has successfully begun to grow. An infertility diagnosis can interrupt the process at any point prior to conception and throughout the pregnancy.
How Is Infertility Diagnosed?
Fertility evaluations are performed by a reproductive doctor. While an inability to conceive over six months is a likely indication of infertility, your doctor will need to run tests to pinpoint the exact issues disrupting your health and parenting goals.
Fertility evaluations for men and women start with a review of their medical history and a physical examination. These exams include:
- Check body mass index (BMI)
- Basic physical and pelvic exam
In addition to the physical assessment, a doctor will perform more comprehensive tests to check for health irregularities that cause infertility:
- Women – Evaluating three key areas in a comprehensive way:
- blood testing on certain days of the cycle
- Ultrasound and/or X-ray to view the fallopian tubes, ovaries, and womb
- Hysteroscopy to assess the uterine cavity
- Egg reserve
- Semen analysis to look sperm abnormalities
- Basic reproductive hormones
Providing a thorough health and medical history to your doctor will improve their ability to diagnose your concern. Dr. Lipari says, “If a woman has irregular or painful cycles, I think it’s important to seek an evaluation right away.” He continues, “The other thing is the male partner. If the male partner is known to have fertility problems or has low testosterone, they should seek treatment right away.”
If either you or your partner is diagnosed as infertile, the next step is to determine the exact cause of your condition.
What Causes Infertility?
Sometimes the primary indication of infertility is an inability to conceive with no other visible symptoms. In these cases, doctors may not be able to identify the cause. However, this is infrequently the case, and doctors are often able to diagnose the condition. Common causes of infertility include:
- Problems with ovulation due to genetic or other health issues
- Structural issues with the uterus, cervix, or other parts of the reproductive tract
- Blockage, infection, or damage to the fallopian tubes
- Endometriosis – a common condition that may or may not cause pelvic pain
- Early menopause (the ovaries stop working before age 40)
- Scar tissue in the pelvis
- Cancer and cancer treatments
- Abnormal sperm production caused by genetic or health problems
- Sperm delivery issues related to sexual or genetic concerns
- Overexposure to environmental conditions that lower sperm count
- Damage related to medical treatments such as chemotherapy or radiation
- Suppression of sperm production by testosterone therapy
However, the causes of infertility are complex and varied. Lifestyle choices may also contribute to infertility, including obesity, tobacco or drug use, alcoholism, or other health conditions that can damage systems within the body. In these cases, treatments can often help.
How Is Infertility Treated?
There are four primary treatments for infertility:
- Lifestyle modification
- Surgical procedures
- Ovulation (medical) therapy with or without artificial insemination
- In vitro fertilization (IVF)
Common medications for women include clomiphene or letrozole, which improve ovulation. Sometimes, injectable medications may also be used. For men, management of hormonal abnormalities can improve fertility by increasing sperm production.
Dr. Lipari says, a diagnosis of infertility “can indicate underlying factors influencing someone’s infertility potential and health.” For example, he says, “If hormones are off or maybe a semen analysis is abnormal, that can indicate underlying health problems.” In these cases, doctors attempt to treat the underlying health condition(s) causing infertility.
For example, if the woman’s fallopian tubes are blocked or scarred, surgery may be able to repair the damage. Endometriosis and fibroids are both common issues for women. Surgery can also be utilized to excise the abnormal tissue and improve your reproductive and overall health.
For men, medicine is often utilized to correct hormonal abnormalities. If an anatomic issue is diagnosed, surgical procedures may help unblock delicate structures.
There are also assisted conception options performed by fertility specialists. These techniques are constantly being advanced and updated, which means procedures such as artificial insemination (AI) are becoming increasingly effective. Artificial insemination entails the placement of sperm manually into the uterus. In vitro fertilization (IVF) is a very effective technique with a variety of indications. It involves extracting the egg(s) from the ovary(ies) and allowing fertilization to occur outside the body. The embryo is then transferred back into the uterus.
For many families, these procedures are life-changing and offer people struggling with infertility the chance to fulfill their dreams of having children.
Jacksonville Center for Reproductive Medicine is dedicated to reproductive health, offering infertility treatments and diagnostic services to both men and women. If you are having difficulty conceiving, please don’t hesitate to call. Dr. Lipari and his experienced team are standing by to help you overcome your reproductive challenges. Contact us today.