Infertility Workup

Even though around 80% of women who try for pregnancy will become pregnant within 12 months, according to the CDC, 10-20% of women of childbearing age will be diagnosed with infertility or subfertility this year. Acquiring this diagnosis can be devastating when planning for pregnancy, mainly due to the tumultuousness of life and family planning.

Infertility

Experts generally define infertility as 12 months of unprotected intercourse without conception and only six months of unprotected intercourse without impregnation in women over 35. While these are strict guidelines, it is sometimes helpful to begin assessing fertility before reaching this point, especially if known factors can cause subfertility (difficulty getting pregnant) that you can mitigate early on.

As a leading gynecology center in New York, Manhattan Women’s Health & Wellness provides comprehensive OB/GYN care for women of all ages in New York City. This includes annual exams and pap smears, initial infertility workups, and GYN treatments, which can be performed in our office or hospital.

Causes of Infertility

A multitude of problems can cause infertility or subfertility. Your gynecologist will always start with taking your medical history to see if any clues might aid in knowing why you have not been able to achieve a pregnancy. After that, the gynecologist will likely investigate each of the major causes of infertility with different tools available to them:

• Hormonal causes – these are very common and can sometimes be corrected with medications. Clues to hormonal causes of infertility can include not having your period regularly every month, having irregular spotting or bleeding, or having male pattern hair growth, such as hair on your chin, chest, back, or belly. Polycystic ovarian syndrome, PCOS, is a common hormonal abnormality that can lead to difficulty becoming pregnant. When diagnosed with PCOS, it is crucial to see a gynecologist when planning pregnancies, as they may help increase your fertility.
• Uterine abnormalities – Anything that can distort the uterus in a way that would make it difficult for sperm to enter the uterus, or an embryo to implant within the uterus, or even take away blood supply from the uterus uterine lining can cause difficulty with pregnancy. Some of these issues can include but are not limited to polyps (small abnormal outpouchings of the inner layer of the uterus, essentially skin tags inside the uterus), fibroids (muscular tumors that can grow in any or multiple layers of the uterus). There is a chance that septums (pieces of tissue that connect one side of the inner lining of the uterus to the other side, distorting the overall shape of the uterus) may also be an issue. Luckily these can be corrected usually with office-based procedures.

Other significant abnormalities can also include a malformed uterus, two uteri, or no uterus at all. An ultrasound exam is an essential step in diagnosing these abnormalities. In some cases, you may need a hysteroscopy, a minor procedure where a tiny camera is introduced into the uterus to diagnose and potentially treat problems seen during the exam.

• Fallopian tube problems – The fallopian tubes, also called oviducts, function to carry an egg, once released, from the ovary into the uterus. This process occurs due to rhythmic contractions of the tubes. Abdominal trauma, history of abdominal surgery, ruptured appendix, or even pelvic infections such as pelvic inflammatory disease (PID) can damage the oviducts and even block them off completely. Your Midtown gynecologist may order imaging techniques like Hysterosalpingogram (HSG), a test where your doctor places dye or fluid into the uterus and notes the tubes either with ultrasound or X-ray to see if they are open and communicate freely with the ovary.
• Male factor infertility – This relates to any problems that may affect male sperm. Sperm are important factors infertility as one sperm must combine with an egg to produce an embryo (early baby). Sperm can have several problems such as low count (not having enough sperm), low motility (not moving correctly), morphology (being deformed). A sperm analysis can elucidate any of these issues. Ejaculatory problems can also cause infertility, i.e., the sperm not making their way into the vagina and uterus.
• Other – This includes medications you may be on, a prior medical history that can cause problems with fertility, obesity, or be severely underweight, current treatments you may be undergoing, perimenopause or premature ovarian failure, and even in the frequency of intercourse.

Treatments

IUDs pose only a shallow risk during placement, maintenance, and removal. During placement, the risk of infection, perforation (poking a hole through the uterus and the IUD going inside the abdomen, which would require minor surgery to remove), or pain can all occur. Luckily, these are all very rare, and there are ways your gynecologist can mitigate these risks, such as using ultrasound during the IUD placement.

Many forms of infertility can be reversed or fixed.

Once you have had a complete evaluation, your gynecologist will discuss the next best in treating infertility or subfertility. There are many ways to aid infertility that your doctor can do in the office. These include ovulation induction (making you ovulate more) with medication, timed intercourse, fixing any uterine abnormalities with hysteroscopy, or more sophisticated management like intrauterine insemination (IUI) or In Vitro Fertilization IVF.

Important Reminder: The only intense of this information is to provide gynecology guidance, not definitive medical advice. Please consult an OBGYN doctor about your specific condition. Only a trained, experienced gynecologist or certified gynecology specialist can determine an accurate diagnosis and proper treatment.

Have questions about Infertility evaluation? Please schedule an appointment with the best OBGYN in Manhattan by calling our office today.

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