Common Fertility Problems

The right treatment for you will depend on factors including the causes of the fertility problems, the age of the female partner, and previous medical history.

Sperm problems

For minor problems with sperm count and movement, lifestyle changes such as losing excess weight or stopping excess drinking can be effective.

In the case of moderately severe sperm problems, intra-uterine insemination (IUI) can be effective. A sperm sample is taken from the man and healthy sperm are chosen to be inserted into the womb when the female partner is ovulating, often after a small dose of a fertility drug.

Severe cases of male infertility are treatable by IVF with intracytoplasmic sperm injection (ICSI), in which eggs are removed from a woman’s body and a single sperm is injected into each egg. This is highly specialised and requires the woman to go through IVF drug stimulation and egg collection first. It's possible to collect sperm from the testis directly, even if the man does not ejaculate sperm.

In a minority of cases, where the male partner has no sperm at all, use of donor sperm is the only option.

Ovulation problems

The most common cause of ovulation problems is polycystic ovarian syndrome (PCOS-See below #7).The symptoms of this condition, including infertility, can sometimes be alleviated with proper diagnosis and treatment protocols.

If low weight, is the suspected cause of ovulation problems, and cessation of menstrual flow, your health practitioner can advise on diet and lifestyle changes to help you achieve a healthy weight. The most likely diagnosis is hypoganodotropic hypogonadism, meaning that the brain is probably not stimulating the ovary. It is caused by a lack of adequate body fat.A Provera challenge will show if the patient is producing estrogen. An increase in hair growth is also consistent with an elevation of the male hormone testosterone. If the ovary is not stimulated to ovulate, it does not produce estrogen and the available hormone precursors go on to make testosterone.

Body fat is important because it is the chemical basis for the production of all hormones. If the body fat is too low, because of excessive exercise or anorexia or bulimia, the brain shuts down the production of FSH and LH. This leads to a lack of stimulation of the ovary, hence the above result.

Blocked fallopian tubes

Fallopian tubes can become blocked by scarring or infection. Some cases of blocked fallopian tubes can be resolved by surgery to remove blockages or repair damaged areas.

In more serious cases of blocked or damaged fallopian tubes, though, IVF may be the best treatment. Eggs from the female partner are removed and, in a laboratory, mixed with a sperm sample from the male partner. The resulting fertilised eggs are then implanted directly into the womb, bypassing the fallopian tubes altogether.

See information on pelvic inflammatory disease under Useful links for more.

Endometriosis

Endometrium is the tissue found on the inside of womb. In endometriosis, this tissue starts to grow outside the womb, usually on the ovaries and the lining of the abdominal cavity. The condition can cause pain, especially before and during a period, and can affect fertility.

Drugs used to treat endometriosis may improve the symptoms but will not help fertility. Surgery to remove the endometriosis from your internal organs can improve your fertility.

In addition, IVF can be used in some cases of endometriosis where the condition is causing damage or blockage to ovaries or fallopian tubes.

Fibroids

These are benign (non-cancerous) growths in the womb. They can cause heavy periods, pain in the abdomen, and pain during intercourse.

Most women with fibroids do not experience problems with fertility. But some fibroids can distort the shape of the womb, and so make pregnancy difficult or impossible.

Drug treatments can help to shrink fibroids. Such treatment can be used alone, but is often used before surgery to remove the fibroids altogether. An operation to remove fibroids is called a myomectomy. Surgery can be carried out via an incision in the abdomen or by keyhole surgery, depending on the size of the fibroids. See Useful links for more information.

Non-specific fertility problems

In around 20% of cases, no cause in either partner can be found for the failure to get pregnant.

In these cases, IVF is usually the preferred treatment. National results for the UK published by the HFEA show that in 2007, the average chance of having a baby for one cycle of IVF in women under 35 was 29.6%. Chances of success decline quickly for women over 35.

Polycystic Ovarian Syndrome and Infertility

PCOS Is An Ovarian Dysfunction

Polycystic Ovarian Syndrome in a patient is a challenging problem that takes a certain amount of finesse on the physician's part to handle, especially in women who are trying to conceive. We began the interview with a discussion of the pathophysiology of this syndrome. PCOS is not a very good name for this syndrome since it is more a description of what the ovaries look like.In reality it is an OVARIAN dysfunction. The real problem is that the ovaries are not processing the hormones correctly. This causes them to not ovulate and produce the female hormones correctly, and instead the hormone precursors are shifted to production of the male hormone testosterone. It is not known exactly what it is in the ovary that causes this dysfunction.

A Diagnosis Of Exclusion

Correctly diagnosing PCOS, based on clinical findings. There is not a specific test that can be done. The physician must draw a clinical picture and look at a variety of factors in order to make this diagnosis. It is also a diagnosis of exclusion, which means that other causes such as other hormonal disorders, tumors and genetic abnormalities, must be investigated and ruled out first. The real name for this disorder is "idiopathic hyperandrogenism", which means increased male hormone.

There Is No Typical PCOS Woman

There are many types of women who fall into this PCOS category. In the past, the classic PCOS was a woman that was obese, had facial hair, thinning hairline and irregular menstrual cycles. Now we are finding more and more atypical women presenting with this syndrome, including patients that may be slim, for instance, and it is only when you look at their ovaries with the ultrasound, or see how they respond to ovarian stimulation, or look at their blood tests, that you find they are PCOS. There are even a few that have regular menstrual cycles, and are found to be PCOS when they hyperstimulate from injectable fertility drugs.

Key Indicators For PCOS

What are some of the key indicators? Well, visually, a patient might present with increased facial hair, acne, perhaps be overweight but not necessarily. Blood tests can be done to show an increase in insulin, glucose or testosterone. We can also observe, through ultrasound, how the ovaries look in their pre-ovulatory state where there are lots of small follicles. Also, in most cases, the patient will have irregular or infrequent menstrual cycles. Hormone testing will show a normal TSH, Prolactin, Estradiol, FSH and LH. In some patients there will be the characteristic elevation in LH/FSH ratio. That is the LH level will be significantly higher than the FSH level. In some, testosterone levels will be elevated, but most will be at the high end of normal. In the patients that do not have regular menstrual cycles, the mid luteal phase progesterone level will be decreased, with a level less than 10, indicating that ovulation did not occur. Because there is such deviation in presentations, in most cases only one or two of the criteria need to be present to make the diagnosis.

A Tough Journey To Pregnancy

For those women who have PCOS and want to get pregnant the journey gets a little tougher. An infertility specialist's job is to try to get PCOS patients pregnant. The goal is to get them to ovulate. Specialists use fertility drugs for this purpose, but it varies as to how a patient responds to these medications. The "fertility drug" is actually stimulating the ovary to ovulate.

The first drug used is Clomid, but it has to be used in higher dosages than normal because of the ovarian resistance that PCO patients have to Clomid. I can be administered in dosages from 150 mg to 250 mg. Another similar medication called Femara (Letrozole)can also be tried. Some Clomid resistant patients will respond to Letrozole. In the patients that do not respond to either of these medications, Some specialists use combination protocols.

Briefly, this entails starting with Clomid or Femara then adding injectable fertility drugs like Follistim, Gonal-f or Bravelle. This "boosts" the Clomid or Femara effect to stimulate a few follicles to grow. The problem with going straight to the injectables is that most PCO ovaries will have a hyper or exaggerated response to the medication, because these ovaries are more sensitive to these drugs, causing the formation and/or ovulation of 10 or more follicles. When that happens the cycle is often converted to an IVF cycle in order to prevent a super-multiple pregnancy to occur, or the cycle is cancelled. With the combination protocol the specialist is trying to give the patient the opportunity to get pregnant using a natural means such as intercourse or IUI. Of course it may take several attempts before pregnancy occurs, since the body has to go through many steps to become pregnant naturally. The medication is just trying to make the ovaries act like normal ovaries.

Keep in mind, most PCOS patients are young with fertile eggs. It can be merely a matter of persistance with them, of trial and error with their treatment until success is hopefully soon achieved. But, national statistics show that up to 80% of PCOS patients have to progress to IVF, indicating that a high number of patients are having to go in that direction.