New to Infertility

award winning fertility doctor new york city

 

Hello Everyone,

As the years have gone by, I have very much enjoyed explaining the fertility treatment in a way that is a little more detailed and hopefully more clear than what you might be getting at your doctors office or from other infertility web sites.

The first blogs were more of a “basic training” in infertility, and with time the posts have become more focused on more complex elements of diagnosis and treatment.

The next few blogs will go back to more basic information for those who are new to the infertility world and need a starting point.  Certainly, all of the posts are available for reference.  Here you are with todays entry.

 

Infertility: The Basics

Infertility is a disease, and as with most diseases, nearly all suffers never thought they would be the ones afflicted.  Becoming pregnant is natural, necessary for us all to continue, and it doesn’t make much sense that barriers to conception could exist.  Unfortunately, some if us are indeed sub-fertile or even infertile.  In some cases there have been indications along the way that a woman or man may have trouble conceiving, maybe due to treatment of other medical or surgical conditions, but for most people, finding out that pregnancy has become evasive is troubling news.  The bright side is that significant advances in infertility care have rendered more people fertile than ever before.

I will first establish a few definitions.  I don’t like to spend too much time categorizing patients because it can lead to depersonalization, but you may encounter some of these terms, so here are a few.

 Infertility: the inability to conceive after one year of actively trying. This should be modified in women over the age of 35 to 6 months of trying.  Age is a very sensitive subject: no one wants to be told they are older or not be enthusiastically treated due to age, but age matters, as we will discus in a later blog.

Primary infertility: infertile and never pregnant.

Secondary Infertility: infertile after being pregnant in the past.

So if you have been trying for 6-12 months with no pregnancy, what is your next step?  It’s time to see a doctor. The workup is very simple, and who knows, there may be something discovered that is very easy to remedy that can quickly fix the problem.  Some people are worried about seeing a doctor because they have heard or read misinformation about the diagnosis and treatment options, but you owe it to yourself to at least find out what the problem may be.  Plus a good infertility doctor will explain many things to you about natural and assisted conception; this is valuable information that you should get from an expert.  Alternative educational sources can be excellent (like this website), but having a single experienced resource put everything together will help you make the best decisions.

What does the doctor do to determine what the problem may be?  The testing phase is not very complicated.  There are 3 initial tests.

1)   The hysterogram (the long word is the hysterosalpingogram, also abbreviated HSG). This is an x-ray test to confirm that the fallopian tubes are open. In order for pregnancy to occur, the egg has to make it from the ovary in to the tube, and then pass through the tube into the uterus.  And, the sperm needs to swim up from the uterus into the tube.  Thus, blockage of the tube does not allow for pregnancy to initiate.  The HSG also confirms that the shape of the uterus is normal. Previous uterine surgery can alter the shape. Also, some women are born with an abnormal shape to their uterus, which at times can be corrected.  Some doctors perform alternatives to the HSG, but others believe it is the best test to confirm normal anatomy.

2)   The Semen Analysis.  This is where the sperm is counted and checked for motility (movement) and morphology (sperm shape). If the counts or motility are low, the male partner may be referred to a urologist who can develop a treatment strategy.

3)   Analysis of ovarian reserve. All women lose eggs as they age, and unfortunately, even some very young women are left with a low or absent egg number.  The lower the egg reserve, the more difficult pregnancy becomes. To test for a diminished ovarian reserve you may be asked to have a blood test in day 2 or day 3 of your cycle for the hormones FSH, Estradiol and AMH (more on this in the next blog).

Once all of these tests are performed, your doctor can help you formulate a plan. There are many options available, your doctor will work with you to develop a course of action that is best for you.

Thank you for reading and I look forward to writing again soon,

Dr. Licciardi

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