When you are trying to conceive, those months of negative pregnancy test results can be painful as you count them off, waiting until your medical professional will refer you for additional testing. The accepted definition of infertility is when couples do not achieve pregnancy on their own after one year of unprotected intercourse in women under 35 years of age, and after six months in women 35 or older. Other terms you may hear when referring to infertility may be “subfertility” or “fecundability.” Fecundability is perhaps more accurate because it refers to the probability of achieving pregnancy within a menstrual cycle.
Infertility affects as many as 15% of couples within the United States every year. Of those couples, about ⅓ of cases are a result of a male factor, ⅓ of all cases are a result of a female factor, and ⅓ from a combination male and female causes or unknown causes. [R] The ability of a couple to become pregnant and sustain a pregnancy may be a result of biological, systemic, or environmental factors.
Causes of Infertility
Some causes of infertility in the female partner are easily identified. These may include physical causes such as tubal blockage, endometriosis scarring or inflammation that may affect implantation, or uterine abnormalities causing problems with achieving or maintaining pregnancy.
Other factors related to female infertility may be less immediately recognized and could include endocrine or systemic disorders including hormonal imbalances that affect ovulation (PCOS or hypothalamic disruption are two examples), premature ovarian failure, or excess prolactin. [R]
Physical disorders such as testicular defects resulting from trauma, torsion, cancer, epididymitis, and hypogonadism are also reviewed. There may also be male reproductive tract disorders caused by infection or inflammation.
Endocrine or systemic causes make up about 2 – 5% of male infertility cases. They refer to dysfunction of the hypothalamic-pituitary-gonadal axis, and like most hormonal pathways within the body, are sensitive to disruption and can be indicative of other disorders. [R]
In approximately 2-5% of cases, no cause of male partner infertility can be identified, known as idiopathic infertility.
You will find more detailed information about male infertility in my blog article Male Infertility.
What Happens When I See a Doctor for Infertility?
Many times the initial process or portions of an infertility consultation can be done by a general practitioner or an OB-GYN. They may begin a medical history, physical examination, or request lab work. For males, a semen test will also be conducted.
The medical professional will pay special attention to anything that might provide clues about infertility, such as sexual development during puberty, sexual history, any illnesses or infections, surgeries, medications, and exposure to environmental factors. Menstrual history, including absent or irregular periods, is especially helpful. [R]
Bloodwork may reveal necessary information such as the presence of luteinizing hormone (LH) levels, including follicle-stimulating hormone (FSH), prolactin (a pituitary hormone) will also be collected. Markers for hormones affecting female fertility, estradiol, anti-mullerian hormone (AMH), TSH (thyroid), and progesterone function are also collected.
For men, the semen analysis will provide valuable information regarding the health of the sperm through examining the number, motility, and shape of the sperm.
Should any preliminary tests or examinations return abnormal results, the individual or couple may be referred to a specialist for additional testing and evaluation. There is sometimes a need for additional testing, which will be determined by your provider.
Integrative Treatment Options for Infertility
Fortunately, there are treatment options to support couples in their journey through infertility. I have chosen a model based on an integrative approach that combines natural methods such as yoga, meditation, acupuncture, and healthy foods, along with assisted reproductive technology. I have found these basic practices towards reducing stress, hormone balancing, reducing exposure to toxins, and achieving optimal wellness to support fertility and pregnancy enhance the body’s fertility and pregnancy ability.
A list of resources and their benefits is included here . Additional articles are included in the blog to provide information on how each discipline can complement traditional medicine and your fertility journey. I also invite you to sign up for Dr. Shala’s resource eBook, Jumpstart Your Fertility, which provides simple practices you can begin with at home if you are experiencing infertility.
If you’d like to schedule a consultation for fertility testing, contact Pacific Reproductive Center today.