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  • 8 Possible Causes of Infertility

    In our previous blog we touched upon the statistics about infertility--- approximately 1 in 6 couples in the U.S. have issues pertaining to infertility. There can be many causes for infertility. The most common causes are listed below:

    Advanced age of the female partner- A woman’s age has a profound impact on the chances of achieving a pregnancy. Women are born with a finite number of eggs and the egg number declines with increasing age along with a decrease in egg quality. Chances of pregnancy and live birth beyond age 43 are <1%. Lifestyle factors such as smoking can accelerate the decline in egg quality and quantity.

    Anovulation – The lack of regular menstrual cycles is a sign of lack of appropriate ovulation. This is a very common cause of infertility. Many women with irregular cycles have polycystic ovary syndrome (PCOS). Other causes of cycle irregularity can be hormonal issues such as with thyroid or prolactin, diminished ovarian reserve, stress, hypothalamic causes, obesity, certain medications and some other conditions. The good news is that issues with ovulation are often easy to treat with simple medications such as the oral pill clomiphene citrate. If you have irregular cycles it is important to seek evaluation with your doctor.

    Polycystic Ovarian Syndrome (PCOS) - This is one of the most common diseases responsible for infertility. There are several hormonal imbalances in this disorder, causing menstrual irregularities and anovulation. In many cases of PCOS, medication can help reverse this imbalance and help a woman achieve ovulation. Also, studies have shown that even an 8-10% reduction in body weight in obese women with PCOS can significantly improve metabolic parameters and response to treatment as well as chances of conception.

    Blocked fallopian tubes – Tubal factor is another common cause of infertility. You may be ovulating normally and everything else checks out alright. However, a blockage in one or both of your uterine tubes can prevent sperm from reaching the egg. A blockage can be diagnosed with a hysterosalpingogram, or HSG. If tubal blockage is diagnosed, sometimes surgery can be undertaken to try and correct the anatomical abnormality, but often In-vitro fertilization is the best treatment.

    Endometriosis - Endometriosis is the presence and growth of functioning endometrial tissue in places other than the uterus. Women with endometriosis have lower chances of conception per cycle than those without. However the chances of conception are significantly improved with fertility treatments. If you have a known diagnosis of endometriosis and have not conceived successfully after trying on your own (barring other issues) for 6 months, it is reasonable to request your doctor give a referral to see an infertility specialist.

    Uterine abnormalities – There can be congenital or acquired abnormalities of the uterus such as a septum or intrauterine adhesions, fibroids, polyps etc which can hinder fertility or cause a miscarriage. These can be often diagnosed via an pelvic sonogram or hysterosalpingogram (HSG). Most infertility specialists will assess you for uterine abnormalities at the initial consultation and order testing as appropriate.

    Male factor - About 30-40% of the time when a couple has infertility it is due to abnormalities with partner’s sperm. A semen analysis is a basic part of infertility evaluation and if abnormal treatment options can range form intrauterine insemination to in-vitro fertilization with intracytoplasmic sperm injection to donor sperm.

    Unexplained infertility – Approximately 10% of couples have unexplained infertility where all the testing is negative. However the good news is that many couples are amenable to treatment and can achieve a successful pregnancy with some help.

    The recommendations to seek care currently are that if a woman is under age 35 and has been trying for one year without success then it is best to seek an evaluation. In women over age 35, best to seek evaluation after 6 months of trying. Of course, if there are concerns prior to that time, it is always okay to see your obgyn or reproductive endocrinologist.

    Rinku Mehta, M.D.
    St. David's Women's Center of Texas

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  • Fertility Facts and Statistics

    Infertility is a very common condition estimated to affect approximately 1 in 6 couples. This may even be an underestimate since many couples never end up seeking care. As patient awareness and education increases, the number of couples seeking care and achieving their goal of family building will increase. Presently the CDC estimates that ART (Assisted Reproductive Technologies) accounts for slightly more than 1% of total U.S. births. There were 142,435 ART cycles reported in 2007 and 57,569 infants born as a result of ART cycles in 2007. These numbers only reflect those births where the babies were conceived via in-vitro fertilization procedures. There are many couples who can conceive with simpler and less expensive treatment than in-vitro fertilization. They key is to seek care early so that appropriate interventions and treatment can be done in a timely fashion. This is important not only because advancing age of the female partner can have a significant impact on the chances of success, but also the emotional toll can keep couples from getting the care they need.

    Generally speaking, it is recommended that if the female partner is under age 35 and the couple has been trying at least for a year without success then they should consider undergoing an evaluation to identify any factors that can contribute to infertility. If the female partner is over age 35, then it is best to seek an evaluation after 6 months of trying without success. This is of course true assuming that there are no known causes of infertility present such as blocked tubes or lack of ovulation or poor sperm etc. If there is a known cause then evaluation should be sought ASAP. 

    When a couple decides they want to start the process of getting evaluated for infertility they could either go to their obgyn, PCP or come directly to a reproductive endocrinology and infertility specialist. Simple treatment and be initiated with the obgyn however studies have shown that time to pregnancy is the shortest with a specialist. Typically once pregnant, the patient is followed by the reproductive endocrinologist until about 8-10 weeks gestation and then referred back to their obgyn for continued obstetric care.

    The take home message here would be that it is important to seek care in a timely fashion. There are many causes of infertility that are amenable to simple treatment options and chances of successful conception are high for many couples. Obtaining the appropriate information is extremely important for patients to make well informed decisions on how they want to proceed to build their family.

    Rinku Mehta, M.D.

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  • What goes up must come down...

    Elevated blood pressures can occur during pregnancy for many reasons. Women may have previous disease, or present with high pressures for the first time in pregnancy.
    Part of the purpose of prenatal visits is to detect blood pressure changes and further evaluate the cause, as treatment may differ depending on the condition.

    If you are found to have elevated blood pressures, your OB may order laboratory studies to evaluate your organ function (kidneys, liver, blood cells) and may have you complete a 24 hour urine looking for elevated protein. The goal is to differentiate high blood pressure alone from a more serious disorder called pre-eclampsia. The latter is a disease process related to the placenta that can lead to serious complications of pregnancy.

    If diagnosed with pre-eclampsia or if blood pressures are persistently elevated, you may be referred to a maternal-fetal medicine specialist for guidance on management of the pregnancy and evaluation of your baby. The specialist will perform an ultrasound to evaluate the health and growth of the baby, and assess if blood flow in the placenta may be affected by the blood pressure. Continued management will often consist of frequent visits to your OB as well as the specialist to monitor you and your baby. In some cases, admission to the hospital or early delivery is necessary, but this occurs in a minority of cases. The goal of management is to ensure the health of both mother and baby with delivery at term.

    Whatever the cause, rest assured that your OB and MFM specialist will work together to determine the reason for your elevated blood pressures and formulate a personalized course of treatment to ensure the safety and health of the pregnancy. 

    Kimberly A. DeStefano, MD
    Medical Director- Maternal Fetal Medicine;
    Specialized Perinatal Programs
    St. David's Women's Center of Texas

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