Female Infertility

When to Seek Help?

After 6-8 months of trying to conceive without pregnancy, you might begin to wonder whether you should seek professional help. While the answer to this question mostly depends on the woman’s age-YES, if you’re 35 or older- there are other factors that should prompt you as a couple to seek help sooner.

At IVFMD we encourage our patients to take a proactive approach in diagnosing the causes of their infertility by paying attention to their menstrual cycle and medical history. So let’s go through the interview:

  1. How long have you been trying to conceive?
    • If the answer is 3 years or longer, and especially if your menses are regular, the cause of your infertility is probably serious. Severe male factor, tubal damage, pelvic adhesions, and advanced endometriosis are often involved in chronic infertility, and these conditions require the most aggressive treatment such as IVF.
    • As can be seen below, most couples (93%) will achieve pregnancy after 2 years of trying. There is only a minimal increase in pregnancy rate (to 95%) when trying on your own for another year. After 3 years of infertility, you should seek professional help.

 

 

  1. What is the duration of your menstrual cycle?
    • The length of the cycle is measured from the first day of normal flow (not just spotting) to the first day of the next menses. The normal cycle length is 28-30 days.
    • A history of long cycles (32 days or longer) can mean that your follicle is developing too slowly. Stress (physical or mental) can impair the release of FSH (follicle-stimulating hormone) from the pituitary. FSH is important for follicle growth and low FSH release can result in a follicle with insufficient support cells to nourish the egg and to produce progesterone after ovulation to prepare the uterine lining for implantation.
    • A history of short cycles, on the other hand, is more worrisome because it can suggest a low egg reserve. Short cycles (26 days or shorter) occur when the ovaries receive strong stimulation from a high level of FSH, which in turn hastens follicular maturation. Ovulation tends to occur earlier- on day 9-10 instead of the usual day 12-13. The presence of hot flash is particularly worrisome as it reflects a state of low estrogen as often seen during the early phase of menopause. Women who smoke tend to have lower egg reserve.

 

 

  1. Do you have milky breast discharge or excessive hair on the face and abdomen that requires weekly removal?
    • Milky discharge can be a sign of excessive Prolactin Prolactin is a pituitary hormone that acts on the breast to produce milk for lactation. A high level of Prolactin can suppress the release of FSH and cause delays in follicle growth. Occasionally, a pituitary tumor can lead to excessive production of Prolactin. Thyroid conditions can also lead to excessive secretion of Prolactin.
    • Excessive hair on the face and abdomen that require removal of at least once a week can be a sign of excessive male hormone production, which can inhibit follicle growth. Polycystic ovary syndrome (PCOS) is a common condition that is associated with elevated production of testosterone.
  2. Have you been diagnosed with hypothyroidism or polycystic ovary syndrome?
    • Patients with thyroid conditions or PCOS can have delayed follicle growth or suboptimal ovulation and would benefit from taking ovulation induction medications to ovulate better.
  3. Have you ever had abdominal surgery?
    • Myomectomy (surgery to remove fibroids) nearly always results in pelvic adhesions that can impair the ability of the tubes to find or pick up the egg after it is released from the ovulating follicle.
    • Tubal surgery for ectopic pregnancy or for tubal adhesions implies existing tubal damage and co-existing pelvic adhesions.
    • Bowel surgery for appendicitis or other conditions can result in significant pelvic adhesions.
  4. Have you ever been treated for any STD (Chlamydia, Gonorrhea, HIV, HPV, herpes, syphilis)?
    • Gonorrhea and Chlamydia are well known to cause infertility by damaging the tubes and causing pelvic adhesions. Chlamydia is an STD that can cause infertility without any symptoms. Treatment is often delayed due to late detection.
    • HPV can cause abnormal changes in the cervical cells that may necessitate surgical treatment of the cervix such as LEEP or cryosurgery, which in turn can lead to cervical stenosis (constriction of the cervical opening), impairing the movement of sperm into the uterus.
  5. Do you have painful intercourse or severe pain with menstruation?
    • Deep pain with intercourse is very suggestive of endometriosis, a condition in which implants of the endometrium grow in the pelvic cavity. Endometriosis can cause pelvic adhesions and impair the fertilization process.
    • While most women experience cramps during menstruation, severe menstrual pain can suggest endometriosis or uterine fibroids
  6. Have you had 2 or more miscarriages?
    • Most miscarriages that occur during the first 12 weeks are caused by suboptimal ovulation and abnormal embryos. Occasionally, thrombophilia (tendency to form clots) or abnormality in the chromosome of the parent(s) can be the cause of recurrent early miscarriages.
    • Miscarriages that occur after the 12th week can be caused by structural abnormalities such as fibroids, uterine septum, and other malformations of the uterus.
  7. Does the male partner have the following?
    • Male surgery- vasectomy reversal, varicocele repair, or testicular surgery can suggest sperm problems (low count and low motility). Surgery can also lead to the formation of sperm antibodies that can impair fertilization.
    • Previous infection of the male organs (prostatitis, epididymitis) can impair sperm motility and survival and cause the formation of sperm antibodies.
    • Heavy smoking can lead to damage of sperm DNA
    • Low semen volume or watery semen can suggest retrograde ejaculation

The table below lists the symptoms and their associated causes of infertility. If you have any of these symptoms, you should consider seeking help to save time and improve your chance of success.

 

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