General Infertility FAQs

Some of the barriers faced by women trying to get pregnant include reproductive age, endometriosis, uterine fibroids, and recurrent miscarriage. Ovulation disorders such as polycystic ovary syndrome (PCOS) and premature ovarian failure (POF) may also cause infertility.

Polycystic ovary syndrome (PCOS) is a disorder in which the ovaries produce excessive amounts of male hormones and develop many small cysts.

PCOS is caused by hormonal imbalances that prevent ovulation. Your body produces too much of some hormones and not enough of others. Women who are diagnosed with PCOS usually have low levels of follicle-stimulating hormone (FSH) yet have high levels of luteinizing hormone (LH).

Some of the causes of male infertility include azoospermia (lack of sperm), varicocele (enlarged veins in the testicles), and abnormalities related to sperm count, sperm mobility, semen volume, consistency, or pH. Male infertility may also be caused by a vasectomy procedure.

Low sperm count may be caused by certain medications or a medical problem such as a blocked duct, low testosterone level, or a condition in which sperm back up into the bladder. Some men may have enough sperm, but their sperm may not swim well enough to reach the egg. Also, sperm that are not normal in shape may not be able to penetrate and fertilize the egg.

Men with low sperm count (less than 5 million motile sperm) will likely have difficulty achieving a pregnancy. Some of these men will have difficulty fertilizing eggs but not all. This makes it difficult to counsel these patients and often we turn to IVF with ICSI (intracytoplasmic sperm injection) to assist these couples in conceiving.

Secondary infertility is when a couple fails to become pregnant after successfully giving birth in the past. Primary infertility is referred to as simply, infertility. Infertility is diagnosed when a couple fails to become pregnant after 6-12 months of trying.

Endometriosis is a condition in which endometrial tissue (tissue that lines the inside of the uterus) grows outside the uterus and attaches to other organs in your abdominal cavity such as the ovaries and fallopian tubes. Endometriosis is a progressive disease. It tends to get worse over time and sometimes recurs after treatment.

Symptoms of endometriosis include pelvic pain, pain during and/or after sexual intercourse, painful bowel or bladder movements, and infertility. A woman can also be asymptomatic and have endometriosis.

Retrograde menstrual flow is the most common cause of endometriosis. Genetic factors, immune system problems, hormones, and abdominal surgeries such as a C-section or hysterectomy can also cause endometriosis.

Endometriosis has four stages and they are based on the number of endometrial implants and their depth, as well as, the size of cysts present on the ovaries and the presence of adhesions.

Per the American Society of Reproductive Medicine (ASRM) the stages of endometriosis are:

• Stage I: Minimal, few superficial implants
• Stage II: Mild, more and deeper implants
• Stage III: Moderate, many deep implants, small cysts on one or both ovaries, presence of filmy adhesions
• Stage IV: Severe, many deep implants, large cysts on one or both ovaries, many dense adhesions

Tests that can be performed by your physician to diagnose endometriosis include a pelvic exam, ultrasound, and/or MRI. In some cases, a short, minimally-invasive surgical procedure called a laparoscopy may be performed to help with a diagnosis.

Hysteroscopic myomectomy is a surgical procedure that is performed to remove uterine fibroids or benign tumors in the uterus. Fibroids are diagnosed through ultrasound or laparoscopy and affect a woman’s quality of life by causing menstrual problems, discomfort, and infertility.