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Infertility Deconstructed

Diagnosis and Treatment

The decision to have a child is one of the most life-changing experiences a couple can undergo. Oftentimes conception occurs without planning or trying, but many times it is carefully planned, and when mother nature doesn’t go along with the plan it can be a very stressful time for a couple.

The definition of infertility can be described as a woman under age 35 who has been unable to get pregnant after one year of unprotected intercourse, or if over age 35 the time frame changes to 6 months.

Infertility is thought to affect men and women equally. It is felt that females and males each have a 30% rate of infertility, 30% are of combined causes, and the remaining 10% is from unknown causes.

Conditions causing female infertility include:

  • Endocrine problems with the most common one being Polycystic Ovarian Syndrome (PCOS), affecting 1 in 10 women
  • uterine problems – either from congenital abnormalities or disease/infection (endometriosis, sexually transmitted infections, tubal damage)
  • ovarian failure
  • immunologic factors
  • age-related decline

Conditions causing male infertility include:

  • hypogonadism/low testosterone
  • low sperm count
  • poor sperm motility and function
  • blockage
  • varicocele
  • genetic problems

A typical infertility evaluation consists of a thorough history and physical exam of the patient, both male and female. For the female, a careful history of her menstrual cycle is taken and risk factors are identified. Often times follow up is done with lab work and diagnostic testing. Once the problem is identified the treatment plan is formulated, which may consist of FDA approved medication and/or surgical intervention. Lifestyle risk factors are addressed such as smoking, drugs, weight issues, and nutrition problems.

Polycystic Ovarian Syndrome (PCOS) is responsible for a large percentage of anovulation and it is easily treated by primary care providers and OB/GYNs. Treatment for PCOS is tailored to each woman with consideration to lifestyle changes, exercise, healthy diet and weight management. There is also medication management of PCOS available to assist with hormonal regulation.

During evaluation and treatment of her fertility issues, the woman becomes very well versed in tracking her cycle and monitoring for signs of ovulation so that timed intercourse can be achieved. There is also close follow up with monthly clinic visits with her provider to further adjust her plan of care.

If a male factor of infertility is identified, a consultation with an urologist may be needed. There may be medical or surgical treatment needed. If there is not an obvious male factor, he does not need any further testing, but his support of the female patient is essential.

If a couple faces a lack of success in achieving pregnancy, a visit with Reproductive Endocrinology may be scheduled and assisted reproductive technology may be offered.

Throughout evaluation and treatment of infertility, there is an emotional component to this problem that should be addressed throughout its entirety. Striving to achieve pregnancy is both emotionally and physically daunting on the patients as individuals and as a couple. Validation and assessment of this component is essential for the success of achievement of pregnancy.

Dr. Thomas Arnold, MD, practices Obstetrics & Gynecology at CHI St. Joseph’s Health Clinic in the Women’s Health department. He has delivered over 5000 babies during that time, including some to mothers whom he delivered early in his practice. In addition to delivering babies, he provides prenatal care to his patients.