What is your diagnosis?
While it is not always a single factor that causes a delay in conceiving, 40% of the time it is a female factor and 40% of the time it is a male factor. The remaining 20% is either unexplained, or a combination of both male and female factors.
Female Factor Infertility
First, a detailed history and fertility evaluation should be performed. Then, a diagnosis can be made based on the findings.
Diminished ovarian reserve
As women, we are born with all the eggs we will ever have. As we age, the quantity and quality of our eggs decreases. If a woman has a low antimullerian hormone (AMH) level, an abnormally elevated day three follicle-stimulating hormone (FSH) level, or a poor response to fertility medication, she has diminished ovarian reserve.
Uterine glands located outside of the uterine wall, known as endometriosis, can impair fertility. Scarring from endometriosis may cause tubal blockage and lead to tubal factor infertility. Endometriosis can also lead to impaired ovulation or a decrease in uterine receptivity, reducing fertility. Surgery to remove foci of endometriosis may reduce the number of remaining eggs and lead to diminished ovarian reserve. Scarring from endometriosis may cause tubal blockage and lead to tubal factor infertility.
If you have had two or more miscarriages, you have recurrent pregnancy loss. An evaluation for a possible cause of these losses is advised.
Tubal factor infertility
Blockage or absence of one or both fallopian tubes is a common cause of infertility. Prior pelvic infection or ectopic pregnancy, endometriosis, or remote pelvic surgery can lead to tubal blockage. Tubal abnormalities can be identified on hysterosalpingogram (HSG) or during surgery.
Uterine factor infertility
An abnormal uterine lining due to a polyp, fibroid or scar tissue can decrease the likelihood of proper implantation of the embryo and lead to miscarriage. Women with no uterus due to a congenital anomaly or surgical removal also have uterine factor infertility.
A detailed history should be obtained to identify possible risk factors for male infertility. The male partner should then have a complete semen analysis performed. If the initial test results, and a repeat test, are abnormal, the diagnosis of male factor infertility is established.
After a complete history of both the female and male partners, a fertility evaluation is recommended. If all of the test results are normal, the couple would be told that they have unexplained infertility.
Whatever we find, we can provide you with treatment to help you achieve a successful pregnancy. The first step is an initial evaluation. Call us at 203-286-6810 to book an appointment.