Infertility means the inability to conceive children. Reproductive endocrinologists define infertility for couples as “failure to achieve clinical pregnancy after regular unprotected sex for more than one year, or half a year for woman older than 35 years old”. Once infertility is diagnosed, the chances of natural pregnancy each time is lower than 5%.

Since it takes two people to become pregnant, infertility is a couple’s problem, not just a man’s or a woman’s problem. About 30% of infertility problem is due to male (inadequate sperm count, poor sperm quality, etc.), 40% due to female (fallopian tube obstruction, poor egg quality, etc.), and 15% due to both partners. For some couples, after careful examination, the cause of infertility still cannot be found. This is termed unexplained pregnancy and occurs in about 15% of couples.

Causes of female infertility:

1. Ovulation problems
2. Poor egg quality
3. Tubal obstruction
4. Uterine problems
5. Endometriosis
6. Luteal phase defect caused by hyperprolactinemia

Causes of male infertility:

1. Sperm abnormality: poor sperm quality or movement or low sperm count
2. Infections
3. Hormonal or immunologic problems
4. Sexual problems (impotence, premature ejaculation, failure of ejaculation)

Initial workup of infertility includes:
1. Check ovulation function and ovarian reserve: AMH (ovarian reserve test) and FSH, LH, and E2 level on 2nd day of period
2. Semen analysis: abstain from sexual intercourse for 3 days
3. Obstetric ultrasound: Check uterus and ovary appearance
4. Hysteroscopy: Examine lining of uterus for fibroids or tumor
5. Hysterosalpingogram: Examine abnormalities of fallopian tube
6. Diagnostic laparoscopy: Examine uterus and fallopian tube for structural abnormalities or blockage (If hysterosalpinogram was unsuccessful)

Other blood tests include:

1. Chromosome analysis: Check both partners for chromosomal abnormalities
2. Autoimmune test: Check if woman has autoimmune antibodies
3. Other hormonal tests: Thyroid stimulating hormone (TSH) and prolactin

If possible, please address all questions and concerns prior to treatment so the doctor can provide the best treatment plan for you.

For sperm abnormality-
If sperm abnormality is found, artificial insemination can be done. Intracytoplasmic sperm injection is an option for low sperm motility.

If infertility is already diagnosed, pregnancy rate per menstrual cycle is less than 5%. The success rate for artificial reproduction is 15-20%, around 3 to 4 times natural insemination. In vitro fertilization success has improved greatly due to advancements in techniques for egg stimulation, egg retrieval, embryo culturing, and laser assisted hatching. Without a doubt, pregnancy rate is affected by age, a woman’s body condition and the severity of infertility. According to international statistics, in vitro fertilization success rate is 35% for all women but 60% for women under 35 years old.

The most common side effects of the use of fertility drugs are multiple births and ovarian hyperstimulation syndrome. Because fertility drugs work to stimulate the ovaries to produce multiple eggs, the chance for multiple pregnancies is raised. For in vitro fertilization, rates for multiple pregnancies are as follow: 25% multiple pregnancies, 20% twins, and 3% triplets. If multiple pregnancies do happen, an early procedure to remove the extra embryos can be done to minimize pregnancy risk. As for ovarian hyperstimulation syndrome, the more eggs that are produced, the higher the risk. This is especially seen in patients with polycystic ovarian syndrome. Symptoms include ovarian hyperplasia, ascites, decreased urination, pleural effusion nausea, vomiting, and diarrhea. Treatment is usually conservative management and less than 1% of cases are severe.

Current medical research shows no connection between fertility drugs and ovarian cancer. Infertility itself actually is a risk factor of ovarian cancer. Studies show that women treated with fertility drugs seemed to show a decreased risk of developing ovarian cancer. The first time a woman becomes pregnant can decrease cancer risk by 25%.

Do fertility drugs affect the ovary? Using fertility injections or medications will not cause early menopause as the number of eggs in a woman’s ovary (around 4 million) is set at birth. When menstruation begins, 7 to 10 immature eggs are prepared for release every week. However, only one egg will prove to be dominant and is released for ovulation. All the other eggs will shrink and slowly die. Fertility medications boost the hormones for those other eggs to actually grow and become mature too. This makes it easier for us to collect. Therefore, the number of eggs in reserve is the same and stimulation drugs will not hasten menopause.