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Infertility Diagnoses

cure-1006827_640Once your test results are reviewed and a diagnosis has been confirmed, your physician will design a treatment plan specifically for you.

At Fertility CARE, we strive to educate all patients extensively about their particular diagnosis to eliminate the ‘loss of control’ often felt by patients.

We feel that knowledge empowers you to reduce apprehension, and to take more control of fertility issues while being proactive in your treatment.

Diagnoses

Various diagnoses for infertility in women and men may include the ones listed below. Click the title of each diagnosis to discover more:

Ovulatory disorders affect the ovaries’ ability to release the egg and are one of the leading causes of female infertility.

Symptoms

  • The absence of regular periods (anovulation)
  • Irregular menses

In anovulation, eggs are not developed and not released from the egg sacs (follicular cysts or follicles) of the ovaries.

Causes of anovulation include:

  • A hormonal imbalance
  • High endurance exercise
  • Extremes of body weight (over and under)
  • Thyroid dysfunction
  • Insulin resistance
  • Eating disorders

Treatment
Focuses on the underlying cause of the disorder. When no clear cause is found this condition can often be treated with ovulation-inducing medications.

Damaged fallopian tubes impact fertility either by decreasing the ability to pick up the released egg of the ovary (reducing the chances of fertilization) or by preventing the fertilized egg (embryo) from moving into the uterus. Tubal infertility can result from tubal ligation (tubal sterilization), tubal infection, or scarring from endometriosis.

Treatment of tubal infertility may initially be attempted surgically but may not be successful and increase the risk of a tubal pregnancy that can be life threatening if not diagnosis and treated early. Ultimately, in vitro fertilization (IVF) can bypass the damaged fallopian tubes and offer a very good chance for pregnancy.

Did you know that the causes of infertility are:

  • 40% male factor (usually poor functioning sperm)
  • 40% female factor (tubal blockage and ovulatory dysfunction)
  • 20% unexplained (no identifiable cause)
  • In approximately 30-40% of couples, a combination of factors is found
Diminished ovarian reserve refers to the decrease in the number of eggs a woman produces and the quality of those that remain. A woman is born with the maximum amount of eggs she will have for her lifetime. The number of eggs declines as she ages until the supply is exhausted at the time of menopause. With fewer eggs, the ovaries respond less well to hormonal signals from the brain.

Endometriosis occurs when tissue that normally lines the inside of the uterus (endometrium) grows and attaches to organs outside of the uterus, usually the ovaries and fallopian tubes. In advanced cases, endometriosis causes scarring of these reproductive organs and can block the tubes and mechanically interfere with ovulation.

Two chronic conditions may result from the presence of this disease: infertility and/or pelvic pain.

Endometriosis can be managed surgically, medically or a combination of both.

Surgery involves removing the endometrial tissue on affected areas in the pelvis. This surgery is usually performed via laparoscopy. Subsequent pregnancy rates and relief of pain will vary depending on the extent of disease.

Since endometriosis is stimulated by estrogen, medical therapy has been used to suppress this hormonal stimulation. A particular approach temporarily places a woman into a ‘medical’ menopause. This may assist in relief of pain and subsequent fertility depending on the particular condition. In a large percentage of these patients, an important implantation protein, integrin, is not present in the endometrium and this will decrease conception. Several months of estrogen suppression has been shown to treat this problem and improve pregnancy rates.

PCOS affects 5 – 10% of women in their reproductive years. Treatment options for PCOS include weight loss, medications to treat insulin resistance, and/or medications to stimulate ovulation.
Even modest weight loss can restore ovulation and improve overall health. Treating insulin resistance not only restores ovulation but also decreases the chance of early miscarriage, and the chance of developing diabetes in pregnancy.
If pregnancy is desired, there are several types of medications (oral or injections) to stimulate ovulation.

PCOS is the most common hormonal disorder of women in their reproductive years. In PCOS, a woman’s ovaries produce an excessive amount of male hormone, resulting in the development of many small cysts on the ovaries, body hair growth in a male pattern and lack of ovulation. PCOS may include some, or all of the following characteristics:

  • Heavy, irregular or no periods
  • Acne
  • Excessive hair growth
  • Thinning hair
  • Obesity
  • Insulin resistance (a condition where the body has an impaired response to the hormone insulin increasing the risk of diabetes)
  • Infertility

The depletion of a woman’s supply of eggs prior to age 40 is called premature ovarian failure. Affecting 1% of women, premature ovarian failure is generally believed to be an autoimmune disease. However exposure to chemotherapy, radiation or genetic factors also may contribute to the condition.

Although there is no known treatment for reversing premature ovarian failure, in vitro fertilization (IVF) utilizing donor eggs offers significant hope for those desiring pregnancy.

Uterine fibroids are non-cancerous growths that develop from smooth muscle tissue. Fibroids can occur inside the uterine cavity, inside the muscle of the uterus, or on the outer surface of the uterus. Depending on the location and/or size, fibroids can interfere with pregnancy by causing changes in the lining of the uterus that make it difficult for an embryo to implant or they can compress or block the fallopian tubes and prevent the sperm from reaching the egg.

Depending on their location and size, a myomectomy (surgically removing the fibroid) is usually performed using a hysteroscope or by making a surgical incision in the abdomen. Sometimes fibroids do not impact fertility, in which case they generally are left in place.

Chronological age does not always equal biological age. Although a woman may appear youthful or healthy enough for pregnancy, her ovarian reserve may be very low.

Treatment for diminished ovarian reserve depends on the severity of the problem. Options include stimulating the ovaries with fertility medications for Intrauterine Insemination (IUI) or in vitro fertilization (IVF).

There are also third party reproductive options (egg donation and embryo donation that offer a high chance of pregnancy.

Recurrent pregnancy loss, or repeated miscarriages, is defined as having experienced two or more spontaneous pregnancy losses. An individual miscarriage is due to genetically abnormal embryo in 60% of cases. Reasons for repeated pregnancy loss include a chromosomal abnormality in one or both partners, a structural problem of the uterus, a hormonal disorder (including Polycystic Ovarian Syndrome) or an autoimmune condition. Following a thorough evaluation, a definite diagnosis is not found in 40% of patients.

Treatment for RPL is individualized based on testing results. When no clear cause is determined, a successful pregnancy can often be achieved with close monitoring (lab work and ultrasound) and supportive care. This careful monitoring apparently reduces the stress associated with recurrent pregnancy loss thereby improving outcomes.

Infertility attributed to a man’s reproductive system is called Male Infertility. These include problems with sperm production, the anatomy or structure of the reproductive organs, or an imbalance in a man’s hormonal system. Immune system disorders occur when men develop antibodies to their own sperm. These antibodies then attach to and weaken sperm, thereby impacting their ability to move and fertilize an egg.

Treatment depends on the particular diagnosis. Structural abnormalities that decrease the sperm count may be treated with surgery, intrauterine insemination (IUI) or in severe cases with in vitro fertilization (IVF) using the advanced technique of Intracytoplasmic Sperm Injection (ICSI) to overcome fertilization obstacles. Hormonal disorders may be managed with medications. Lastly, sperm antibodies are usually first treated with IUI and, if unsuccessful, IVF with ICSI.

Approximately 20% of all infertility remains unexplained. Unexplained infertility is the failure to determine a specific cause of infertility even after a thorough evaluation of both the male and female partners.

Treatment for unexplained infertility is based on a number of factors including the age of the female, the duration of infertility, and, most importantly, on the couple’s emotional, physical and financial investment. Treatment options may include controlled ovarian hyperstimulation (fertility medications) with intrauterine insemination, and in vitro fertilization (IVF).

Frequently Asked Questions

My husband/wife has children from a prior relationship; doesn’t that prove that he/she does not have fertility issues?

No. Age is a large issue and secondary infertility is actually more common than primary infertility. Also, recent miscarriages should not be viewed as reassuring.

Does my partner need to be at the initial appointment?

It is encouraged but not required that your partner attends the initial appointment. If your partner has multiple questions, this will be the best to get answered in real time instead of speculating what the correct answer will be.

The IVF Center – Why Fertility CARE is Unique

Dr. Trolice and the team supporting Breast Cancer Awareness month.

Dr. Trolice and the team supporting Breast Cancer Awareness month.

At Fertility CARE we recognize the process of IVF can at times be overwhelming.

To address this issue, we have an IVF Nurse available 24/7 to answer questions, guide you through the process, and provide emotional support. We also offer a Reproductive Health Psychologist to help couples develop their best coping strategies along their journey.

Success of the IVF Program at Fertility CARE is due to our scientific and technological excellence coupled with our compassionate and highly personalized approach to patient care.

Fertility CARE is committed to each couple’s success by providing individualized and supportive care along the way. We consider each couple part of our family as we attempt to help them create their own.

What our Patients are Saying

“The staff here was very helpful & courteous & understanding of my needs. I love the warm welcoming they provide when I first came to the office.”

Fertility CARE Patient, Facebook Review

“We can’t thank Dr. Trolice and Fertility CARE enough for this compassion and expert care. when we felt lost from misinformation from other doctors, Dr. Trolice guided us and gave us hope again.”

Fertility CARE Patient, RateMds.com Review

“Doctor Trolice has compassion and understands what you have been going through not being able to conceive on your own since he and his wife also had trouble conceiving. Every procedure that I have had with Dr. Trolice he has explained every step of the way.”

Fertility CARE Patient, Vitals.com Review

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