Diagnosis and Treatment

Infertility Introduction

Getting a Diagnosis and Treatment for Your Fertility in Arizona Let's be clear, infertility is a disease. It is defined as the inability to achieve a pregnancy after a year or more of regular, unprotected sexual activity. Eighty five percent of couples who are going to achieve a pregnancy without help get pregnant within 1 year. If you are a woman 35 years of age or older, have a history of abnormal or infrequent ovulation, may have a tubal or uterine abnormality, have endometriosis or have a partner with a known or suspected abnormal semen analysis, then you should seek evaluation and treatment after only 6 months of attempting pregnancy.

If you are experiencing the inability to conceive, you are not alone. Infertility affects 6.1 million people in the United States. That's about one couple in eight that will have trouble with infertility sometime in their lives. What's more interesting is that infertility plays no favorites, impacting men and women equally. Roughly 30% of the time causes are linked to the female and 30% are linked to the male. Another 30% is attributed to both male and female factors with the remaining 10% determined to be of unknown causes.

Your Fertility Diagnosis
- Being infertile doesn't mean that you can't conceive. You just may need some medical assistance and we at Troché Fertility Centers are here to assist you in your journey. As part of our diagnostic investigation, we will review past medical histories and medical records. We will perform tests that are relative, thorough and efficient, making sure not to repeat any tests done previously by other physicians as long as they have been done appropriately.
  
  Once we have determined the cause of infertility, a plan is customized to fit your unique situation and move you along on the path to conceiving a child. In fact, nearly 90% of infertility cases are treatable with medical therapies such as drug treatment, surgical repair of reproductive organs and assisted reproductive techniques such as in vitro fertilization (IVF).
Hysterosalpingogram (HSG)
- Hystero = uterus + Salpingo = fallopian tubes + Gram = x-ray
- This test is now offered at Troché Fertility Centers.
- Definition:
  
  A test conducted by a gynecologist or radiologist where dye is injected through the cervix in order to see whether or not a woman’s fallopian tubes are open and to document the shape of the interior of the uterus.
  
  Purpose:
  
  In a normal menstrual cycle, an egg is released from an ovary, passes into the fallopian tube where it is fertilized by sperm, and continues down the tube to implant in the uterus. There can be a blockage of this passage at any point of the journey, and the HSG can reveal an obstruction and its location. Additionally, during the HSG the shape of the uterus is noted to rule out anatomic irregularities that might interfere with pregnancy. By taking X-rays during the procedure, a permanent record is made for future comparison should additional tests be needed.
  
  Procedure:
  
  The HSG is usually performed in the first half of a woman’s menstrual cycle after the menstrual flow is completed, but before ovulation has occurred, ensuring absence of interference with a possible early pregnancy (not later than cycle day 11). The woman lies on an examination table with legs in stirrups, as in any gynecological examination, and the doctor performing the procedure injects dye through a small tube placed through the cervix (opening of the uterus) into the uterine cavity and out through the fallopian tubes, where it spills into pelvic cavity where it is harmlessly absorbed. The doctor may need to put an instrument on the cervix in order to inject the dye. This instrument, as well as the pressure caused from injecting the dye can cause moderate to strong cramping or pain.
  
  We recommend that an hour before the procedure, you take a medication similar to ibuprofen (Motrin, Midol) to relieve the discomfort associated with this test. You should continue to take this medication for 24 hours.
  
  Also, as a precaution against the remote possibility of a pelvic infection following the procedure, the physicians performing the procedure usually prescribe an oral antibiotic.
  
  For further information regarding the Hysterosalpingogram, please contact Troché Fertility Centers.
Sonohystogram (SHG)
- Definition:
  
  A test conducted by a gynecologist where a liquid (normal saline) is injected through the neck of the womb (cervix) in order to evaluate the inside of the uterine cavity (womb).
  
  Purpose:
  
  In a normal menstrual cycle, an egg is released from an ovary, it passes into the fallopian tube where it is fertilized by sperm, continues traveling down the tube, and finally arrives into the uterus to implant. Abnormalities of the uterine cavity could interfere with the process of implantation. These abnormalities could involve the shape of the uterine cavity, growths such as a fibroid tumors or polyps, and sometimes scar tissue from a previous procedure or infection.
  
  Procedure:
  
  The SHG is usually performed in the first half of a woman’s menstrual cycle after the menstrual flow is completed, but before ovulation has occurred, ensuring absence of interference with a possible early pregnancy. The woman lies on an examination table with legs in stirrups, as in any gynecological examination, and the doctor performing the procedure injects normal saline through a small tube (catheter) placed through the cervix (opening of the uterus) into the uterine cavity. A transvaginal pelvic ultrasound is then performed while the uterine cavity is gently distended with normal saline. The examination takes only a few minutes. On rare occasions the doctor may need to put an instrument on the cervix in order to perform the procedure. This instrument, as well as the pressure caused from injecting the normal saline can cause moderate to strong cramping or pain.
  
  We recommend that an hour before the procedure, you take a medication similar to ibuprofen (Motrin, Midol) to relieve the discomfort associated with this test. You should continue to take this medication for 24 hours.
  
  Also, as a precaution against the remote possibility of a pelvic infection following the procedure, the physicians performing the procedure usually prescribe an oral antibiotic.
  
  For further information regarding the Sonohystogram, please contact Troché Fertility Centers.
Possible Causes for Your Infertility
- Listed below are some of the most common causes of infertility.
  
  Abnormal Ovulation
  
  Disorders of ovulation will be found in approximately 15% of couples with infertility, and accounts for up to 40% of infertility in women. It usually presents with irregular, infrequent or absent menstrual cycles. The vast majority of the time, this is caused by a hormonal imbalance due to improper coordination and communication between the parts of the brain called the hypothalamus and the pituitary gland. These two are responsible for the release of hormones into the bloodstream. In many cases, abnormal ovulation may also be associated with extremely low body weight or with being over weight, as well as any significant recent change in weight (loss or gain).
  
  Age
  
  Maximum fertility for women occurs between the ages of 15 and 24 with fertility levels decreasing with age after that. About one third of women who defer pregnancy until their mid-30s will have a problem becoming pregnant, and at least half of all women over age 40 will have difficulties. Because the likelihood of conceiving declines with age, women 35 and older should wait no more than 6 months before seeking help if they suspect a possible problem.
  
  Damaged Fallopian Tubes
  
  Damaged or blocked fallopian tubes are a common cause of infertility. Tubal damage can be caused by a past infection, such as pelvic inflammatory disease (PID), or previous abdominal operation. When the fallopian tubes are obstructed the sperm and the egg cannot meet. In addition, when blocked fallopian tubes are filled with fluid (hydrosalpinx), this fluid can negatively affect the development of embryos that have been placed in the uterus during In Vitro Fertilization (IVF). As a result, it is recommended that the hydrosalpinx be removed before patients are treated with IVF. Surgical repair of damaged fallopian tubes is possible, but pregnancy results following surgery tend to be much lower than with IVF. Also, a higher ectopic (tubal) pregnancy rate is noted following tubal surgery than with IVF.
  
  Endometriosis
  
  Every month the lining of the uterus (endometrium) thickens in preparation for the implantation of an embryo. If a pregnancy doesn't take place then most of the lining is shed during menstruation. On occasion, during menstruation some of these endometrial cells will find its way into the abdomen through the fallopian tubes (retrograde menstruation). In women susceptible to endometriosis these cells may attach to the ovaries and other pelvic organs creating islands of endometrium outside the uterus (endometriosis). This displaced endometrial tissue causes irritation in the pelvis that may lead to pain and infertility. Symptoms of endometriosis may include painful menstrual periods, painful intercourse, and pelvic pain. There is no correlation between the severity of the symptoms and the extent of the disease. Sometimes there are no symptoms at all. Several forms of treatment are available, including surgery and medical therapy.
  
  Male Factor
  
  When a male infertility factor is present, it is almost always defined by an abnormal semen analysis. The semen analysis may reveal no sperm or low concentration, abnormalities of sperm movement (motility), and or abnormalities of sperm shape (morphology). Male infertility can be due to a variety of conditions. Some of these conditions are identifiable and reversible, such as when there is an obstruction in the male's genital tract, an anatomic abnormality such as varicocele, or when there is a hormonal deficiency that can be medically treated. Other conditions are identifiable but not reversible, such as when there is severe damage to the testicles by a previous infection (i.e. mumps). Environmental factors, some medications (i.e. sulfa drugs), and habits (alcohol, tobacco and recreational drugs) can also adversely affect sperm quality and function. When there is no explanation for an abnormal semen analysis, as is the case in many patients, the condition is termed idiopathic.
  
  Cervical Factor
  
  Abnormalities of cervical mucus production or sperm-mucus interaction are rarely identified as the only or principal cause of infertility. Examination of cervical mucus may reveal evidence of a chronic infection of the cervix that needs treatment. The post-coital test is the traditional method for identifying cervical factors. The test consists of the microscopic examination of cervical mucus obtained around the time of ovulation for the presence of sperm within hours of sexual activity. Nowadays the post coital test is infrequently performed because controversies exist regarding technique, timing, and interpretation of the test. In addition, treatments such as intrauterine insemination (IUI) and in Vitro Fertilization (IVF) effectively compensate for any unrecognized cervical factor.