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Infertility is much more common than once believed. In fact, approximately 15% of couples will experience infertility at some time in their reproductive lives. This figure is difficult to establish because many couples facing infertility do not seek medical advice. Fortunately, public awareness has increased dramatically leading more couples to seek care infertility care sooner.
 Infertility has many causes. Until fairly recently, it was thought that infertility was primarily a female problem; however, we now know that almost 50% of couples will have a male infertility component. For this reason it is critically important that the husband also be evaluated.
The road leading to the conception and delivery of a healthy baby involves multiple physiologic processes-
- The husband must be able to produce sperm and deliver the sperm into the vagina. The sperm must swim “through” the cervical mucus and into the uterus. Poor quality sperm, or decreased sperm counts, can lead to male infertility.
- The cervical mucus must be the right consistency to allow sperm to swim freely. The mucus must also contain nutrients to support the sperm. Cervical factor infertility results when the cervical mucus is inadequate.
- Once the sperm reach fallopian tube, one must be capable of penetrating the egg's membrane (zone pellucida) and undergo successful fertilization.
- The sperm and egg must be genetically normal. Even in healthy young (and fertile) men and women, there is occasionally an abnormal gamete (eggs and sperm).
- A woman has to ovulate. This step involves brain’s ability to send chemical messages (FSH) to the ovaries to stimulate the growth and maturation of a dominant follicle. At the time of ovulation a mature egg is released from this dominant follicle.
- Once the egg is ovulated it must be picked up by the ends (“fimbria”) of the fallopian tube. Infertility can result when the tubes are damaged or blocked by conditions such as endometriosis, surgical scarring, or prior infection.
- During an ovulatory cycle, the lining of the uterus (endometrium) must thicken under the influence of estrogen and mature under the influence of progesterone. This increased vascularity is needed to support a developing embryo. “Under development” of the endometrium can be caused by a luteal phase defect, which can usually be corrected by administration of progesterone.
- After ovulation, the remaining follicle, now called the corpus luteum, produces progesterone to support the endometrium. After another month, the placenta begins progesterone production.
- The uterine cavity must be normally shaped, free of significant congenital defects, large polyps or fibroids. Oftentimes surgery can correct uterine abnormalities, however, when severe damage is present a surrogate may be the only option.
- The uterus and placenta must grow and support the embryo / fetus throughout its development.
Given the complexity of the reproductive system, and the many causes of infertility, most couples should seek medical advice if pregnancy is not established after one year of ‘trying’. Because of the natural decline in fertility with age, we encourage women over the age of 35 to seek medical advice from a fertility specialist even sooner, often after 6 months. Interestingly, studies show that early treatment by a specialist helps control infertility treatment costs.
The incidence of genetic abnormalities in the embryo increases as women age, which also increases the risk of miscarriage. We offer PGD performed at our Dallas Tx, fertility clinic which can screen for an abnormal number of chromosomes (aneuploidy).
The good news is that many couples (>80%) will become pregnant when the appropriate treatments are employed. Our fertility specialists are available to answer any questions you might have concerning infertility treatment. Also, please review our page on fertility treatment cost.
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