Infertility affects 1 in 8 couples trying to get pregnant. Sometimes infertility can be attributed to women, sometimes to men, and sometimes it’s unexplained. To help provide information about infertility, what it means to be infertile, and what to do if you think you may be infertile, Circle Surrogacy partnered with Dr. Vicken Sepilian, Infertility Specialist & Reproductive Endocrinologist at Pacific Fertility Center Los Angeles for the content of this post. Circle Surrogacy works closely with the wonderful staff at PFC-LA on surrogacy and egg donation parenthood journeys through our Boston, San Francisco, and New York offices.
At Circle Surrogacy, we’re intimately familiar with the physical and emotional challenges that go hand-in-hand with infertility. Many of our parents through surrogacy and egg donation have faced fertility challenges, and have spent months and years trying to achieve their dreams of parenthood.
In this blog, we’ll explore what being infertile means, the causes of infertility, and when to see an IVF doctor if you’re not successful at getting pregnant. In this infertility 101 overview, we’ll answer some of the most commonly asked questions around infertility.
What does it mean to be infertile?
Infertility is defined as the inability of a couple to achieve pregnancy after one year of unprotected intercourse. It is recommended that a couple who has tried for a year without success seek evaluation to determine what can be done. In couples where the woman’s age is 35 years or older, it is recommended that the couple seek an evaluation after six months of trying and not wait the entire year. Couples or individuals who have an underlying condition that may increase the risk of infertility, such as irregular periods, endometriosis, premature ovarian failure, or a known male factor should also seek evaluation sooner. Infertility affects approximately 15% of couples. The good news is that with the appropriate evaluation and management, most patients will succeed in achieving their dream of becoming parents.
Can both men and women be infertile?
Both women and men can experience infertility. It is believed that approximately 50% of infertility cases are due to a female factor, whereas approximately 30% of cases are due to a male factor. In some cases there are both female and male factors that occur at the same time. Conversely, in some infertile couples, the results of the diagnostic work-up reveal all normal findings. This is referred to as unexplained infertility.
What causes infertility?
Before we explore what causes infertility, let’s take a look at what needs to happen in order for a female to become pregnant. In order for normal human reproduction to take place, there needs to be some normal eggs and sperm, as well as a normal functioning female reproductive tract that would allow an egg to be fertilized by a normal sperm resulting in the formation of an embryo. Once this occurs, a normal female reproductive tract would then allow for the embryo to further develop and eventually implant inside the uterine cavity where it will grow for nine months. The female reproductive tract includes the ovaries, the fallopian tubes, and the uterus.
Couples may experience infertility if there are aberrations in function of any of the aspects of human reproduction mentioned above.
As you can read in one of our related blog posts, one of the common misconceptions about infertility is that it is mostly a woman’s problem. But male factor infertility (when couples or individuals experience inadequate sperm production) is seen in approximately 30% of couples.
What causes male infertility?
Causes of male factor infertility are many and include certain genetic conditions, other systemic health problems, some forms of brain tumors, hormonal imbalances, testicular damage due to infection or trauma, testicular torsion, prior surgery in the groin, blockages in the male reproductive tract, varicoceles (dilated veins on the testicles), exposure to gonadotoxic agents and some medications to mention a few. The use of anabolic steroids and testosterone replacement therapy can also lead to male factor infertility. Poor lifestyle habits can also contribute to poor sperm parameters.
What causes female infertility?
One of the most common causes of female infertility is a dysfunction in normal ovulation. This is when a normal egg is not released by the ovary every cycle. Oftentimes a woman who has an ovulatory dysfunction experiences irregular menses and – in some cases – no menses at all. Polycystic ovary syndrome (PCOS) is a common condition we encounter where there is ovulatory dysfunction. Women with PCOS often present with irregular periods, hormonal abnormalities and infertility.
Infertility can also be experienced when there is an inadequate number of normal eggs. This is referred to as diminished ovarian reserve and is commonly due to advanced maternal age, though it can occur at any age. Oftentimes, the causes of diminished ovarian reserve are unknown, however a past history of ovarian surgery, history of endometriosis, exposure to chemotherapy or radiation, and a family history of premature ovarian failure and premature menopause are potential risk factors.
Abnormalities in the female reproductive tract, such as blockage of the Fallopian tubes can also lead to infertility. The fallopian tubes can be damaged as a result of a past history of certain sexually transmitted infections and pelvic inflammatory disease. Other factors that can lead to abnormalities in the fallopian tubes include history of ectopic pregnancy, appendicitis with a ruptured appendix, past pelvic and reproductive tract surgery, as well as a condition called endometriosis.
Abnormalities and distortion of the uterus can also lead to infertility. This is referred to as uterine factor infertility. Fibroids are benign soft tissue tumors that are very common in women of reproductive years and can interfere with normal procreation. Uterine polyps occur when there is an overgrowth of tissue in the inside lining of the uterus. Polyps can also interfere with fertility and should be properly diagnosed and managed. Other uterine factors include scarring of an endometrium which can be due to a past surgical procedure or an infection. In some cases, there are congenital abnormalities of the uterus which were there from birth. These abnormalities can range in severity and in some cases may require surgical procedures to correct them.
What should someone who thinks s/he may be infertile do? What are the first steps in trying to have a family?
A thorough evaluation by a fertility specialist is warranted if a couple is experiencing infertility. The first step is to find a fertility specialist in your area with the necessary training and expertise who can conduct a proper evaluation and accordingly apply the application treatment options available to us to address and overcome the underlying issue. (As a starting point in your search for a fertility specialist, feel free to take a look at the list of fertility clinics we work with for surrogacy and egg donation.)
The evaluation begins by first obtaining a detailed history of the individual or the couple to unearth any potential problem. Aspects of that past history include the age of the couple, how long they have been trying to conceive, the female partner’s menstrual history, history of any prior pregnancies and their outcomes, any past medical conditions in both the female and male partners, past surgical history, the use of any medications, coital history, past history of certain infections, social and lifestyle histories.
The evaluation continues by conducting a physical exam to assess the reproductive organs. This often includes a pelvic ultrasound to visualize the ovaries, the uterus, and other aspects of the pelvic anatomy. Other tests that are often ordered include measuring various hormones in the blood, evaluation of the ovarian reserve, and a semen analysis. In cases where a blockage of the fallopian tubes is suspected, an imaging test called a hysterosalpingogram (HSG) may be ordered. Uterine factors are often evaluated by performing a pelvic ultrasound, a saline infusion sonogram, a hysteroscopy, and in some cases a pelvic MRI.
The good news is that with a thorough evaluation and proper diagnosis and management, most cases of infertility can be overcome.
How invasive are procedures and tests to determine if I’m infertile?
Tests and procedures performed to evaluate Infertility can range from simple blood tests – which are noninvasive – to some minimally invasive procedures. The most common imaging method performed in the work-up of infertility is a pelvic ultrasound. This is done by gently placing a specially made ultrasound probe in the vagina in order to visualize the pelvic organs and anatomy. The vaginal ultrasound exam is well tolerated by most patients and is not considered to be invasive.
The saline infusion sonogram and the hysterosalpingogram require the placement of a small flexible catheter inside the uterine cavity. This may cause some cramping and discomfort but it is short-lived and often can be minimized by taking some ibuprofen prior to the procedure.
If a hysteroscopy is warranted, it would require the placement of a small camera inside the uterus through the cervix to directly visualize the uterine cavity and correct any abnormalities as deemed appropriate. This procedure can be done under sedation for patient comfort and is considered a minimally invasive diagnostic or therapeutic modality.
What should I look for in an IVF doctor?
IVF is a procedure that is done by a Reproductive Endocrinology and Infertility (REI) specialist. In the USA, these doctors are required to complete four years of residency training in obstetrics and gynecology (OB-GYN) followed by three years of fellowship training in Reproductive Endocrinology and Infertility. REI doctors are board-certified by the American Board of Obstetrics and Gynecology. When choosing a fertility doctor, it is recommended that your doctor is fellowship trained in REI and is double board-certified in OB-GYN as well as REI.
What type of support is available for me if I’m struggling with infertility?
The American Society for Reproductive Medicine (ASRM) and the National Infertility Association have some helpful information.
You may contact the offices at Pacific Fertility Center Los Angeles at any time and we will be more than happy to guide you along your journey towards becoming a parent.
While infertility is often a difficulty and anxiety-provoking condition, the overwhelming majority of couples and individuals will be able to overcome it with the proper evaluation and treatment. You can reach out to Brittany at PFCLA by email or by calling 310-209-7700.
If you’re in need of surrogacy or egg donation to create your family, Circle Surrogacy is here to speak with you about your parenthood options. You can email us, use our online contact form, or call us at 857-299-7900.
Infertility 101 was written by Kristin Marsoli and Dr. Vicken Sepilian of PFCLA.
Kristin joined Circle in 2017 as Marketing Director. Prior to this role, Kristin worked at advertising and marketing agencies creating successful brand, digital and social campaigns for clients. Her personal experience brought her to Circle: Kristin and her husband are proud parents to their son thanks to Circle Surrogacy. Having been through the process, Kristin brings an experienced perspective to all of Circle’s digital and social marketing, and is excited to use her marketing expertise for something for which she has so much passion.
Dr. Vicken Sepilian
Reproductive Endocrinology and Infertility