Trying to treat infertility

Dec 17, 2016

Infertility does not discriminate. The disease is a little more common for women as they get older but it can affect anyone and everyone, according to Dr. Eve Feinberg.

This week on “Take Care,” Feinberg joins the program to discuss the causes of infertility, the right time to seek out specialist assistance and how initial consults and treatments generally will go. She is an OB/GYN and reproductive endocrinologist, as well as the medical director of Northwestern Medicine Fertility and Reproductive Medicine in Highland Park, Illinois.

After a year of inability to conceive or sustain a pregnancy, couples should seek out a fertility specialist or their OB/GYN. However, women over 35 years old can be considered infertile after six months of trying.

When patients first come to see Feinberg, she will either meet with the woman individually or the couple. She says approaches are both are completely fine, but she really enjoys meeting the male partner upfront.

The conversation usually starts with a careful medical history of both partners before the focus turns to the woman.

The first question tends to be about how long the couple has been trying to get pregnant and what methods of contraception they have used in the past.

“Many times, couples will say, ‘Oh, we’ve been actively trying to get pregnant for a year,’” Feinberg said. “But, what they fail to recognize is that they haven’t been using contraceptives for many, many years, and even though they haven’t been actively trying to get pregnant, in my mind, non-contraception is the same thing as trying to get pregnant.”

From there, the process goes as follows:

A pregnancy history

  • Any previous pregnancies, even an unplanned one during the teenage years, can be important to the overall assessment

The menstrual cycle

  • The average cycle is 27 to 32 days. A shorter cycle could warn of a decreased egg supply, while a longer cycle causes the doctor to wonder whether a woman is releasing an egg or ovulating.
  • Also, pain during the cycle is normal but excessive amounts can be a sign of an underlying medical process, like endometriosis.
  • An average period is four to seven days. A shorter or longer one can signify an underlying issue with hormones or something anatomic within the uterus

Gynecologic issues

  • A past chlamydia infection can damage the fallopian tubes and make a woman infertile.
  • Make sure the woman has optimized her health before becoming pregnant, including being up to date with her pap smear. Women over 40 years old need to make sure they have had a mammogram as well.

Family history

  • Ask about genetic diseases within the family
  • Often recommend some form of genetic carrier screening on women at risk, such as Horizon Genetic Carrier Screening, which will screen up to 274 diseases*
  • Ask about a history of miscarriages in the family
  • Ask about a history of early menopause. It can be an underlying clue for a decreased egg supply

Social history

  • Alcohol consumption, caffeine consumption and smoking cigarettes can all be important to a woman’s overall fertility potential
  • Smoking is one of the most detrimental things women can do for their fertility

Surgical history

  • Sometimes, abdominal surgery can cause scar tissue within the pelvis that may render a woman infertile later in life

Then, the conversation turns to the man. He is asked similar questions about genetic diseases and genetic carrier screenings are discussed as well.

Other questions include his health habits, such as use of tobacco, alcohol and illegal drugs, and exercise habits, underwear habits, etc. Marijuana use can impact his sperm production.

Next, the doctor will discuss testing with the couple. One of those tests will be to look at ovarian reserve. This will let the doctor think about the woman’s egg supply in her ovaries. While there are not tests to measure a woman’s exact egg supply, doctors believe some tests can serve as surrogate markers for egg supply.

After that, testing is usually broken down to look at four factors: ovaries, fallopian tubes, uterus and the male component through semen analysis. Testing for each is:

For the ovaries

  • An ultrasound is done to look for the size and shape of the uterus in order to see whether or not the ovaries contain a good supply of eggs
  • Some hormone testing is also done in the beginning of a woman’s menstrual cycle

For the fallopian tubes

  • Either do an X-ray test to see whether the fallopian tubes are open and if the inside of the uterus is normal or do a saline ultrasound test to look at the shape of uterus and inside of the uterus and the fallopian tubes

For ovulation

  • Do some sort of assessment of ovulation by doing a blood test to see whether or not a woman is releasing an egg every month

For the male component

  • Do a semen analysis to evaluate the concentration of sperm and the shape of the sperm

These tests will help the doctor target treatment to the diagnosis, according to Feinberg. Treatment will differ depending on which factor is affecting the couple’s ability to get pregnant.

Common treatments for each factor are:

  • Uterine factor — May recommend surgery
  • Male factor — May jump straight into intrauterine insemination or in vitro fertilization
  • Ovulatory factor — May just put her on a medication like clomid or letrozole in order to allow her to release an egg every month

Couples ready to seek advice from a fertility doctor or clinic can go to the Society for Reproductive Endocrinology and Infertility website. The SREI has an online database of all board certified reproductive endocrinologists and infertility specialists.

*This is a correction. The Horizon Genetic Carrier Screening can screen up to 274 diseases. The audio file associated with this broadcast and web post incorrectly states that the test can screen up to 237 diseases.