Infertility Prevention, Detection, and Management

National Infertility Awareness Week is a great time to talk about infertility prevention and management. Infertility is a public health problem, affecting one in every eight couples trying to conceive. Insurance doesn’t routinely cover it, and because it is a complex issue, it often doesn’t get addressed during routine doctor visits. 

What will be covered in this article

• Learn how some infertility problems can be prevented 
• What causes infertility for females and males
• Infertility diagnosis and treatments
• And what we can do to treat infertility 

Prevention: Can infertility be prevented? The answer is sometimes! If you don’t want a baby now but know you will want one in the future, you can take steps to maximize your chances of success. 

1. Clean up your act. Healthy eating, lots of plants in your diet, minimizing sugar and processed foods, lots of water is a great start. Regular exercise is good for you in so many ways. Minimizing alcohol and stopping smoking (even marijuana) all promote fertility in both men and women. Starting these good habits now will improve your odds of success when you are ready to conceive. 
2. Use a condom. If you are not currently trying to get pregnant, use a condom to prevent STDs, even if you have another form of birth control. Some STDs, such as chlamydia and gonorrhea, can cause blockage of the sperm ducts and the fallopian tubes. HPV causes cervical cancer, and treatment of abnormal paps can interfere with and delay pregnancy plans. Other diseases, such as syphilis and herpes, can cause serious birth defects or complications at birth. While we discuss infectious diseases, make sure that your vaccinations are up to date for varicella, influenza, rubella, measles, HPV, and COVID. COVID has been shown to cause at least temporary severe sperm count reduction in some men. 
3. Get checked. If you are concerned about your fertility, get an assessment. You can have your eggs counted with ultrasound, and your ovarian reserve checked with an AMH blood test. Sperm tests are inexpensive and straightforward. A consultation for a fertility assessment can also help you troubleshoot any other possible problems that could affect your fertility. You can also discuss fertility preservation options and determine if this is right for you. You can schedule an appointment at kindbody.com.

Detection: Infertility is diagnosed as the inability to conceive a successful pregnancy after 12 months without using birth control. This timeframe is reduced to 6 months if the female partner is more than 35 years old. Detection of fertility problems can usually be done in 1-2 visits and with one test for the male partner. 

1. Pelvic ultrasound: This is a simple and painless procedure. Vaginal ultrasound gives the most transparent view of the pelvic organs, and we can look at the uterus, the uterine lining, the cervix, and the ovaries. We can check for endometriosis, fibroids, and even count visible follicles, which are tiny fluid-filled sacs that contain eggs. 
2. Blood tests: depending on your circumstances, various hormone tests may be recommended. Typically we will want to check a TSH thyroid test and an AMH ovarian reserve test, but we may also want to check other hormone levels depending on your circumstances. 
3. Tubal evaluation: This test should be done after your period stops and before you are ovulating. These tests are done pretty much the same way: a speculum is placed in the vagina, like for a pap test, and then the cervix is cleaned. A thin plastic tube is inserted into the uterus, and the speculum can be removed. 

HSG: dye is then injected into the uterus, and an X-ray is taken to view the tubes.

Saline sonogram/Femvue: Water is injected into the uterus, and a vaginal ultrasound is done to check flow through the tubes and fluid in the pelvis.

4. Sperm test: Semen analysis is done by collecting sperm via masturbation into a collection cup. The semen is then analyzed under the microscope. We can check the sperm count, look at how well they are moving, and look at how normally shaped they are. 

Management: Fertility problems can be managed by a variety of treatments. Sometimes an underlying health problem, such as thyroid disease, is the issue. Sometimes fertility is unexplained. Some basic options are listed below, but this is not a comprehensive list.

1. Fertility meds and IUI: We often call these ovulation induction cycles. This type of treatment is simple and relatively inexpensive. A cycle usually involves two ultrasound visits and oral medication. Injectable medications may also be uses if you don’t respond to the oral medications or if you need to trigger and ovulation. You can then either timed intercourse based on your predicted date of ovulation or do an IUI (insemination) where sperm is washed and placed in the uterus with a skinny plastic tube. This is a good option for mild male factors, irregular menstrual cycles, or unexplained infertility.
2. In Vitro Fertilization: IVF is an excellent option for severe male factor, tubal disease, or unexplained infertility that has not responded to simpler treatments. IVF is also an option for a couple who wish to ensure they have multiple opportunities to have children or who wish to prevent passing on a specific genetic disease. IVF is the only effective option for patients who desire gender selection. It is also a good treatment for recurrent pregnancy loss caused by abnormal fertilization. It is a more costly and complex process involving injectable fertility medications and frequent visits over a couple of months. However, pregnancy rates are very high. 
3. 3rd Party Reproduction: To have a baby, you need sperm, eggs, and a uterus. Sometimes one of these factors is not available! In this case, 3rd party reproduction can help with donor sperm, donor eggs, and gestational carrier (surrogacy). If you are in this situation, the third party (donor or surrogate) is carefully screened to prevent genetic or infectious disease transmission. Special counseling and sometimes legal advice are required. This is an excellent option for LGBTQ couples and for couples who have challenges related to previous health problems such as cancer. 

At Kindbody, we aim to empower you with knowledge and the ability to make great decisions, regardless of where you are in your fertility journey.