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Infertility Services – Female Infertility


To understand how the couple is affected by the respective contribution from each individual, we need to understand the main causes affecting each partner. Female infertility is divided into several groups depending on the main source. However, keep in mind that it is common that two or more of those factors may be involved at the same time.


Age and Reproduction


Females are born with a fixed amount of oocytes in their ovaries. Even in-utero, the fetal ovary starts to shed eggs. Those eggs will be lost due to atresia. This happens because the eggs lack the stimulatory influence of the reproductive hormones to continue their growth. The eggs are continually lost all the way through childhood, puberty and adult age until the ovarian pool is exhausted when the woman reaches the menopause. The reduction of the ovarian pool is a reflection of the reduction of fecundity among persons older than 35 years. Studies conducted with women that were inseminated a maximum of 12 times with donor semen indicate that the probability of pregnancy was 55% for those younger than 30 years, 40% for those between 31 and 35 and declined precipitously to less than 10% in those older than 35 years. Data obtained from couples that had IVF treatments show a similar pattern. Not only the number of eggs is reduced but the quality of those eggs is influenced as well. For example, the risk of chromosomal abnormalities increases with maternal age. When the maternal age is 20, 30, 40 and 50 the risk of Down syndrome goes from 1/1667, 1/952, 1/106 and 1/11 respectively. The total risk for chromosomal abnormalities also goes up from 1/562, 1/385, 1/66 to 1/8 respectively. To increase the chances of success and decrease the probability of chromosomal abnormalities on the offspring, women over 40 may consider seriously the alternative of utilizing donor eggs.



Ovulatory


Problems with ovulation are present in 25% of female infertility cases. Although there are factors such as chromosomal abnormalities, and endocrine dysfunctions interfering with infertility, perhaps the three most common ones are emotional stress, strenuous exercise and excessive weight loss or weight gain.

Ovulatory factors are often treated with Clomiphene. When that doesn’t work, patients usually move to Exogenous (Injectable) Gonadotropin therapy or IVF.


Tubal/Peritoneal


The contribution of tubal and peritoneal factors in infertility is around 35%. Free and open fallopian tubes are necessary for gamete transport and fertilization to occur. Blocked tubes (including surgical tubal ligation), adhesions, and scar tissue are commonly associated with infertility. Endometriosis, appendicitis (especially when ruptured), abdominal or pelvic operations, infectious or non-infectious pelvic inflammatory diseases are among the main common causes in peritoneal factors.An HSG test performed at the Center before 14th day of your cycle can determine if this is an issue for you.The Center has developed expertise in the surgical treatment of blocked tubes including Robotic Microsurgical Tubal Reversal (hyperlink)


Uterine


Uterine factors are present in about 5% of infertility disorders. Prenatal exposure to DES, abortions, myomas (fibroids), uterine trauma or infections, polyps, and congenital abnormalities of the uterus are the most common factors involved with this type of infertility. Congenital anomalies of the uterus including uterine septum can be corrected by hysteroscopic resection of the septum (Hyperlink to video). Fibroids irrespective of their location may cause infertility including recurrent pregnancy loss. If the fibroid is more than the size of the uterus or if the blood flow to the fibroid is more than half of the total blood flow to the uterus, we recommend surgical removal of the fibroids. The Center has expertise in robotic myomectomies (hyperlink to video).


Immune


Recent studies have shown an increased link of infertility with immunological events. In fact, it appears that most of the so called “Unexplained Infertility” may have an underlying immunological component. Although it appears to be generally accepted that there is an immunological component in certain cases of infertility, the treatment options have elicited a great deal of controversy. At this moment there is no agreement on what is the best treatment alternative and it appears in some cases unjustified claims have put some treatments above others. Some of those treatments are particularly expensive and not without danger.


Environmental


The contribution of environmental factors in infertility is not well quantified. However, it is well documented that smoking not only decreases fertility but also it increases the probability of acquiring other diseases such as cancer, heart and lung diseases. Fertility among light smokers (20 cigarettes / day) was 75% of that of nonsmokers and fertility among heavy smokers (more than 20 cigarettes / day) fell to 57% of that of nonsmokers


Miscellaneous


  • Recurrent pregnancy loss
  • Secondary infertility (the inability to conceive and deliver a baby following the birth of one or more biological children)
  • Unexplained
  • Tests may include chromosome testing and other genetic profile work ups.
  • IVF/PGT-A is an excellent source of treatment for AMA and RPL. This includes an IVF cycle with intracytoplasmic sperm injection and assisted hatching. The blastocyst is biopsied on the fifth day of culture and a few cells are removed from the embryo and sent off for chromosome analysis and the results are available the next morning. We can then transfer back to the uterus the embryos that have the normal number of chromosomes. This technology has helped many couples to have ongoing pregnancies and live births.

At The Center for Reproductive Medicine and Robotic Surgery(CRMRS) we provide private, professional and compassionate fertility care. Dr. Jacob and our reproductive team provide a very personalized approach, from diagnostic assessment and early intervention through high-tech procedures like In Vitro Fertilization (IVF), and Intracytoplasmic Sperm Insertion (ICSI), intrauterine insemination (IUI) and Pre-Implantation Genetic Testing – Aneuploidy (PGT-A).

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