An important step to solving a medical problem is to understand the cause. Understanding how the body works under normal conditions and being able to identify what is going wrong allows the fertility doctors at STL Fertility to address the problem at its source, making an infertility treatment more effective.
There are a wide range of tests that can be performed to diagnose infertility and determine the best course of treatment. Certain factors increase the likelihood of infertility, but each cause of infertility has its own signs and symptoms. In general, the main red flags indicating potential infertility are failure to conceive after a year of trying, difficulty staying pregnant, recurrent miscarriage, and irregular or painful periods.
To achieve a pregnancy, a precise sequence of events must take place. An egg must mature and be released from the ovary. Healthy sperm must be produced and delivered into the female reproductive system to meet and fertilize an egg. The resulting embryo must move into the uterus and become implanted in the endometrium. Once implanted, the embryo must continue to grow and develop normally. An interruption in one or more of these key processes can result in infertility. Once the problem is identified, our fertility specialists can then correct or bypass the issue.
1 in 8 couples has trouble conceiving. At STL Fertility, you are not alone, and we are here to help. There are a number of tests that can be done to gauge a woman’s fertility, even when she isn’t trying to conceive. In fact, the fertility doctors at STL Fertility recommend undergoing periodic fertility evaluations, as it’s a good way for a woman to know her options when it comes to planning for her future. If she knows in advance that fertility may be a challenge, she can plan accordingly, seek out a specialist earlier, and adjust her time frame to compensate.
It’s estimated that 10-15% of women of childbearing age have trouble conceiving. There are many factors that can lead to infertility in women. These include ovulation problems, blocked or damaged fallopian tubes, egg quality, egg quantity (ovarian reserve), and uterine conditions that hinder implantation of the embryo.
We typically recommend women under the age of 35 who have been trying to get pregnant for 6 months to a year should consult with one of our fertility specialists, also known as reproductive endocrinologist (RE).
Women over the age of 35 who have been attempting to conceive for at least 6 months are recommended to come visit one of our fertility specialists. Another sign to watch out for are consecutive miscarriages. It is common for a woman to miscarry, and then continue with a healthy pregnancy. However, more than two consecutive miscarriages could be a sign of infertility.
Some everyday choices can affect fertility. Our STL Fertility doctors know it is crucial to practice proper nutrition as well as routine exercise to help prepare your body for a healthy pregnancy. Overweight women, with a body mass index (BMI) higher than 29, and underweight women, with a BMI less than 19, are potentially at higher risk for experiencing infertility.
When trying to conceive, avoid unhealthy habits such as smoking, drinking alcohol, and recreational drug use. Changing these habits will not only improve your chances of conceiving, but also allow for a healthier lifestyle, which is especially important when starting a family and planning for their future.
The causes of infertility are fairly evenly divided between men and women. Approximately 40% of infertility cases can be traced to the woman, 40% to the man, and the remaining 20% are a combination of male/female factors or “unexplained.”
Nearly 1 in 10 men will experience infertility. Traces of infertility in men can range from issues with sperm production to interference with sperm delivery. Common lifestyle factors may also contribute to infertility in men, including: smoking, excessive heat exposure to the scrotum, excessive alcohol use, and stress.
Once you have come to the conclusion that you are having issues conceiving, the fertility experts at STL Fertility believe it’s important that both partners are tested. Most of our diagnostic tests are quick, non-invasive, and often covered by insurance. We will work with you to determine a diagnosis and the best treatment option for you.
Every journey needs a map. At STL Fertility, we perform a comprehensive fertility work-up and health history review to help guide us towards success for each patient individually. Our fertility work-up will consist of a physical examination as well as hormonal testing.
Some of the hormones we will look at include:
In women, FSH is released by the hypothalamus and helps to both regulate the menstrual cycle and stimulate the growth of eggs in the ovaries. FSH levels in women change throughout her menstrual cycle, with the highest levels happening just before an egg is released by the ovary, typically just before day 14 of a 28-day menstrual cycle.
Estrogens are hormones that are important for sexual and reproductive development, mainly in women. They are also referred to as female sex hormones, although men produce estrogen as well. In women, estrogen is produced mainly in the ovaries. Ovaries are grape-sized glands located by the uterus and are part of the endocrine system to produce and store a woman’s egg. During ovulation, an ovary releases an egg.
Estrogen also helps regulate the menstrual cycle, controlling the growth of the uterine lining during the first part of the cycle. If the woman’s egg is not fertilized, estrogen levels decrease sharply and menstruation begins. If the egg is fertilized, estrogen works with progesterone, another hormone, to stop ovulation during pregnancy. If the uterine lining is too thick, it cannot support implantation of the fertilized egg, which results in infertility.
Low estrogen levels can prevent ovulation, making it more difficult to get pregnant, and high estrogen levels can indicate a problem with ovarian reserve.
Fertility and menstruation are largely controlled by hormones, and one of these hormones is progesterone. Progesterone is a steroid hormone belonging to a class of hormones called progestogens. It is secreted by the corpus luteum, a temporary endocrine gland that the female body produces after ovulation during the second half of the menstrual cycle.
If an egg is fertilized and conception takes place, the corpus luteum continues to produce progesterone to supply the placenta and prevent pregnancy loss by nurturing the developing fetus. Recurrent miscarriage can be a sign of progesterone deficiency.
AMH, or anti-mullerian hormone, may be measured to assess a woman’s ovarian reserve or egg count and is often used as one marker of oocyte quantity. Your AMH level won’t tell you whether or not you can have a baby, but knowing your AMH level can help with a better understanding of your reproductive health and your timeline for getting pregnant.
AMH levels of 1 ng/mL or higher usually signify that a woman has a normal ovarian reserve and lower numbers under 1 ng/mL may indicate a woman with a low ovarian reserve. Lower AMH levels can indicate a shorter reproductive window than a woman with a normal AMH level.
IMPORTANT FERTILITY TREATMENTS
Intrauterine insemination (IUI)
Intrauterine Insemination (IUI) is one of several infertility treatments that uses a small catheter to insert “washed” sperm directly into the uterus in a process similar to a pap smear. IUI is a simple procedure that puts sperm directly inside the uterus in order to increase the number of good sperm that reach the fallopian tubes, and subsequently increase the chance of fertilization.
IUI with injectable medications is sometimes used as part of a progressive treatment approach by some physicians among a specific patient group. The treatment may progress from timed intercourse, to IUI with oral medications (clomiphene/clomid), to IUI with injectable medications. IUI is a low-tech procedure, and can increase your chances of pregnancy, but every patient is different, and there’s no guarantee IUI will result in a successful pregnancy.
In vitro fertilization (IVF)
While more complicated than IUI, IVF produces higher success rates with lower risk of multiple delivers when single embryo transfer (SET) is used. Despite the common belief that implanting multiple embryos increases the result of pregnancy, SET is recommended to reduce the risk of C-sections, NICU admission, health complications, and multi-births.
During the IVF process, mature eggs are retrieved from a woman’s ovaries and fertilized by sperm in an embryology laboratory to create an embryo. The embryos then develop directly in our world-class embryology laboratory until they reach the blastocyst stage (3-5 days after fertilization when it has approximately 6-10 cells). It is at this point when the embryo/s are transferred directly to the uterus using a thin tube. Embryo transfer is usually not painful.
IVF may take several months to complete, and while it sometimes works on the first try, many patients need more than one round of IVF to successfully get pregnant.
Egg freezing, also known as mature oocyte cryopreservation, is a method used to save a woman’s ability to get pregnant in the future. Eggs harvested from the ovaries are frozen unfertilized and stored for later use. A frozen egg can be thawed, combined with sperm in a lab, and implanted back to the patient via IVF. Frozen egg transfers are preferable to fresh because they will be from a genetically younger woman.
There are many reasons why patients may need to preserve their fertility. For some it may be a focus on education and career, and for others it may be due to an illness. Although the decline in reproductive potential that occurs with age cannot be reversed, freezing your eggs at a younger age may allow the eggs to be preserved until you are ready to conceive. Freezing your eggs and getting tested early for infertility can bring peace of mind to any patient.
When a woman is unable to carry a pregnancy on her own, a gestational carrier may be used to carry the pregnancy for her. Gestational carriers are also used for same-sex male couples trying to achieve their dream of parenthood.
At STL Fertility, we manage a donor/surrogate cycle effectively by being intimately involved and familiar with the process. Our team of specialists work closely with a number of established egg donor/surrogacy agencies and can provide referrals. We understand this is an incredibly intimate and personal journey, and hope to help guide patients towards a healthy baby, no matter the process.
Egg donation is a process in which a fertile woman donates an egg, or oocyte, to another woman to help her conceive. The procedure involves a doctor removing an egg or eggs from the donor, fertilizing them in a laboratory, and then transferring the resulting embryos into the recipient’s uterus. Doctors do this using an implantation procedure, such as IVF.
Donor-egg IVF may be needed if a woman’s ovaries aren’t producing enough eggs. While nothing is guaranteed, there are many cases of successful births through donor-egg IVF.
LGBT Family Building
Modern families come in all shapes and sizes. We understand, and are supportive of couples of all sexualities on their journey to a successful baby. At STL Fertility, our team is well versed in supporting gay and lesbian patients with personalized treatment plans that put them on the path to parenthood.
Embryonic Genetic Testing (PGTA, PGT-M, PGT-S)
PGT-A, or preimplantation genetic testing for aneuploidies, is a genetic test performed on embryos to determine if the embryo has a balanced set of chromosomes, or euploid. Embryos that have too few or too many chromosomes or aneuploid are highly unlikely to produce a healthy delivery.
With PGT-A, only chromosomally normal (euploid) embryos are chosen for transfer. This improves the chances of a healthy baby, and can reduce the risk of miscarriage.
PGT-M, or preimplantation genetic testing for monogenic/single gene defects, can be performed prior to pregnancy to greatly reduce the risk of having an affected child. Patients who are at high risk for passing on genetic diseases such as Huntington’s Disease, Tay-Sachs, or BRACA I and BRCA II, are recommended to use PGT-M to accurately identify which embryos are affected and which are not. Compared to PGT-A, which tests for chromosomes, PGT-M tests for specific genetic defects.
PGT-SR, or preimplantation genetic testing for structural rearrangement, is used to identify embryos with the correct amount of genetic material. People with chromosome rearrangements are at an increased risk of producing embryos with the incorrect amount of genetic material, which typically do not lead to a successful pregnancy. PGT-SR improves the chance of the IVF cycle resulting in a successful pregnancy by allowing fertility specialists to transfer only one embryo at a time.