Understanding Infertility

We understand the many reasons and many emotions you might be feeling right now. Anger, frustration, loss of control but also hope. More hopeful parents deal with infertility across St. Louis than you might think. You’re not alone if you’re having trouble trying to get pregnant or can’t stay pregnant. According to the American Society for Reproductive Medicine (ASRM.org), as much as 15% of women and men of childbearing age have some degree of trouble getting pregnant every month.

Issues like anovulation, blocked or damaged tubes, egg quality and quantity (ovarian reserve), as well as uterine factors can impact female fertility. For men, it’s a little more straightforward and a matter of sperm quantity, sperm quality, or vasectomy reversal. With your STL Fertility team at your side, we’ll explore every reason and every potential solution. Whatever is happening to you, is also happening to us at STL Fertility.

Age and Infertility Explained

Age is your biggest barrier to success with fertility treatments. If you’re under 35 years old and trying to get pregnant for twelve months or more without success, you should schedule an appointment with a reproductive endocrinologist to talk about your fertility. If you’re over 35 years old, and trying without success for six months or more, it’s time to talk with a specialist, now.

Unfortunately, women are born with all the eggs or oocytes they’ll ever have in their lifetime. By the time a woman reaches her early 30’s her quantity of eggs has dropped from over 1-million to 100,000 or less. Age also impacts quality of eggs: by the time a woman is in her late thirties, over 40% of her embryos will be low-quality due to genetic imbalances or other issues related to maternal age. For men, the issues of sperm quantity and quality are also impacted by age and decline with advanced age.

What is Premature Ovarian Failure?

Premature Ovarian Failure (POF) can be plainly described as early menopause. Usually happening in women in their mid-to-late 40’s, POF is a condition in which menopause occurs before the age of 40 and where women have little to no eggs. Like a lot about infertility, POF is still not well understood. However, genetics and hereditary factors, autoimmune diseases like rheumatoid arthritis can be linked, and medical treatments like chemotherapy can be linked to POF.

What is Recurrent Miscarriage?

Often patients who can get pregnant but can’t stay pregnant don’t think of themselves as infertility patents. But they should. The tools and resources to overcome pregnancy loss and miscarriage have advanced dramatically in just the last several years giving us all reason for hope at STL Fertility.

According to the American College of Obstetricians and Gynecologists (ACOG), miscarriage is defined as three or more consecutive, spontaneous pregnancy losses. Approximately 20% of pregnancies end in miscarriage (loss before 20 weeks). Most miscarriages occur within the first several weeks of gestation. While there are many factors behind multiple miscarriages including uterine malformations, one of the biggest drivers are genetic abnormalities like chromosomal imbalances.

New genetic tests like PGT-A, or preimplantation genetic testing for aneuploidy, can be performed at the embryonic level during IVF cycle to gain information about embryos’ genetic health and improve the chance of a healthy pregnancy and delivery.

What is Polycystic Ovary Syndrome?

Polycystic Ovary Syndrome (PCOS) is very common in women and caused by hormonal imbalances – typically too much androgen which inhibits normal ovulation. Patients with PCOS often have low levels of FSH or follicle stimulating hormone and too much LH or luteinizing hormone.

FSH is one of the most important hormones responsible for stimulating follicular or egg growth in the ovaries. Too little FSH and the immature follicles in your ovaries develop into small cysts – or what can be seen on an ultrasound image commonly known as a “string of pearls.”

Too much FSH generates too much estrogen and androgens (male hormones) also impairing proper fertility. Endometrial tissue is also affected by high androgen levels causing it to get thick, lead often irregular periods. Acne and/or hair on your face, or hair loss are symptoms of PCOS.

What about Infertility & Men?

Like women, the factors behind male infertility are based on largely on issues of quality and quantity. Unlike women however, the vast majority of issues are related to one thing: sperm. Azoospermia or lack of sperm, poor morphology (shape and size), varicocele which is an enlargement of veins in the testicles), and the presence or prevalence of anti-sperm antibodies, cover most of the reasons for infertility in men.

During a routine infertility work-up and examination, male partners will be asked to provide a semen sample or semen analysis (SA) to look at sperm count, motility, and morphology. At STL Fertility, we can perform a semen analysis on site or happy to receive results from a referring Urologist.

Infertility Testing and Work-Up

At STL Fertility, we look at everything because everything matters when you’re dealing with infertility.

Maybe your OB/GYN did some testing a year ago and said keep trying on your own. Or maybe it’s been 6-12 months without success and time to get a formal fertility work-up with a reproductive endocrinologist.

On your first consult at STL Fertility we’ll review your health history information, we’ll do bloodwork and physical examination to get as many of the answers we need as quickly as possible. We’ll check FSH and AMH levels and all the other acronyms of infertility.

We’re looking for clues in hormonal imbalances, genetic information, or infectious disease history – all of which can impact getting and staying pregnant. An infertility work-up can usually be completed within 30-days of your first consultation, so you won’t have to wait too long to get started with your first treatment cycle.

Infertility Hormones 101

Hormones are the “software” or the “code” often impacting your fertility. Understanding which ones do what and when they’re activated is critical to overcoming infertility.

Estradiol (E2)

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.

Anti-Mullerian Hormone (AMH)

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.

Follicle-stimulating Hormone (FSH)

Follicle-stimulating Hormone (FSH) stimulates the development of the egg in the ovary. 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.

Luteinizing Hormone (LH)

Luteinizing Hormone (LH) triggers the release of the egg from the follicle (ovulation).

Progesterone (P4)

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.


Prolactin stimulates milk production. Blood levels may be higher than normal in certain disorders or if you are taking certain medications.


An under-active thyroid (hypothyroidism) can result in high prolactin levels.

What is a Hysterosalpingogram (HSG)?

A hysterosalpingogram (HSG) is basically an x-ray of your uterus. Typically, it’s a 20-minute procedure that looks for scaring, polyps, fibroids, or other growths that may be blocking the fallopian tubes or preventing pregnancy. While it can be performed in the office, the procedure generates some discomfort for some patents requiring a little bit of same day recovery time.

What is a Saline Sonogram?

A Saline Sonogram is short office procedure which evaluates the uterus from the inside. During a saline sonogram, a small amount of saline water will be injected into the uterus. The water opens up the uterine cavity slightly so that the doctor can look for abnormalities inside the uterus, such as polyps, scar tissue, fibroids, or other abnormalities.

Our Family Is Here to Help Build Yours

Families come in all shapes, sizes, and situations here at STL Fertility. Many of us have struggled with infertility ourselves, so we understand what family means and the importance of having one no matter your personal situation or sexual orientation.

Have a question or need something while you’re at STL Fertility? Contact our Patient Experience Manager, Andrea McClain at contact@stlfertility.com

For Hopeful Parents Across St. Louis

At STL Fertility we treat people from all walks of life, different backgrounds, and experiences.  We provide judgment-free care for all patients who need a little help starting or continuing their families. While many of our patients come with traditional infertility issues, we see many others who come to STL Fertility without infertility or looking to preserve the fertility for the future. We understand. We can help.

Single by Choice

Maybe you haven’t found the right partner and your dreams of having a family can’t wait, STL Fertility can help. For women, we can help you navigate your choices between using a known sperm donor or working with a third-party donor sperm bank. For Dads-to-be, the road to single parenting requires the use of an egg donor as well as a gestation surrogate to support a healthy pregnancy and delivery. Regardless of your situation, STL Fertility can help support your choices safely and successfully.

Fertility Preservation

You’ve just been diagnosed with Cancer and need to freeze your eggs or sperm as quickly as possible to have a family someday. Maybe you’re not ready for a family but recognize the connection between age and egg quality and quantity.  Whatever your story, ask your STL Fertility provider about your fertility preservation options today. 

Egg Donors and Recipients

For many women, the path to pregnancy includes the use of an egg donor. Maybe it’s someone you know or an anonymous egg donor, either way STL Fertility can help. For women interested in donating their eggs, you can give someone a gift of a lifetime. Would you like to be an egg donor, email us at contact@stlfertility.com

LBGTQ Family Building

Love is love. St. Louis has a strong and vibrant LGBT community. At STL Fertility we’ve helped hopeful parents regardless of sexual orientation have the the family and the want and deserve. While same-sex male couples require a few more steps to have a family like the use of an egg donor and gestational surrogate, what is most needed to have a family is love.

Gestational Surrogacy

In our great state of Missouri, gestational surrogacy or the process of having another woman carry a pregnancy for an intended parent(s) is legal and widely accepted. At STL Fertility, we will work close with you to ensure the surrogacy process is smooth and successful.

Fertility Treatment Travelers

Although we’re based in St. Louis, we all kinds of patients from all kinds of US states because of our hands on, high touch approach to care. If you’re a fertility treatment traveler, we can help you coordinate your time with us. Connect with our Patient Experience Manager, Andrea McClain at contact@stlfertility.com and she can help with local travel logistics.