OHSU

Fertility Factors

Each couple has a unique set of circumstances. The chances of fertility treatment success vary widely.  Treatment success depends on many factors, especially the age of the female partner. An overview of some of the most common fertility concerns or “factors” are listed below.

Ovulation Factor

If you have regular menstrual cycles, you are probably ovulating (releasing ripe eggs from your ovary). If you only have a period every few months or not at all, you are probably not ovulating. Or you may be ovulating infrequently.

By monitoring when you ovulate, you may be able to conceive (become pregnant) more quickly and easily. You can use an over-the-counter ovulation prediction kit. The test kit helps you plan for ovulation before it takes place. That way you can schedule intercourse or insemination at a time when you are most likely to become pregnant. These urine test kits are designed to detect the surge of luteinizing hormone (LH) that occurs just before you ovulate. The LH surge stimulates one of the ovaries to release an egg and produce progesterone. Ovulation prediction kits usually detect the LH surge about a day or a day and a half before you ovulate.

If you are not ovulating, your doctor may order special tests to determine the reason. We may also prescribe ovulation medications to induce ovulation.

Your doctor  may perform a pelvic ultrasound examination to evaluate your ovulation. However, this exam is not done routinely.

Tubal Factor

To conceive (become pregnant), you need to have open and functional fallopian tubes. Tests to determine tubal openness (patency) are important. Tubal factors account for about 35 percent of all infertility problems. A special x-ray called a hysterosalpingogram (HSG) can be used to evaluate your fallopian tubes and uterus. If the HSG shows blocked fallopian tubes, your doctor may recommend a laparoscopy. This exam is used to assess the degree of damage to your tubes.

Male Factor

In approximately 40 percent of infertile couples, the male is either solely responsible for, or contributes to the infertility problem. Therefore, a semen analysis is important in the initial evaluation. If the semen analysis reveals abnormalities, we can refer you to a urologist who specializes in male infertility.

Age Factor

Delaying pregnancy is a common choice in today’s society. Fertility begins to decline significantly in your mid-30s. It declines even faster in your late 30s.

Fertility declines with age because fewer eggs remain in your ovaries. Also, the quality of your remaining eggs is lower than when you were younger. Blood tests are now available to determine your ovarian reserve. These tests indicate your age-related fertility potential. In the simplest of these tests, the hormones FSG and estradiol are tested in your blood on the third day of your menstrual period. An elevated FSH level indicates that your chances for pregnancy may be reduced, especially if you are age 35 or older.

Uterine Factor

The HSG test, which is used to examine the fallopian tubes, can also reveal defects inside your uterine cavity. These defects could interfere with the ability of an embryo to implant. There are a number of uterine abnormalities that may be identified. They include uterine scar tissue, polyps, fibroids or an abnormally shaped uterine cavity. Surgery (a hysteroscopy) may be required to further evaluate and possibly correct uterine structural problems. Uterine abnormality can also be seen by a saline infusion hysterogram, also called a sono-hysterogram.

Peritoneal Factor Infertility

Peritoneal factor infertility refers to abnormalities involving the peritoneum (the membrane that lines the inside of your abdomen) such as scar tissues (adhesions) or endometriosis. Endometriosis is a condition where tissue that normally lines the uterus begins to grow outside the uterus. Laparoscopy is surgery that is performed to diagnose and treat adhesions or endometriosis.

Unexplained Infertility

In approximately 10 percent of couples trying to conceive, all of the above tests are normal and there is no apparent cause for infertility. In these cases, the infertility is referred to as unexplained. Even in these cases we successfully help people achieve their goal of parenthood. If this is the case for you, we will present you with options that may help you conceive.

(Adapted from “Infertility: An Overview. A Guide for Patients.” American Society for Reproductive Medicine, 2003)