Causes of Infertility
Our team has decades of experience in diagnosing and successfully treating the full spectrum of fertility-related conditions. Below is a brief overview of the more common diagnoses we see at AFCC.
Ovulation Problems
Anovulation is the absence of ovulation. A common cause of anovulation is polycystic ovarian syndrome (PCOS) — more on that below.
Typically, we can tell from the information you share regarding previous menstrual cycles whether there is likely to be an ovulation disorder. Blood testing and ultrasound studies of the ovaries at various times of the menstrual cycle can affirm this and provide more information.
In general, cumulative pregnancy success rates are high with treatment from a fertility specialist when the fertility issue is an ovulation problem.
Polycystic Ovaries (PCOS)
PCOS, short for polycystic ovarian syndrome, is a common cause of anovulation and female infertility. It’s also sometimes referred to as PCO (polycystic ovaries) or PCOD (polycystic ovarian disease).
Women who are having fertility issues due to polycystic ovaries typically do not release eggs (i.e., ovulate) regularly, and their ovaries may contain small, typically unharmful cystic structures.
PCOS is a clinical diagnosis. First, blood tests are done to rule out other causes of anovulation. After these causes are ruled out, the diagnosis is made by patients having 2 out of 3 clinical criteria:
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Polycystic ovaries on ultrasound
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Evidence of elevated testosterone
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Irregular menstrual cycles
The chance of getting pregnant with PCOS using fertility treatments is very good, especially for women under age 35. The real question is more about which treatment will be most effective, rather than whether treatment will work at all.
Endometriosis
The endometrium is the tissue that lines the inside of the uterine cavity. Endometriosis is a disease in which some of this tissue has spread elsewhere.
If you have a history of very painful menstrual cycles, painful intercourse, and/or pain while urinating or during bowel movements, it’s a strong indicator that endometriosis is present. A physical exam or ultrasound will generally reveal additional indicators. However, the only way to be sure whether a woman has endometriosis is to perform a minimally invasive surgical procedure called laparoscopy.
There are effective treatment options for endometriosis associated with infertility. The best option for you will depend on several factors, like the severity of the disease, its location in your pelvis, your age, and the length of infertility.
Tubal Infertility
Tubal factor infertility accounts for about 20-25% of all cases of infertility. It includes cases of:
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Completely blocked fallopian tubes
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At least one blocked tube
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No blockage but tubal scarring or other damage
Tubal factor infertility is often caused by pelvic infection, such as pelvic inflammatory disease (PID), endometriosis, or scar tissue that forms after pelvic surgery.
The diagnosis of tubal factor infertility is initially investigated in most cases with a hysterosalpingogram, and sometimes surgically via laparoscopy. There are two types of tubal blockage – one occurring at the junction where the tube and uterus meet, and one where the tube is blocked at its distal end (i.e., hydrosalpinx).
Treatment options for proximal blocks include tubal cannulation (i.e., surgical or radiologic procedures), medications to suppress endometriosis for endometriosis-related blocks, or in vitro fertilization (IVF).
For a distal block, or hydrosalpinx, one treatment option is tubal surgery to attempt repair of the tube by opening up the blocked end. However, with current advances in IVF, this option has become less popular because of the increased risk of tubal (ectopic) pregnancies and the risk of re-closure of the diseased tube. Hydrosalpinx can also decrease fertility rates in women attempting to do IVF. However, removal of the diseased tube restores pregnancy chances with IVF.
Uterine Problems
Several issues in the uterus and uterine lining can cause or contribute to infertility or recurrent miscarriage. These include:
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Uterine polyps
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Uterine fibroids
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Intrauterine adhesions (Asherman’s Syndrome)
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Congenital uterine malformations, such as a bicornuate uterus, a T-shaped uterus, or a uterine septum
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Luteal phase defect
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Thin endometrial lining
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Uterine isthmocele (i.e., defect at prior cesarean section scar)
A hysteroscopy is a surgical procedure that allows us to see any defects inside the cavity. The fertility treatment we recommend will depend on your individual diagnosis.
Unexplained Infertility
Sometimes, following standard infertility testing and procedures, we’re still unable to identify a reason for infertility. This is known as “unexplained infertility” or “idiopathic infertility.”
While this can be frustrating, it does not mean that pregnancy is impossible. Treatment options that lead to successful outcomes for women with unexplained infertility include oral medication (e.g., Clomid, Letrozole), intrauterine stimulation (IUI), and in vitro fertilization (IVF).
Male Infertility
About 25% of all infertility is caused by a sperm defect, and 40-50% of infertility cases have a sperm defect as the main cause or a contributing cause. While sperm count and motility matter, the main factor is whether the sperm can fertilize the female partner’s eggs. To assess male fertility and provide insights as to what is causing infertility, a semen analysis is the best available test.
Fertility Testing Procedures at Advanced Fertility Center of Chicago
As we work to determine what may be preventing you from achieving pregnancy on your own, we may perform one or more of these infertility tests or procedures.
History
Before performing any tests, we start with a conversation. Our fertility specialists ask questions to get clues into the cause of your infertility. These questions pertain to your medical, surgical, gynecological, and obstetric history, as well as lifestyle. If you have seen other fertility doctors in the past, those records will also be carefully reviewed.
Physical Exam and Ultrasound
Typically, we’ll perform a physical exam that includes a pelvic ultrasound. Ultrasounds can help us discover abnormalities within the uterus, fallopian tubes, and/or ovaries. It’s also a good way to assess ovulation.
Ovarian Reserve Tests
A very important assessment of a woman’s remaining egg supply, ovarian reserve testing is performed through blood testing and ultrasound.
Semen Analysis
The semen analysis is performed early in the evaluation process. If a severe sperm defect is discovered, testing on the female patient is typically modified, and therapy is immediately directed to the sperm problem.
Blood Tests
Blood tests that might be needed include day 3 follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), anti-müllerian hormone (AMH), prolactin, testosterone (T), progesterone (P4), 17-hydroxyprogesterone (17-OHP), thyroxin (T4), thyroid stimulating hormone (TSH). If there is a history of recurrent miscarriages (2 or more) a lupus anticoagulant (LAC) and anti-cardiolipin antibody (ACL) are often done, as well as other tests.
Hysterosalpingogram (HSG or Dye Test)
The HSG assesses the uterus and fallopian tubes. It’s usually scheduled between days 6 and 13 of the cycle — after bleeding and before ovulation – and is often performed in a radiology facility.
Hysteroscopy
Hysteroscopy is a minimally invasive surgical procedure, performed under anesthesia, that involves the insertion of a narrow telescope-like instrument through the vagina and cervix into the uterus. The uterus is then distended with fluid (such as salt water) and can be visualized through the scope. This procedure allows us to see any defects inside the cavity.
Laparoscopy
Laparoscopy is a minimally invasive surgical procedure, performed under anesthesia, that involves the insertion of a narrow telescope-like instrument through a small incision in the belly button. This allows visualization of the abdominal and pelvic organs including the area of the uterus, fallopian tubes, and ovaries. We always perform basic testing on both partners before considering laparoscopy.
