Conditions causing infertility are often complex and best evaluated by a reproductive endocrinologists/infertility specialist. These physicians, like Dr. Shaykh must undergo an additional two years of fertility fellowship training after completing their OB/GYN residency. The Fellowship provides advanced training in the diagnosis and treatment of infertility.
Some OB/GYNs treat infertility with medications such as Clomid but rarely offer more advanced fertility treatments such as intrauterine insemination (IUI) after stimulation with follicle stimulating hormone (FSH). Unfortunately, the appropriate treatment can be delayed resulting in lost time and resources. This is clearly seen in cases where Clomid has be used for extended periods of time event though the data clearly indicate that pregnancy is most likely to result in the first three treatment cycles. Long term use of Clomid can lead to additional fertility problems.
The American Society for Reproductive Medicine defines infertility as the inability to conceive after one year of regular unprotected intercourse in women less than 35 years of age. The time is often shortened to 6 months in women 35 and older.
There are several fertility processes that must occur for a successful pregnancy to result. When one of these processes fails, the result is sub fertility.
The male must be capable of producing enough sperm of acceptable quality and ejaculating them into the vagina. Some men have low sperm counts or their sperm may be inadequate when evaluated using g the Kruger Strict Criteria. Male infertility is the cause of infertility in almost half of couples, this is why performing a semen analysis is crucial before beginning any type of infertility treatment.
Fortunately, with the treatment of intracytoplasmic sperm injection (ICSI) and In Vitro Fertilization, men with very poor sperm can father offspring. See the section on male infertility for more information.
Sperm are deposited into the vagina and swim in the cervical mucus through the cervix and into the uterus. The mucus must be of the correct consistency to support the sperms transport. The cervical mucus must also be free of antisperm antibodies which destroy sperm.
The ovaries contain all of the eggs a woman will produce in a lifetime. Each month, under the stimulation of hormones such as follicle stimulating hormone, ovarian follicles develop, each of which contains one egg. The ovarian follicles develop, and produce estrogen, until they are mature and ready for ovulation (release from the follicle).
Ovulatory irregularities often called Ovulation Dysfunction, usually caused by disorders of the hypothalamic pituitary axis, are seen as irregular or absent menses. The HPA is the complex interaction of reproductive hormones leading to egg development, endometrial thickening, and many other biologic processes. Polycystic Ovary Syndrome (PCOS) is another common disorder and can be the cause of female infertility.
Ovulatory disorders are often treated with Fertility Drugs such as Clomid or FSH which case increase in FSH production albeit by different mechanisms. See the section on ovulatory disorders. In cases of significantly reduced ovarian reserve or ovarian failure our Florida donor egg program is the best treatment option.
Endometriosis is the implantation of endometrial tissue (tissue lining the uterus). The endometrium thickens and becomes more vascular to accept and support a developing embryo. Endometrial cells grow rapidly under the influence of estrogen, and when they implant in organs such as the tubes, can cause obstruction and infertility. Endometriosis also creates an inflammatory environment in the pelvic cavity. More information on endometriosis.
The fallopian tubes transport the eggs from the uterus to the distal end where fertilization takes place. It the tubes are damaged or blocked by endometriosis, scar tissue, or other conditions the eggs cannot reach the site of fertilization.
IVF is often a first line treatment because the procedure bypasses the eggs. See the section on tubal disease. In women who underwent tubal sterilization, tubal reversal surgery may be an option.
Unexplained infertility is a frustrating diagnosis because an exact cause for a couple’s infertility cannot be identified. Many believe that unexplained infertility is often caused by failed fertilization that may have a genetic basis.
Reduced Ovarian Reserve
Reduced ovarian reserve occurs as a female ages at different rates in different women. The condition means that she does not have eggs that will fertilize and develop into a healthy embryo usually as a result of age. One indicator of reduced ovarian reserve is an elevated FSH level (>12 mcg/ml) on day three of the menstrual cycle.
An abnormal Clomid Challenge test indicates that IVF using the woman’s own eggs is unlikely to be successful. Many of these women are candidates for our Florida or Virginia donor egg programs which produce high pregnancy rates.
Luteal Phase Defect
A luteal phase defect occurs when the endometrium fails to develop properly during the luteal phase. The endometrium must thicken and increase in vascularity to provide nourishment to the embryo. The hormones progesterone and estrogen stimulates this development in a normal ovulatory cycle. Progesterone is often administered to insure proper endometrial development.
Fortunately, advances made over the last fifteen years make it possible for 85% of couples who seek care from a reproductive endocrinologist to conceive. Dr. Shaykh conducts an in depth evaluation of both partners to identify the potential cause(s) of infertility.
He believes in rapid evaluation (fertility testing) and the use of the technology most likely to be successful while considering other factors such as couples personal circumstances, financial situation, and individual desires.