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Infertility



J. Kyle Mathews, MD, Plano OB Gyn Associates

Welcome to the Virtual Office for Plano OB Gyn Associates.  Founded by J. Kyle Mathews, MD, Plano OB Gyn Associates is dedicated to providing state of the art care for women.  Our staff offers timely, compassionate and personalized care. We strive to provide you with answers and options, as quickly as possible, and to assist you in understanding the personal solutions best suited to meeting your individual needs. Through this site you access to the latest medical information on Women’s Health and the ability to establish a personal medical home in order to receive guidance regarding you healthcare concerns.


Infertility

If getting pregnant has been a challenge for you and your partner, you’re not alone. Fifteen percent of couples in the United States are infertile. Infertility is defined as not being able to get pregnant despite having frequent, unprotected sex for at least a year.  If you have not been able to become pregnant after one year, or six months if you are older than 30, or you have irregular cycles, an infertility workup may be indicated.

Dr. Mathews provides Initial workup of infertile couples includes a complete history, physical exam, laboratory test, and ultrasound.  The husband will be ask to obtain a semen analysis which may be ordered by his primary care physician or by our office.  The couple is given a detailed outline of the diagnostic, treatment plan along with options available to them. With a compassionate, experienced and dedicated staff, and comfortable surroundings, your care may be discussed in a private setting with confidence. 


Infertility Glossary of Terms – Click Here

Causes of Infertility

J. Kyle Mathews, MD, Plano OB Gyn Associates

  • To achieve pregnancy, the egg and sperm must meet at the right time and place in an environment that promotes fertilization.  This is obviously a complex process and may be upset by many factors.  Some of these are discussed bellow:
  • Each month the pituitary gland in a woman’s brain sends a signal to her ovaries to prepare an egg for ovulation.
  • The pituitary hormones — follicle-stimulating hormone (FSH) and luteinizing hormone (LH) — stimulate the ovaries to release an egg. This is called ovulation. It is during this time that a woman is fertile (usually about day 14 of a 28-day menstrual cycle).
  • The egg travels through the fallopian tube and can be fertilized within about 24 hours after its release. Conception is more likely to occur when intercourse takes place one to two days prior to ovulation.
  • For pregnancy to occur, a sperm must unite with the egg in the fallopian tube during this time. Sperm are capable of fertilizing the egg for up to 72 hours and must be present in the fallopian tube at the same time as the egg for conception to occur. In order for a sperm to reach an egg, the man must have an erection and ejaculate enough semen to deliver the sperm into the vagina. There must be enough sperm, and it must be the right shape and move in the right way. In addition, the woman must have a healthy vaginal and uterine environment so that the sperm can travel to the egg.
  • If fertilized, the egg moves into the uterus where it attaches to the uterine lining and begins a nine-month process of growth.
  • For some couples attempting pregnancy, something goes wrong in this complex process, resulting in infertility. The cause or causes of infertility can involve one or both partners:
  • In about 20 percent of cases, infertility is due to a cause involving only the male partner.
  • In about 30 to 40 percent of cases, infertility is due to causes involving both the male and female.
  • In the remaining 40 to 50 percent of cases, infertility is due entirely to a cause involving the female.


    • Causes of male infertility

  • A number of things can cause impaired sperm count or mobility, or impaired ability to fertilize the egg. The most common causes of male infertility include abnormal sperm production or function, impaired delivery of sperm, general health and lifestyle issues, and overexposure to certain environmental elements.
  • Impaired production or function of sperm. Most cases of male infertility are due to problems with the sperm, such as:
  • Impaired shape and movement of sperm. Sperm must be properly shaped and able to move rapidly and accurately toward the egg for fertilization to occur. If the shape and structure (morphology) of the sperm are abnormal or the movement (motility) is impaired, sperm may not be able to reach or penetrate the egg.
  • Low sperm concentration. A normal sperm concentration is greater than or equal to 20 million sperm per milliliter of semen. A count of 10 million or fewer sperm per milliliter of semen indicates low sperm concentration (subfertility). Complete failure of the testicles to produce sperm is rare.
  • Varicocele. A varicocele is a varicose vein in the scrotum that may prevent normal cooling of the testicle, leading to reduced sperm count and motility. This is the most common cause of an abnormal semen analysis.
  • Undescended testicle. Undescended testicle occurs when one or both testicles fail to descend from the abdomen into the scrotum during fetal development. Because the testicles are exposed to the higher internal body temperature, compared with the temperature in the scrotum, sperm production may be affected.
  • Testosterone deficiency (male hypogonadism). Infertility can result from disorders of the testicles themselves or from an abnormality affecting the hypothalamus or pituitary gland in the brain that produces the hormones that control the testicles.
  • Infections. Infection may temporarily affect sperm motility. Repeated bouts of sexually transmitted diseases (STDs), such as chlamydia and gonorrhea, are most often associated with male infertility. These infections can cause scarring and block sperm passage. If mumps, a viral infection usually affecting young children, occurs after puberty, inflammation of the testicles can impair sperm production. Inflammation of the prostate (prostatitis), urethra or epididymis also may alter sperm motility. In many instances, no cause for reduced sperm production is found. Often when reduced counts are noted, intrauterine insemination is indicated.
  • Impaired delivery of sperm. Problems with the delivery of sperm from the penis into the vagina can result in infertility. These may include:
  • Sexual issues. Often treatable, problems with sexual intercourse or technique may affect fertility. Difficulties with erection of the penis (erectile dysfunction), premature ejaculation, painful intercourse (dyspareunia), or psychological or relationship problems can contribute to infertility. Use of lubricants such as oils or petroleum jelly can be toxic to sperm and impair fertility.
  • Retrograde ejaculation. This occurs when semen enters the bladder during orgasm rather than emerging out through the penis. Various conditions can cause retrograde ejaculation, including diabetes, bladder, prostate or urethral surgery, and the use of certain medications.
  • Blockage of epididymis or ejaculatory ducts. Some men are born with blockage of the part of the testicle that contains sperm (epididymis) or ejaculatory ducts. Some men lack the tube that carries sperm (vas deferens) from the testicle out to the opening in the penis.
  • No semen (ejaculate). The absence of ejaculate may occur in men with spinal cord injuries or diseases. This fluid carries the sperm from the penis into the vagina.
  • Misplaced urinary opening (hypospadias). A birth defect can cause the urinary (urethral) opening to be abnormally located on the underside of the penis. If not surgically corrected, this condition can prevent sperm from reaching the woman’s cervix.
  • Anti-sperm antibodies. Antibodies that target sperm and weaken or disable them usually occur after surgical blockage of part of the vas deferens for male sterilization (vasectomy). Presence of these antibodies may complicate the reversal of a vasectomy.
  • Cystic fibrosis. Men with cystic fibrosis often have a missing or obstructed vas deferens.
  • General health and lifestyle. A man’s general health and lifestyle may affect fertility. Some common causes of infertility related to health and lifestyle include:
  • Emotional stress. Stress may interfere with certain hormones needed to produce sperm. Your sperm count may be affected if you experience excessive or prolonged emotional stress. A problem with fertility itself can sometimes become long term and discouraging, producing more stress.
  • Malnutrition. Deficiencies in nutrients such as vitamin C, selenium, zinc and folate may contribute to infertility.
  • Obesity. Increased body mass may be associated with fertility problems in men.
  • Cancer and its treatment. Both radiation and chemotherapy treatment for cancer can impair sperm production, sometimes severely. The closer radiation treatment is to the testicles, the higher the risk of infertility. Removal of one or both testicles due to cancer also may affect male fertility.
  • Alcohol and drugs. Alcohol or drug dependency can be associated with poor health and reduced fertility. The use of certain drugs also can contribute to infertility. Anabolic steroids, for example, which are taken to stimulate muscle strength and growth, can cause the testicles to shrink and sperm production to decrease.
  • Other medical conditions. A severe injury or major surgery can affect male fertility. Certain diseases or conditions, such as diabetes, thyroid disease, Cushing’s syndrome, or anemia may be associated with infertility.
  • Age. Men older than age 40 may be less fertile than younger men.
  • Environmental exposure. Overexposure to certain environmental elements such as heat, toxins and chemicals can reduce sperm count either directly by affecting testicular function or indirectly by altering the male hormonal system. Specific causes include:
  • Pesticides and other chemicals. Herbicides and insecticides may cause female hormone-like effects in the male body and may be associated with reduced sperm production and testicular cancer. Lead exposure may also cause infertility.
  • Overheating the testicles. Frequent use of saunas or hot tubs can elevate your core body temperature. This may impair your sperm production and lower your sperm count.
  • Substance abuse. Use of cocaine or marijuana may temporarily reduce the number and quality of your sperm.
  • Tobacco smoking. Men who smoke may have a lower sperm count than do those who don’t smoke.

    • Causes of female infertility

    • The most common causes of female infertility include fallopian tube damage or blockage, endometriosis, ovulation disorders, elevated prolactin, polycystic ovary syndrome (PCOS), early menopause, benign uterine fibroids and pelvic adhesions.
    • Fallopian tube damage or blockage. Fallopian tube damage usually results from inflammation of the fallopian tube (salpingitis). Chlamydia, a sexually transmitted disease, is the most frequent cause. Tubal inflammation may go unnoticed or may cause pain and fever. Tubal damage may result in a pregnancy in which the fertilized egg is unable to make its way through the fallopian tube to implant in the uterus (ectopic pregnancy). One episode of tubal infection may cause fertility difficulties. The risk of ectopic pregnancy increases with each occurrence of tubal infection.
    • Endometriosis. Endometriosis occurs when the uterine tissue implants and grows outside of the uterus — often affecting the function of the ovaries, uterus and fallopian tubes. These implants respond to the hormonal cycle and grow, shed and bleed in sync with the lining of the uterus each month, which can lead to scarring and inflammation. Pelvic pain and infertility are common in women with endometriosis.
    • Ovulation disorders. Some cases of female infertility are caused by ovulation disorders. Disruption in the part of the brain that regulates ovulation can cause low levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Even slight irregularities in the hormone system can prevent the ovaries from releasing eggs (anovulation). Specific causes of hypothalamic-pituitary disorders that can result in anovulation include injury, tumors, excessive exercise and starvation. In addition, some medications can be associated with ovulation disorders.
    • Elevated prolactin (hyperprolactinemia). The hormone prolactin stimulates breast milk production. High levels in women who aren’t pregnant or nursing may affect ovulation. An elevation in prolactin levels may also indicate the presence of a pituitary tumor. In addition, some drugs can elevate levels of prolactin. Milk flow not related to pregnancy or nursing can be a sign of high prolactin.
    • Polycystic ovary syndrome (PCOS). In PCOS, your body produces too much androgen hormone, which affects ovulation. PCOS is also associated with insulin resistance and obesity.
    • Early menopause (premature ovarian failure). Early menopause is the absence of menstruation and the early depletion of ovarian follicles before age 40. Although the cause is often unknown, certain conditions are associated with early menopause, including immune system diseases, radiation or chemotherapy treatment, and smoking.
    • Uterine fibroids. Fibroids are benign tumors in the wall of the uterus and are common in women in their 30s and 40s. Rarely, they may cause infertility by blocking the fallopian tubes. More often, fibroids interfere with proper implantation of the fertilized egg.
    • Pelvic adhesions. Pelvic adhesions are bands of scar tissue that bind organs after pelvic infection, appendicitis, or abdominal or pelvic surgery. This scar tissue formation may impair fertility.
    • Other causes in women
    • Medications. Temporary infertility may occur with the use of certain medications. In most cases, fertility is restored when the medication is stopped.
    • Thyroid problems. Disorders of the thyroid gland, either too much thyroid hormone (hyperthyroidism) or too little (hypothyroidism), can interrupt the menstrual cycle and cause infertility.
    • Cancer and its treatment. Certain cancers — particularly female reproductive cancers — often severely impair female fertility. Both radiation and chemotherapy may affect a woman’s ability to reproduce. Chemotherapy may impair reproductive function and fertility in men and women.  A new Development in Infertility is the ability to now store unfertilized eggs for future fertilization.
    • Other medical conditions. Medical conditions associated with delayed puberty or amenorrhea, such as Cushing’s disease, sickle cell disease, kidney disease and diabetes, can affect a woman’s fertility.

    Testing for Infertility

    J. Kyle Mathews, MD, Plano OB Gyn Associates

    Testing for Infertility

    Tests for women: For a woman to be fertile, the ovaries must release healthy eggs regularly, and her reproductive tract must allow the eggs and sperm to pass into her fallopian tubes to become fertilized by a sperm. Her reproductive organs must be healthy and functional. Dr. Mathews offers complete evaluation of infertility for women with a compassionate, experienced and dedicated staff, and comfortable surroundings. Insert picture of couple consult

    Specific fertility tests may include:

    • Ovulation testing. A blood test is sometimes performed to measure hormone levels to determine whether you are ovulating.
    • Post Coital Testing. The test checks a woman’s cervical mucus after sex to see whether sperm are present and moving normally. This test may be used if a woman is not able to become pregnant (infertility) and other tests have not found a cause. The test is done 1 to 2 days before ovulation when the cervical mucus is thin and stretchy and sperm can easily move through it into the uterus. Within 2 to 8 hours after you have sex, we collect a sample of the mucus and evaluate sperm movement.
    • Hysterosalpingography. This test evaluates the condition of your uterus and fallopian tubes. Fluid is injected into your uterus, and an X-ray is taken to determine whether the fluid progresses out of the uterus and into your fallopian tubes. Blockage or problems often can be located and may be corrected with surgery.
    • Laparoscopy. Performed under general anesthesia, this procedure involves inserting a small scope into your abdomen and pelvis to examine your fallopian tubes, ovaries and uterus. The most common problems identified by laparoscopy are endometriosis and scarring. Your doctor can also detect blockages or irregularities of the fallopian tubes and uterus. Laparoscopy generally is done on an outpatient basis.
    • Hormone testing. Hormone tests may be done to check levels of ovulatory hormones as well as thyroid and pituitary hormones.
    • Ovarian reserve testing. Testing may be done to determine the potential effectiveness of the eggs after ovulation. This approach often begins with hormone testing early in a woman’s menstrual cycle, usually a Day 3 FSH and measurement of Estrogen levels. Anti-Mullerian Hormone is also measured and an ultrasound is performed for ovarian volume.
    • Genetic testing. Genetic testing may be done to determine whether there’s a genetic defect causing infertility.
    • Pelvic ultrasound. Pelvic ultrasound may be done to look for uterine or fallopian tube disease.

    Tests for men: For a man to be fertile, the testicles must produce enough healthy sperm, and the sperm must be ejaculated effectively into the woman’s vagina. Tests for male infertility attempt to determine whether any of these processes are impaired.  Some of these tests are performed by a Urologist.

    • General physical examination. This includes examination of your genitals and questions concerning your medical history, illnesses and disabilities, medications and sexual habits. Done by Urologist.
    • Semen analysis. This is the most important test for the male partner. Your doctor may ask for one or more semen specimens. Semen is generally obtained by masturbating or by interrupting intercourse and ejaculating your semen into a clean container. A laboratory analyzes your semen specimen for quantity, color, and presence of infections or blood. Detailed analysis of the sperm also is done. The laboratory will determine the number of sperm present and any abnormalities in the shape and movement (motility) of the sperm. Often sperm counts fluctuate from one specimen to the next.
    • Hormone testing. A blood test to determine the level of testosterone and other male hormones is common. Done by Urologist.

    Not everyone needs to undergo all, or even many, of these tests before the cause of infertility is found. Which tests are used and their sequence depend on your particular condition.

    Treatment of Infertility J. Kyle Mathews, MD Plano OB Gyn Associates

    Treatment of infertility depends on the cause, how long you’ve been infertile, the age of the partners and many personal preferences.

    Treatment for couples
. These approaches can involve steps related to the male or to the female, or both.
    Timed intercourse. Having intercourse every other day around the time of ovulation may improve fertility. Too-frequent ejaculation can lessen sperm quality and actually decrease fertility. Sperm survive in the female reproductive tract for up to 72 hours, and an egg can be fertilized for up to 24 hours after ovulation.

    Treatment for men: Often involves treatment by Urologist and may include treatment for:

    • Lack of sperm. If a lack of sperm is suspected as the cause of a man’s infertility, surgery or hormones to correct the problem or use of assisted reproductive technology is sometimes possible. For example, varicocele can often be surgically corrected. For blockage of the ejaculatory duct or in the case of retrograde ejaculation, sperm can be taken directly from the testicles or recovered from the bladder and injected into an egg in the laboratory setting.
    • Low Hormones. Replacement of hormones.

    Treatment for women: Fertility drugs are the main treatment for women who are infertile due to ovulation disorders. These medications regulate or induce ovulation. In general, they work like natural hormones — such as follicle-stimulating hormone (FSH) and luteinizing hormone (LH) — to trigger ovulation. Commonly used fertility drugs include:

    • Clomiphene (Clomid, Serophene). The most common drug used, is taken orally and stimulates ovulation in women who have polycystic ovary syndrome (PCOS) or other ovulatory disorders. It causes the pituitary gland to release more FSH and LH, which stimulate the growth of an ovarian follicle containing an egg. This drug is usually taken day 3 thru 7 or day 5 thru 9 of your cycle and is effective in causing ovulation in about 80% of patients.  The risk of twins with Clomid is 6%.
    • Human menopausal gonadotropin, or hMG, (Repronex). This injected medication is for women who don’t ovulate on their own due to the failure of the pituitary gland to stimulate ovulation. Unlike clomiphene, which stimulates the pituitary gland, hMG and other gonadotropins directly stimulate the ovaries. This drug contains both FSH and LH.
    • Follicle-stimulating hormone, or FSH, (Gonal-F, Bravelle). FSH works by stimulating the ovaries to mature egg follicles.
    • Human chorionic gonadotropin, or HCG, (Ovidrel, Pregnyl). Used in combination with clomiphene, hMG and FSH, this drug stimulates the follicle to release its egg (ovulate). It is often used to time ovulation for intrauterine insemination.
    • Gonadotropin-releasing hormone (Gn-RH) analogs. This treatment is for women with irregular ovulatory cycles or who ovulate prematurely — before the lead follicle is mature enough — during hMG treatment. Gn-RH analogs deliver constant Gn-RH to the pituitary gland, which alters hormone production so that a doctor can induce follicle growth with FSH.
    • Metformin (Glucophage). This oral drug is taken to boost ovulation. It’s used when insulin resistance is a known or suspected cause of infertility. Insulin resistance may play a role in the development of PCOS.
    • Bromocriptine (Parlodel). This medication is for women whose ovulation cycles are irregular due to elevated levels of prolactin, the hormone that stimulates milk production in new mothers. Bromocriptine inhibits prolactin production.

    Fertility drugs and the risk of multiple pregnancies. Injectable fertility drugs increase the chance of multiple births. Oral fertility drugs such as Clomid increase the chance of multiple births but at a much lower rate (6%). The use of these drugs requires careful monitoring using blood tests, hormone tests and ultrasound measurement of ovarian follicle size. Generally, the greater the number of fetuses, the higher the risk of premature labor. Babies born prematurely are at increased risk of health and developmental problems. These risks are greater for triplets than for twins or single pregnancies.

    Surgery: Maybe indicated to address abnormalities of the uterus and/or fallopian tubes. Hysteroscopic and Laparoscopic techniques allow evaluation and treatment using minimally invasive techniques.

    Assisted reproductive technology (ART) :  ART has revolutionized the treatment of infertility for couples not able to become pregnant by the above-mentioned means. In Vitro Fertilization is a highly specialized treatment and should a couple require Assisted Reproductive Technology, referral will be made.

    This site offers you access to the latest medical information on Women’s Health.

    Infertility Click Here

    Cancer & Fertility Click Here

    Links for Infertility Information

    ACOG American Congress of Obstetrics and Gynecology
    http://www.acog.org/publications/patient_education/patientpage.cfm

    Web MD

    http://www.webmd.com/

    American Society for Reproductive Medicine

    http://www.reproductivefacts.org/






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