FERTILITY
TREATMENT CENTER offers evaluation & diagnosis of all aspects of reproductive care including...
Infertility – is generally defined as the inability of a couple to conceive a child after one year of unprotected sexual intercourse,
the time in which about 90% of couples succeed. When a female is in her 20s, the average time to pregnancy is six months. This time frame reflects
not only the limited few days in the middle of a woman's menstrual cycle when she ovulates and conception is possible, but also the fact that most
conceptions do not survive beyond early embryonic development and are lost before a woman's next menstrual period. In addition, about 15% of couples
with a clinical pregnancy go on to a spontaneous miscarriage. The female partner's reproductive age is also an important determinant of the man's
ability to initiate pregnancy since the length of time required to establish pregnancy increases progressively with advancing maternal age. Fertilization
of the egg is more difficult and early pregnancy loss is more frequent as a woman becomes older. Age is just one of a number of factors
to consider when evaluating and diagnosing infertility causes.
Endometriosis - is a condition in which endometrial tissue that normally lines the inside
of the uterus, grows outside the uterus and attaches to the ovaries, fallopian tubes, or other organs in the abdominal cavity. Blood
flow from the endometrial tissue is restricted and can cause inflammation and form scar tissue which can block the fallopian tubes or interfere
with ovulation.
Polycystic Ovarian Syndrome (PCOS) - is a condition in which the ovaries secrete abnormally
high amounts of androgens (male hormones) that often cause problems with ovulation. Women with PCOS have enlarged ovaries which contain multiple,
small cysts. Although PCOS, also called Stein-Leventhal syndrome, can be completely asymptomatic, it more often is associated with symptoms
such as irregular periods or amenorrhea (no periods), weight gain or obesity, excessive hair or abnormal hair growth, acne, and oily skin.
| “Drs. Craig and Rychlik have published papers on
PCOS as a potential cause of infertility and have been guests on
local TV and radio offering their expertise on the topic.” |
Ovulation Dysfunction – is one of the leading infertility causes and describes a group of disorders in which ovulation fails to occur, or occurs
on an irregular basis. Anovulation (no ovulation) is a disorder in which eggs do not develop properly, or are not released from the follicles
of the ovaries. Women who have this disorder may not menstruate for several months. Others may menstruate even though they are not ovulating.
Although anovulation may result from hormonal imbalances, eating disorders, and other medical disorders, the cause is often unknown. Women athletes
who exercise excessively may also stop ovulating. Oligoovulation is a disorder in which ovulation doesn't occur on a regular basis, and a menstrual
cycle may be longer than the normal cycle of 21 to 35 days.
Diminished Ovarian Reserve – is one of the more difficult diagnoses that a patient can have. That
is because such patients are much more difficult to help to achieve pregnancy since the normal tools to achieve pregnancy don't work as well. Some patients
will likely have at most a few years of potential fertility left, so the situation is urgent. Some may have limited or no fertility left, but the process
of finding this out, at times, involves a process of trial and error.
A woman is born with one to two million eggs. Although she will only ovulate three
to four hundred of them, the rest will essentially wither away until there are none left. She will then be menopausal. Most of the time, the eggs
are in a protected state with a small group of them constantly being released from this protection. We do not know what causes the ovary to change
the status of these eggs, so we refer to it as a women's biological clock. Those eggs that have left this arrested state will go on and ovulate
provided they receive optimal hormonal stimulation. If they don't get this stimulation, they soon undergo an actively defined degeneration (called
apoptosis).
One way of defining decreased ovarian reserve is when a woman has fewer than 25,000 eggs in her ovaries. Statistically, this occurs around age
38. Fertility is still present until around 42 years old and, for most women, therapy to achieve pregnancy is still a reasonable thing to do. Menopause
(no eggs) occurs around age 51. However, these numbers are only averages and these events have a distribution around these averages. For example,
many women don't experience menopause until well past age 51. Similarly about 10% of all women will have decreased ovarian reserve by age 32. In
a practice such as mine, where women are self-selected to come here on the basis of not being able to get pregnant, the incidence of decreased
ovarian reserve is even higher.
Women with certain histories need to be especially concerned about their reproductive potential. Of greatest concern is a family history of early
menopause, certain chemotherapies, and pelvic radiation. Also of concern are a history of (significant) pelvic surgery, pelvic infection, severe
endometriosis, and smoking (dose and duration related). FTC performs a complete assessment for those patients at risk for diminished ovarian
reserve, and does not exclude these patients from its practice nor have them pay more, as other practices due, because of their situation.
| “FTC performed IVF on at least twice as many patients with diminished
ovarian reserve as the next closest fertility clinic in Arizona, according to data reported to the Society of Assisted Reproductive Technology
(SART) for 2003 and 2004.” |
Menstrual Irregularities - A menstrual disorder is a physical or emotional problem that interferes with the normal menstrual cycle, causing pain,
unusually heavy or light bleeding, delayed menarche, or missed periods. Typically, a woman of childbearing age should menstruate every 28 days
or so unless she's pregnant or moving into menopause. But numerous things can cause irregularities with the normal menstrual cycle, some the result
of physical causes, others emotional. These include amenorrhea (the cessation of menstruation), menorrhagia (heavy bleeding), and dysmenorrhea
(severe menstrual cramps). Nearly every woman will experience one or more of these menstrual irregularities at some time in her life.
Menopause/Perimenopause (early) – Menopause is defined as the cessation of menstrual cycles. This usually occurs at about the age of
50 in most women. For 2 to 8 years preceding this menstrual cycles may be irregular. This is referred to as the menopausal transition or
perimenopause. As estrogen and progesterone levels decline women may experience a variety of symptoms. This is a time when the levels of
hormones produced by the aging ovaries fluctuating leading to irregular menstrual patterns (irregularity in the length of the period, the time
between periods, and the level of flow) and hot flashes (a sudden warm feeling with blushing). Other changes associated with the perimenopause
and menopause includes night sweats, mood swings, vaginal dryness, and fluctuations in sexual desire (libido), forgetfulness, trouble sleeping
and associated fatigue.
Premature Ovarian Failure Syndrome (POF) - is associated with an elevated FSH (follicle stimulating hormone) level. Symptoms include hot
flashes, increased insomnia, vaginal dryness, irregular periods, or a loss of periods entirely in women less than 40 years of age. POF is actually
quite common. There are four sub-types of POF, so the initial medical evaluation should determine which type a patient has. The most common is
an autoimmune ovarian failure, in which a patient’s own antibodies “burn out” the eggs and ovaries. The second cause of POF is if a woman has
mumps as an adolescent (after age 10), many of her eggs may “burn out,” which oftentimes results in POF. Many women are unaware that
they’ve had an ovarian mumps infection until they are diagnosed with POF. The third cause of POF is Savage Syndrome, resulting from abnormal
FSH hormone receptors. Finally, POF may be idiopathic, meaning a specific cause cannot be found.
If POF is diagnosed early, and the FSH level isn’t significantly elevated, a patient has a reasonable chance of achieving pregnancy. However,
a significant number of women with POF need donor egg IVF to become pregnant. Interestingly, for autoimmune POF patients, birth control pills may
work backwards by actually increasing the chances of ovulation and conception, but with a relatively low success rate. An experimental method to
treat Savage Syndrome involves laparoscopic removal of half of one ovary, thinly slicing it, removing and maturing the eggs, and then fertilizing
them using IVF.
Fibroids – are also known as leiomyomas. They can develop from the smooth muscle cells of the uterus and can interfere with pregnancy
in many ways. The ones that grow on the inside wall of the uterus can cause changes in the endometrial tissue, making it difficult for a fertilized
egg to attach to the uterine wall. Fibroids that develop outside the uterus can interfere with pregnancy by compressing or blocking the fallopian
tubes, thereby preventing the sperm from reaching the egg.
Recurrent Miscarriage - is defined as 3 or more consecutive, spontaneous pregnancy losses. Approximately 20 percent of pregnancies end in miscarriage,
which is defined as the loss of a pregnancy before 20 weeks of gestation. Most miscarriages occur within the first 12 weeks of gestation. When
miscarriage occurs this frequently, there may be underlying causes such as genetic factors, an abnormally shaped uterus, uterine fibroids, or scar
tissue in the uterus which may hinder implantation or growth of the fetus. Hormonal imbalances or illnesses such as diabetes or immune system abnormalities
may increase the chance of miscarriage.
Genetic Factors - are proving to be important contributors to male infertility. Inherited disorders can genetically impair fertility. Examples
include the following: Cystic fibrosis patients often have missing or obstructed vas deferens (the tubes that carry sperm) and hence a low sperm
count; Klinefelter syndrome patients carry two X and one Y chromosomes (the norm is one X and one Y), which leads to the destruction of the lining
of the seminiferous tubules in the testicles during puberty, although most other male physical attributes are unimpaired; and Kartagener syndrome,
a rare disorder that is associated with a reversed position of the major organs, also includes immotile cilia (hair-like cells in lungs and sinuses
that have a structure similar to the tails of sperm). Germ cells may also be affected by this condition.
Male Infertility - is a syndrome encompassing a wide variety of disorders. In more than half of infertile men,
the cause of their infertility is unknown and could be congenital or acquired. Recognition of a male factor influence in an infertile partnership
is often delayed because women have traditionally been the primary focus of the infertility evaluation and have ready access to gynecological care;
men are much more reluctant to seek advice. Men are also more apt to confuse fertility with sexual potency (the ability to have an erection), ejaculation
and ability to perform sexually, and they assume that if they produce seminal fluid at orgasm then they also produce sperm. Causes of fertility problems
in men include sperm disorders, obstructive problems (blockages in sperm-carrying tubes), testicular injury and disease, varicocele,
genetic disorders, hormonal problems, general medical disorders that reduce fertility, drugs that reduce fertility, and environmental toxins and
radiation.
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