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Infertility: What to Expect When Faced With the Unexpected

Infertility affects women of all reproductive ages and people creating families at different life stages with varied backgrounds. It can feel like a lonely road, filled with unexpected twists and turns. Whether you are just beginning your family building journey or have been on this path for some time, know that you are not alone. At Hoag, we are here to help you through these uncertain times.

“There are many causes of infertility and sometimes, with the right treatment, we can help couples conceive naturally,” said Sharon Moayeri, M.D., F.A.C.O.G., M.P.H., M.S., Hoag reproductive endocrinology & infertility. “If interventions are needed, Hoag provides expert fertility care.”

“A common misconception is that infertility is primarily related to women. “However, nearly half of infertility involves male factor, and the remaining is caused by a combination of problems in both partners, or unknown,” Dr. Moayeri said.

The most common cause of female infertility is ovulation disorders due to polycystic ovary syndrome and advanced (ovarian) aging, especially given that women are starting families later and ovarian function declines as women enter their mid-30s. Other causes include problems in the uterus or fallopian tubes due to uterine fibroids, pelvic inflammatory disease, endometriosis, ormcongenital anomalies. In addition, women who have undergone chemotherapy or radiotherapy may experience short- or long-term infertility issues as a side effect of these treatments, since they may enter early menopause or be unable to carry a pregnancy. Consequently, discussing fertility and reproductive options before cancer treatment is essential.

The most common cause of male infertility is related to abnormal semen parameters, including low sperm count, no sperm, low sperm motility (movement) and abnormal sperm shape, called morphology. There are many issues that can cause abnormal semen, such as testicular infection, aging, genetics, structural abnormalities or disease, lifestyle and ejaculatory or hormonal disorder. Certain drugs, medications and therapies may also impact male fertility, such as chemotherapy or radiotherapy, anabolic steroids and sulfasalazine anti-inflammatory medications. However, often the cause is unknown.

Because fertility issues can affect both men and women, it’s important for both partners to seek the care of a physician. For both men and women, your physician will perform a thorough physical/pelvic examination, discuss your medical and family history, habits, lifestyle and order blood work, including genetic screening.

For men, your physician may also order a semen analysis and ultrasound study to determine if there are any structural abnormalities.

For women, your physician may also order an ultrasound study to check for structural pelvic abnormalities. In addition, your physician may recommend a diagnostic procedure, such as      hysterosalpingography to check the structure of the uterus and fallopian tubes, or minimally invasive surgical procedure such as hysteroscopy or, rarely, a laparoscopy. Other tests your physician will likely recommend include ovarian reserve assessment, thyroid function testing and preconception genetic screening.

When it comes to treatment, the majority of infertility cases are treated with conventional therapies such as medication treatment or surgical repair of the reproductive organs. In more complex cases, reproductive endocrinologists (physicians who specialize in the diagnosis and treatment of infertility) often utilize assisted reproductive technologies, such as intrauterine insemination and in vitro fertilization including embryo genetic screening, fertility preservation, egg or sperm donor and surrogacy to assist couples in becoming pregnant.

At Hoag, our multidisciplinary team of board-certified gynecologic health experts includes gynecologists, urogynecologists, reproductive endocrinologists and other subspecialists who work together to provide a coordinated approach in the treatment of uterine fibroids, including the latest progressive treatment options personalized to meet the needs of the individual patient.

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