Infertility is defined as the inability to conceive or carry a pregnancy to term after 12 months of trying (six months for women over 35). It affects both men and women equally: about one-third of cases are due to female factors, one-third to male factors, and one-third to combined or unknown causes.

Infertility generally occurs as a result of a disease or disorder of the reproductive system. Infertility can affect both men and women. There are many different causes for infertility, which is why it’s important to see your physician if you are experiencing difficulty in becoming pregnant.

Most common causes:

• Women: Ovulation disorders (e.g., PCOS, ovarian failure, thyroid imbalance), uterine or fallopian tube issues (fibroids, PID, endometriosis, congenital anomalies), aging, and side effects from cancer treatments.

• Men: Abnormal semen (low count, poor mobility, no sperm, abnormal shape) caused by testicular disease, infections, overheating, ejaculation disorders, hormone imbalances, or certain medications/therapies.

Uterine fibroids are noncancerous growths of the uterus that are very common in women during the childbearing years. You may not experience symptoms and, therefore, be unaware that you have fibroids. However, depending on the location of the fibroid and its size, some women do experience uncomfortable symptoms.

The most common symptoms of uterine fibroids include:

• Abnormal uterine bleeding, such as excessive bleeding and prolonged menstrual periods

• Pelvic pressure or pain

• Lower back or leg pain

• Urinary problems, such as frequent urination, or difficulty emptying the bladder

• Constipation

Your doctor may diagnose your uterine fibroids during a routine pelvic exam. If you have symptoms of uterine fibroids, your doctor may order additional tests, including:

• Ultrasound

• Blood tests

• Magnetic resonance imaging (MRI)

• Hysterosonography, or saline infusion sonogram

• Hysterosalpingography, which uses a dye to highlight the uterine cavity and fallopian tubes on X-ray images

• Hysteroscopy, which uses a small, lighted telescope called a hysteroscope to examine your cervix into your uterus

Many treatment options exist, ranging from watchful waiting to surgery. Our gynecologic team are leading experts in gynecologic robotic surgery with advanced capabilities in minimally-invasive procedures to address these conditions.

Up to 10% of pregnant women in the U.S. develop diabetes during pregnancy, called gestational diabetes mellitus (GDM). Furthermore, about 50% of women with GDM go on to develop type 2 diabetes, but it can be prevented. To ensure a safe pregnancy and a healthy baby, it is essential to carefully manage preexisting diabetes and GDM during pregnancy.

The Ueberroth Family Program for Women with Diabetes at Hoag (also known as Sweet Success) ensures that all women experiencing pregnancy with diabetes have access to diabetes care before, during and after pregnancy. This includes women with preexisting type 1 diabetes (T1D) or type 2 diabetes (T2D) as well as women who develop gestational diabetes mellitus (GDM) during pregnancy. Our Sweet Success Program provides educational, nutritional and emotional resources to support expectant mothers with diabetes to have a successful and healthy pregnancy. In the program, certified diabetes educators work with you and your OB provider to ensure continuity of care.

High blood pressure during pregnancy can put both mother and baby at risk. It may be chronic (preexisting), gestational (developing during pregnancy), or progress to preeclampsia.

Risk factors include preexisting conditions such as hypertension, kidney disease, or diabetes, as well as age, multiple pregnancy, and race. Symptoms may range from none to headaches, swelling, vision changes, or abdominal pain.

Diagnosis involves blood and urine testing, along with close monitoring of mother and baby. Treatment may include medications, steroids to support fetal lung development, and fetal monitoring tests. In some cases, early delivery around 37 weeks is recommended.

Early detection and consistent prenatal care are key to preventing complications and ensuring the best outcome for both mother and child.

If your pregnancy is considered high-risk or if your pregnancy has complications, Hoag provides advanced, personalized care for you and your baby. Our nationally recognized team offers maternal-fetal medicine specialists, specialized testing, state-of-the-art antepartum and neonatal units, OB Emergency and triage services, and dedicated support programs. With 24/7 OB Hospitalists and a full spectrum of maternity services, Hoag ensures expert, compassionate care every step of the way.

Miscarriage, or pregnancy loss before 20 weeks, affects about 10–20% of pregnancies, most often in the first trimester. Causes vary and may include chromosomal abnormalities, health conditions, uterine issues, or lifestyle factors, though in many cases the cause is unknown. Common symptoms include bleeding, cramping, and back pain, and diagnosis often involves ultrasound or lab testing.

Treatment options depend on the stage of pregnancy and may include expectant management, medication, or surgical procedures. While miscarriage rarely leads to long-term health problems, follow-up care is important to prevent complications and support future pregnancies.

At Hoag, we provide medical expertise, compassionate support, and resources to help families navigate pregnancy loss.

Obesity (BMI of 30 or greater) increases health risks for both mother and baby during pregnancy. For mothers, risks include gestational hypertension, preeclampsia, gestational diabetes, and sleep apnea. For babies, risks may include birth defects, growth complications, preterm birth, stillbirth, and difficulties with monitoring during pregnancy and delivery.

Despite these risks, women with obesity can have healthy pregnancies with close medical care, regular monitoring, healthy nutrition, and exercise. Hoag physicians provide personalized guidance on safe weight gain, prenatal care, and delivery planning to reduce complications. Post-pregnancy, healthy habits and breastfeeding can support recovery and long-term health.

Pelvic health plays an important role before, during, and after pregnancy. Issues such as scar tissue, endometriosis, painful intercourse, or infertility can often be improved with pelvic floor therapy. During pregnancy, therapy and complementary services like acupuncture and Pilates can help manage pain, improve strength, and prepare the body for labor and delivery. In later pregnancy, pelvic floor therapy can support smoother delivery and minimize tearing.

After childbirth, Hoag offers specialized postpartum care to address common concerns such as incontinence, prolapse, painful intercourse, diastasis recti, and scar tissue recovery. With a physician referral, women can access personalized therapy and treatment plans designed to restore function and support long-term health.

Maternal mental health conditions, such as depression and anxiety, are among the most common complications of pregnancy and postpartum, yet they often go undiagnosed. Supporting emotional well-being before, during, and after pregnancy is critical for the health of both mother and baby. An outpatient clinic and Maternal Mental Health Support Line (949-764-8191, Mon–Fri, 9 a.m.–5 p.m.) offer direct access to expert support.

Hoag Maternal Mental Health Program We understand the importance of identifying and treating mental health conditions before, during and after pregnancy to ensure healthy outcomes for both mothers and babies. Our Maternal Mental Health Program is a collaboration between the Pickup Family Neurosciences Institute and the Women’s Health Institute, this program provides comprehensive care grounded in four core principles: universal screening, connection to services, early intervention, and community education.

Our program includes an outpatient clinic where expectant and new moms with various mental health conditions can meet with a psychiatrist, licensed marriage and family therapist or a licensed clinical social worker to receive the care they need or be connected to local resources. Additionally, we offer the following services:

• Preconception planning (women with existing mental health conditions or who are already taking medications and are planning to conceive)

• Mental health assessment during pregnancy and postpartum

• Individual and group psychotherapy

• Medication safety evaluation during pregnancy and breastfeeding

• Pharmacogenomics testing

• Connection to local support services

We Stand by Our Patients

Everyone needs help at different times in life, so don’t hesitate to reach out to your care team at Hoag. We’ll help find fast answers to your questions before, during, and after your treatment.

The Hoag Maternal Mental Health Program understands the importance of promoting mental health and wellness for mothers and babies—pre, during and postpartum—ensuring positive outcomes.

Additional Resources

Hoag has compiled a directory of Women’s Mental Health resources for your reference along with support groups if you or a loved one has difficulty identifying the appropriate resource for mental health needs.

• Perinatal Mood and Anxiety Disorders Pamphlet

Support Groups

• Postpartum Support Group

• Prenatal Support Group

Preeclampsia is a serious pregnancy complication marked by high blood pressure and organ involvement, typically developing after 20 weeks of pregnancy and sometimes continuing after delivery. Affecting about 5% of pregnant women, it can progress quickly and, if untreated, may lead to eclampsia, seizures, or life-threatening complications for both mother and baby.

Hoag’s Approach to Preeclampsia Because symptoms may be silent or subtle, diagnosis relies on blood and urine tests and close monitoring by your obstetrician. Warning signs may include swelling, persistent headache, vision changes, abdominal pain, sudden weight gain, or difficulty breathing.

Treatment may involve frequent monitoring, dietary adjustments, hospitalization, or early delivery in severe cases. After childbirth, blood pressure and organ function are carefully followed, as complications can still arise in the weeks after delivery.

Hoag provides specialized maternal care to monitor, manage, and treat preeclampsia, with a focus on safeguarding both mother and baby.

Pregnancy termination, also known as abortion, is a safe medical option to end a pregnancy through medication or a procedure. They can take place in a doctor’s office, a surgical center or hospital, or at home using medication. Abortions are safe procedures and should not affect your future health, the health of your future children or your fertility.

In California, abortion is legal up to the point of viability (around 24–26 weeks), with most performed during the first trimester. The type of abortion recommended depends on your health, the stage of pregnancy, and personal preference. Hoag physicians provide respectful, compassionate care to support you in making the decision that is right for you.

Most pregnancies last about 40 weeks. Preterm labor occurs when labor begins before 37 weeks of pregnancy, increasing the risk of premature birth. Babies born too early may face serious short- and long-term health complications, so preterm labor requires immediate medical attention.

Symptoms

The most common symptoms of preterm labor are:

• Tightening of the uterus (contractions), especially more than 4 in 1 hour

• Menstrual-type cramps

• Pressure in the lower belly

• Backache

• Diarrhea

• Change in the type or amount of vaginal discharge. This might be blood, mucus, or watery fluid.

• “Water breaking,” or a gush of fluid from the vagina

Call your doctor as soon as possible if you are experiencing symptoms of preterm labor. Hoag provides advanced obstetric care, including a dedicated OB Emergency Department, to help manage preterm labor and support the best possible outcomes for both mother and baby.

Twins, Triplets or More Pregnancy with multiples is an exciting journey but comes with unique challenges and risks. Expectant mothers of twins, triplets, or more often experience stronger pregnancy symptoms, require additional calories and specialized prenatal care, and face higher risks of complications such as preterm birth, preeclampsia, and gestational diabetes. At Hoag, our obstetricians and perinatologists provide close monitoring and personalized care to help ensure the best outcomes for both mother and babies.