Women's Care and Fertility Infertility Information

It is estimated that 1 in 7 couples will have difficulty achieving a pregnancy.
Patients at Women's Care & Fertility have access to every modern advance available in the field of infertility.

First, an interview is performed where we review your medical history and prior medical records to minimize any duplication of testing. We want to see all of your lab results and operative reports. We would like to hear your thoughts and opinions and see any information that you have gathered. Patients are welcome to bring printouts from any web research they may have done. We enjoy working with patients who actively participate in their own care. Together we will map out a strategy that appropriately meets your needs while making available all treatments.

Remember, two of the important pillars of medical ethics are autonomy - the patient's right to make choices, and beneficence - the doctors responsibility to provide care that can benefit the patient. Therefore our strategy will be based on your priorities, needs and desires, while maximizing the chance for your success.

Make the correct diagnosis
To get pregnant you need sperm and eggs (oocytes), and they need to be able to meet and adhere to the uterus.

Oocytes
Some patients may not be ovulating, that is producing eggs well, or not at all. Causes may include premature menopause, polycystic ovarian syndrome or other illnesses that interfere with egg production such as thyroid disease. An irregular menstrual pattern is usually the key to diagnosing these problems. Blood tests may provide quick and easy evidence for a problem that may be treatable.

The only way to know for sure that you have indeed ovulated is to get pregnant.

All of the methods available provide only circumstantial evidence that an egg has in fact left the ovary for the fallopian tube. This includes temperature charts, urine ovulation kits, blood tests, and even ultrasound images. These tests are only useful in helping us predict ovulation and aid in the timing of procedures. Fertility drugs can be given to "force" the ovary into developing more mature eggs. It is generally accepted that these fertility drugs do not deplete the ovary of their supply of eggs. Normally, as many as a thousand eggs are "called up" for a given cycle only to have one actually make it (often two-twins, very rarely three). These drugs only allow more eggs to reach the finish line that otherwise would have been lost.

However, short of actually removing the eggs with a needle (aspiration) one cannot be sure the eggs have escaped the ovary. An injection is usually given to the patient when the follicles, or sacs of fluid in the ovary that contain the eggs, reach a certain size. This injection causes the eggs to mature to the point that they would be at the time of spontaneous release (ovulation).You could then retrieve the eggs through an aspiration procedure, OR you may choose not to and hope for spontaneous release.

Sperm

As many as 30% of all couples who seek our care have a male related issue. Infertility may be caused by a decreased number of sperm in the ejaculate, a decrease in their motility (or ability to move) or their lack of appropriate development, leading to immature or misshapen forms. Many men have a combination of issues. Sometimes the cause is genetic, the male was born that way. Sometimes the problem is acquired, an event or process caused the problem.

Egg and sperm need to meet and adhere to the uterus.

Sperm are deposited in the vagina and travel up through the neck of the womb (cervix). The sperm then propel themselves through the uterine cavity to the fallopian tubes, where they travel to the part of the tube near the ovary called the ampulla. There the egg awaits after leaving the ovary and arriving from the opposite direction. The sperm penetrates the egg, genetic material is combined and the resulting embryo travels back down the tube into the uterine cavity, where it must attach itself (implant) to the wall and start to penetrate in search of the mother's blood supply.

Many obstacles may lie in the path of success for the egg, sperm and the subsequent embryo.

The egg transport may be disrupted by adhesions around the tube and the ovary that physically block the way to the entrance of the tube. Severe endometriosis may provide a hostile environment for the egg during it's brief stay in the women's pelvic cavity. Disease that was once in the tube may have damaged the inside lining of the tube or block them, stopping transport of the sperm and egg. Sometimes the damage in minimal, allowing the egg and sperm to meet, but does not allow the subsequent embryo to move toward the uterus. This may cause the pregnancy to miscarry or develop in the tube, an ectopic pregnancy.

On the other hand the problem may lie in the uterus. It may be malformed or obstructed, blocking transport of the sperm or proper implantation of the growing embryo. Causes include: adhesions in the uterine cavity (Asherman's Syndrome), fibroids tumors, polyps or various malformations from birth. Illnesses that can affect a woman's whole body may lead to conditions where the lining of the womb are inflamed or unreceptive to the embryo trying to attach itself.

Testing
Complete testing of the couple looking for treatable causes of infertility will be done.

History and Physical exam

Blood tests - aimed primarily at those patients who have ovulation difficulties or those that have an illness that might lead to faulty implantation.

Semen testing

A hysterosalpingogram

Laparoscopy - this was once done routinely as part of the patient's work up. Changes in medical insurance coverage make it harder to do. Nevertheless, the history of the patient will often dictate that a laparoscopy be done for reasons allowed by their insurance. Very often we find surprises such as adhesions and endometriosis.

Remember, many couples will not have an identifiable cause and will be given the diagnosis of "Unexplained Infertility". Do not be unhappy if you fall into this category. Most programs have their greatest successes with these couples!

Treatment
First we will attempt to fix any identifiable causes of infertility.

Egg production issues are addressed by giving medications when appropriate. Sometimes the egg supply is exhausted and donor eggs are the only answer if the couple is interested.

Sperm production problems are difficult to correct, however thanks to new technology and procedures nearly all cases can be treatable. For those who we cannot obtain viable sperm donor semen is can be used if the couple is willing to do this.

Egg and sperm transportation problems can sometimes be treated with surgery. These anatomic obstacles can often be treated with minimally invasive techniques such as laparoscopy and hysteroscopy. Adhesions can be removed, endometriosis vaporized, fibroids and polyps that block implantation, excised. Surgeries are performed at several hospitals in the St. Louis area.

Unexplained infertility can often be treated by just helping the couple time sexual intercourse more accurately. At Women's Care we believe that intercourse is best initiated 24 hours prior to anticipated ovulation.

Some couples benefit from insemination. The partner's sperm is washed with special materials to remove substances that usually do not enter the uterine cavity. The prepared sperm is then injected into the uterine cavity using a very thin tube (catheter) to minimize the mother's discomfort. This process works by bypassing any factors (infection or mucous that is hostile to sperm) that may be present in the cervix, the entrance to the womb. Some patients with low sperm counts or low mobility (ability to move forward) may be benefited in this way. The best results occur in the first 4-5 attempts, so we generally limit insemination to this number. Success rates per try are quoted at 5-10% which sounds low, but compared to 20% per month in a normal, fertile couple, it is not bad. Cumulative rates of insemination, that is your chance of success after 4-5 attempts, are probably 30-40%.

All in all there is much hope for couples where once there was little. We try to provide a warm and encouraging environment to help couples meet the challenges of infertility. With close doctor-patient contact, an engaging staff, and creative and fair financial options, we try to make your dreams come true.