Fertility and Reproductive Medicine
Fertility and Reproductive Medicine is a branch of medicine that deals with prevention, diagnosis and management of reproductive problems; goals include improving or maintaining reproductive health and allowing people to have children at a time of their choosing. It is founded on knowledge of reproductive anatomy, physiology, and endocrinology, and incorporates relevant aspects of molecular biology, biochemistry and pathology.
Infertility is defined as the failure of a couple to conceive after 12-months of regular intercourse without the use contraception in women >35 years of age and after six months of regular intercourse with out the use of contraception if the woman is 35 years or older. Infertility should be addressed since it is a common condition with important psychological, economical and medical implications.
Infertility is a common problem in today’s society affecting approximately 15% of couples. There are multiple etiologies with the most common being problems with the male reproductive system (35%), and anatomic abnormalities or damage involving the female reproductive organs (35%). Endometriosis is a major cause of damage to the female pelvic organs, especially the ovaries and fallopian tubes. If left untreated, endometriosis increases the risk of infertility and may decrease the success of IVF. Abnormalities with ovulation account for about 15% of cases and another 10-15% of infertility is unexplained. Other causes such as autoimmune disorders, genetic abnormalities, and asymptomatic genital infections have also been implicated.
Some of the most common causes of infertility are:
– Male Factors: 26%
– Ovulatory Dysfunction: 21%
– Tubal Damage: 14%
– Endometriosis: 6%
– Coital Problems: 6%
– Cervical Factors: 3%
– Unexplained: 28%
Dr. Nezhat works with the patient to diagnose infertility by performing an infertility workup. A series of tests are conducted to check if the woman is ovulating and to look for any abnormalities in her uterus or fallopian tubes.Hormone levels, including FSH, LH, prolactin, and progesterone, are also checked. A basic workup is usually done within one or two menstrual cycles.
Indication and timing of evaluation: For women under 35 years of age with out risk factors of infertility, initial evaluation after 12 months of unprotected and frequent intercourse. For women age 35-40 years initial evaluation of should be started after six months of unprotected and frequent intercourse.
Initial evaluation advised upon presentation despite less than 6-months of unprotected and frequent intercourse for the following groups:
1: Women in the age group over 40 years
2: Women with oligomenorrhea/amenorrhea
3: Women with a history of chemotherapy, and radiation
4: Advance stage endometriosis
5: Known or suspected uterus/tubal disease
6: Women who’s male partner has previous testicular or groin surgery, impotence, chemotherapy and/or radiation, or a history of sub-fertility with another partner
Treatment is based on the findings from a diagnostic workup, which can include various blood tests and imaging studies. If there is identifiable cause of infertility, therapy should be aimed at correcting reversible etiologies. The couple should also be counseled on Life-style modification, such as smoking cessation, reducing caffeine and alcohol consumption and appropriate time and frequency of coitus.
To find out more information on Fertility and Reproductive Medicine, or to find out if you are a good candidate for this procedure, contact an associate to request an in-office consultation with Dr. Ceana Nezhat.