According to the NIH, about 9% of men and about 11% of women of reproductive age in the United States have experienced fertility problems. Although your fertility journey can feel overwhelming, you are not alone, and it is normal to have questions. Andrea Twomey, PA-C at Essex County OB/GYN, sat down to answer some of the most frequently asked questions about infertility.
How do you define infertility, and when should someone consider seeking medical advice?
Infertility is clinically defined as not being able to achieve pregnancy after 1 year of having regular, unprotected intercourse if the woman is under age 35, or after 6 months if the woman is older than 35 years of age.
What are some of the most common causes of infertility in women?
The most common causes of female infertility include:
- Ovulatory dysfunction (age or non-age related): Ovulation, which is controlled by hormones, is the time in your monthly cycle when your ovary releases an egg into your fallopian tube. Pregnancy occurs if a sperm fertilizes the egg as it travels to the uterus after ovulation. Your chances of getting pregnant are highest if you have sex 1 to 2 days before ovulation or on the day of ovulation, but in some people, ovulation does not happen regularly or at all, making it difficult to get pregnant.
- Fallopian tube abnormalities (related to pelvic adhesions and infection) or uterine abnormalities (congenital or acquired): For example, if you have scar tissue in your fallopian tubes from past infections or surgery, this can cause the fallopian tubes to be blocked. If the tubes are blocked, sperm may not be able to get through to the egg.
- Endometriosis: Endometriosis is a condition that can cause pain in the lower part of the belly. This can also lead to trouble getting pregnant.
- Uterine abnormalities (congenital or acquired): Scar tissue of a fibroid in your uterus can prevent pregnancy.
How does age impact fertility, and what should patients know about their reproductive timeline?
Fertility declines as a female matures, with a gradual decline beginning at 32 years of age and a more rapid decline around 37 years of age. This decline in fertility is likely multifactorial.
Females are born with a fixed number of oocytes, which decreases with age. The quality of oocytes also falls with age because meiotic errors occur more frequently with increasing age, so the number of chromosomally anomalous oocytes ovulated increases, resulting in lower fertility and an increased risk of miscarriage.
What fertility-related evaluations and tests do you offer at Essex County OB/GYN?
Infertility evaluation at Essex County OB/GYN includes:
- A review of your detailed health history
- Physical
- Diagnostic testing, which might include labs, ultrasound, HSG (hysterosalpingogram), SIS (saline infusion sonohysterography), or hysteroscopy
We can also help arrange for semen analysis for partners.
What treatment options or interventions do you provide for fertility-related concerns?
Treatment options/interventions depend on the cause of infertility. For example, for ovulatory disorders, the recommended intervention might be lifestyle modifications for weight loss or weight gain. Or, it may be an ovulation induction agent like clomiphene.
If the cause is endometriosis, we can offer robotic-assisted resection of endometriosis. If the cause is fibroid-related, we could offer robotic myomectomy. For uterine polyps or a uterine synechiae, we could offer hysteroscopic resection.
The best option will be different for each patient based on their unique health history and circumstances. Talk to your provider and care team about the best choice for you!
Can you explain how surgical procedures (such as treating fibroids, endometriosis, or blocked fallopian tubes) can improve fertility?
A few of the surgical procedures we offer are robotic-assisted myomectomy or endometriosis excision, and hysteroscopic resection of fibroids or polyps. These help improve your fertility by restoring normal uterine anatomy, reducing obstructive effects, and improving endometrial receptivity.
What conditions do you treat in your office that may impact fertility?
We can treat PCOS, endometriosis, and fibroids.
When would you refer a patient to a fertility specialist, and how does that process work?
We refer to a reproductive endocrinologist when patients meet the criteria for infertility described above and in the absence of structural reasons for infertility. For additional support, we can refer patients to infertility support groups!
If you are struggling with infertility or have unanswered questions about your reproductive health, contact Essex County OB/GYN today. We are here to support you and provide comprehensive care through every stage of your healthcare journey.