Every Day

May - July 2006 Issue

Female Infertility Has Many Causes

“When a couple is having difficulty conceiving, there may be many causes,” says Paul Robb, MD, Medical College of Wisconsin obstetrician/gynecologist. Dr. Robb evaluates and treats women for infertility in the Reproductive Medicine Clinic at Froedtert & the Medical College of Wisconsin.

In the Reproductive Medicine Clinic, Dr. Robb partners with Estil Strawn, Jr., MD, and Jay Sandlow, MD, along with in vitro fertilization (IVF) lab experts, nurses and other support staff. Dr. Strawn is a Medical College of Wisconsin obstetrician/gynecologist, medical director of the Reproductive Medicine Clinic and director of Reproductive Endocrinology and Infertility. Dr. Sandlow is a Medical College of Wisconsin urologist who specializes in male infertility. He is also vice chairman of Urology.

“About 40 percent of infertility in couples is female-related and about 40 percent is male-related,” says Dr. Robb. “In other cases, the problem may be caused by a combination of male/female factors, or the cause may be unknown.”

Drs. Robb, Strawn and Sandlow help couples struggling with a wide range of fertility issues. The Reproductive Medicine Clinic is one of few in the country to offer treatment for males and females in one setting. The service was created so couples may be evaluated and counseled by a reproductive endocrinologist and urologist during the same visit. This approach ensures both partners hear explanations and treatments recommendations at the same time. It also ensures that physicians treating the couple coordinate their plan of care.

“Infertility is not a woman’s or a man’s problem; it’s a couple’s issue and finding the cause must involve both partners,” Dr. Robb says. He recommends treatment after one year of unprotected intercourse — sooner if the woman has an obvious problem such as irregular menstrual cycles or blocked tubes or is over age 35.

In women, the cause of infertility generally falls into four categories:

40 percent related to ovulation
40 percent related to tubal factors (blocked or damaged fallopian tubes) or other problems in the abdominal area, such as endometriosis, adhesions or infections
10 percent related to unusual problems, such as disorders of the uterus or cervix
10 percent remain unexplained

Within these groups are many other factors. For example, ovulation problems may be due to polycystic ovary syndrome, a chronic disorder involving a hormonal imbalance that causes abnormal functioning of the ovaries.

If the fallopian tubes are blocked or damaged, eggs can’t travel through the tubes into the uterus. A blocked tube may be caused by an infection of the tubes called pelvic inflammatory disease, endometriosis, (when cells that normally line the uterus grow outside the uterus) or prior surgery such as tubal ligation, (having the tubes “tied”) as well as other factors.

Uterine problems may be related to a malformation of the uterus, fibroids (benign tumors) or polyps. All of these conditions may prevent a fertilized egg from implanting in the uterus.

Age is another factor. As a woman ages, her ovaries lose the ability to produce eggs and proper levels of hormones. Fertility declines with age and this decline occurs more sharply between ages 38 and 40. After age 42, it can be difficult for a woman to conceive.

“To determine the cause of infertility in a woman,” Dr. Robb says, “we take a complete medical history and typically conduct hormonal testing and an exam of the reproductive system. There may be more than one factor responsible.”

Treatment Options

“Treatment for infertility depends on the cause(s) as well as the woman’s age,” Dr. Robb says. “We also must consider fertility problems the woman’s partner may have when we plan treatment. Getting a woman to ovulate when her partner has a very low sperm count may not be useful. The couple will likely require IVF. In addition, we investigate why the man’s sperm count is so low and if this relates to other health concerns for him.

“We look beyond infertility treatment and think of the patient’s whole health,” Dr. Robb says.

Many infertility problems can be treated with medication or surgery. For unexplained infertility, a combination of oral medication and intrauterine insemination may help. Assisted reproduction, such as IVF, is another option for couples. This involves collecting a woman’s eggs and fertilizing them in the lab. Sperm provided by the partner is mixed with the woman’s eggs and the fertilized eggs, now embryos, are transferred to the uterus, where a pregnancy may occur.

“Because health insurance often does not cover infertility treatment, we’re mindful of the financial burden it can create,” Dr. Robb says. “Our goal is to help couples conceive in the most natural, cost-conscious manner, always keeping in mind their wishes.”

Source: Every Day

Date: May - July 2006 Issue