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Houston Fertility Journal

    Infertility Care Simplified: Let's Break it Down

    Aug 10, 2018, 1:48:07 PM / by Center of Reproductive Medicine   

    Center of Reproductive Medicine

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    One in eight couples struggles with infertility. Nearly 12% of women have sought or received services for infertility. Infertility is tragically common. It’s also shrouded in secrecy. Many couples choose to suffer in silence, thanks to cultural stigma and messages about what infertility means. This can make infertility a deeply isolating experience. You might not know what to expect, or might think you don’t know anyone who has walked this lonely road before.

    Rest assured, you are not alone. Infertility care includes a wide range of treatment options. It’s about far more than just IVF. Here’s what you can expect from your journey, and what options your doctor may suggest.

    The Consultation

    Your fertility appointment begins with a consultation. You’ve probably spent a lot of time and expended a lot of emotional energy getting to this point. So the first visit might feel a bit anticlimactic. There won’t be any treatment, and there might not be any testing. Instead, this is a chance to orient you to the practice, to get to know you as a person before the team begins poking around and looking for medical problems.

    During your initial follow-up, you may meet with a fertility counselor, a doctor, a nurse, or all three. You’ll discuss:

    • Your fertility history, including your detailed medical history and how long you’ve been trying. You’ll answer questions about each partner’s health and fertility, including the woman’s menstrual cycle and the man’s sexual functioning.
    • Your values. Are there certain fertility treatments you want to avoid? Is a specific approach to pregnancy important to you? How aggressive do you want to be with treatment? Would you rather start with a conservative approach, or use the approach that is most likely to be effective first?
    • Your lifestyle and diet. What do you eat? Do you exercise? Are you taking supplements?
    • Your well-being. How has infertility affected you or your relationship? What would make things better?
    • The specific tests that may be right for you, and the reasons to consider them.
    • A brief overview of treatment options, though you’ll get more into that after you get your diagnostic test results back.
    • Finances. We’ll discuss what insurance may cover, including treatments for underlying conditions, and what it might not cover. We’ll talk with you about financing, about paying for treatment, and about strategies that can keep your costs low.
    • Any questions or concerns you may have. We often find that our patients arrive at our clinic with a number of myths and misconceptions about infertility and its treatment. We want to dispel myths and ensure you have accurate, useful, actionable information. A proactive patient is a patient who is healthier, happier, and more likely to have a healthy pregnancy.

    We want to get to know you as a person. We want you to get to know us, too. After all, we’re working with you on an intimate and emotionally fraught topic. We want you to feel comfortable being vulnerable, and to always feel like we treat you -- and value you -- as a human being, not a “problem” or a patient.

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    Initial Testing

    To treat infertility, we first have to see what’s wrong. Dozens of medical conditions can cause infertility. Most cases of infertility involve either infrequent or absent ovulation, or issues with the man’s sperm count. Numerous underlying conditions can cause these problems. One of the most common in women is polycystic ovary syndrome (PCOS), which is a hormone disorder that can be detected based on symptoms and blood work.


    The right initial testing depends on your symptoms and medical history. Some tests you can expect include:

    • Blood work to measure hormone levels, detect certain disease, and look for signs of infection.
    • Semen analysis to test a man’s sperm quality, count, and motility.
    • Imaging scans, such as of the fallopian tubes, to look for inflammation, blockages, and other problems.

    We may also do additional testing if we suspect there may be a chronic underlying medical condition. The goal is to get a clear diagnosis, and to ensure that the diagnosis fully explains the infertility. Having one diagnosis doesn’t necessarily explain the problem. For example, a woman might have a disorder that prevents ovulation. But if the man also has a low sperm count, treatment only the woman’s side of things won’t resolve the problem. That’s why we aim for testing to be thorough and complete.

    Sometimes the cause of infertility is unexplained. This is known as unexplained infertility. That doesn’t mean nothing is wrong. It simply means we can’t find the cause. We aim to avoid this whenever possible. When it happens, we try to focus on treatment strategies that are likely to maximize fertility.

    Follow-Up Testing

    Sometimes we discover something in our testing that necessitates follow-up testing. For instance, we might realize that the woman is not ovulating, requiring us to test for issues linked to ovulation. Or we might find that there are no sperm in a man’s semen, suggesting there might be a structural or hormonal problem.

    We may also do some initial treatment and then need follow-up testing. If we find that a woman needs hormonal treatments, we might treat with hormones and then test her levels again at the end of a month or two. This follow-up testing is as important as initial testing. In many cases, it means the difference between having an idea of what’s wrong and knowing the problem with certainty.

    Reviewing Treatment Options

    After initial testing, we’ll review your treatment options. The world of infertility care offers a wide range of treatment options tailored to your needs and overall health. Some of the most common infertility treatments include:

    • Lifestyle changes such as changing diet or exercising more. In women with PCOS who are insulin resistant, this can increase the chances of a pregnancy. In almost all people, a healthier body is a useful complement to infertility treatment.
    • Hormone treatments. One of the best and most reliable options is using the drug Clomid to induce ovulation. This works well in women who don’t ovulate or who ovulate infrequently. Even if the man has issues with his sperm, more frequent ovulation can increase the chances of a successful pregnancy. Women who don’t produce enough progesterone can have trouble sustaining an early pregnancy. Progesterone treatments may help.
    • Treating underlying medical conditions. Sometimes a serious medical condition is a culprit. For instance, pelvic inflammatory disease due to an untreated STD can make it difficult for the egg to implant in the uterus. We may offer medication, lifestyle changes, or refer to surgery to address a medical condition.
    • Clearing blocked fallopian tubes. Adhesions and scar tissue can block the fallopian tubes, making it difficult for an egg to travel through the uterus. A number of different procedures can detect and clear blocked tubes.
    • Using donor sperm or eggs. If one partner does not produce sperm or eggs, or the sperm or eggs are of very low quality, working with a donor can be a faster route to a pregnancy.
    • Surgery. A number of medical conditions can make pregnancy more difficult. Surgery can remove endometrial tissue due to endometriosis. It can also address uterine fibroids.
    • Intrauterine insemination (IUI). This treatment inseminates an egg with sperm at the time of ovulation, increasing the odds of a successful pregnancy. Unlike IVF, IUI occurs inside the body.
    • In vitro fertilization (IVF). This is a procedure that fertilizes the egg outside of the body. Then, when the egg grows into an embryo, it is placed back in the uterus.
    • Sperm retrieval. When a man can’t ejaculate, or if his sperm count is very low, surgically retrieving sperm can allow the sperm to be implanted into the woman’s body.

    In many cases, the right treatment is a blend of several of the above treatments. Some couples may need other treatments, especially if they have rare medical conditions.

    Pursuing Treatment

    You are the one in the driver's seat when it comes to treatment. While your doctor will test you and recommend which treatments might work best, it’s up to you to decide which to pursue. Some factors you’ll discuss with your doctor following diagnosis include:

    • The specifics of each treatment, including potential risks and side effects.
    • The success rate for each treatment, particularly the likely success rate when taking into account your age, lifestyle, and other factors.
    • The cost of treatment.
    • Whether there are less expensive or invasive treatment available.
    • What the odds are, given your diagnosis, of a successful pregnancy without treatment.
    • Whether lifestyle changes might be an alternative eto treatment.

    Supporting a Healthy Pregnancy

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    If treatment works, you or your partner will soon be pregnant. Pregnancy is just the beginning of the journey. Some infertile couples struggle with repeat miscarriage, or with chemical pregnancy. So during the first weeks of the pregnancy, we’ll continue monitoring your progress. We may perform hormone tests and other assessments to ensure the pregnancy is healthy. Sometime late in the first trimester, you’ll transition care to an obstetrician or midwife. If you have other medical conditions or a high-risk pregnancy, we may also refer you to a maternal-fetal medicine (MFM) specialist.

    Adjusting and Adapting Treatment Options

    If the first treatment doesn’t work, or if you or your partner have a miscarriage, you might feel demoralized. That’s normal and understandable. But there’s a bright spot at the end of this long tunnel: failed treatments give us important information about your fertility. We can then use this information to increase your odds of success next time. For instance, if we are able to induce ovulation in a woman with PCOS, but the egg fails to implant, we may take steps to support implantation nxt time.

    Fertility medicine uses the scientific method -- the process of information-gathering and trial and error -- to get ever closer to a solution. This is one of the many reasons it’s so important and beneficial to work with a fertility expert, rather than just relying on your family doctor or gynecologist. Fertility medicine is constantly changing, and a specialist is far more equipped to know about recent developments in the field and to provide comprehensive, quality care that works.

    Emotional Support and Care

    Infertility care is about more than just sperm and eggs, babies and pregnancies. We are keenly aware that we are treating human beings. Trying to make a baby is about trying to shape your future and your family. It is a profound act of love and hope. It matters, regardless of the ultimate outcome of fertility treatment.

    One of the benefits of seeing a fertility specialist is that you’ll know you’re doing all you can to solve this problem. That can free up time and space in your mind. It can ease the relationship stress of infertility. It can free you to focus on work, stop obsessing over your cycle, and stop taking advice from the Internet.

    At the Center of Reproductive Medicine, we also offer referrals to therapists, support groups, and other resources. We know that infertility is tough, and we want to help ease the burden. Your well-being matters. Let us help you find your way back to emotional health.

    When to Seek Treatment

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    It’s never too early to seek infertility care. Fertility declines with age, so if you’re not having luck getting pregnant, each passing month could be a month of wasted time if there’s something wrong.

    We recommend seeking fertility treatment:

    • After a year of trying if the woman is under the age of 35.
    • After six months of trying if the woman is over the age of 35.
    • If either partner has a serious, chronic medical condition.
    • If either partner has a history of infertility.
    • If you are over the age of 40.
    • If you are trying to get pregnant without a partner.
    • If you use medications that affect your immune system or fertility.
    • If you have had two or more consecutive miscarriages.
    • The woman has reason to believe she is not ovulating.
    • The man is unable to ejaculate or has a serious physical deformity.
    • The woman has very irregular periods, or menstrual cycles that are longer than 35 days or shorter than 25 days.

    It’s also important to trust your body and your intuition. So if you have a feeling something might be wrong, there’s no shame in seeking early treatment. A quick consultation may ease your mind, or uncover a treatable issue.

    With 5 locations in and around Houston, Texas, the Center of Reproductive Medicine is committed to your physical and emotional health. We believe in your ability to have a child, and we want to find infertility solutions that are consistent with your values. You can do it with our help.

    Ready to begin your journey? Give us a call today.

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    Topics: Fertility Specialist, Fertility Journey, Infertility Treatment

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