Infertility

Female Infertility

The inability of women to conceive after a year of having unprotected sex, or the inability of women to sustain pregnancy is known as infertility.

When to get help?

You may have reason to be concerned if you have been trying to get pregnant for at least one year and:

• You are in your late 30s and have been trying to get pregnant for six months or longer
• Your menstrual cycles are either irregular or absent
• You have painful periods
• You have a known history of fertility problems
• You have a history of pelvic inflammatory disease or endometriosis
• You have had multiple miscarriages
• You have been treated for cancer with drugs and radiation

What are the causes?

Infertility can be present from birth (congenital) or can be acquired as you age. Some of the causes may include:

• Problems with ovulation: Certain conditions, like polycystic ovarian syndrome (ovaries secrete excessive amounts of male hormone testosterone) and hyperprolactinemia (produce high amounts of prolactin, a hormone that induces the production of breast milk), can prevent your ovaries from releasing eggs.
• Damaged fallopian tubes: Fallopian tubes carry the eggs from the ovaries to the uterus. Any damage to them can affect the fertilization of the egg by the sperm. Pelvic surgeries and infections can cause formation of scar tissue that can damage your fallopian tubes.
• Abnormalities of the cervix and uterus: Abnormal mucus production in the cervix, problems with the cervical opening, abnormal shape and presence of benign tumors in the uterus can all contribute to infertility.
• Premature menopause: Mostly caused by a condition known as primary ovarian insufficiency, premature menopause occurs when menstruation stops before the age of 40. The exact cause of this condition is unknown, though various treatments for cancer and abnormalities with the immune system have been known to contribute to it.
• Adhesions: Bands of scar tissue can form in the pelvis after an infection or surgery.
• Other medical conditions: Diabetes, endometriosis, thyroid disorders, sickle cell disease or kidney diseases can affect the fertility of a woman.
• Medications: Certain medications have been known to cause temporary infertility. Stoppage of those medications can restore fertility in most of the cases.

Who is at risk?

Your risk for infertility increases with age. You are at a greater risk if you smoke, consume excess alcohol, or are overweight, obese, or underweight.

Diagnosis

Female infertility can be confirmed with the following tests:

• Blood tests measure your hormone levels and determine if you are ovulating.
• Biopsies may be obtained to evaluate the inner lining of your uterus.
• Ovarian reserve testing may be performed in order to determine the number and quality of eggs ready for ovulation.
• Imaging studies such as a pelvic ultrasound or hysterosonography may be performed to obtain a detailed view of your fallopian tubes and uterus.
• Hysterosalpingography involves obtaining an x-ray image after injecting a contrast material into your cervix which travels up to your fallopian tubes. This can help identify any blockages in your fallopian tubes.
• Laparoscopic evaluation involves inserting a thin tube fitted with a camera through an incision in your abdomen, in order to detect any abnormalities in your reproductive organs, such as the ovaries, uterus, and fallopian tubes.

How is infertility treated?

Dr. Pinto has over 20 years of experience in treating fertility with conventional and non-conventional medical approaches. We are so excited to introduce Healthy Living Dallas as an add-on service to infertility treatment that he practices at his ReproMed Fertility practice. Research has been accumulating over the last 10-15 years that particular nutrients can drastically affect egg heath and viability, help regulate menses, reduce effects of polycystic ovary syndrome that result in increased difficulty getting pregnant or sustaining pregnancy. Several recent research studies have noted a significant increase in fertility in individuals with polycystic ovary syndrome or male infertility who use nutrition as an adjunct therapy to standard fertility procedures.

Dr. Pinto will use a combination of nutrition and lifestyle recommendations with traditional fertility treatments to help you have the best chances of starting or growing a family of your own. Traditional approaches may include fertility drugs to stimulate and regulate ovulation, in women who are infertile due to ovarian disorders. You could also be chosen for assisted insemination, where healthy sperm is collected, concentrated, and placed directly into your uterus, when your ovary releases eggs to be fertilized. This procedure is also known as intrauterine insemination (IUI), and can be in tandem with your normal menstrual cycle or fertility drugs. Apart from these, problems with your uterus, such as intrauterine polyps or scar tissue, can be treated with surgery.

In vitro fertilization (IVF) is a type of assisted reproductive technique, which involves collecting multiple mature eggs from a woman and fertilizing them with sperm outside the body, in the lab. Once fertilized, the embryos are implanted into the uterus within three to five days.

Some of the other techniques used in IVF include intracytoplasmic sperm injection (a single healthy sperm cell is directly injected into a mature egg), assisted hatching (the outer covering of the embryo is removed to facilitate embryo implantation into the uterus), and using donor eggs or sperm. Gestational surrogates may also be considered for women for whom pregnancy poses high health risks, or for those who have a nonfunctional uterus.

Conclusion

Infertility can be of a variety of causes, and the treatment may differ accordingly. Dealing with infertility can be difficult, stress, and emotional, but there is hope – about two-thirds of couples treated for infertility conceive successfully. Dr. Pinto will address your concerns, both emotionally and medically during this journey together.

Male Infertility

Male infertility is a common reproductive problem affecting men. It is a condition where the male in the relationship affects the ability of the woman to become pregnant. When couples are not able to conceive even after having unprotected sex over a long period of time, it is important for both partners to be checked by their physician. Up to 1 out of 3 infertility cases are linked partly to issues with the male partner. A number of tests are performed to help confirm the diagnosis of male infertility.
With the advancements in medical technology, it is now possible to treat the condition of male infertility.

Causes of male infertility:

Male fertility may be impaired by a number of factors. These include:

• Sperm production problems: The quality and quantity of sperm are the key factors to male fertility. Any defect such as immature sperm or low sperm count (oligospermia) can lead to infertility.
• Varicoceles: This is a condition characterized by swelling of the veins that supply the testicle.
• Backward ejaculation of the sperm
• Blockage of the sperm carrying ducts
• Development of sperm antibodies (auto-immune disorder)
• Hormonal/stress problems
• Infections/tumors of the male reproductive system
• Genetics (chromosomal disorders)
• Sexual problems
• Use of certain medications such as steroids
• Excessive radiation exposure affects the sperm production.
• Work related causes (example: laptop use elevates the temperature of the testes leading to low sperm production)
• Smoking and alcohol abuse

Diagnosis:

Your doctor will make the diagnosis of male infertility based on the following:

• Medical history
• Complete physical examination
• Semen analysis: This is a laboratory test carried out to assess the sperm count and quality. The test sample is obtained by ejaculating into a sterile bottle.
• Transrectal ultrasound of the prostate: It is an investigation carried out to evaluate the prostate gland and detect any obstruction of the ducts that transport the sperm.
• Scrotal ultrasound: This is an imaging test to diagnose abnormalities of the scrotum or testicles.
• Testicular biopsy: A small piece of tissue is removed from the testicle using a sterile needle and sent for evaluation under a microscope to help determine the cause of infertility.
• Anti-sperm antibody tests to trace the antibodies that attack sperm.

Treatment:

• Lifestyle modification: These include changing habits such as not smoking, limiting alcohol intake, and using stress reduction techniques. Appropriate nutrient intake and status, regular and sustained exercise, and appropriate body composition can all related to the amount and quality of sperm that a male produces.
• Surgery: Surgery is indicated in cases of varicocele and obstruction of the sperm duct to improve the sperm motion.
• Medications: Antibiotics are prescribed to treat infections of the reproductive system.
• Treatment for sexual problems: Counseling about sex and relationships can help boost fertility levels.
• Male hormone replacement therapy may be used to treat hormonal deficiency.
• Assisted reproductive technology (ART): These are revolutionary treatment procedures that help couples with infertility problems to conceive. Some of them include in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) methods.

As a male, you have a unique opportunity to control the type and quality of genes that you pass to your children since sperm is made at regular intervals. Your body can change what genes are ‘expressed’ based on your current food choices, exercise patterns, and lifestyle choices. Making healthy decisions now can help influence your child’s health in the future.

Your Weight and Fertility- The Facts Behind How Weight Affects Fertility and Fertility Outcomes