Fertility Overview
40-50% of cases are caused by female factors and 40-50% are attributed to male factors. Because of this, it is important to be tested as soon as you realizes they are having fertility issues. RCC Fertility can help determine the cause of infertility and suggest an effective treatment plan to help overcome it.
Causes of Infertility
The causes of infertility are numerous and not always easy to identify. In some cases, infertility can stem from an obstruction in the genital tract or from a lesion. In other cases, it may be due to low sperm count, poor sperm motility or abnormal shape.
The most common causes of reduced fertility include:
Azoospermia
Azoospermia is defined by the absence of sperm in the ejaculate.
Oligo-astheno-teratospermia (OATS)
OATS is defined as sperm of low concentration, reduced mobility and abnormal morphology. This is not a sterility problem but rather a decline in fertility.
Unexplained Infertility
Some patients go through all the recommended fertility examinations, but the cause of their infertility cannot be found with tests. More advanced investigations may be needed.
Advancing Age
Fertility declines with age. Commonly, this decline begins slowly in the late 20s and drops off more steeply by age 37. It is very rare for those patients in their late 40s and older to conceive a child naturally because aging eggs do not fertilize, implant or respond to stimulation medications as well as younger eggs. Older eggs also present an increased risk of pregnancy loss and babies with chromosomal abnormalities.
Amenorrhea
Amenorrhea means the absence of periods. There are two types: primary and secondary. Primary is often diagnosed when a patient does not have any menstrual periods before they are 16 years old. Secondary can occur when a patient has previously menstruated, but then stops menstruating for 3-6 months or more.
Endometriosis
Endometriosis is a common disorder that occurs when endometrial tissue, which lines the uterus, grows outside the uterine cavity. This misplaced tissue may implant and grow anywhere in the body, most commonly within the abdominal cavity.
Endometriosis affects everyone differently. Some patients experience no symptoms; others have severe menstrual cramps, abnormal uterine bleeding, painful intercourse and other symptoms. Patients with very little endometriosis may endure severe pain, while those with extensive endometriosis may not feel a thing.
Endometriosis can hinder conception by producing scar tissue, inflammation or adhesions which bind the ovaries, fallopian tubes and intestines together. These adhesions can interfere with the release of eggs from the ovaries or the pick-up of eggs by the fallopian tube, thereby reducing the chance of pregnancy.
Your physician may suspect endometriosis based on your history and pelvic exam, but additional tests are necessary to confirm a diagnosis. The only valid diagnostic tool is often a laparoscopy. Ultrasound and blood tests may also be used to confirm a diagnosis.
Ovulatory Disorders
A series of complex steps must occur to produce a fertilizable egg each month. If one thing goes awry, you won’t be able to get pregnant. A number of conditions can interfere with, or prevent, ovulation including:
- Polycystic Ovarian Syndrome
- Thyroid disease
- Hyperprolactinemia, a hormone that stimulates milk production and suppresses ovulation
- Low levels of fertility hormones (Hypothalamic Amenorrhea, FSH and LH)
- Premature Ovarian Failure
- Extreme weight loss or weight gain
- Excessive exercise
- Eating disorders
A decline in both egg quantity and quality make it challenging for a patients to conceive. The infertility experts at RCC Fertility know that some patients experience ovarian dysfunction well before menopause. Known as Premature Ovarian Failure (POF), or early menopause, it occurs when someone is under the age of 40 stops producing eggs capable of fertilization. On average, the age for natural menopause is about 51, but some patients with POF go into menopause much sooner.
Ovulatory disorders are the most common cause of female infertility. The good news is that many of these issues are treatable at our fertility centre in Mississauga.
Polycystic Ovary Syndrome
Polycystic ovary syndrome (PCOS), or polycystic ovary disease (PCOD), is an endocrine disorder. It is one of the most common hormone problems someone of reproductive age face. Despite the name, ovarian cysts are not usually present, although some patients have many small follicles visible on ultrasound. Egg production is affected by the hormone imbalance. Some patients with PCOS experience irregular ovulation, often having less than eight menstrual cycles per year. Other patients with PCOS can have more than one period of bleeding per month and each episode can be lengthy.
PCOS is sometimes associated with a resistance to insulin. Elevated insulin levels stimulate the ovaries to produce androgens. Those patients with PCOS are also at increased risk for diabetes, heart disease and high cholesterol. Proper diet and exercise are very important in managing this condition.
Recurrent Pregnancy Loss
When a pregnancy is lost prior to 20 weeks gestation it’s called a miscarriage. It occurs in 15-20% of pregnancies and the risk increases with age. Most miscarriages, also known as spontaneous abortions or pregnancy losses, occur within the first trimester. If a viable fetus (heart activity is seen by ultrasound) is detected in the first 12 weeks of gestation, there is a less than 5% chance pregnancy loss will occur. If vaginal bleeding occurs after a viable fetus is detected, the chance of miscarriage rises to approximately 20%.
The chances of experiencing recurrent pregnancy loss vary widely. Those patients who have had at least one full-term normal delivery have a better chance of a subsequent healthy pregnancy, despite having a miscarriage. Extensive evaluation usually only occurs after two-three consecutive miscarriages. Some patients who have recurrent pregnancy loss will find out the cause, and can be treated. An abnormal chromosome pattern in the embryo is the cause of most miscarriages. The cause is almost always unrelated to the health of the mother, although the risk of miscarriage increases for patients 35 years of age and older. By age 40, the risk is 35-40% and by 45 years of age it is more than 50%.
Recurrent pregnancy loss may be due to some of the following factors:
- Abnormalities in the shape of the uterus
- Uterine fibroids
- Genetic abnormalities
- Hormonal disorders
- Immunological factors
- Infection
- Unexplained
Unexplained Infertility
Unexplained infertility is defined as more than three years of infertility with normal semen analysis, normal ovulation by basal body temperature charting or serum progesterone and normal tubes and pelvic cavity on laparoscopy, with or without a hysterosalpingogram (HSG). Patients with normal studies and less than three years infertility have a 60% chance of conceiving within 18 months without therapy. After three years, however, the chances are 30%, or lower, of ever conceiving depending on the woman’s age and the length of infertility. This number breaks down to approximately 3%, or less, per month.
With unexplained infertility, or when traditional treatments have failed, advanced infertility treatments may be recommended by your fertility doctor. These include HS/IUI and IVF/ICSI.
Tubal Factor Infertility
The fallopian tubes are an important piece of successful fertilization and pregnancy. As many as 25% of infertile patients find that damaged tubes are the cause. Modern techniques, however, have enabled many patients with tubal damage to have healthy pregnancies.
Evaluation of the Issue
The following exams can help determine the cause of the fertility issue:
Urological Exam/ Consultation
This physical exam is instrumental in identifying a wide variety of fertility problems. The urologist starts by assessing the size of the testicles and examines the scrotum and the rectum to evaluate the prostate and seminal vesicles.
Semen Analysis
Performed at the beginning of the fertility treatment during the general work-up, this exam requires that a sperm sample be obtained through masturbation. The spermogram is a basic test used to examine the quality of sperm contained in the ejaculate as well as its consistency. It is also used to determine the number of sperm (count), the proportion of moving sperm (motility), their ability to move forward (progression) and the number of abnormal sperm (morphology).
Swim Up Semen Analysis
This is a more in depth semen test performed at RCC Fertility that looks at the function and probability of sperm being able to fertilize eggs spontaneously or with Assisted Reproductive Techniques such as IUI, IVF or ICSI.
Hormone Levels
Hormones are complex chemical substances, synthesized by an endocrine gland, that circulate in the body’s fluids. They trigger or control organs or groups of cells located elsewhere in the body.
- FSH (Follicle Stimulating Hormone) stimulates the development and maturation of Graafian follicles in the ovaries and spermatogenesis.
- Testosterone stimulates the development of certain sex characteristics.
Testicular Biopsy
This examination consists of taking a sample, under local anesthesia, of a small fragment of the testicle. The cells from this small fragment are then examined under a microscope.
Treatment Options and Possible Solutions
There are many treatment options available for those patients who experience problems with fertility.
Medical Treatment
- Antibiotics to treat an urogenital tract
- Hormones in cases where the testicle is not receiving enough stimulation from the pituitary hormones
Surgical Correction and Proposed Solutions through Medically Assisted Procreation
- Surgery to correct obstructive azoospermia. In this case, the testicles are producing sperm, but they are not found in the ejaculate because of an obstruction somewhere along the path. The surgical procedure identifies the obstruction and then removes it and reconnects the segments.
- Surgical intervention can be attempted so as to cut away the obstructed area and restore continuity between both segments.
- Intracytoplasmic Sperm Injection (ICSI): It is indicated in cases of severe infertility in conditions where abnormal sperm movement and low sperm count make it impossible for sperm to penetrate the egg. Using a sperm sample, the embryologist injects a single sperm captured using a glass needle with a microscopic diameter into each of the eggs.
- Testicular Sperm Aspiration (TESE): This treatment is only administered to those undergoing In Vitro Fertilization (IVF) with ICSI. The procedure, performed under local anesthesia, consists of taking a sperm sample directly from the testicles using a very small needle. This technique is used in cases where there is a complete absence of sperm in the ejaculate or epididymis and the testicles still produce sperm.
- Insemination.
- In Vitro Fertilization.
- In Vitro Fertilization through intracytoplasmic sperm injection (ICSI).
The doctors at RCC Fertility in Mississauga are here to help diagnose and treat your infertility. Contact us today to speak with a specialist!