Infertility is a problem commonly seen in the gynecologist’s office.  Traditionally, it has been defined as unprotected intercourse for one year without achieving a pregnancy. Probably the most common cause is bad timing-not having intercourse at the time of ovulation, which is why most recommend trying for a year prior to seeking help.

In order to become pregnant, five things have to occur:
1. An egg has to be released-called ovulation.
2. An adequate number of sperm have to be deposited into the vagina.
3. There has to be a sufficient amount of mucous in the cervix to allow passage of sperm into the uterus.
4. The fallopian tubes (at least one) must be open in order for the sperm and egg to meet, fertilize and to let the embryo move into the uterus.
5. The lining of the uterus must be properly hormonally prepared to allow the embryo to implant, grow and develop.

A basic infertility evaluation is easily done.  Ovulation can be documented by temperature charting, over-the-counter urine testing, blood work or ultrasound.  Semen analysis looks at the number of sperm as well as the volume of ejaculate, the shape of the sperm, the motility of the sperm and the pH (acid-base balance) of the ejaculate.  Cervical mucous is assessed by simple visualization of the amount of mucous and the activity of sperm in the mucous at midcycle called the post-coital (after intercourse) test.  A hysterosalpingogram is an x-ray study of the fallopian tubes to determine if they are open.  In order to assess the lining of the uterus, a small sample is taken by a procedure called an endometrial biopsy done just prior to the menstrual cycle.

Infertility treatment depends on the area where the problem occurs.  Ovulatory problems can be treated with ovulation induction medications or if there is a hormonal abnormality by correcting it.  Sperm deficiencies can be treated medically, surgically or by changing life style habits that may be interfering-clothing, smoking, alcohol or drug use.  Cerv ical mucous production can be enhanced by estrogen.  If the problem is severe -such as due to damage to the cervix from surgery, the cervix can be bypassed by a procedure called “intrauterine insemination”.  Tubal occlusions can sometimes be repaired surgically.  If the damage is severe and the tubes cannot be repaired, in vitro fertilization is recommended.  Proper development of the lining of the uterus is dependent on progesterone.  If the testing shows a problem, progesterone supplementation easily corrects it.

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