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Ultrasound for Infertility

Dr. HelloDox Care #
HelloDox Care
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Ultrasound for infertility

What is Ultrasound for infertility?
Ultrasound scans are an essential part of infertility testing and fertility treatment. If you’ve had a child before, you may be familiar with the kind of ultrasound done during mid to late pregnancy. Even if you’ve never had a child, you may have seen pregnancy ultrasound exams on movies or television. Or, perhaps, a friend or family member may have shared an ultrasound image of their unborn child with you.

Ultrasounds done during mid to late pregnancy are usually abdominal ultrasounds. In other words, a transducer (a device that emits and receives sound waves for an ultrasound) is moved around over the abdomen.

For fertility testing and treatment, the majority of ultrasounds are done transvaginally—that is to say via the vagina—with a slender specialized wand.

The ultrasounds are not painful, though they can be slightly uncomfortable.

During infertility testing, ultrasound scans can provide information on the ovaries, endometrial lining, and uterus. Specialized ultrasounds can be used to evaluate ovarian reserves, the uterine shape in more detail, and whether the fallopian tubes are open or blocked.

During fertility treatment, ultrasound is used to monitor follicle development in the ovaries and the thickness of the endometrial lining. Ultrasound is also used during IVF for egg retrieval, to guide the needle through the vaginal wall to the ovaries. Some doctors use ultrasound during embryo transfer.

If you get pregnant, your reproductive endocrinologist will likely order a few ultrasounds before transferring you back to your regular OB/GYN.

Infertility Ultrasound Scan Basics:
Ultrasound scans work by using high-frequency sound waves to create an image of your internal organs. You won’t be able to hear the sound waves.

A transducer is a device used during an ultrasound to emit and receive these high-frequency sound waves. During fertility testing and treatment, the technician is likely to use two different kinds of transducer devices: one that is used for abdominal ultrasound and a second that is used transvaginally.

During an abdominal ultrasound, a gel is squirted over your abdomen. Then, the transducer is gently moved over the abdomen. The gel makes it easier for the transducer to slide around over your skin.

During a transvaginal ultrasound, the transducer is shaped like a slender, long wand. A condom is placed over the wand and a lubricant gel is generously squirted over the condom.

The technician will hand you the handle of the transducer wand, so you can place the transducer gently inside of your vagina as far as it will comfortably go. You will then hand off the handle to the technician, who will conduct the exam.

Sound waves are emitted by the transducer. They echo (or bounce back) when they hit your internal organs. The ultrasound machine interprets these signals and turns them into a digital image.

Before an abdominal ultrasound, your doctor will likely ask you to drink several cups of water in the hours before your exam but request that you don’t relieve yourself if you feel the need to urinate. (You probably will feel the urge to go!)

A full bladder pushes your intestines out of the way, so your reproductive organs are easier to see. Once the abdominal ultrasound is finished, you’ll be able to use the bathroom.

However, to see the detail needed for fertility testing and treatment, transvaginal ultrasound provides even better imagery.

The transvaginal transducer tip is placed right below the cervix, which is closer to your reproductive organs.

Beside the abdominal and transvaginal ultrasound, there are other specialized ultrasound scans that your doctor may request.

Antral follicle count ultrasound: this is done with the usual transvaginal ultrasound device, but requires special training for the technician to complete accurately.
Antral follicle count ultrasounds can help determine your ovarian reserves and possibly help diagnosis polycystic ovarian syndrome (PCOS). You may or may not have an antral follicle count exam as part of your basic fertility workup.
This may also be scheduled separately or at the same time as a general ultrasound scan.
3D ultrasound: Most ultrasound imagery is two-dimensional. Advancing technology now can also generate three-dimensional images.
This allows for better detection of some uterine abnormalities and fallopian tube problems that are not visible on a typical 2D ultrasound scan.
Sonohysterogram: A sonohysterogram is a specialized ultrasound that involves transferring a saline solution into the uterus via a catheter. The saline solution fills your uterus, making it easier to visualize the shape and any possible adhesions within.
A sonohysterogram may be done during a basic fertility workup, but is more commonly used for specific situations.

Hysterosalpingo-contrast sonography (HyCoSy): This is similar to a sonohysterography, except a dye or a saline solution mixed with air bubbles is used to determine whether the fallopian tubes are open or blocked.
It’s more common for doctors to evaluate whether the fallopian tubes are open with an HSG, which is a specialized X-ray.
The advantages of having an HyCoSy over an HSG are that the HyCoSy may cause less discomfort than an HSG.
HyCoSy doesn’t require radiation or iodine exposure.
An HyCoSy may be done at the same time as a general ultrasound exam (which would mean one less appointment).

What Your Doctor Is Evaluating With Ultrasound?
General position and presence of the reproductive organs: Is everything that should be there present? Is everything in the correct area?

It seems like a very basic question, but some women are born without the ovaries or their uterus.

The ovaries: The ultrasound tech will look at your ovaries. She will take note of their size and shape.

She will also look for evidence of both normal and not normal cysts on the ovaries. Many small cysts that look like a pearl necklace may indicate polycystic ovarian syndrome. The presence of a larger endometrioma cyst may indicate possible endometriosis.

In rare cases, a mass that is not a cyst may be found on the ovaries.

Antral follicle count: This may be part of a general infertility ultrasound scan or may be scheduled separately. Antral follicles are a specific kind of follicle found in the ovaries. They are part of the egg/oocyte lifecycle.

A very low antral follicle count may indicate poor ovarian reserves. An unusually high antral follicle count may indicate PCOS.

The uterus: The ultrasound tech will note the uterine size, shape, and position.

If the ultrasound is 3D, it may also be possible to visualize certain uterine abnormalities, like a bicornuate or septate uterus.

The technician will also look for any indication of uterine masses, like fibroids, polyps, or an adenomyosis.

These can’t always be seen with a regular ultrasound. Further evaluation may require a sonohysterogram or a hysteroscopy.

Endometrium thickness: The lining of the uterus, the endometrium, thickens and changes as your menstrual cycle progresses.

The technician will look for healthy indications that the endometrium is at the stage it should be, based on the day of your exam.

The ultrasound tech will also measure the thickness of the endometrium. It should be thin before ovulation and thicker after ovulation.

Possibly fallopian tube problems: A basic ultrasound isn’t capable of capturing healthy fallopian tubes. However, a fallopian tube may be seen with a regular 2D ultrasound if it is swollen or filled with fluid, which can occur with a hydrosalpinx.

A basic ultrasound can’t determine if the fallopian tubes are clear and open. To evaluate whether the tubes are open or closed, your doctor will most likely order an HSG.

However, with a specialized ultrasound known as a hysterosalpingo-contrast sonography (HyCoSy), your doctor may be able to detect whether the tubes are blocked or not.

Possible evidence of adhesions: By gently pressing on the reproductive organs with the transvaginal transducer, the technician can see if the organs move freely and as they should, or if they seem to adhere to each other.

The tech may also use the ultrasound wand to gentle push at the ovaries, to see how they move around in the pelvic cavity. Ovaries that seem stuck to each other are sometimes called “kissing ovaries.”

Adhesions may prevent the reproductive organs from freely moving. Adhesions can form from a previous pelvic infection or from endometriosis.

Blood flow to reproductive organs: if your doctor is using color Doppler, the technician may be able to evaluate blood flow around a cyst or mass. This can help distinguish between a healthy cyst, an endometrial cyst (endometrioma), or an ovarian tumor.

Here’s what to expect:

Baseline ultrasound scan: Your doctor will likely tell you to call their office on the first day of your period, the month of your scheduled treatment cycle. They will want to schedule blood work and an ultrasound within the next few days.

This is known as your baseline ultrasound. The purpose is to check that there are no unusual cysts on the ovaries before starting the fertility drugs.

Sometimes, a stubborn corpus luteum cyst sticks around even after your period starts. This isn’t dangerous and will usually go away without intervention. However, treatment may be delayed in the meantime. Fertility drugs could exasperate the cyst.

(This first transvaginal ultrasound will likely occur when you're menstruating. While this can be an uncomfortable experience, it's nothing to be embarrassed about. You're not the first woman to be on her period during an ultrasound exam. This doesn't bother the ultrasound technician at all.)

Follicle growth: This is the number one monitoring focus during fertility treatment. These are all transvaginal ultrasound scans, and, depending on your treatment, you may be at the clinic every couple of days for one of these scans.

The doctor or ultrasound tech will be looking to see how many follicles are developing and how quickly they are growing. Your fertility medications may be adjusted up or down, depending on follicle growth.

Once the follicles reach a particular size, your “trigger shot” (an injection of hCG) or the egg retrieval will be scheduled.

It’s also possible that too few or too many follicles may develop.

If you’re going through IVF treatment, and few to no follicles are appearing, your cycle may be canceled.

If you’re having IUI or gonadotropin treatment, and too many follicles are growing, your cycle may be canceled to avoid the risk of having a high-order multiple pregnancy.

Endometrial thickness: The ultrasound tech will also likely measure your endometrial thickness. Based on this information, your doctor may change your fertility medication dosages.

Ultrasound-guided procedures: Not a part of monitoring, ultrasound may also be used during treatment itself.

During egg retrieval, for IVF treatment, an ultrasound-guided needle is used to retrieve eggs from the ovaries. Some doctors also use ultrasound during embryo transfer.

Published  

Vitamins in Body

Dr. HelloDox Care #
HelloDox Care
Consult

Vitamins in Body

Published  

Infertility

Dr.
Dr. Sairandhri Shinde
MBBS Gynaecologist Infertility Specialist 10 Years Experience, Pune
Consult

Infertility

What is infertility?

Infertility is defined as not being able to get pregnant (conceive) after one year (or longer) of unprotected sex. Because fertility in women is known to decline steadily with age, some providers evaluate and treat women aged 35 years or older after 6 months of unprotected sex. Women with infertility should consider making an appointment with a reproductive endocrinologist—a doctor who specializes in managing infertility. Reproductive endocrinologists may also be able to help women with recurrent pregnancy loss, defined as having two or more spontaneous miscarriages.
Pregnancy is the result of a process that has many steps.

To get pregnant
A woman’s body must release an egg from one of her ovaries (ovulation).
A man’s sperm must join with the egg along the way (fertilize).
The fertilized egg must go through a fallopian tube toward the uterus (womb).
The fertilized egg must attach to the inside of the uterus (implantation).
Infertility may result from a problem with any or several of these steps.
Impaired fecundity is a condition related to infertility and refers to women who have difficulty getting pregnant or carrying a pregnancy to term.

Is infertility just a woman's problem?

No, infertility is not always a woman’s problem. Both men and women can contribute to infertility.
Many couples struggle with infertility and seek help to become pregnant, but it is often thought of as only a woman’s condition. However, in about 35% of couples with infertility, a male factor is identified along with a female factor. In about 8% of couples with infertility, a male factor is the only identifiable cause.

What causes infertility in men?

Infertility in men can be caused by different factors and is typically evaluated by a semen analysis. When a semen analysis is performed, the number of sperm (concentration), motility (movement), and morphology (shape) are assessed by a specialist. A slightly abnormal semen analysis does not mean that a man is necessarily infertile. Instead, a semen analysis helps determine if and how male factors are contributing to infertility.

Disruption of testicular or ejaculatory function
Varicoceles, a condition in which the veins on a man’s testicles are large and cause them to overheat. The heat may affect the number or shape of the sperm.
Trauma to the testes may affect sperm production and result in lower number of sperm.
Unhealthy habits such as heavy alcohol use, smoking, anabolic steroid use, and illicit drug use.
Use of certain medications and supplements.
Cancer treatment involving the use of certain types of chemotherapy, radiation, or surgery to remove one or both testicles
Medical conditions such as diabetes, cystic fibrosis, certain types of autoimmune disorders, and certain types of infections may cause testicular failure.
Hormonal disorders
Improper function of the hypothalamus or pituitary glands. The hypothalamus and pituitary glands in the brain produce hormones that maintain normal testicular function. Production of too much prolactin, a hormone made by the pituitary gland (often due to the presence of a benign pituitary gland tumor), or other conditions that damage or impair the function of the hypothalamus or the pituitary gland may result in low or no sperm production.
These conditions may include benign and malignant (cancerous) pituitary tumors, congenital adrenal hyperplasia, exposure to too much estrogen, exposure to too much testosterone, Cushing’s syndrome, and chronic use of medications called glucocorticoids.
Genetic disorders
Genetic conditions such as a Klinefelter’s syndrome, Y-chromosome microdeletion, myotonic dystrophy, and other, less common genetic disorders may cause no sperm to be produced, or low numbers of sperm to be produced.

What causes infertility in women?

Women need functioning ovaries, fallopian tubes, and a uterus to get pregnant. Conditions affecting any one of these organs can contribute to female infertility. Some of these conditions are listed below and can be evaluated using a number of different tests.

Disruption of ovarian function (presence or absence of ovulation (anovulation) and effects of ovarian “age”)

A woman’s menstrual cycle is, on average, 28 days long. Day 1 is defined as the first day of “full flow.” Regular predictable periods that occur every 24 to 32 days likely reflect ovulation. A woman with irregular periods is likely not ovulating.

Ovulation can be predicted by using an ovulation predictor kit and can be confirmed by a blood test to check the woman’s progesterone level on day 21 of her menstrual cycle. Although several tests exist to evaluate a woman’s ovarian function, no single test is a perfect predictor of fertility. The most commonly used markers of ovarian function include follicle-stimulating hormone (FSH) value on day 3 to 5 of the menstrual cycle, anti-müllerian hormone value (AMH), and antral follicle count (AFC) using a transvaginal ultrasound.

Disruptions in ovarian function may be caused by several conditions and warrants an evaluation by a doctor.

When a woman doesn’t ovulate during a menstrual cycle, it’s called anovulation. Potential causes of anovulation include the following

Polycystic ovary syndrome (PCOS). PCOS is a condition that causes women to not ovulate, or to ovulate irregularly. Some women with PCOS have elevated levels of testosterone, which can cause acne and excess hair growth. PCOS is the most common cause of female infertility.
Diminished ovarian reserve (DOR). Women are born with all of the eggs that they will ever have, and a woman’s egg count decreases over time. Diminished ovarian reserve is a condition in which there are fewer eggs remaining in the ovaries than normal. The number of eggs a woman has declines naturally as a woman ages. It may also occur due to congenital, medical, surgical, or unexplained causes. Women with a diminished ovarian reserve may be able to conceive naturally but will produce fewer eggs in response to fertility treatments.
Functional hypothalamic amenorrhea (FHA). FHA is a condition caused by excessive exercise, stress, or low body weight. It is sometimes associated with eating disorders such as anorexia.
Improper function of the hypothalamus and pituitary glands. The hypothalamus and pituitary glands in the brain produce hormones that maintain normal ovarian function. Production of too much of the hormone prolactin by the pituitary gland (often as the result of a benign pituitary gland tumor), or improper function of the hypothalamus or pituitary gland, may cause a woman not to ovulate.
Premature ovarian insufficiency (POI). POI, sometimes referred to as premature menopause, occurs when a woman’s ovaries fail before she is 40 years of age. Although certain exposures, such as chemotherapy or pelvic radiation therapy, and certain medical conditions may cause POI, the cause is often unexplained. About 5% to10% of women with POI conceive naturally and have a normal pregnancy.
Menopause Menopause is an age-appropriate decline in ovarian function that usually occurs around age 50. By definition, a woman in menopause has not had a period in one year. She may experience hot flashes, mood changes, difficulty sleeping, and other symptoms as well.
Fallopian tube obstruction (whether fallopian tubes are open, blocked, or swollen)

Risk factors for blocked fallopian tubes (tubal occlusion) can include a history of pelvic infection, history of ruptured appendicitis, history of gonorrhea or chlamydia, known endometriosis, or a history of abdominal surgery.

Tubal evaluation may be performed using an X-ray that is called a hysterosalpingogram (HSG), or by chromopertubation (CP) in the operating room at time of laparoscopy, a surgical procedure in which a small incision is made and a viewing tube called a laparoscope is inserted.

Hysterosalpingogram (HSG) is an X-ray of the uterus and fallopian tubes. A radiologist injects dye into the uterus through the cervix and simultaneously takes X-ray pictures to see if the dye moves freely through fallopian tubes. This helps evaluate tubal caliber (diameter) and patency.
Chromopertubation is similar to an HSG but is done in the operating room at the time of a laparoscopy. Blue-colored dye is passed through the cervix into the uterus and spillage and tubal caliber (shape) is evaluated.
Abnormal uterine contour (physical characteristics of the uterus)

Depending on a woman’s symptoms, the uterus may be evaluated by transvaginal ultrasound to look for fibroids or other anatomic abnormalities. If suspicion exists that the fibroids may be entering the endometrial cavity, a sonohystogram (SHG) or hysteroscopy (HSC) may be performed to further evaluate the uterine environment.

How long should couples try to get pregnant before seeing a doctor?

Most experts suggest at least one year for women younger than age 35. However, for women aged 35 years or older, couples should see a health care provider after 6 months of trying unsuccessfully. A woman’s chances of having a baby decrease rapidly every year after the age of 30.
Some health problems also increase the risk of infertility. So, couples with the following signs or symptoms should not delay seeing their health care provider when they are trying to become pregnant
Irregular periods or no menstrual periods.
Very painful periods.
Endometriosis.
Pelvic inflammatory disease.
More than one miscarriage.
Suspected male factor (i.e., history of testicular trauma, hernia surgery, chemotherapy, or infertility with another partner).
It is a good idea for any woman and her partner to talk to a health care provider before trying to get pregnant. They can help you get your body ready for a healthy baby, and can also answer questions on fertility and give tips on conceiving.

How will doctors find out if a woman and her partner have fertility problems?

Doctors will begin by collecting a medical and sexual history from both partners. The initial evaluation usually includes a semen analysis, a tubal evaluation, and ovarian reserve testing.

How do doctors treat infertility?

Infertility can be treated with medicine, surgery, intrauterine insemination, or assisted reproductive technology.
Often, medication and intrauterine insemination are used at the same time. Doctors recommend specific treatments for infertility on the basis of
The factors contributing to infertility.
The duration of infertility.
The age of the female.
The couple’s treatment preference after counseling about success rates, risks, and benefits of each treatment option.

What are some of the specific treatments for male infertility?

Male infertility may be treated with medical, surgical, or assisted reproductive therapies depending on the underlying cause. Medical and surgical therapies are usually managed by an urologist who specializes in infertility. A reproductive endocrinologist may offer intrauterine inseminations (IUIs) or in vitro fertilization (IVF) to help overcome male factor infertility.

What medicines are used to treat infertility in women?


Some common medicines used to treat infertility in women include
Clomiphene citrate is a medicine that causes ovulation by acting on the pituitary gland. It is often used in women who have polycystic ovary syndrome (PCOS) or other problems with ovulation. It is also used in women with normal ovulation to increase the number of mature eggs produced. This medicine is taken by mouth.
Letrozole is a medication that is frequently used off-label to cause ovulation. It works by temporarily lowering a woman’s progesterone level, which causes the brain to naturally make more FSH. It is often used to induce ovulation in a woman with PCOS, and in women with normal ovulation to increase the number of mature eggs produced in the ovaries.

Published  

Infertility

Dr. HelloDox Care #
HelloDox Care
Consult

Infertility

What is infertility?

Infertility is defined as not being able to get pregnant (conceive) after one year (or longer) of unprotected sex. Because fertility in women is known to decline steadily with age, some providers evaluate and treat women aged 35 years or older after 6 months of unprotected sex. Women with infertility should consider making an appointment with a reproductive endocrinologist—a doctor who specializes in managing infertility. Reproductive endocrinologists may also be able to help women with recurrent pregnancy loss, defined as having two or more spontaneous miscarriages.
Pregnancy is the result of a process that has many steps.

To get pregnant
A woman’s body must release an egg from one of her ovaries (ovulation).
A man’s sperm must join with the egg along the way (fertilize).
The fertilized egg must go through a fallopian tube toward the uterus (womb).
The fertilized egg must attach to the inside of the uterus (implantation).
Infertility may result from a problem with any or several of these steps.
Impaired fecundity is a condition related to infertility and refers to women who have difficulty getting pregnant or carrying a pregnancy to term.

Is infertility just a woman's problem?

No, infertility is not always a woman’s problem. Both men and women can contribute to infertility.
Many couples struggle with infertility and seek help to become pregnant, but it is often thought of as only a woman’s condition. However, in about 35% of couples with infertility, a male factor is identified along with a female factor. In about 8% of couples with infertility, a male factor is the only identifiable cause.

What causes infertility in men?

Infertility in men can be caused by different factors and is typically evaluated by a semen analysis. When a semen analysis is performed, the number of sperm (concentration), motility (movement), and morphology (shape) are assessed by a specialist. A slightly abnormal semen analysis does not mean that a man is necessarily infertile. Instead, a semen analysis helps determine if and how male factors are contributing to infertility.

Disruption of testicular or ejaculatory function
Varicoceles, a condition in which the veins on a man’s testicles are large and cause them to overheat. The heat may affect the number or shape of the sperm.
Trauma to the testes may affect sperm production and result in lower number of sperm.
Unhealthy habits such as heavy alcohol use, smoking, anabolic steroid use, and illicit drug use.
Use of certain medications and supplements.
Cancer treatment involving the use of certain types of chemotherapy, radiation, or surgery to remove one or both testicles
Medical conditions such as diabetes, cystic fibrosis, certain types of autoimmune disorders, and certain types of infections may cause testicular failure.
Hormonal disorders
Improper function of the hypothalamus or pituitary glands. The hypothalamus and pituitary glands in the brain produce hormones that maintain normal testicular function. Production of too much prolactin, a hormone made by the pituitary gland (often due to the presence of a benign pituitary gland tumor), or other conditions that damage or impair the function of the hypothalamus or the pituitary gland may result in low or no sperm production.
These conditions may include benign and malignant (cancerous) pituitary tumors, congenital adrenal hyperplasia, exposure to too much estrogen, exposure to too much testosterone, Cushing’s syndrome, and chronic use of medications called glucocorticoids.
Genetic disorders
Genetic conditions such as a Klinefelter’s syndrome, Y-chromosome microdeletion, myotonic dystrophy, and other, less common genetic disorders may cause no sperm to be produced, or low numbers of sperm to be produced.

What causes infertility in women?

Women need functioning ovaries, fallopian tubes, and a uterus to get pregnant. Conditions affecting any one of these organs can contribute to female infertility. Some of these conditions are listed below and can be evaluated using a number of different tests.

Disruption of ovarian function (presence or absence of ovulation (anovulation) and effects of ovarian “age”)

A woman’s menstrual cycle is, on average, 28 days long. Day 1 is defined as the first day of “full flow.” Regular predictable periods that occur every 24 to 32 days likely reflect ovulation. A woman with irregular periods is likely not ovulating.

Ovulation can be predicted by using an ovulation predictor kit and can be confirmed by a blood test to check the woman’s progesterone level on day 21 of her menstrual cycle. Although several tests exist to evaluate a woman’s ovarian function, no single test is a perfect predictor of fertility. The most commonly used markers of ovarian function include follicle-stimulating hormone (FSH) value on day 3 to 5 of the menstrual cycle, anti-müllerian hormone value (AMH), and antral follicle count (AFC) using a transvaginal ultrasound.

Disruptions in ovarian function may be caused by several conditions and warrants an evaluation by a doctor.

When a woman doesn’t ovulate during a menstrual cycle, it’s called anovulation. Potential causes of anovulation include the following

Polycystic ovary syndrome (PCOS). PCOS is a condition that causes women to not ovulate, or to ovulate irregularly. Some women with PCOS have elevated levels of testosterone, which can cause acne and excess hair growth. PCOS is the most common cause of female infertility.
Diminished ovarian reserve (DOR). Women are born with all of the eggs that they will ever have, and a woman’s egg count decreases over time. Diminished ovarian reserve is a condition in which there are fewer eggs remaining in the ovaries than normal. The number of eggs a woman has declines naturally as a woman ages. It may also occur due to congenital, medical, surgical, or unexplained causes. Women with a diminished ovarian reserve may be able to conceive naturally but will produce fewer eggs in response to fertility treatments.
Functional hypothalamic amenorrhea (FHA). FHA is a condition caused by excessive exercise, stress, or low body weight. It is sometimes associated with eating disorders such as anorexia.
Improper function of the hypothalamus and pituitary glands. The hypothalamus and pituitary glands in the brain produce hormones that maintain normal ovarian function. Production of too much of the hormone prolactin by the pituitary gland (often as the result of a benign pituitary gland tumor), or improper function of the hypothalamus or pituitary gland, may cause a woman not to ovulate.
Premature ovarian insufficiency (POI). POI, sometimes referred to as premature menopause, occurs when a woman’s ovaries fail before she is 40 years of age. Although certain exposures, such as chemotherapy or pelvic radiation therapy, and certain medical conditions may cause POI, the cause is often unexplained. About 5% to10% of women with POI conceive naturally and have a normal pregnancy.
Menopause Menopause is an age-appropriate decline in ovarian function that usually occurs around age 50. By definition, a woman in menopause has not had a period in one year. She may experience hot flashes, mood changes, difficulty sleeping, and other symptoms as well.
Fallopian tube obstruction (whether fallopian tubes are open, blocked, or swollen)

Risk factors for blocked fallopian tubes (tubal occlusion) can include a history of pelvic infection, history of ruptured appendicitis, history of gonorrhea or chlamydia, known endometriosis, or a history of abdominal surgery.

Tubal evaluation may be performed using an X-ray that is called a hysterosalpingogram (HSG), or by chromopertubation (CP) in the operating room at time of laparoscopy, a surgical procedure in which a small incision is made and a viewing tube called a laparoscope is inserted.

Hysterosalpingogram (HSG) is an X-ray of the uterus and fallopian tubes. A radiologist injects dye into the uterus through the cervix and simultaneously takes X-ray pictures to see if the dye moves freely through fallopian tubes. This helps evaluate tubal caliber (diameter) and patency.
Chromopertubation is similar to an HSG but is done in the operating room at the time of a laparoscopy. Blue-colored dye is passed through the cervix into the uterus and spillage and tubal caliber (shape) is evaluated.
Abnormal uterine contour (physical characteristics of the uterus)

Depending on a woman’s symptoms, the uterus may be evaluated by transvaginal ultrasound to look for fibroids or other anatomic abnormalities. If suspicion exists that the fibroids may be entering the endometrial cavity, a sonohystogram (SHG) or hysteroscopy (HSC) may be performed to further evaluate the uterine environment.

How long should couples try to get pregnant before seeing a doctor?

Most experts suggest at least one year for women younger than age 35. However, for women aged 35 years or older, couples should see a health care provider after 6 months of trying unsuccessfully. A woman’s chances of having a baby decrease rapidly every year after the age of 30.
Some health problems also increase the risk of infertility. So, couples with the following signs or symptoms should not delay seeing their health care provider when they are trying to become pregnant
Irregular periods or no menstrual periods.
Very painful periods.
Endometriosis.
Pelvic inflammatory disease.
More than one miscarriage.
Suspected male factor (i.e., history of testicular trauma, hernia surgery, chemotherapy, or infertility with another partner).
It is a good idea for any woman and her partner to talk to a health care provider before trying to get pregnant. They can help you get your body ready for a healthy baby, and can also answer questions on fertility and give tips on conceiving.

How will doctors find out if a woman and her partner have fertility problems?

Doctors will begin by collecting a medical and sexual history from both partners. The initial evaluation usually includes a semen analysis, a tubal evaluation, and ovarian reserve testing.

How do doctors treat infertility?

Infertility can be treated with medicine, surgery, intrauterine insemination, or assisted reproductive technology.
Often, medication and intrauterine insemination are used at the same time. Doctors recommend specific treatments for infertility on the basis of
The factors contributing to infertility.
The duration of infertility.
The age of the female.
The couple’s treatment preference after counseling about success rates, risks, and benefits of each treatment option.

What are some of the specific treatments for male infertility?

Male infertility may be treated with medical, surgical, or assisted reproductive therapies depending on the underlying cause. Medical and surgical therapies are usually managed by an urologist who specializes in infertility. A reproductive endocrinologist may offer intrauterine inseminations (IUIs) or in vitro fertilization (IVF) to help overcome male factor infertility.

What medicines are used to treat infertility in women?


Some common medicines used to treat infertility in women include
Clomiphene citrate is a medicine that causes ovulation by acting on the pituitary gland. It is often used in women who have polycystic ovary syndrome (PCOS) or other problems with ovulation. It is also used in women with normal ovulation to increase the number of mature eggs produced. This medicine is taken by mouth.
Letrozole is a medication that is frequently used off-label to cause ovulation. It works by temporarily lowering a woman’s progesterone level, which causes the brain to naturally make more FSH. It is often used to induce ovulation in a woman with PCOS, and in women with normal ovulation to increase the number of mature eggs produced in the ovaries.

Published  

Is Poor Thyroid Function Impacting Your Fertility?

Dr. HelloDox Care #
HelloDox Care
Consult

The human body works as directed by the various hormones released by the endocrine system. These hormones are essential for coordination of various body functions. From the height a person achieves to the metabolic reactions in the body to the reproductive cycle to the stress levels a person can handle, all are hormone controlled.

Pregnancy is another critical, complicated phase that a woman goes through. It is one of the most awaited phases in a woman’s life; however, it is not very simple either. The above-noted hormones play a major role in this pregnancy, as the baby is dependent on the mother for its initial supply of hormones until it can start producing its own hormones. If the baby does not receive the require amounts, there could be various detrimental effects during development and post birth.

Hypothyroidism or an underactive thyroid is extremely common in women and there are multiple theories about how hypothyroidism can affect a woman’s chances of getting pregnant. While the correlation between hypothyroidism and pregnancy are quite well researched, a strong connection stating hypothyroid women being not able to be pregnant is yet to be proven.

The following are some correlations between hypothyroidism and pregnancy.

Increased chance of miscarriage: Women with reduced thyroid functions have double the chances of having a miscarriage. Women suffering from thyroid are at a risk of recurrent miscarriages during the first trimester. The chances of miscarriages during the second trimester are also about 40% higher in hypothyroid women. These women are also at a risk of:

Premature labour

Low birth weight

Increased chances of stillbirth

Maternal anemia

Postpartum hemorrhage

Developmental defects and/or delays in the newborn

Placental abruption

High blood pressure

One of the reasons identified for infertility in women is hypothyroidism. This range varies from 1% to 40% and so remains to be proven still. In addition, the hypothyroid mother will have a set of symptoms to live through, which may be further complicated given the pregnancy. Thyroid replacement should be religiously done and monitored to ensure TSH levels are at the optimal required levels (2.5 to 3 mIU/L) during the entire duration of pregnancy.

If you have the following, be sure to go through a comprehensive thyroid screening before and during pregnancy.

Family history of thyroid

History of thyroid dysfunction or goitre or thyroid antibodies

Clinical signs and symptoms suggestive of hypothyroidism

History of repeated miscarriages

History of head and neck radiation

Family/personal history of autoimmune disorders

While it still remains to be proven that hypothyroidism per se can stop a woman from being pregnant, there are definitely effects of hypothyroidism on the developing child and the mother. A comprehensive screening and close monitoring through pregnancy are extremely essential.

Dr. Sucheta  Mokashi
Dr. Sucheta Mokashi
BDS, Dentist, 3 yrs, Pune
Dr. Manna  Varghese
Dr. Manna Varghese
BAMS, Ayurveda, 4 yrs, Pune
Dr. Shrikant Tile
Dr. Shrikant Tile
MBBS, Gynaecologist, 10 yrs, Pune
Dr. Pavan Prakash Pargaonkar
Dr. Pavan Prakash Pargaonkar
BHMS, Family Physician, 6 yrs, Pune
Dr. Vijay Mane
Dr. Vijay Mane
BHMS, Homeopath Family Physician, 22 yrs, Pune
Hellodox
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