Any condition which interferes with the normal cascade of hormonal events can lead to irregular, or no, ovulation and infertility. One common cause of ovulatory dysfunction is polycystic ovarian syndrome (PCOS). PCOS causes elevated insulin levels and excess androgen (male hormones) production leading to ovulatory failure.Another condition is hyperprolactinemia, or elevated levels of prolactin. Prolactin is known as the breast milk hormone because it stimulates milk production in pregnant women. When levels are elevated in non pregnant females, ovulatory disorders often result.Abnormal levels of other hormones, such as the thyroid hormones, can also lead to ovulatory failure. Most of these conditions can be treated effectively with the appropriate fertility drug.
Once the eggs mature within the ovarian follicles they are ovulated and must travel from the ovary through the fallopian tubes and into the uterus. Fertilization occurs at the distal end of the fallopian tube (end away from the ovary).Any condition which causes a narrowing or blockage of the tubes can lead to infertility. These abnormalities are usually seen during the hysterosalpingogram (HSG) test.Some women, who previously had their fallopian tubes tied for birth control, wish to have the procedure reversed. While pregnancy after tubal ligation is possible, this form of birth control should be considered permanent.
Endometriosis is a common cause of tubal occlusion. Endometriosis can attach to virtually any organ and grow thus interfering with the organs normal function. Endometriosis can attach to, and penetrate/block, the fallopian tubes making passage of the eggs impossible. Fortunately, endometriosis can often be treated by a skilled reproductive endocrinologist using laparoscopy. Dependant upon the extent and location of the endometrial implants, IVF may be the best treatment choice.
In vitro fertilization is often the treatment of first choice for tubal blockage or to achieve pregnancy after a tubal ligation. Using IVF, the eggs are retrieved directly from the follicles and do not have to travel through the Fallopian tubes. Per cycle success rates with IVF are higher than tubal reanastamosis.
Once the sperm are ejaculated into the vagina, they must swim in the cervical mucus to the uterus. The cervical mucus must be of the correct consistency and in sufficient quantity to support the sperm.
Sometimes the female produces antibodies, known as antisperm antibodies, to her partner’s sperm. Her immune system “mistakes” sperm for invading pathogens, such as virus and bacteria, and “protects” the body by trying to destroying them. The post coital test is used to visually examine the cervical mucus after intercourse. Numerous “dead or non motile” sperm may indicate the presence of antisperm antibodies.
Intrauterine insemination (IUI) is usually the first choice treatment for cervical factor infertility. Using IUI, the specially washed and prepared sperm are inserted directly into the uterus thus bypassing the cervical mucus.
The uterus must be free of large obstructions such as polyps and fibroids. When present these obstructions can sometimes interfere with the implantation and growth of the embryo and fetus. There can also be congenital deformities of the uterus such as the bicornuate (two horned) uterus, which can sometimes be treated surgically. Also, some women may have scarring of the uterus as a result of pelvic inflammatory disease (severe infection).
Many times a skilled reproductive surgeon can remove fibroids and/or polyps using laparoscopy. Compared to other surgical procedures, laparoscopy greatly reduces pain after surgery, is less expensive, and shortens recovery time.