Approximately 11% of couples of reproductive age will have difficulty conceiving.  The number of couples seeking care for infertility related problems has increased over the last several years.  No one really knows if the incidence of infertility is increasing, or if public awareness is responsible for the increased physician visits. Our Greensboro, NC fertility clinic, Premier Fertility offers all diagnostic and treatment services for infertility including IVF and a donor egg program.

Infertility was once considered a “female problem” but we now know that sperm abnormalities (male factor infertility) are present in up to half of all couples.  Certainly, this awareness has increased consults for evaluation of the male. Premier Fertility Clinic has a "world class" reproductive laboratory located in Greensboro, NC.

The American Society for Reproductive Medicine defines infertility in women less than 35 years of age as the inability to conceive after one year of unprotected intercourse.  The incidence of infertility in females increases dramatically after the age of 35 and these women are often counseled to seek care after only 6 months of trying.

Significantly more women are waiting until later in life to have children. Often they want to establish their careers first, or are marrying at older ages. These societal trends have contributed to the overall increase in assisted reproductive technology cycles (IVF) especially donor egg. Unfortunately, the biological clock does not sync with these new societal morays, as women are most fertile in their teens and early twenties.

Female aging ultimately leads to reduced ovarian reserve (lower quality eggs) meaning the eggs are less likely to fertilize and develop normally. This condition is often first diagnosed by high FSH hormone levels on day 3-4 of the menstrual cycle. Oftentimes the Clomid Challenge Test will be administered to predict how a woman will respond to fertility drugs (FSH). Women aged 35 or older who suspect they may be infertile should consult a fertility specialist immediately. Many of these women can only become pregnant using donor eggs. The good news is that women in their forties and fifties can become pregnant using donor eggs as long as their overall health is good.

In order for pregnancy to occur the following processes must occur:

• Follicles, each of which contains an egg, must be recruited and develop under the influence of follicle stimulating hormone (FSH). As healthy follicles grow, they produce increasing amounts of estrogen.    
• The endometrium must thicken and become more vascular under the influence of estrogen and progesterone so that an embryo can implant and develop.
• The eggs must reach maturity and be “ovulated” after a surge in luteinizing hormone (LH).
• The eggs must travel unimpeded through the fallopian tubes to the distal end where fertilization occurs. "Scarred" or blocked fallopian tubes are a major cause of infertility.
• The male must develop viable sperm that can be ejaculated into the vagina. Sperm development requires three months and sperm quality today is a reflection of conditions three months earlier. The semen analysis is one of the most important fertility tests. We have expert technicians at our Greensboro, NC fertility clinic.
• The sperm swim through the cervical mucus into the uterus and ultimately to the end of the fallopian tubes. The mucus must be the correct consistency and be free of antisperm antibodies.
• A sperm must attach to, and penetrate, an egg.
• The genetic material of the male and female must combine to result in the proper number of chromosomes with no breaks or other abnormalities. An abnormal number of chromosomes can lead to miscarriage.
  
• The fertilized egg must travel into the uterus and embed in the endometrium.
• The leftover follicle, known as the corpus luteum, must produce progesterone to support the embryo.
• The embryo must undergo normal cell development resulting in a healthy fetus.
• The placenta forms and must produce progesterone to support the pregnancy.
• The fetus must be carried to term and delivery.

If any of these processes fail, infertility is often the result.

We divide the causes of infertility into ten categories:

Ovulatory Disorders and Infertility

Ovulation may not occur, or it may be irregular. These conditions are often treated with medications including Clomid, Femara or FSH. Ovulation is documented using ultrasound, progesterone levels, and other methods. PCOS is included in this category. Clomid may be a first line fertility drug to regulate ovulation. FSH (Gonal-F, Follistim, Repronex, Menopur, Bravelle) is usually the next treatment step.

Ovarian Failure and Infertility

Ovarian failure results when the eggs loose their ability to fertilize and develop normally, usually as a result of age. However, premature ovarian failure occurs in younger women. Oftentimes, our donor egg program is the only option for these women.

Tubal Disease Infertility

Tubal disease- The eggs must be able to pass through the fallopian tubes. If the tubes are damaged by endometriosis, infection, scarring from previous surgery, or other reasons, the eggs cannot make their passage. The fallopian tubes are evaluated using the hysterosalpingogram and/or laparoscopy.

Uterine Disease and Infertility

The developing embryo must embed in the endometrium and continue its growth as a fetus.  If the uterus is abnormally shaped, or has large fibroids or polyps, the embryo may be unable to continue normal growth. A woman with a severely damaged uterus may have to use a surrogate mother. The uterus is often evaluated using hysteroscopy.

Cervical Factor Infertility

The sperm must be able to swim in the cervical mucus to make their passage to the uterus. If the mucus has poor consistency, the sperm will be unable to reach the eggs. Cervical mucus may also contain antisperm antibodies, which destroy sperm as if they were bacteria or viruses. The post coital test is used to evaluate the interaction of sperm with the cervical mucus.

Endometriosis and Infertility

Endometriosis is a very common cause of infertility. It can attach to the reproductive organs, including the ovaries, tubes, and uterus causing blockage, inflammation, and even organ penetration. An endometrial biopsy may be performed to evaluate endometrial development. Endometriosis may be treated with fertility drugs (Lupron) and/or laparoscopic surgery.

Luteal Phase Defect

The endometrium thickens and develops during the luteal phase of the cycle as a result of stimulation by progesterone and estrogen. If an endometrial biopsy shows the endometrium “to be out of phase” external progesterone may be administered. 

Male Factor Infertility

The male must be able to produce enough sperm of adequate quality to cause fertilization. The semen analysis examines sperm for several characteristics including their number, shape, swimming ability, consistency of the semen, and other characteristics.

Genetic Factors and Infertility

Sometimes, for reasons unknown, the egg and sperm will combine to yield an abnormal number of chromosomes in the embryo, known as aneuploidy, which can lead to miscarriage.  The chromosomes may also be broken or have other abnormalities which can lead to miscarriage.

Unexplained Infertility

Sometimes all fertility tests performed on both partners are normal and no cause for their infertility can be found. There is certainly a cause, but science has not advanced to the point where it can be identified. This is typically termed unexplained infertility. We discusses in detail all of the causes of infertility and their treatments.  The best news is that the majority of couples (>80%) who seek care from a fertility specialist, reproductive endocrinologist, will become pregnant.

Premier Fertility Center

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