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Infertility Assessment – Female

Female Factors

Assessment for factors associated with infertility can be an intrusive and daunting process which we endeavour to make as easy as possible. In addition to specific hormone testing (if indicated) and general well-being assessment, tests available at Grace Facility Centre include:

  • Vaginal ultrasound assessment of antral follicle count (AFC) for ovarian reserve screening as well as the ovaries and uterus for normal appearance and function (presence of a dominant follicle and thickness of the lining of the womb “endometrium”) and atypical findings such as polycystic ovaries (PCO), endometriomas (“chocolate cysts”) or fibroids.
  • Saline Infusion Sonohysterography / Hysterosalpingo-Contrast-Sonography (SIS / HyCoSy) to assess the uterine cavity and tubal status.

Both tests can be done at the same time for convenience.

 

SIS/HyCoSy uses modern ultrasound approach to assess the uterine cavity and tubes: more

For SIS, a fine catheter is inserted into the cervix and a small amount of normal saline is introduced to outline the contour of the uterine cavity under vaginal ultrasound guidance. There is minimal discomfort if any.

For HyCoSy, some air is introduced in addition to assess the patency of the fallopian tubes. This may generate period-like discomfort which resolves promptly.

Hysteroscopy involves passing a thin “telescope-like” instrument into the cervix and is most useful in the following situations:

  • Removal of polyps or fibroids present inside the uterine cavity
  • Separation of adhesions or a “septum” present inside the uterine cavity.

Laparoscopy also involves passing a “telescope-like” instrument into the peritoneal cavity under general anesthesia. In modern fertility practice, laparoscopy is no longer routine and considered only on a case-by-case basis..more

Examples where laparoscopy may be indicated:

  • Surgical correction of blockage of the distal end of the tube (“hydrosalpinx”) before IVF treatment. The rationale is to prevent fluid in the tube from flowing into the uterine cavity to create an adverse environment for embryo implantation.
  • Co-existing severe pelvic pain requiring laparoscopic assessment.

If indicated, we perform both procedures in the Day Surgery Unit in the hospital.

 

Comments:

  1. Conventional hysterosalpingraphy (HSG) uses radiological approach and is usually done by radiologists in Vancouver.
  2. Spontaneous pregnancy may occasionally occur during or following the investigation phase. Spontaneous pregnancy may also occur in some couples even following failed IVF.

 

The following are some factors that may interfere with female infertility:

  • Female age and ovarian reserve
  • Irregular or no period (“anovulation” or “amenorrhea”
  • Polycystic ovary syndrome (PCOS)
  • Blocked fallopian tubes
  • Endometriosis
  • Uterine factors – fibroids, adenomyosis

Roughly 25% of all infertile women have issues with ovulation, and the majority of them are due to hormonal imbalances caused by impaired communication between the glands that produce the hormone and the brain.

Polycystic Ovary Syndrome is one such condition that is not uncommon and contributes to a range of symptoms including infertility.

Abnormal ovulation can also be caused by such things as significant weight loss or weight gain, (extremely low or extremely high Body Mass Index (BMI)). Treatment may include medication, lifestyle changes like diet and exercise, and/or In Vitro Fertilization (IVF).

Blocked tubes can be caused by endometriosis or past infections leading to  pelvic inflammatory disease (PID). Treatment may include IVF or in some cases, surgery  .

Cervical disorders can prevent the sperm from being able to enter the uterus. Treatment may include Intrauterine Insemination (IUI) or IVF.

A woman’s fertility starts to decline gradually after age 30, and more dramatically as she gets into her late 30s. As a woman ages, the chance of genetic mutations and/or fetal abnormalities also increases. A combination of diminished ovarian reserve and the associated increase risk of chromosomal abnormalities with age often makes donor eggs a viable option. Individual profiles must always be considered however.

This very common disorder affects approximately 10% of women in their child-bearing years and results in absent or infrequent ovulation due to a hormonal imbalance. Common symptoms include irregular menstrual cycles (oligomenorrhea), male-patterned hair growth on the face and body (hirsutism), obesity, and acne. Treatment may include medication, lifestyle changes like diet and exercise, and/or IVF.

Approximately 35 to 50 percent of women with infertility also have endometriosis, which occurs when the tissue that lines the uterus (the endometrium) grows outside of it. This can lead to fallopian tube scarring, pelvic inflammation and pain, and other complications. Symptoms include painful menstruation, pain during sex, pain during urination or bowel movements, fatigue, nausea, and recurrent yeast infections. Treatment may include surgery or IVF.

Excessive clotting is associated with recurrent miscarriage as well as slow fetal growth and high blood pressure. Treatment frequently includes blood-thinning medication.

This condition occurs when endometrial tissue, which lines the uterus, grows into the outer muscular tissue, causing structural issues. Adenomyosis can occur throughout or in localized spots and  is oftern associated with painful heavy periods.  IT may or may not contribute to infertility. Treatment may  include medication to help with pain and (less frequently) surgery.

The disease itself, along with treatments such as chemotherapy and radiation, can greatly diminish or damage sperm and eggs. To prevent this, many patients freeze their eggs or sperm or embryos for future use prior to receiving cancer treatment.

Everyone’s health and therefore fertility is affected to some degree by lifestyle. Being overweight, smoking, drinking excessive alcohol,using street drugs, being sedentary, and  exposure to certain chemicals can all decrease or at least impact fertility. Positive lifestyle approaches include optimizing one’s diet, weight loss if indicated, moderate exercise, and avoiding exposure to harmful substances including those that can be absorbed throught he skin.

Despite having extremely healthy lifestyle habits, however,  there is a background loss of egg quality and numbers  with advancing age and this is predestined and can’t be avoided.  However making healthy lifestyle choices does impact the health of all systems in the body  including fertility and thus is very important.

Defined as having two or more miscarriages, recurrent pregnancy loss can be caused by many things, with the risk going up with age.