What are some of the causes of infertility?

Endometriosis, a cause of female infertility, is a condition in which endometrial tissue, the tissue that lines the inside of the uterus, grows outside the uterus and attaches to other organs in the abdominal cavity such as the ovaries and fallopian tubes. Endometriosis is a progressive disease that tends to get worse over time and can reoccur after treatment. Symptoms can include painful menstrual periods, abnormal menstrual bleeding and pain during or after sexual intercourse.
With endometriosis, the endometrial tissue growing outside your uterus responds to your menstrual cycle hormones the same way the tissue inside your uterus responds – it swells and thickens, then sheds to mark the beginning of the next cycle. This process can cause scar tissue in the pelvis that can block the fallopian tubes or interfere with ovulation. Another result of endometriosis is the formation of ovarian cysts called endometrioma that may also interfere with ovulation.
If endometriosis is suspected, our physicians will determine the best treatment plan for you which may include medication or surgery, or a combination of both.

Male Factor
Impairment of any aspect of sperm function that affects its ability to fertilize an egg is called male factor infertility. Normally, sperm must travel through the female reproductive tract to reach and fertilize an egg. This requires large numbers of moving sperm that possess the biochemical capability to undergo fertilization. Male factor infertility may be the result of abnormal sperm production, abnormal sperm ejaculation, environmental factors, and/ or health issues.

Approximately 30-50% of infertile couples may be affected by male factor infertility complications, making the semen analysis an essential part of the infertility work-up. The diagnosis of male factor infertility can be made with the semen analysis and your physician may suggest further testing to determine the cause of any abnormalities identified. Treatment may include medication, intrauterine insemination (IUI) or in-vitro fertilization(IVF) with or without intracytoplasmic sperm injection(ICSI).

Amenorrhea is the term used to describe the absence of a menstrual period. There are two main types of amenorrhea:

Primary amenorrhea occurs when a woman has not begun menstruation by the age of 16 as a result of hormone deficiency. This may be the result of chromosomal, anatomical, or hormonal issues.

Secondary amenorrhea develops when a woman has had otherwise normal periods and then begins to have no menstrual period for more than three months. This is usually a result of a change in hormone levels or other complications affecting the reproductive system.

Factors that may contribute to hormonal imbalance include pituitary gland, hypothalamus and ovary disorders, weight loss or weight gain, poor diet, eating disorders, stress and excessive exercise.

Unexplained infertility is a term that is used to describe a couple that is unable to get pregnant despite normal results from infertility testing. Approximately 20 percent of infertile couples have unexplained infertility. Although frustrating as a diagnosis, this type of infertility can typically be treated with conservative methods.

Tubal disease, one of the many causes of female infertility, is a disorder in which the fallopian tubes are blocked or damaged. Your physician will review your medical history, any operative reports, and often perform a hysterosalpingogram xray to diagnose a tubal disorder.

Scar tissue, infections and tubal ligation are often causes of tubal disease. Scar tissue can block an egg from entering or traveling down the fallopian tube to meet the sperm, preventing fertilization. Infections can damage the cilia, the tiny hairs lining the fallopian tubes that help transport the egg, often preventing the sperm and egg from meeting. One result of damaged cilia is an ectopic pregnancy, which occurs when an egg is fertilized but, due to the damaged cilia, it is unable to travel to the uterus, growing instead in the wall of the fallopian tube. This condition can result in rupture, internal bleeding and further tubal damage. Many women who have undergone tubal ligation decide they want to have a baby at some point after the procedure. These patients most often undergo in vitro fertilization to bypass the blockage.

There are a number of treatment options available to overcome infertility caused by tubal disease. Successful treatment options include surgical removal of scar tissue, tubal ligation reversal or in vitro fertilization.

Uterine Anomaly
Congenital anomalies of the uterus can cause difficulty getting pregnant and can predispose a mother to miscarriage. How often these birth defects occur is not well known.

The uterus is formed by two tubes that come together and the joining walls dissolve to leave a single cavity for the uterus and the ends of the two tubes as the fallopian tubes. On rare occasions, the joining walls either don’t dissolve or only partially dissolve. Sometimes the tubes don’t even come together. The cause for this anomaly is multi factorial and not just a single genetic defect.

There are multiple varieties of uterine anomaly. Most importantly, the type of anomaly should be diagnosed through ultrasound and xray imaging to determine if a correction is necessary and / or possible. Often these abnormalities of the uterus can be corrected with a simple same day surgery that can make a significant difference in the ability to get pregnant and prevent miscarriage.

Who is a Candidate for Fertility Preservation?

You are a candidate for fertility preservation if you are at risk of infertility due to proposed exposure such as cancer treatments. Preservation of fertility is also an excellent option for those delaying parenthood or those seeking to ensure against regret following vasectomy or tubal ligation.

What is the Risk of Infertility for Cancer Patients?

Chemotherapy and radiation treatments for cancer and other serious illnesses can affect reproductive health. Surgery involving reproductive tissue may also affect fertility. The likelihood that cancer treatment will harm your fertility depends on several factors, including

  1. The type of cancer and cancer treatment
  2. Your age at the time of treatment

The regimens that threaten ovarian and testicular function are mainly radiation therapy to the pelvic area and some types of chemotherapy. The effects of chemotherapy and radiation therapy depend on the drug or size and location of the radiation field, the dose, intensity of the dose and how treatment is given — orally or intravenously. Some chemotherapy is associated with high risk. These include the following: procarbazine and alkylating drugs, ifosfamide, busulfan, melphalan, chlorambucil and chlormethine. Other treatments carry a medium to low risk of infertility including doxorubicin and platinum analogs and carboplatin, plant derivatives such as vincristine and vinblastine, antibiotics such as bleomycin and dactinomycin and antimetabolites such as methotrexate, mercaptopurine and 5-fluoruracil.

With regard to age, the risk of developing premature menopause increases with the age of the woman undergoing treatment.

Your oncologist can help you determine whether decreased reproductive function is a high risk with your proposed treatment.

When Should a Cancer Patient Seek Fertility Consultation?

Upon learning your cancer therapies are associated with a risk to your fertility, we urge you to schedule an initial consult immediately. The Fertility Center of Charleston understands the time sensitivity. We leave consultation openings in each month to accommodate patients needing fertility preservation. We expedite the process in order to not delay your cancer treatment. One oncology treatment session can have lasting fertility effects. Seeking preservation services prior to your scheduled treatment is optimal.

How Can Women Preserve Fertility Prior To Cancer Treatment?

Women who are embarking on cancer treatment may consider the following fertility preservation services and procedures:

  1. Embryo Cryopreservation
  2. Egg Freezing or Oocyte Cryopreservation
  3. Gonadal Shielding
  4. Ovarian Transposition (oophoropexy)
  5. Trachelectomy
  6. Hormonal therapies

How Can Men Preserve Fertility Prior to Cancer Treatment?

Men can take steps to preserve their fertility prior to cancer treatment with the following fertility preservation services:

  1. Sperm Cryopreservation
  2. Gonadal Shielding
  3. Methods under research including, Testicular Tissue Cryopreservation and the use of hormonal therapies to protect testicular tissue during cancer treatment.