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- Okay, so we make an appointment with OBGYN West. What happens then?
- Getting pregnant shouldn't be this difficult, should it?
- What is a laparoscopy...and how do you pronounce it?
- What are some of the other common causes for infertility in women?
- Are cysts the same as uterine fibroids?
- Are there other possible causes for infertility in women?
- I heard there was this test for checking for blockage in the fallopian tubes. I think it's called HSG. What exactly is that? And does it hurt?
- Okay, you have my attention. What else should I know about this HSG?
- We've talked a lot about the woman here. Didn't you say the men played a role in infertility, too?
- So how can my partner find out if his sperm are "up to code"?
First of all, thanks for making an appointment with us. Please trust that we'll treat your challenge, like all our patients' issues, with the utmost sensitivity and privacy. We say this because we know how delicate and painful discussing infertility can be. We also know that in our first meeting, we'll be asking detailed questions about your medical and sexual history, which can be extremely uncomfortable. Yes, we know it's tough to talk about such private matters, but it is essential to successfully identifying and treating any problems.
Despite what you may remember from your high school biology class, getting pregnant is a much more complex and fragile process than you can imagine. Even if the sperm and egg do chance to meet, the window of opportunity they have is so brief, any little hitch they encounter will prevent fertilization. And surprisingly, there are quite a few potential hitches. Let's talk about a few of the more common ones.
Like we mentioned earlier, there are many reasons for infertility. To find out if the cause can be traced to the woman, we often perform a laparoscopy (LAP-ah-ROS-ko-pee). This is a surgical procedure, performed under general anesthesia, where the doctor makes a small incision near the woman's navel and inserts a tiny, fiber optic telescope (called a laparoscope) inside the abdomen. With this laparoscope, the doctor can look at the uterus (inside and out), the ovaries and the fallopian tubes. So what are we looking for? Fibroids, scar tissue, endometriosis and blocked fallopian tubes-all of which can cause infertility.
Polycystic (pol-e-SIS-tik) Ovarian Syndrome (PCOS) is a common culprit. This is a disorder in which the ovaries produce excessive amounts of male hormones and develop many small cysts. No one knows exactly why it happens, but the hormone imbalance PCOS creates prevents a woman from ovulating. This disorder also has other unappreciated symptoms, including acne, excessive hair growth on the face and obesity. The good news is, the earlier we can diagnose and treat PCOS, the greater likely we can reduce these unfortunate symptoms...and, hopefully, increase your chances of getting pregnant.
Cysts are different than fibroids in many ways, but they both can cause infertility. While cysts tend to form in the ovaries, fibroids can grow inside and outside the uterus. When they're inside, they can inhibit pregnancy by making it difficult for the egg to attach to the uterine wall. When they grow outside of the uterus, they can compress or block the fallopian tubes, making it impossible for the sperm to reach the egg. There can also unpleasant symptoms with fibroids. Depending upon the number, size or shape of fibroids you're carrying around, they can give you bad cramps, abnormal or excessive bleeding and make it hard to go to the bathroom. On the other hand, if the fibroids are small, you may not even know you have them until you come in for infertility treatment.
Yes, actually. There are many, but one of the more common is Tubal Disease. Tubal disease is a disorder in which the fallopian tubes are blocked or damaged. There are many ways this blockage can occur, for example, from endometriosis and gynecological surgery (like bowel surgery, cesarean section and a ruptured appendix). Tubes can also be compromised by infections, like chlamydia, which can damage the tiny hairs in the fallopian tubes, called cilia. Without normal cilia, the egg may not have the motility it needs to meet the sperm in the uterus. Or worse, the egg may not make it to the uterus and get fertilized in the tube itself. This can result in an ectopic pregnancy, which can further damage to the tube. Fortunately, there are treatments to tubal disease. For one, we can try removing any scar tissue that is blocking the tubes. Or, if the damage is too severe, we can suggest in vitro fertilization. That's where we remove eggs from your ovaries, mix them with your partner's sperm and then skip the fallopian tubes all together by placing the placing the mixture directly into the uterus. This is also done when a woman has had her tubes tied (called a tubal ligation) and the reconstructive surgery to reverse the procedure is unsuccessful.
I heard there was this test for checking for blockage in the fallopian tubes. I think it's called HSG. What exactly is that? And does it hurt?
The HSG, also called a hysterosalpingogram (HIS-ta-ro-sal-PING-o-gram-say that three times fast) is a test that uses x-rays and a special dye so your doctor can examine the inside walls of your uterus and fallopian tubes. With the dye, the doctor can detect scar tissue, polyps, fibroids and other growths that may be blocking your tubes or keeping a fertilized egg from implanting properly in your uterus. As for pain, we've got to be honest. Many women feel some cramping when we inject the dye. And for women who have a blocked fallopian tube, the pain may feel intense. That's why we suggest you talk to your doctor about taking a pain medication, like ibuprofen, 30 to 60 minutes before going through this procedure.
Well, many women have no pain after the HSG. But, since you might feel crampy afterwards, it would be good to have someone drive you home. As for the risk of the HSG, they include pain or discomfort, infection and vaginal spotting or bleeding. Also, you should contact your doctor if you feel a fever or continue to feel pain for more than a few days.
Absolutely. In fact, roughly a third of all cases of infertility originate in the man. The most common has to do with sperm disorders. This three main sperm disorders are: 1) The man is not making enough sperm, 2) the sperm he's got don't move well or 3) many of his sperm are abnormally shaped. For the oddly shaped sperm, they just may not be able to penetrate an egg. The ones who don't move well might just run out of gas before the get to the egg. And if the sperm count is low, there are a myriad of reasons-it could be a genetic defect, infection, testicular trauma, a hormonal imbalance or exposure to radiation or certain medications.
It's called a semen analysis. The doctor will need a sample that evaluated on three major criteria: 1) Sperm count (number of sperm in your semen), 2) Morphology (whether they are normally shaped) and 3) Motility (how well they can swim). A low sperm count can result from many causes: a fever, reaction to certain medications, a blocked duct, a low testosterone level or a condition in which the sperm back up into the bladder. The good news is, many of these issues can be treated by your doctor.