As much as the tenets of fertility factors are common to all men and women, we are very different in the degree these factors contribute to the difficulty of getting pregnant. The ability to conceive is reduced with advance in reproductive age. Ovarian reserve, though, at any age is very different from one woman to another. The number of good quality, chromosomally normal eggs, widely varies.
- Significant effort is devoted at the workup stage to explore these differences. Ovarian reserve is tested through history, ultrasound and some blood markers. Male factor is also explored through sperm analysis and other special tests.
- Men and women also vary in terms of their genetics. We employ the widest available genetic screening tests and genetic counseling to minimize the risk of transmission of genetic disease to children. All genetic risk factors are evaluated prior to starting treatment.
- We are also very different in terms of our aspirations and the size of family we intend to build. From the professional single woman that wants to freeze her eggs or embryos for later use to couples that want to get pregnant with a male baby for family balancing and adamant about avoiding a twin pregnancy to the couple that are having difficulty conceiving their first child and are ok with twins. Many women also were not successful after one or more rounds of treatment and need special attention to all delicate factors in their prior treatment history to achieve pregnancy. Apart from healthy, we are very different regarding the outcome we want to achieve.
- When treatment starts, women respond to fertility medications differently. Some women are very sensitive to medicine and require frequent adjustment of medication dose and combinations to avoid overstimulation and adverse effects of ovarian hyperstimulation syndrome. Others do not respond very well to stimulation. When low response is anticipated, we employ special protocols to improve response including minimal stimulation and modified natural cycles.
- Men with male-factor also require detailed attention. Sometimes no ejaculated sperm is available and obtaining sperm may require special intervention.
We sit with you and take a significant amount of time to study these factors and discuss with you what you want to achieve. We then give you a realistic perspective of the best way to go and the chances for successful outcome. You are not rushed into any treatment before a full workup and a full discussion of your options.
How do you pursue further fertility choices after completing the initial fertility evaluation?
Female Factor Infertility
Learn more about the factors in Female Infertility.
Male Factor Infertility
Male Factor Infertility Is Present In About 40% Of Infertility Cases.
Initial testing for male factor infertility requires a sperm analysis. Normal male ejaculate is 2-5mL in volume. Each milliliter contains 15 to 20 million sperm, 50% of them are moving and about 30% of them are normal in shape, using World Health Organization criteria or 4%, using Kruger strict criteria for morphology. Fertility treatment for male factor is extremely successful even with very few sperm, ejaculated or surgically retrieved.
Consultation with a reproductive endocrinologist, in addition to a urologist, is extremely helpful because they are able to evaluate female factors and also can suggest simple measures such as freezing a sperm sample that can preserve your potential for having children in the future. Many times the indication or type of intervention in males needs to be changed due to female factors as blocked tubes or low egg reserve.
In general, supplements, medical treatment and most varicocele repairs yield lower success and longer waiting time to conception than assisted reproduction.