by William R. Crowe, Jr., MD | Commonwealth Urology
Infertility affects 10-15% of couples and can be a tremendously frustrating experience. However, there is hope for infertile couples and knowing when to get help and who to see can make all the difference.
The majority of couples will conceive within one year, with their chances of a pregnancy being approximately 25% at one month, 75% at six months and 90% at one year. Fertility rates are highest for men and women around 24 years of age. Beyond that, fertility rates begin to decrease. At a time when couples delay children due to career choices or financial stability, it is no surprise that infertility is on the rise.
While traditional dogma urges couples to wait 12 months before becoming concerned about infertility, a medical evaluation can and should be performed at a couples' earliest concern about their fertility status. Infertility affects both men and women. Therefore, scheduling an examination with a physician trained in infertility, such as an OB/GYN for women or a urologist for men, is a crucial step for both individuals.
The first step taken by your chosen physician will be to collect a very thorough history, including menstrual history, presence of pelvic pain and previous surgery. Ovulation problems, often suggested by menstrual cycle irregularities, are present in 15-20% of infertile couples. Fallopian tube problems are present in up to 40% of infertile couples; and are usually the result of endometriosis or pelvic adhesions. Disorders involving the cervix are present in 5% of infertile couples.
After a detailed history has been obtained, women will receive a physical examination, including a complete pelvic exam. Once the physical examination is complete, laboratory testing, including urine and blood tests, as well as biopsy and laparoscopy may be ordered.
The first step taken by your chosen physician will be to collect a very thorough medical history. Once this is obtained, men will receive a physical exam, including a thorough examination of male genitalia. During this examination, attention should be paid to secondary sex characteristics, such as decreased body hair, breast enlargement and penile size.
Areas of concern during the examination can include decreased testicular size (normal is 4 cm), penile opening not at the end of the penis, absence of the vas deferens (tubes that transport sperm from the testis), the presence of a varicocele (a dilation of the spermatic veins in the scrotum, leading to an increase in scrotal temperature and a decrease in sperm concentration and quality), and an abnormal prostate exam. Once the physical examination is complete, laboratory testing, including a semen analysis and hormone studies may be ordered.
If it is determined that a couple is grappling with infertility, there are a number of treatments available. Once a specific problem is identified, your physician will present you with all available options and a treatment plan will be developed to address your unique needs.