The Initial Consult: Identifying Potential Causes of Infertility

The Initial Consultation at the beginning of any fertility treatment cycle is generally the first opportunity patients have to speak with their doctor about the potential reasons they are experiencing infertility and the treatment plan that is best suited to their individual circumstances. This can be an overwhelming appointment full of new medical jargon and the feeling of having limited time with your physician, but it is our hope that it can also be an opportunity for you to get educated about your health, your body, and your options for treatment. This is your time to learn, ask questions, and feel supported by your care team through the process.

While all initial consultations will differ based on your medical history and family planning goals, nearly all patients who are experiencing infertility will fall into the following categories of potential causes of infertility:

Embryo Quality:

In instances where infertility is explained by embryo quality, the cases are either determined to be Age Dependent or Age Independent. In Age Dependent Embryo Quality patients, we see that the older the female is, the more likely the embryo(s) is to carry an abnormal set of chromosomes, regardless of the morphologic assessment. Preimplantation genetic testing for aneuploidy (PGT-A) can help screen embryos for chromosomal abnormalities, to select chromosomally normal embryos for implantation to decrease risk of miscarriage of chromosomal conditions such as Downs Syndrome. IVF is the best course of treatment in order to plant the embryo with the highest grading and likelihood for successful pregnancy.

In Age Independent Embryo Quality patients, embryos will generally present with poor development post-fertilization. Unfortunately, age independent cases can be the hardest to treat and IVF may not always be a successful course of treatment. In either case, if chromosomally normal embryos cannot be created, use of donor tissue (donor sperm and/or donor eggs) may be the next course of action.

Tubal:

In these cases, an issue with the female's fallopian tubes is not allowing the egg and sperm to meet. The tests used to diagnose tubal factor are a semen analysis and HSG, which can determine if one or both of the fallopian tubes are blocked and preventing sperm from reaching the egg, or if the sperm’s motility is preventing successful travel through the fallopian tubes. The treatment plan for tubal infertility is often IVF (as long as the male partner has a normal sperm count). These cases are generally straightforward and allowing the egg and sperm to meet in vitro is usually sufficient to resolve any issues.

Fertilization:

 Patients who have experienced an ongoing history of no pregnancies and those diagnosed with unexplained infertility may fall into this category, including those patients with a normal semen analysis. Unfortunately, problems with fertilization are unable to be confirmed unless there has been a failed conventional IVF cycle. ICSI can help to minimize the risk of failed fertilization by selecting the best sperm from the sample and injecting it directly into the egg, where the fertilization and maturation into a blastocyst can be monitored daily in the lab.

Implantation:

For patients who are experiencing issues with implantation, their diagnosis may be defined as either Pathologic or Unknown. Pathologic issues with the uterus may be visible on a saline infusion ultrasound and present as polyps, scars, or adhesions. A hysteroscopy can also be useful to diagnose. Unknown implantation issues present when euploid embryos or high quality blastocysts are transferred, but no implantation follows. Current research results are mixed and inconclusive, but your physician may wish to proceed with further testing to investigate immunology, implantation windows, and endometriosis. If an embryo cannot implant after treatment, working with a surrogate may be the next course of action.

Male Factor Infertility:

In these cases, conception may not be occurring naturally due to abnormal sperm production, low sperm count, or blockage of sperm delivery. Erectile dysfunction can also impact a couple’s ability to achieve pregnancy. In these cases, IUI can be a path toward successful pregnancy (if the partner with ovaries has no fertility-related issues) to help sperm reach the egg at ovulation. If IUI is unsuccessful, IVF is often the treatment plan to identify healthy sperm with which to fertilize the eggs and create embryos. Male factor infertility currently makes up about 30% of all infertility cases.

If you believe one of these factors may be impacting your ability to get pregnant, the best first step is to book an initial consultation appointment and get a 360 degree understanding of your fertility so that you, your physician, and your care team can create a plan that works for you and your family-building goals. 1 in 6 couples deal with a fertility diagnosis while trying to conceive, so please know that if a fertility consultation is the next step on your path to parenthood, you are not alone and there are many options and courses of treatment to help you achieve your dreams.

Click here to book an initial consult with Spring Fertility! We’re here for you.