Why seek a fertility specialist

A fertility specialist is a doctor, generally a reproductive endocrinologist, who helps treat conditions of infertility in men and women. According to the American Society of Reproductive Medicine, a couple is deemed infertile if they have been unable to conceive after one year of trying (six months for women over 35). Resolve, The National Infertility Association also recommends that women with a previous miscarriage, those with painful or irregular periods, or those who do not ovulate see a fertility specialist as well. Infertility can have a number of causes, which an experienced fertility specialist is trained to diagnose and treat.

What are some common causes of infertility?

Both men and women can be affected by conditions of infertility, due to a wide variety of factors.

Women

• Polycystic Ovarian Syndrome (PCOS) - Developing due to a hormonal imbalance where a woman's body creates excess androgens, PCOS usually causes small, otherwise benign cysts to grow on the edge of each ovary. PCOS often results in irregular periods and ovulations, if ovulation occurs at all, making conception difficult. It has a wide range of other symptoms that not all women experience, including extra hair growth, acne, and darkened areas of skin. A fertility specialist might treat PCOS with Clomid, a drug that induces ovulation to occur, or through a procedure called ovarian drilling, in which ovarian follicles are bored with small holes to encourage ovulation. Some research suggests that a healthy diet is very effective in reducing PCOS symptoms and complications.
• Endometriosis - Caused by a buildup of uterine tissue outside of the uterus, endometriosis can result in blockage that preventing passage of the egg through the fallopian tube. Endometriosis can sometimes be treated with hormonal supplements, but your fertility specialist may also recommend laparoscopic surgery to remove the obstructive endometrial tissue. Endometriosis can cause pain, cyst development, bleeding, and scarring in the pelvic region and make it more difficult to get pregnant. Symptoms are typically most severe during your menstrual phase.
• Hormonal problems - Often, women who have irregular cycles will have trouble getting pregnant due to irregular, infrequent, or absent ovulations, as well as short luteal phases. A fertility specialist might try to treat these conditions with a medication like Clomid, or other hormone regulators. In vitro fertilization (IVF) is another option for women who experience infertility due to ovulation problems.

Men

• Poor sperm quality - Whether due to age, lifestyle factors, or bad luck, some men’s sperm have trouble making their way to, or fertilizing, an egg waiting in the fallopian tube. This may be because of the sperm's shape (called morphology), ability to swim (called motility), or genetic makeup (including damaged DNA), among other possibilities. Various tests can reveal if low sperm quality is an issue for your partner. If this is the case, a fertility specialist may recommend lifestyle changes, certain medications, IVF, or other forms of Assisted Reproductive Technology.
• Low sperm count - Sperm quality isn't the only thing that affects fertility for men: the number of sperm contained in ejaculate also matters. Also called oligospermia, a low sperm count means that a man has fewer than 15 million sperm per milliliter of seminal fluid. There may be no outward symptoms of low sperm count, but some men with this issue also experience hormone imbalances, testicular or groin pain or swelling, erectile dysfunction, or low libido. There are a wide variety of lifestyle and medical factors that can cause low sperm count, including smoking, being overweight, exposure to x-rays or chemicals, heavy bicycle riding, taking certain medications, and excessive heat. A doctor will perform a physical exam and semen analysis to determine whether sperm count is within normal range, then may prescribe a variety of medications and treatments depending on the cause.
• Varicocele - Varicoceles are enlarged veins in the scrotum, which raise the temperature of the testes and hinder sperm production. They sometimes feel like a heaviness or an ache, and the veins may be visibly enlarged. A fertility specialist may recommend surgery to repair the varicocele, or IVF.
• Blockages - Some men may have blockages in the vas deferens or epididymis, which can prevent healthy sperm from reaching and fertilizing the egg. These obstructions are common, affecting about one in every five infertile men. A fertility specialist may treat blockages with surgery or recommend IVF.