Houston infertility specialists who provide personal, individualized care on your path to parenthood.
At The Woman’s Hospital of Texas, we have the top infertility specialists Reproductive Endocrinologists to evaluate and treat couples with infertility. Our specialists provide personal, individualized care to help you become a parent.
What is Infertility?
Infertility is defined as the inability to achieve conception after 12 months or more of regular unprotected sexual intercourse.
To become pregnant:
- An egg is released from a woman’s body ovaries (ovulation).
- The egg is picked up by the fallopian tube where fertilization by sperm and early embryo growth occurs. The tube then passes the embryo into the uterus.
- The uterus and uterine lining (endometrium) must be normal to allow the embryo to implant. Fertilize egg needs to attach to the inside of the uterus which we called implantation.
Infertility in Women
According to the Centers for Disease Control and Prevention (CDC), over 10% of women have difficulty getting pregnant or staying pregnant.
If you have not conceived after a full year of regular sexual intercourse without using contraception, then you may be struggling with infertility. For women over the age of 35, this time frame decreases to six months. Infertility is also considered when a woman achieves conception but is unable to attain the pregnancy. Most infertility is caused by problems in ovulation or maintaining the pregnancy, which can include:
- Inability to produce eggs
- Blocked fallopian tubes.
- Problems with uterus
Other factors that may affect conception:
- Excessive athletic training
- Excess alcohol use
- Health problems
- Sexually transmitted infections (STIs)
Infertility in Men
Sperm function can be affected by the presence of other diseases (high blood pressure, diabetes, kidney disease, hormonal problems, etc.), physical factors such as a varicocele (testicular varicose veins), infection, congenital disease, or inherited genetic factors.
Evaluation and Infertility Treatment Options
You should see a fertility specialist if you are under 35 and have been trying for pregnancy for a year. If you are 35 or older, after 6 months. If you 40 or over, you should see a specialist even if you haven’t started trying.
If you have irregular periods, a history of pelvic surgery, pain or disease, or if you think your partner may have a factor affecting sperm production or ejaculation, you should be seen regardless of your age.
The first aim is to determine what factor(s) may affect your fertility. Testing for the cause(s) of infertility involve four areas:
- Ovulatory factor – testing of ovarian reserve examines ovarian function and the ability to produce eggs and ovulate
- Tubal factor – the initial test is a hysterosalpingogram (HSG) to see if the tubes are open
- Uterine factor – the HSG also gives information about the shape of the uterus
- Sperm function – a semen analysis tells about the sperm count, motility and morphology (shape)
Depending on those findings, an individualized treatment plan can be created to give you your best chance of success. This may involve medical therapy, surgery, intrauterine insemination (IUI) or in-vitro fertilization (IVF).
Medicine for Infertility Treatment
Any woman taking fertility medication should be monitored closely to maximize the chance of success and minimize the chance of multiple pregnancy. Multiple pregnancies are associated with a significant increase in complications for both the mother and her children.
- Clomiphene citrate (Clomid):
This medicine causes ovulation by acting on the pituitary gland. It is often used in women who have polycystic ovary syndrome (PCOS) or other problems with ovulation. This medicine is taken by mouth.
- Human menopausal gonadotropin or hMG (Repronex,):
This medicine is often used for women who don't ovulate due to problems with their pituitary gland. hMG acts directly on the ovaries to stimulate ovulation. It is an injected medicine.
- Follicle-stimulating hormone or FSH (Gonal-F, Follistim):
FSH works much like hMG. It causes the ovaries to begin the process of ovulation. These medicines are usually injected.
- Human chorionic gonadotropin (hCG, Ovidrel);
HCG is used in ovulation induction cycles to trigger ovulation and in IVF cycles to induce egg maturation prior to egg retrieval.
- Gonadotropin-releasing hormone (Gn-RH) analog (Lupron):
Lupron is sometimes used in conjunction with IVF to prevent ovulation or to trigger maturation of eggs prior to egg retrieval. These medicines are often used for women who don't ovulate regularly each month. Women who ovulate before the egg is ready can also use these medicines. Gn-RH analogs act on the pituitary gland to change when the body ovulates. These medicines are usually injected or given with a nasal spray.
Artificial Insemination (AI) or Intrauterine Insemination (IUI)
IUI is done by inserting sperm directly into the uterus at ovulation to increase the likelihood of pregnancy. It is valuable in couples with unexplained infertility, and in some couples with male factor infertility. TIUI is usually combined with a medicine that can stimulate ovulation.
In-vitro fertilization (IVF)
IVF involves stimulating the ovaries to produce multiple eggs, removing the eggs from a woman’s body, and inseminating them with sperm. The resulting embryos are allowed to grow in the IVF laboratory and then either transferred back to the woman’s uterus, or, more commonly, frozen for transfer in a later cycle.
IVF offers the best chance of pregnancy, especially when combined with Preimplantation Genetic Screening (PGS) to test the embryos for chromosome number so that only a normal embryo is transferred.