Common Diagnosis

Our Physicians and Nurses are dedicated to conducting a thorough medical evaluation and review of each of our patient’s medical histories to determine the possible causes of infertility. Once your diagnosis has been established, your physician will work closely with you to outline a treatment plan tailored to meet your specific needs; allowing you to feel at ease as we undertake a gradual evaluation. More often than not, a diagnosis will be established after the infertility evaluation and workup. In this section, you will find details about some of the many potential causes of infertility that face couples today.

PCOS

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. For women trying to conceive a child, PCO is a serious, common cause of infertility - nearly half of all female factor infertility cases can be traced to PCO. New medical insight into the disease has led to treatment options, including insulin-reducing and ovulation induction medication (clomiphene, metformin), dietary changes (low glycemic diet) and surgery (ovarian drilling), which have proven successful and allow many women to overcome PCOS and conceive a child naturally, while reducing the risk of miscarriage. Women who undergo treatment for PCOS but are still unable to conceive naturally often turn to assisted reproductive technologies, including IVF, and experience high pregnancy success rates.

At Eve Fertility Centers, our physicians specialize in this common, yet often misunderstood cause of infertility. We work closely with each patient to understand her specific medical case and personal goals, including weight loss, pregnancy or improving general health, and develop a holistic approach to reach those goals. Often, the road to overcoming PCOS is not an easy one and it takes a strong commitment from both the patient and the physician to overcome it. Our team at Eve Fertility Centers is committed to supporting you throughout the treatment process and will do everything in their power to help you through.

Ovulatory Disorders

Ovulatory disorders are one of the leading causes of female infertility. The main factor in diagnosing anovulatory disorder is examining your medical history, though blood tests, ultrasounds and urine tests are sometimes performed to confirm a diagnosis.

Ovulatory dysfunction can manifest itself as the absence of menses (amenorrhea) or irregular, sometimes infrequent, menses. Anovulation is a condition in which eggs are not developed properly, or are not released from the egg sacs (or follicles) of the ovaries. Women who suffer from anovulation may not menstruate for several months or may continue to menstruate regularly even though they are not ovulating. The cause of anovulation is often unknown. However, in some cases the disorder can be traced back to an eating disorder, hormonal imbalance, excessive exercise, thyroid dysfunction, insulin resistance or other medical disorders.

The physicians at Eve Fertility Centers will examine your medical history and test results thoroughly before making an ovulatory disorder diagnosis. Based on the diagnosis, your physician will work with you to determine the treatment plan that will be most effective for you. When possible, the underlying cause of the ovulatory disorder is treated; when no cause is found, ovulation-inducing medications are prescribed as treatment.

Tubal Factors

Tubal disease-one of the many causes of female infertility-is a disorder in which the fallopian tubes are blocked or damaged. Your physician will review your medical history and undergo a complete pelvic exam to diagnose a tubal disorder. It is often necessary to perform additional tests, including hysterosalpingography and laparoscopy, to confirm the diagnosis.

Scar tissue, infections and tubal ligation are often causes of tubal disease. Scar tissue resulting from endometriosis or abdominal or gynaecological surgery, such as bowel surgery, caesarean section or a ruptured appendix, can block an egg from entering or traveling down the fallopian tube to meet the sperm, preventing fertilization. Infections, including Chlamydia, can damage the cilia (the tiny hairs lining the fallopian tubes that help transport the egg), often preventing the sperm and egg from meeting. One result of damaged cilia is an ectopic pregnancy, which occurs when an egg is fertilized but, due to the damaged cilia, it is unable to travel to the uterus, growing instead in the wall of the fallopian tube. This condition can result in rupture, internal bleeding and further tubal damage. Many women who have undergone tubal ligation (had their "tubes tied"), decide they want to have a baby at some point after the procedure. These patients most often undergo in vitro fertilization to bypass the blockage. In some rare cases, surgery can be done to reattach tubes after ligation.

There are a number of treatment options available to overcome infertility caused by tubal disease. Your physician will go over the options with you and together you will determine the treatment that will be most effective for you and lead to the desired outcome of having a baby. Successful treatment options used by Eve Fertility Center physicians include surgical removal of scar tissue, surgical repair of damaged tubes, tubal ligation reversal or in vitro fertilization. IVF typically provides the best results; however, surgical approaches may be advisable due to religious issues, or other pelvic findings such as hydrosalpinx or leiomyoma (fibroid).

Male Factor Infertility

Misconceptions are very common in the world of infertility. One popular myth is that infertility is the woman's problem and that once that "problem" is fixed; the couple will be able to conceive. This could not be farther from the truth. In fact, in nearly 30% of all infertility cases, the cause is attributed to a factor in the male and in an additional 30% of cases the cause is attributed to both male and female factors. Male factor infertility is one of our specialties at Eve Fertility Centers. Less than a decade ago, treatment for a severe male factor was limited to inseminations or IVF using donor sperm. Today, innovative advances in male infertility treatment have introduced new therapeutic options that offer men, including those with no sperm in their ejaculate due to genetic conditions, a greatly improved chance to conceive their own biological offspring.

At Eve Fertility Centers, we understand that couples seeking treatment for infertility are in search of a program that will provide them with the best chance possible for conceiving a child. In order to maximize the chances for conception, we create a partnership with each couple to determine exactly what the goals are and establish a treatment plan to maximize all resources in an effort to reach those goals. Coupling this with modern treatment facilities and innovative new technologies, means your chances of conceiving are much higher.

Age and Infertility

As a woman's age increases, her ability to become pregnant and carry a pregnancy to term decreases due to the many biological changes taking place in her body. From age 30 to 40 the chances of becoming pregnant gradually decline and after age 40 there is a sharp decline. Even if a woman becomes pregnant at a later age, chances of miscarriage and chromosomal abnormalities, resulting in birth defects such as Down's Syndrome, increase with age. Assisted reproductive technologies, including in vitro fertilization and intracytoplasmic sperm injection, also become less successful as age increases.

Although it varies from woman to woman, fertility typically declines during your mid- to late-thirties. The number of your eggs declines, the likelihood of medical problems such as endometriosis increases, ovulation often becomes irregular, your ovaries produce less estrogen and progesterone and your eggs become resistant to fertilization and tend to have more chromosomal abnormalities.

Despite this, however, physicians here at Eve Fertility Centers will evaluate your medical history, conduct a pelvic exam and run other tests to determine hormone levels and ovulatory function before making a diagnosis. After the diagnosis is made, your physician will discuss options for increasing your chances for pregnancy including ovulation-inducing medications, assisted reproductive technologies (IVF and ICSI) or the use of special procedures when other therapies fail. This ensures you that here at Eve Fertility Centers, all options are taken in order to maximise the chances of you conceiving a child no matter what limitations are placed in front of you.

Endometriosis

Endometriosis -a cause of female infertility- is a condition in which endometrial tissue (the tissue that lines the inside of the uterus) grows outside the uterus and attaches to other organs in the abdominal cavity such as the ovaries and fallopian tubes. Endometriosis is a progressive disease that tends to get worse over time and can recur even after treatment. Symptoms include painful menstrual periods, abnormal menstrual bleeding and pain during or after sexual intercourse.

The endometrial tissue outside your uterus responds to your menstrual cycle hormones the same way the tissue inside your uterus responds. It swells and thickens, then sheds to mark the beginning of the next cycle. The blood that is shed from the endometrial tissue in your abdominal cavity has no place to go, resulting in pools of blood causing an inflammation that forms scar tissue. The scar tissue can block the fallopian tubes or interfere with ovulation. Another result of endometriosis is the formation of ovarian cysts called endometrioma that may also interfere with ovulation.

The cause of endometriosis is unknown though there are a few theories that suggest possible causes. One theory suggests that during menstruation, some of the menstrual tissue backs up through the fallopian tubes into the abdomen where it implants and grows. Another theory indicates that it is a genetic birth abnormality in which endometrial cells develop outside the uterus during foetal development.

A laparoscopy, an outpatient surgical procedure, is necessary to confirm a diagnosis of endometriosis after a medical history review and pelvic exam. After the initial diagnosis, your physician will classify your condition as stage 1 (minimal), stage 2 (mild), stage 3 (moderate) or stage 4 (extensive) based on the amount of scarring and diseased tissue found. Based on the stage of endometriosis, your physician will determine the best treatment plan for you which may include medication or surgery, or a combination of both. Whichever is recommended, you can be assured that we will be with you at every step of the way in order to increase your success of conceiving and that you are comfortable with the procedure that is to be undertaken.

Unexplained Infertility

In approximately 15% of all infertility cases, the cause remains unknown after a thorough examination and testing of both the male and the female. In some cases, a comprehensive review of all testing and treatment previously performed reveals clues in a past evaluation that may help lead to a diagnosis. Your physician may also request that your partner repeat a semen analysis for a more recent specimen and that you undergo a hysterosalpingogram (HSG) to confirm that there is no scarring or abnormalities in the uterine cavity. If risk factors suggest tubal disease, a laparoscopy may be performed to treat endometriosis and rule out pelvic scarring.

If the cause of infertility is still unexplained after additional testing, your physician will work closely with you to determine the most effective treatment plan available. Treatment options for unexplained infertility cases are based on a number of factors including age of the female, duration of infertility, working diagnosis of the problem and the desired outcome of the couple. Treatment options include controlled ovarian hyper stimulation, intrauterine insemination (IUI) and in vitro fertilization (IVF).

Recurrent Miscarriage

Miscarriage is defined as the loss of a pregnancy before 20 weeks of gestation. Nearly 20% of pregnancies end in miscarriage, most often within the first 12 weeks. Recurrent miscarriage, or habitual pregnancy loss, is defined as three or more consecutive, spontaneous pregnancy losses.

Often, no cause for miscarriages is found but possible causes include genetic defects, abnormally shaped uterus, uterine fibroids, scar tissue, hormonal imbalances and illness such as diabetes. Increased age, habits such as smoking, caffeine and alcohol, and the use of certain medications increase a woman's risk for miscarriage.

There are a number of tests that your physician may run, in addition to reviewing your medical history and conducting a pelvic exam, to diagnose the possible cause of your recurring miscarriages. These tests may include a mapping of your chromosomes to detect genetic defects, a hysterosalpingogram, blood tests to detect immune system abnormalities and measure hormone levels, a vaginal ultrasound and an endometrial biopsy. Once the cause has been determined, your physician will work with you further to map out a treatment plan, which may include surgery to correct problems with the shape of the uterus or medication to correct immune problems and hormone imbalances.

Treatment increases your chances of becoming pregnant and carrying a pregnancy to term. However, even if no cause is found and no treatment is given your chances of eventually delivering a baby after recurring miscarriages is about 60%. Here at Eve, we will try our utmost best to make that happen and ensure that all relevant tests are taken to maximise the possibility of success.

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