Reproductive Conditions + Testing
An elaborate set of miracles must occur for a normal pregnancy to develop. First, the ovary has to release a viable egg at the right time. The microscopic egg has to find its way into the fallopian tube, where it needs to find suitable sperm in order to be fertilized by one. The fertilized egg (embryo) now must make its way into the uterus and hope to find a suitable spot to implant. Any problems with one or more of these steps will not allow a normal pregnancy to occur.
Current fertility testing allows us to examine many of the problems that can thwart a pregnancy from happening. However, there are limitations to current testing – and approximately 20% of couples with infertility are deemed to have ‘unexplained infertility’. This means that in 80% of cases, testing can reveal one or more problems which are causing infertility.
To understand the process further, it can help to think about where the normal steps of fertility occur.
Women are born with all the eggs they will ever have. Over time, women lose eggs…and the eggs that are remaining in the ovaries deteriorate over time. It is more and more likely as a woman gets older that she releases a ‘bad’ egg – one that will either lead to no pregnancy or to a pregnancy which leads to miscarriage.
On the plus side, we have a fairly easy way to measure a woman’s egg quantity through blood work. However, the challenge is that the only current way to measure egg quality is through a more involved fertility treatment called IVF (in vitro fertilization).
Many women have regular, monthly cycles; this indicates that they are ovulating regularly. However, some women may experience very irregular or absent cycles. This means they are not ovulating regularly. This can be due to a variety of hormonal reasons, including polycystic ovarian syndrome (PCOS), hypothalamic amenorrhea, or even early ovarian failure.
When the egg releases from the ovary, obstacles can occur in its path to the fallopian tube, making it difficult or impossible to get in. Scar tissue (from past surgery, infection, or a condition called endometriosis) is a common culprit. The fallopian tube itself may be damaged from previous infection or a previous abnormal pregnancy in the fallopian tube (called an ectopic pregnancy). This can make it difficult for an embryo to travel from the fallopian tube into the uterus.
During normal conception, millions of moving sperm are released into the upper vagina with intercourse. Relatively few ever make it to the uterus – and even fewer make it into the uterus to meet the egg. If the sperm are much lower in number or moving abnormally, it can make fertility much less likely. Once the sperm reach the egg, a normal one must attach to the egg shell and burrow through the wall to start the process of fertilization. Some sperm may not be able to complete this process.
The womb is the final resting spot for the embryo, which needs a healthy environment in which to develop. Scar tissue in the uterus from a previous surgery can impede this process. Also, common benign growths can develop in the uterus that can also interfere with the normal fertility process. Examples would be polyps (soft, fleshy growths) and fibroids (firm, muscular growths). Both these things occur more commonly as a woman gets older.
Basic fertility testing involves 4 relatively easy tests:
- Blood work can help to evaluate hormonal issues that cause infertility. It can also reveal a woman’s ovarian reserve (egg count).
- An ultrasound is typically done to look for uterine growths (polyps or fibroids) or ovarian cysts that could be contributing to infertility.
- A hysterosalpingogram (HSG) is a dye test that is commonly used to evaluate the fallopian tubes. It also gives some information about the inside of the uterus.
- Sperm testing can be performed to evaluate the number, movement, and appearance of the sperm.
Further testing may involve a laparoscopy (a ‘key-hole’ surgery which allows viewing of the inside of the abdomen) or a hysteroscopy (a surgery which involves inserting a slim camera into the uterus). Both procedures are done with some level of anesthesia.
Given the complexity of normal fertility, it is not hard to understand how a patient or couple may experience difficulties when trying on their own. However, with the advancements that are currently occurring in the field of infertility care, we have more and more options available to lead us to success!
Fertility Expert Natalie Burger, MD | Texas Fertility Center
A native of Marietta, Georgia, Dr. Burger received her undergraduate degree in Molecular Biology from Massachusetts Institute of Technology with a minor in Mathematics. She attended medical school at Medical College of Georgia and completed her residency in Obstetrics & Gynecology at the University of Vermont. She also received her fellowship training in Reproductive Endocrinology and Infertility at the University of Vermont.
Dr. Burger is Board Certified in both Obstetrics & Gynecology and Reproductive Endocrinology & Infertility. She has special interests in hysteroscopic surgery, ovulation induction, PCOS, hypothalamic amenorrhea, and recurrent pregnancy loss. She is a member of the American Society of Reproductive Medicine and the American College of Obstetrics & Gynecology. She is currently a Clinical Assistant Professor at the University of Texas/Southwestern. She has been voted as one of America’s Top Obstetricians and Gynecologists for multiple years and as one of the Best Doctor’s in America recently.
In 2011, Dr. Burger was the program director for The Southwest Fertility Forum, which is a conference designed to provide reproductive endocrinologists, embryologists, IVF lab professionals, obgyns and nursing providers with information on the latest clinical and laboratory advances in reproductive medicine and infertility.