Infertility

Infertility is defined as not being able to get pregnant after one year of unprotected sex. The main symptom of infertility is lack of pregnancy without any pronounced symptoms. According to the American Society for Reproductive Medicine, one third of the case is due to the female fertility factors. The other one third is related to the male fertility factors and the remaining one third is due to the combination of factors from both partners. In addition, we treat both men and women for fertility.

• ovulation needs to occur.
• The female patient needs to have regular menstrual cycle activities.
• Male partner needs to have healthy viable sperm.
• The sperm must fertilize from the woman’s cervix to the uterus and travel through the fallopian tube to meet and fertilize the egg.
• The fertilized egg must implant to the endometrium.

The most important cause of female infertility is age!!!

The graph above shows the change in pregnancy rate and egg quality according to women’s age.
Naturally, as women age, the pregnancy rate decreases. When they reach the age of 35, the pregnancy rate decreases significantly, and the average pregnancy rate reduces by 10% at the age of 40 and 1% at the age of 45.

The biggest reason why the pregnancy rate decreases as a woman get older is.

01
Unlike male sperm, female eggs are not newly created, and the number of eggs they had at birth gradually decreases as they repeat ovulation and degeneration.

02
This is because eggs stored in women’s ovaries for decades are more likely to develop chromosomal abnormalities in the process of division as time passes.

Several hormones work for fertility. Problems with the working of these hormones interfere with pregnancy. Infertility-related hormones include thyroid hormone, prolactin, follicle-stimulating hormone, and luteinizing hormone. Blood tests can identify to check for abnormalities of these hormones, among which female hormones must be performed on the 2nd to 3rd day of menstruation to obtain accurate test results.

Follicle-stimulating hormone (FSH)
Follicle-stimulating hormone (FSH) helps control the menstrual cycle and egg production. FSH levels are tested on day 2 or 3 of the menstrual cycle to determine a woman’s ovarian function and evaluate egg quality.
In general, women with elevated FSH levels found in their blood on day 2 or 3 of the menstrual cycle have reduced chances of live birth compared to other women of the same age, even with ovulation induction and IVF.

Estradiol
In conjunction with the FSH test, a woman’s ovarian function and quality of eggs can be evaluated through testing estradiol, an important form of estrogen. This test is also performed on day 2 or 3 of the menstrual cycle.
The results of these tests are not absolute indicators of infertility, but abnormally elevated levels correlate with decreased response to ovulation induction medications, and thus lowered IVF success.

Luteinizing hormone
Luteinizing Hormone (LH) stimulates the ovaries to release an egg and start producing progesterone – a hormone that prepares the uterine environment to nurture a fertilized egg. LH can be found in a woman’s urine just before ovulation occurs. Over-the-counter tests that help predict ovulation measure this increase of LH via a urine sample. Urinary LH testing is commonly used to help time intercourse in order to improve pregnancy chance.

Progesterone
The ovaries produce the progesterone hormone just after ovulation. At about mid-cycle – 12 to 16 days after the first day of the menstrual cycle – progesterone prepares the uterus for a fertilized egg’s arrival.
Progesterone levels generally peak one week after ovulation and can be measured through blood tests to detect the amount of progesterone present in the blood stream. After establishing a baseline of progesterone in the blood, a doctor will obtain a mid-luteal serum progesterone test around day 21 of the menstrual cycle or, if urinary LH predictor tests show a positive surge consistent with ovulation, seven days after this test is positive.

BBT Chart
By estimating the ovulation date with the BBT chart, you can find out when you can get pregnant and determine whether you are ovulating.
The rise in body temperature is evidence of progesterone’s smooth secretion. The endometrium secretes more mucus by the progesterone, creating a favorable environment for the fertilized egg to be implanted.
However, suppose the fertilized egg is not fertilized or implanted. In that case, the luteal body atrophy and the progesterone decrease after about two weeks, causing the endometrium to peel and fall, and menstruation begins.

Thyroid Stimulating Hormone
The hormone plays an important role in the proper development and implantation of eggs.
Thyroid Stimulating Hormone(TSH) should be part of the routine evaluation of recurrent pregnancy loss and infertility. TSH should be part of the evaluation for infertility. Here is why: A TSH level of 5mU/l or greater is indicative of hypothyroidism. A TSH level less than 5 mUl but greater than 2.5mU/l is associated with implantation failure and early pregnancy loss. A recent study published in the European Journal of Obstetrics and Gynecology and Reproductive Biology in 4,643 women who had thyroid function tests performed when pregnant found a TSH level in the hypothyroid range in 1.5% of women and 10.3% had a TSH between 2.5 mU/l and 5mU/l. Approximately 19% of women with a TSH higher than 2.5 mU/l but less than 5mU/l went on to develop clinical hypothyroidism. Women with a TSH greater than 5 mU/l delivered infants of low birth weight.
* TSH should be determined and treated if found to be over 2.5 mU/l. The TSH level should be reassessed in early pregnancy since there is increased utilization and demand for thyroid hormone in early pregnancy. The dosage usually needs to be adjusted by as much as 20% to keep the TSH level less than 2.5 mU/l.

Here is how to measure your basal body temperature:
1. The basal thermometer should be used exclusively for basal body temperature, not a general thermometer or electronic thermometer.

2. Wake up in the morning and put the thermometer in your mouth without moving for about 3 minutes.

3. It is essential to measure daily, and all-important items (menstruation, sex, medication administration, and other health conditions) should be recorded.

4. You can save time by measuring at least two months in advance to get infertility treatment.