Resolving Infertility

Once you are ready to start a family, waiting is the last thing you want to do. But, having a baby does not come easily for everyone. Although most couples conceive within a year of trying, about 10 percent of reproductive-age couples in the U.S. experience fertility issues, according to the Centers for Disease Control and Prevention.

There are many reasons couples can have trouble getting pregnant – from female anatomical conditions to male infertility. Age is becoming a growing cause of fertility problems among women, says Maria Bustillo, M.D., an infertility specialist at South Miami Hospital’s Center for Women & Infants. That’s because many women are waiting until their 30s and 40s to have children. But, the clock is ticking, she warns.

“The optimal conception age for a woman is 25 to 35,” Dr. Bustillo said. “Because the quality and number of eggs a woman’s ovaries produce declines significantly with age, women should not wait to have children.”

She recommends seeing a specialist for an infertility evaluation if you’ve been trying to conceive for more than a year, or six months if you’re over age 35. She also encourages couples who know they have a condition that puts them at higher risk of infertility should see a specialist sooner rather than later. Bottom line: The sooner you see a specialist, the more likely you are to get pregnant.

“Many of the couples I see wish they had sought treatment earlier,” Dr. Bustillo said.

Infertility and reproductive specialists affiliated with the Center for Women & Infants can help couples find the best treatment options. Specialists perform a comprehensive evaluation that begins with collecting a medical and sexual history from both partners. This information will help determine the next step, which may include a variety of tests.

In some cases, tests show no clear explanation for infertility. For answers, doctors may look at a woman’s lifestyle factors such as weight problems (being significantly under- or overweight), excessive exercise or stress that cause absent periods, smoking and alcohol use and even environmental toxins.

In other cases, tests may reveal that one or more of the following conditions is causing a woman’s infertility:

Endometriosis occurs when the uterine lining tissue, called endometrial tissue, grows outside your uterus, usually in the abdominal-pelvic cavity.

Ovulation problems are usually hormonal and can prevent a mature egg from developing in your ovaries.

Polycystic ovarian syndrome (PCOS) is a condition in which small follicles in your ovaries don’t develop into the larger, mature follicles that release eggs.

Tubal factors can prevent your partner’s sperm from getting to your egg and the fertilized egg from getting to your uterus. Blocked or damaged fallopian tubes can be caused by pelvic inflammatory disease, sexually transmitted infections and previous sterilization surgery.

Uterine fibroids are noncancerous growths in the uterus that can change its environment and interfere with embryo implantation, says gynecologist Rafael Perez, M.D., medical director of the Fibroid Center at South Miami Hospital. The Center, along with Baptist Cardiac & Vascular Institute, specializes in the treatment of uterine fibroids.

Shirley Lampert, 38, knows how uterine fibroids can lower a woman’s chances of conceiving. She and her husband tried to have a baby for several years. The multidisciplinary team at the Fibroid Center discovered that submucosal fibroids in Ms. Lampert’s uterus were the cause of the couple’s infertility.

Dr. Perez performed a minimally-invasive robotic myomectomy to remove her uterine fibroids. The couple’s daughter is proof that the fertility-sparing procedure was a success.

“In the past, surgery to remove uterine fibroids was performed as an open procedure, which often resulted in scar tissue and ultimately, infertility problems,” Dr. Perez said. “Now, even very complicated cases can be performed laparoscopically, preserving a women’s fertility and increasing her chance of having a successful pregnancy.”

Robotic surgery was the best option for Ms. Lampert. For others, infertility can also be treated with fertility drugs, artificial insemination or other assisted reproductive technology, such as in-vitro fertilization, egg donation, surrogacy or cryopreservation, which is the freezing and storing of eggs or embryos. Many times these treatments are combined.

Because infertility can be stressful, Dr. Bustillo and other experts recommend that couples dealing with infertility seek support by joining a support group or confiding in a friend or family member.

The good news is that the majority of couples who seek treatment for infertility do end up with a healthy baby.