Infertility affects approximately 15% of couples and can be a challenging and emotional journey. For couples under the age of 35, it is typically diagnosed after a year of regular, unprotected intercourse without conception. Additionally, couples who experience repeated miscarriages may also be considered infertile. At the Center for Human Reproduction (CHR) in New York City, we understand the complexities of infertility and are here to guide you through understanding your personal fertility and available treatment options.
Since our founding in 1981, CHR has dedicated itself to advancing research and clinical care, producing a wealth of knowledge we’re eager to share with you. Many of our patients have long treatment histories and may feel like "expert patients," but we also want to support those just beginning their fertility journey. Our resources provide a comprehensive overview of infertility conditions and treatments, helping you make informed decisions about your fertility and treatment plan.
Watch Dr. Barad explain infertility diagnosis and treatment
Couples under the age of 35 who have been trying to conceive through regular, unprotected intercourse for more than a year are generally diagnosed with infertility. For older couples, conception may take longer, but time is often a critical factor. Due to the limited window of female fertility, it’s important for older couples to seek professional advice even if they've been trying for less than a year. Further testing is typically required to identify the underlying cause of infertility and guide the appropriate treatment..
Couples under 35 years of age who have been having regular unprotected sexual intercourse for more than 1 year are typically diagnosed with infertility. In older couples, it may take longer to conceive. However, older couples also may not have the luxury to "wait and see," since the female reproductive time frame is limited. Older couples, therefore, should seek professional counsel even before a full year of unsuccessful unprotected sexual intercourse. Further testing is needed to determine the specific underlying cause.
Typical diagnostic tests that are prescribed may include:
Identifies contributing risk factors such as medications, history of sexually transmitted disease, prior ectopic pregnancies, weight, or other health conditions that may impact fertility. Significant family history of infertility, autoimmune problems, etc. can also be discovered in this process. This is the most basic but possibly the most important diagnostic process for fertility patients. Unfortunately, many IVF centers neglect the importance of this step, delegating the responsibility to non-physician staff members.
Both the male and female reproductive structures are evaluated for abnormality.
Males and females are tested for hormone levels that impact ovulation and sperm production. These may include follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroid hormone, progesterone, testosterone, anti-mullerian hormone (AMH) and more.
Infections from sexually transmitted diseases can negatively impact your ability to become pregnant.
A blood test can be done to help determine whether or not a woman is ovulating each month. This can also be evaluated through the use of basal body temperature readings.
This type of x-ray evaluation uses contrast dye to visualize the uterus and fallopian tubes for damage or abnormalities. In the hands of an experienced fertility specialist, HSG is a good technique to diagnose subtle tubal infertility that may be overlooked by a radiologist who does not specialize in fertility care.
An ultrasound (HSN) can help screen for abnormalities of the reproductive organs.
This is the most commonly ordered and most important test for diagnosing male infertility. Sperm count, concentration, morphology (shape of sperm) and motility (mobility of sperm) are tested. Semen analysis is an indirect way to assess the sperm's ability to fertilize an egg.
In rare cases where a genetic causes of infertility is suspected, this testing may be indicated.
This procedure used to be common. However, with the development of less invasive and more accurate diagnostic methods, laparoscopy is rarely used for diagnostic purposes only. In most high-quality IVF centers, laparoscopy nowadays is a therapeutic procedure, not a purely diagnostic one.
The term "tubal infertility" refers to the inability to become pregnant due to a problem in the fallopian tubes.
The fallopian tubes are the two long hollow appendages on either side of the uterus that connect the uterus to the ovaries. Each month, the ovaries release a mature egg into the fallopian tubes, where they can be fertilized by sperm. Once fertilized, tiny hairs inside the fallopian tubes move the embryo (fertilized egg) down the tubes and into the uterus for implantation and pregnancy.
Tubal infertility is most often caused by either damage or blockage in these tiny tubes. This can be due to past infections, sexually transmitted diseases, pelvic inflammatory disease, history of an ectopic pregnancy or endometriosis. Tubal infertility is a mechanical problem that prevents either the fertilization or implantation.
It is estimated that approximately 20-25% of all infertility cases involve tubal infertility. However, damage to the fallopian tubes is often missed due to limitations in diagnostic screenings. This statistic likely under-represents the real prevalence of tubal infertility. At CHR, we often see patients with a dubious diagnosis of "unexplained infertility." Many of them have undiagnosed tubal infertility.
The best way to diagnose tubal infertility is through a procedure known as a hysterosalpingography (HSG), in which contrast dye is inserted through vagina to the uterus and fallopian tubes. X-ray images are then taken while the dye is flowing through the structures in order to illuminate any area that may be blocked or partially occluded. It sometimes takes an experienced physician, preferably a fertility expert (not a regular radiologist) to diagnose subtle cases of tubal infertility.
Treatment for tubal infertility depends on the type of damage that is present. In some cases the dye from a HSG exam is enough to clear a blockage whereas in many other cases IVF offers the best hope for pregnancy.
Surgery is often overused as a treatment for infertility and, in many cases, can do more harm than good. For example, performing a laparoscopy to open a blocked fallopian tube in a 45-year-old patient is unnecessary, as she would likely need IVF, making the condition of her tubes irrelevant. Surgical procedures for conditions like endometriomas can sometimes result in reduced fertility. It's crucial to thoroughly explore less invasive treatment options before considering surgery to ensure it's the most appropriate choice for the patient's needs. To learn more or to find out what your options could be, contact our center in Manhattan to schedule a consultation with one of our infertility specialists.