FAQs About Infertility

From the Woman's Diagnostic Cyber - Frederick R. Jelovsek MD

Double uterus
How often is there a male factor causing infertility?
Anovulation and excess weight
Initial infertility consultation
Missed abortion after Clomid® therapy
Ovulation prediction with a kit
Short luteal phase

Yes. It can be as much as a full period although most of the time it is less -- light bleeding or spotting.

I don't think I'm anovulatory. I was tested for TSH, FSH, prolactin, as well as a complete blood count and blood chemistry. Everything came out fine, but creatinine and MPV were low, HGB, HCT, MCH and neutrophils were high. Is there any kind of pregnancy that won't show up on a pregnancy test, such as ectopic?

Sometimes pregnancy tests can be negative like with an ectopic if the HCG levels are low. Other times there can be secretion of urine proteins that actually interfere with the pregnancy test. A blood pregnancy test (quantitative serum B-HCG) is the most accurate and if it's negative, you aren't pregnant.

I have found that having the second uterus makes me a medical mystery. Doctors treat me like a guinea pig and won't address my concerns. I'm almost afraid to go to the doctor anymore. I had five manual exams in six months by doctors trying to find a second cervix. For awhile, I was going to the doctor two and three times a week, and yet I know nothing about what's inside my body.

Ask the doctor to order an MRI (magnetic resonance imaging). It's expensive but it is most likely to answer the question short of surgery to "look".

I am concerned about the hormonal implications of having additional ovaries. Wouldn't my "normal" hormone levels be different if I had four ovaries instead of two?

Almost always there are still only two ovaries even though there are two uteri. 4 ovaries would be a reportable case.

Wouldn't I need a second pap smear?

Its likely that there is not a 2nd cervix if they can't see one. Abnormal development of the genital tract can do that. You may have 2 cavities but only one fully formed cervix.

The list goes on. I know you can't answer all of my questions, but could you at least tell me whether I could be pregnant even though the tests keep coming out negative?

It's possible but you need to get the quantitative beta-HCG to be sure, or wait a week for the regular pregnancy test to be sure.

How often is there a male factor causing infertility?

How common is it for men to be sterile?

Male factor contributing to infertility is about 40-50%. In less than half of that though, the male is totally sterile (about 10- 20%).

My husband is going in for semen analysis in a couple weeks and is quite nervous that HE is the reason we haven't become pregnant in the past year. Are there any stats I can give him for the different fertility problems in men?

See the two abstracts listed at the end of this response.

I am aware of only a couple problems such as low motility, varicose veins, low sperm count. What are the treatments, if any, for the various problems?

If there is any sperm at all, it can be concentrated or even micro-injected into an egg (intracytoplasmic sperm injection - ICSI) by infertility specialists using advanced reproductive technologies such as in-vitro fertilization. This is the most common way this problem is currently treated

If my question is too time-consuming to answer, maybe you could direct me to a web site that could answer.

Be sure to see the Infertility FAQs at: Infertility FAQs

***** Abstracts

Endocrinol Metab Clin North Am 1994 Dec;23(4):783-793
Male infertility.
Baker HW
Department of Obstetrics and Gynaecology, University of Melbourne, Royal Women's Hospital, Australia.

Male infertility is a common problem but only about one quarter of patients have specific or defined conditions that make them either sterile or severely infertile. About half of these patients have untreatable primary seminiferous tubule failure, and donor insemination or adoption are the only possibilities of having a family. The other half have potentially treatable conditions, including genital tract obstruction, sperm autoimmunity, gonadotropin deficiency, coital disorders, or reversible toxin effects. The majority of men seen for infertility (75%) have reduced semen quality, which impairs fertility to a variable degree. Thus far no treatments have been shown unequivocally to increase semen quality and fertility in this group. Assisted reproductive technology has improved the outlook for pregnancy in couples with male infertility and the new technique of intracytoplasmic sperm injection promises to further improve results for those with severe sperm defects or previous failure of in vitro fertilization.

*****

Arch Androl 1997 Nov;39(3):197-210
Relationship between etiological factors and total motile sperm count in 350 infertile patients.
Martin-Du Pan RC, Bischof P, Campana A, Morabia A
Department of Obstetrics and Gynecology, University of Geneva, Switzerland.

The prevalence of different etiologic factors has been evaluated in 350 male patients consulting the same physician in an urban, ambulatory setting for primary or secondary infertility of more than 1 year. Environmental factors such as alcohol or drugs represented 12% of the etiologies, acquired diseases such as varicocele and prostatitis 40%, congenital diseases and primary testicular failure 16.2%, idiopathic cases 19.4%, and abnormality of sperm transport 7.4%. The severity of sperm alterations in the different etiologic categories was evaluated by the total motile sperm count per ejaculate (TMS) (normal > 16). The TMS was less than 5 in classical causes of male infertility such as testicular failure, endocrinopathy, cancer, or antisperm antibodies. It was more than 10 in controversial causes of infertility such as varicocele, prostatitis, chlamydial infections, and professional exposure to heat. After treatment, there was a nonsignificant increase of the TMS in the latter cases. In cases of azoospermia of pituitary origin, the TMS was normalized by a hormonal treatment. In some cases of azoospermia of possible obstructive origin, sperm appeared in the ejaculate after diclofenac treatment. The utility of andrological investigation and treatment is discussed.

Anovulation and excess weight

I need some advice and I will listen to what you tell me. I have been trying to get pregnant for 2 years, have had a HSG, all sorts of blood work and my husband had a sperm test. All results were within the norm, but I do not ovulate. I have not ovulated in 2 yrs of keeping a BBT chart. My periods are quite irregular also. My LH was 6.1, my prolactin was 17.5, and my FSH was 4.1. It says luteal phase 0.8-7.5 mIU/mL and postmenopausal 34.4-95.8 mIU/mL My glucose test was fine.

My question is this...I have many of the symptoms of PCO, most of these showing up in the last 10 yrs, so it's not something I've always had. The symptoms are these...obesity (324 and gaining w/o changing any eating habits) acne, excessive facial hair on chin, sideburns and jaw line, irregular cycles and unusually long cycles, brownish rough skin on the back of the neck, skin tags (many around my neck and armpits), infertility, painful periods and large clotting, anovulation, and androgen body type. My RE told me that I don't have PCO because my FSH levels are not high enough. He said most infertile women have these symptoms. I have not had a vaginal u/s and don't want to question the RE but I have heard that your levels can be normal while still having PCO. Could I still have it, and insist on a vag u/s, or is there no way I could have it since my blood work was okay.

In polycystic ovarian syndrome, usually the LH/FSH ratio is greater than 3 but not always. It's not the absolute levels that are key. Your values may or may not represent PCOS. The ultrasound may help but there can be follicles present in ANY anovulatory state. If there were more (or equal to) 10 follicles in one or both ovaries, that would be evidence toward PCOS. See our news article about Diagnosis of Polycystic Ovarian Syndrome

The rough skin makes me think of hypothyroidism. I assume you had that checked; its pretty routine for anovulation. The excess hair growth can represent androgen excess from the ovary (testosterone) or from the adrenal gland (DHEA). Have both of those hormones been checked?

Also at your weight, a check for diabetes or abnormal glucose tolerance should be done. Any abnormal glucose findings would go along with PCOS. The weight itself is a problem for anovulation as I'm sure you know. Weight watchers or Overeaters Anonymous may be helpful for this at your weight. I don't mean to be unkind, but I know its affect on health.

At this point, I would ask your RE (not quarrelously but firmly) to do any additional studies such as the above. There is a tendency on the part of many physicians to skip tests in the interest of reducing costs if there is not going to be a difference in the treatment. In your case, there may not be any difference in how you are going to be treated unless the thyroid test (TSH) or the adrenal test (DHEA) is abnormal. It may also be that your RE is just judgmental about "large" women and may be jumping to the conclusion that the weight is the only problem.

Are you currently on any medication?

Have you had any treatment for the anovulation or are you just in the diagnostic process now?

I read your reply, you asked if I am currently on meds. I am not. My RE told me that Gonal F would be my next step, and as we cannot afford this, and our insurance doesn't cover treatment, this isn't an option. I was on 6 cycles of Clomid® last yr, starting at 50 mg and ending at 150 mg. With HCG on day 14 of my last cycle of Clomid®. I failed to ovulate on these (according to BBT) I was not monitored. I had a glucose tolerance and the GYN has written to the side of the numbers, "normal". This is why my 2nd GYN concluded that I didn't have PCO and referred me to an RE. I have my records in front of me, and do not see the tests for testosterone, DHEA or TSH anywhere, unless they are written out in some other way. I had a thyroid test done in March of this yr. The TSH from that test results say 4.26, this test was done by a diet doctor, not my GYN or RE. If these are all important tests, why weren't they done on me? Wouldn't a testosterone test be a given? I don't want to sound argumentive but I would think they would perform every test possible before I had to give up with the Gonal F? None of my Dr's have mentioned my weight and I have even asked them if it was affecting my fertility, they all said no. Each said losing might help with labor and delivery, but might not cure my infertility. The diet doctor said with my low BBTs I wouldn't be able to get pregnant. I haven't heard any other Dr mention this. They average 96.7 to 97.3 upon awakening. Thank you very much for your help, and if you have any other ideas, PLEASE reply. Do you think I should switch REs? He is dead set on my beginning Gonal F. His reasoning for this was my FSH was 4.1 and my E2 was 105.

I don't think you need to change REs, but just ask him to check out the excess hair growth by looking at the ovarian and adrenal androgens (testosterone and DHEA).

You probably will still need something like the Gonal F (pituitary gonadotropin releasing hormone) because you failed to ovulate with Clomid®. Moderate weight loss is well known to help many women resume ovulation whether or not PCOS or adrenal hyperplasia is a problem. The low basal body temperatures just reflect the lack of ovulation. They don't CAUSE anything.

Initial infertility consultation