Learn More About Infertility From Dr. Maria Culotta
Garden OB/GYN Physician, Dr. Maria Culotta is here to share helpful information about infertility, treatment and more!
One of the most exciting times in our lives is making the decision to have a family. Although exciting, it can also come with much anxiety if you find yourself having issues. Whether you are looking to start or looking to expand your family, we are happy to help!
We welcome any issues or concerns regarding your fertility and provide care for all family types (male/female partners, same sex partners, single parents with donor sperm, etc.). We also offer pre-conception consultations for anyone who may have questions about their fertility prior to conceiving.
Below you will find a brief outline of what you may expect:
Infertility evaluation usually starts after a year of regular unprotected intercourse in women under 35 years of age and after six months in women over 35 years of age. However, it can be initiated if you have irregular menstrual cycles or any known risk factors for infertility, which may include, but is not limited to, endometriosis, or any previous sexually transmitted infections.
Your work-up will include a thorough history which focuses on:
- Length of time of infertility
- Previous infertility work up, interventions, and outcomes
- Fertility in other relationships
- Gynecological history
- Menstrual history (which can assess ovulatory function)
- Personal and lifestyle history (including alcohol use, smoking, and drug use)
- Sexual history (including sexual dysfunction and frequency of intercourse)
- Medical and surgical history (including chemotherapy and radiation therapy)
- Family history
Your physical exam will focus on:
- Your body mass index and fat distribution
- Evidence of other medical conditions that would affect fertility (this can include endocrine disorders, endometriosis, structural abnormalities of pelvic organs)
- Assessment of your ovulatory status and ovarian reserve (through pelvic ultrasound and blood work)
Imaging studies done to assess uterine cavity abnormalities and tubal patency will include:
- Pelvic ultrasound (done in our office)
- Saline infusion sonohysterogram (done in our office)
- Hysterosalpingogram (done at a radiology center)
Also part of the evaluation:
- Semen analysis (we will provide you with information on where to go)
- History of male partner
- Tracking of menstrual cycle (performed at home)
- Over-the-counter ovulation prediction kit (performed at home)
Once a cause is identified, we can then tailor your treatment.
It is always critical to focus on lifestyle modifications to improve fertility. This may include smoking cessation; reduce excessive caffeine and alcohol consumption; weight modification; establish appropriate frequency of coitus.
If surgery is indicated prior to the start of treatment, this may involve a hysteroscopy (diagnostic or operative), laparoscopy (diagnostic or operative), or major abdominal surgery. A hysteroscopy is performed at our same-day surgery center or at one of our affiliated hospitals. A diagnostic hysteroscopy allows us to assess your uterine cavity and remove any intrauterine pathology, such as polyps, that may be affecting your fertility. It also allows us to look inside your cavity to assess for any congenital anomalies. An operative hysteroscopy serves to resect and correct any congenital malformations or fibroids affecting the uterine cavity. If we believe a laparoscopy is indicated, this would be performed at one of our affiliated hospitals by one of our talented surgeons. A laparoscopy can help identify tubal blockage (through chromotubation), identify the presence of intraabdominal scarring that may contribute to infertility, and assess for structural anomalies and any abnormalities of your pelvic organs (this may include ovarian pathology, uterine fibroids, endometriosis, hydrosalpinges, uterine anomalies, and/or pelvic adhesive disease). These conditions can then be surgically corrected. Others still may need major abdominal surgery to remove certain fibroids that may be distorting the uterine cavity. This would also be performed at one of our affiliated hospitals.
Once we have established that you are ready to move forward, treatment will include ovulation stimulation, with or without intrauterine insemination (IUI). This is done in concert with ultrasounds to assess efficacy of the medication and allow us to accurately time the IUI or guide you on timed intercourse. The prescribed medications may include clomiphene citrate (clomid); letrozole (more effective in women with polycystic ovarian syndrome (PCOS)); metformin (improves insulin sensitivity in women with PCOS, which can then lead to spontaneous ovulation). IUI is then scheduled at the appropriate time. IUI is a quick and simple procedure done in our office, with minimal discomfort. It allows the sperm to be deposited into the uterine cavity. This process will allow the sperm to bypass the cervical canal and decrease the distance the sperm needs to travel. This is optimal if there are cervical issues, abnormal semen analysis, or if using donor sperm. This can then be done over several cycles, making modifications as indicated.
If irreversible causes of infertility are identified, we will then refer you to the appropriate specialist for further treatment.
Please come and see us at any of our many locations for your initial consultation, work up, and treatment! We look forward to hearing from you and being a part of your journey!