History & Physical
At IVFMD we offer an efficient diagnostic pathway to determine the cause of infertility. Both partners are evaluated since male factors are involved in half of the cases. In general, the cause of infertility can be found within 1 to 2 cycles.
A careful history can often help narrow down the causes of infertility. We pay attention to the following clues:
Irregular periods can indicate a problem with ovulation. Short cycles (26 days or shorter) are especially worrisome since they can be early signs of low egg reserve (aging ovaries). Long cycles (32 days or longer) are usually associated with stress (emotional or physical) and are easier to treat with medications. Spotting for 2-3 days before menses can indicate low progesterone production from suboptimal ovulation.
Excessive facial or body hair, weight gain or milky breast discharge can indicate hormonal imbalances that can impair ovulation. These symptoms are often found in polycystic ovary syndrome and thyroid conditions.
Prior treatment for Pelvic Inflammatory Disease (PID) or STDs (for chlamydia, HPV, herpes, syphilis or trichomonas) can suggest tubal damage and pelvic adhesions.
Prior abdominal operations such as appendectomy, myomectomy and tubal surgery can suggest pelvic adhesions and tubal problems.
Prior abnormal Pap smears with cervical treatment such as conization, cryosurgery or LEEP can result in constriction of the cervical opening (stenosis) that can impede the movement of sperm into the uterus.
Severe pain during menstruation and especially during intercourse can be symptoms for endometriosis, a condition in which menstrual implants colonize the pelvis outside of the uterus. These implants can lead to scarring of the pelvic structures, thus impairing the tubes’ ability to pick up the egg.
Heavy menstrual flow (with clots) can indicate abnormalities within the uterine cavity such as fibroid tumors or polyps. These lesions can prevent embryo implantation through their destabilizing effect on the endometrium.
Recurrent miscarriages can be caused by suboptimal ovulation, abnormal embryo or parental chromosomes, tendency of the maternal circulation to form blood clots that can block blood flow to the embryo (thrombophilia), abnormalities of the uterus and other causes. Extensive testing is usually required to determine the cause of multiple miscarriages.
Signs and Symptoms of Female Infertility
The physical exam can confirm the above clinical suspicions and reveal further clues
Abnormal weight can impair the ovulation process. Women with Body Mass Indexes of >35 may not respond well to oral fertility medications and thus may have to use injectable medications that carry higher cost and risks. Likewise, women with BMIs of <20 may not respond to clomiphene and may have to use injectable medications.
Facial and abdominal hair can suggest overproduction of testosterone which can impede follicular development and ovulation.
Skin hyperpigmentation, or acanthosis nigricans, is the darkening of the skin on the back of the neck, abdomen and inner thighs. This finding has been associated with insulin resistance as well as higher risks for diabetes and ovulatory problems.
Neck swelling can indicate problems with the thyroid gland that must be corrected to prevent ovulatory impairment, miscarriages and fetal development delay.
Breast discharge, when milky in appearance and occurs in both breasts, can suggest a pituitary problem such as a pituitary tumor.
An enlarged and irregular uterus may be caused by fibroid tumors that, depending on the size and location, may impair implantation or lead to miscarriages.
Cervical stenosis is the excessive narrowing of the cervical opening that can impede the movement of sperm into the cervix and uterus. Sperm can live only for 1 hour in the vagina, whereas they can live for 3-4 days in the cervix and beyond.