Fertility Care
One in six couples face fertility challenges. Our physicians combine their expertise with sensitivity and advanced treatments to help couples become parents. Our patients benefit from excellent success rates, personal attention and affordable financing plans.
What Is Infertility?
Couples who have never become pregnant after at least 1 year of unprotected sex . Also considered infertile are couples who have been pregnant at least once, but have not been able to become pregnant again.
Causes, Incidence, and Risk Factors
 Causes of infertility include a wide range of physical and emotional factors. A couple's infertility may be due to female factors, male factors, or both.
Female infertility
Female infertility may be due to:
- Problems with a fertilized egg or embryo being able to survive once it is attached to the lining of the uterus
- Problems with the fertilized egg being able to attach to the lining of the uterus
- Problems with the eggs being able to move from the ovary to the uterus
- Problems with the ovaries producing eggs
Female infertility may be caused by:
- Autoimmune disorders
- Clotting disorders
- Defects of the uterus and cervix (myomas or fibroids, polyps, birth defects)
- Excessive exercising, eating disorders, or poor nutrition
- Exposure to certain medications or toxins
- Heavy use of alcohol
- Hormone imbalance or deficiencies
- Long-term (chronic) disease, such as diabetes
- Obesity
- Ovarian cysts and polycystic ovary syndrome (PCOS)
- Pelvic infection or pelvic inflammatory disease (PID)
- Scarring from sexually transmitted infection or endometriosis
- Tumor
Male infertility
Male infertility may be due to:
- A decrease in the number of sperm
- Sperm being blocked from being released
- Sperm that do not work properly
Male infertility can be caused by:
- Environmental pollutants
- Exposure to high heat for prolonged periods
- Genetic abnormalities
- Heavy use of alcohol, marijuana, or cocaine
- Hormone deficiency or taking too much of a hormone
- Impotence
- Infections of the testes or epididymis
- Older age
- Previous chemotherapy
- Previous scarring due to infection (including sexually transmitted diseases), trauma, or surgery
- Radiation exposure
- Retrograde ejaculation
- Smoking
- Surgery or trauma
- Use of prescription drugs, such as cimetidine, spironolactone, and nitrofurantoin
In healthy couples both under age 30, having sex regularly, the chance of getting pregnant is only 25 - 30% per month. A woman's peak fertility occurs in her early 20s. As a woman ages beyond 35 (and especially after age 40), the likelihood of getting pregnant drops to less than 10% per month.
When to seek help for infertility depends on your age. For women under age 30, it is generally recommended to try to conceive for at least a year before seeking testing.
Signs and Tests
A complete medical history and physical examination of both partners is essential.
Tests in women may include:
- Blood hormone levels
- FSH and clomid challenge test to check ovarian reserve
- Hysterosalpingography (HSG)
- Pelvic ultrasound
- Laparoscopy (especially if endometriosis is suspected)
- Luteinizing hormone urine test (ovulation predictor kit)
- Pelvic exam
- Progestin challenge if periods are infrequent
- Serum progesterone
- Temperature first thing in the morning to check for ovulation (basal body temperature charting)
- Thyroid function tests
Tests in men may include:
- Semen analysis
- Testicular biopsy (rarely done)
Treatment
Increase your chance of becoming pregnant each month by having sexual intercourse at least every 3 days in the weeks leading up to and through the expected time of ovulation. Ovulation occurs about 2 weeks before the next period starts. So, if you get your period every 28 days, you should have sexual intercourse at least every 3 days between the 10th and 18th day after you get your period, and concentrating on the 72 hours before ovulation occurs.
Treatment depends on the cause of infertility. It may involve:
- Education and counseling
- Medical procedures such as intrauterine insemination (IUI) and in vitro fertilization (IVF)
- Medicines to treat infections and clotting disorders, or promote ovulation
It is important to recognize and discuss the emotional impact that infertility has on you and your partner, and to seek medical advice from your doctor.
Dr. Karen Berkowitz, reproductive endocrinologist and infertility specialist at Drexel Medicine, treats many issues, including polycystic ovary syndrome (PCOS) and other hormonal disorders, that affect fertility for women. She also performs in vitro fertilization (IVF), donor insemination, oocyte and sperm cryopreservation, and genetic screens prior to implantations.
Expectations (prognosis)
Up to 60% of couples who were considered infertile become pregnant after receiving appropriate therapies (not including advanced techniques such as in vitro fertilization). However, as many as one in five couples diagnosed as infertile eventually become pregnant without treatment.
Prevention
Because sexually transmitted infections (STIs) often cause infertility, practicing safer sex behaviors may minimize the risk. Gonorrhea and chlamydia are the two most common causes of STI-related infertility.
STIs often don't have symptoms at first, until PID or salpingitis develops. These conditions scar the fallopian tubes and lead to decreased fertility, infertility, or an increased risk of ectopic pregnancy.
Getting a mumps vaccine in men has been shown to prevent mumps and its complication, orchitis. The vaccine prevents mumps-related sterility.
Some forms of birth control, such as the intrauterine device (IUD), carry a risk for pelvic infection, especially in women with more than one sex partner and when sexually transmitted infections occur.
Maintain a healthy diet, weight, and lifestyle to optimize your chances for getting pregnant and having a healthy pregnancy.
Remember to take either prenatal or multivitamins containing folate starting before you are trying to become pregnant to decrease your risk for miscarriage and problems with the baby.
Read more about infertility.
Our Physician
Karen M. Berkowitz, M.D.
Infertility and Polycystic Ovary Syndrome
Call 215-762-5181 for an appointment.
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