Infertility can be one of the most difficult challenges a couple will face. Few situations are more frustrating for a couple than having difficulty starting a family despite an intense desire to do so. But at what point does one conclude they have infertility? Eighty-five percent of couples will conceive within one year of having unprotected intercourse. It is the fifteen percent that do not conceive within this time frame who have an infertility issue. There are many causes of infertility. The cause may be from a male factor (low sperm count), female factor (anovulation), or both. Although it may sound obvious, three basic requirements must exist to achieve pregnancy. You need a sperm, you need an egg, and you need a place where they can successfully come together. This simple tenet is the basis for the basic infertility work-up.
You must first determine whether or not the female patient is ovulating. Often this may be determined simply by collecting a thorough history. Other times, bloodwork or endometrial biopsy may be required. Then one must obtain a semen analysis from the male patient to ensure that the sperm count, morphology (shape), and motility are adequate to achieve fertilization. Finally, you must evaluate the patency (openness) of the fallopian tubes to rule out the presence of tubal factor infertility. This can be accomplished utilizing a radiographic study known as a hysterosalpingogram or intraoperatively with a similar test called chromotubation. In both cases, either a contrast fluid or dyed fluid is gently injected into the uterus while observing the fallopian tubes for evidence of the fluid passing through the tubes and successfully spilling into the abdominal cavity, thus demonstrating patency of the fallopian tubes.
Once the cause is identified, the focus is shifted toward providing appropriate treatment. This may involve ovulation induction (Clomid), intrauterine insemination, correction of tubal factor infertility and/or consultation with additional providers such as a reproductive endocrinologist or urologist. In any case, Dr. Grisham walks couples through this process by providing information, counsel, and emotional support in an environment that is unrushed and one which encourages questions and the participation of both his patient and her husband.
“Few aspects of my practice are more rewarding than helping a couple diagnose and treat an infertility issue and subsequently seeing them successfully start their family.”
If you have infertility concerns you would like to discuss with Dr. Grisham, click here to schedule an appointment.