Reproductive and Infertility Care

In many cases of infertility, we’re able to identify an issue or variety of issues that may be preventing you from conceiving and remaining pregnant.

Some of the most common causes of infertility in women include:

• Ovulation disorders – Ovulating (releasing a mature egg for fertilization) irregularly or not at all causes roughly 40% of infertility cases. Some of the most common conditions that disrupt ovulation are polycystic ovary syndrome (PCOS), premature ovarian failure and the dysfunction of the pituitary gland, which can produce too much or too little of certain reproductive hormones.
• Damage or blockage in the fallopian tubes – Also called tubal infertility, a scarred or blocked fallopian tube will prevent the sperm from getting to the egg or will block a fertilized egg from reaching the uterus. Tubal damage can be caused by an infection (such as chlamydia or gonorrhea), pelvic inflammatory disease, previous abdominal surgery or prior ectopic pregnancy.
• Endometriosis – This condition occurs when tissue like that of the uterine lining grows and implants itself where it shouldn’t. The extra tissue, or in some cases the surgical removal of it, can cause scarring in the pelvis, blocking the sperm from the egg, or it can disrupt implantation of the embryo in the uterus.
• Uterine or cervical abnormalities – Examples of these include benign polyps and fibroids, an unusually shaped uterus or a narrowing of the cervix, called cervical stenosis.
• Age – Egg quality and quantity begin a steady decline after age 35. With the reduction in quality, it becomes more difficult to conceive.

Other risk factors that may contribute to reproductive challenges include weight extremes, smoking, alcohol or drug use or genetic issues.

What causes infertility in men?

It’s important to remember that infertility can affect one or both partners trying to conceive. Causes of infertility in men include:

• Structural abnormalities – This is typically when scarring blocks the sperm ducts in the vas deferens. Other abnormalities include enlarged veins on your scrotum or undescended testicles.
• Sperm abnormalities – An estimated 90% of male infertility is caused by sperm abnormalities, such as shape or size, movement (motility) or sperm count.
• Ejaculation disruption – Issues related to the ability to obtain or maintain an erection, premature ejaculation or retrograde ejaculation and low testosterone can all contribute to infertility.

Risk factors, such as an obese weight, drug or alcohol use or previous STIs and injury can play a role in infertility.

No matter the cause of your infertility, our infertility specialists are here to help diagnose the issue and find a treatment that works best for you.

When should I see an infertility specialist?

A common misconception is that you need a referral or must try to conceive on your own for a certain period of time before you can see an infertility specialist.

No referral is needed to see a reproductive endocrinologist with Ohio State. While the definition of infertility includes a time frame, if you think there’s an issue, for example you don’t think you’re ovulating or you’ve been diagnosed with PCOS or endometriosis, you should make an appointment with us. We can help you determine what you may or may not need to grow your family.

What to expect at my first reproductive care appointment

Your first appointment will be an information gathering meeting. Don’t worry, yet, about cost or painful procedures, as in many cases we’re able to find noninvasive and affordable solutions to your fertility issues.

At your first appointment, we’ll discuss:

• Relevant medical history of you and your partner
• Prior diagnoses of reproductive conditions
• How long you’ve been trying to conceive
• What, if any, treatments you’ve tried
• Past bloodwork and other lab results

Then, we’ll most likely order some bloodwork and diagnostic tests to give us a better understanding of what might be happening with you and your partner.

How is infertility diagnosed?

Diagnostic tools are incredibly important to finding the right fertility treatments. Most of them are inexpensive or covered by insurance. There are tests for both male and female infertility.

Infertility tests for women

Blood tests for female infertility

Simple blood tests can evaluate for:

• Hormone levels
• Egg reserve and egg quality
• Ovulation problems
• Thyroid issues
• Vitamin deficiencies

Ultrasounds

Transvaginal ultrasounds can evaluate your reproductive organs, alerting us to any issues, such as:

• Uterine shape abnormalities
• Fibroids or scarring
• Ovarian issues

Hysteroscopy

This special type of imaging tool gives us a closer look at the uterus and any uterine conditions. During this noninvasive procedure, a thin, lighted device with a camera on the end is inserted into the uterus through the cervix.

Hysterosalpingogram (HSG)

Another form of imaging, this is an X-ray that looks for any blockages or scarring in the fallopian tubes and abnormalities in the uterus. During the procedure, dye is injected into the uterus through the cervix, and the dye flows through the fallopian tubes while X-rays are taken.

Infertility tests for men

Blood tests for male infertility

Simple blood tests can look at hormone imbalances, testicular issues or genetic conditions that might impact fertility.

Semen analysis

A semen analysis happens when a sperm sample is collected either at home or in our offices and then is tested in our lab for a variety of factors. A semen analysis evaluates sperm:

• Count
• Motility
• Shape

Treatments for infertility

There are a wide variety of fertility treatment options available through Ohio Reproductive Medicine and the Ohio State Wexner Medical Center. We’ll work with you to recommend the best care plan that considers these factors:

• Your age
• Any diagnosed fertility conditions
• Who the infertility affects (male or female, or both)
• How well you handle certain medications or procedures
• Your opinion or preferences

Typically, we’ll start with the least invasive treatments first. Sometimes a combination of therapies is needed to produce the desired result. Treatments that may be in your infertility treatment plan include:

• Medications for ovulation induction: These medications can be oral or injectable and help you ovulate regularly if your cycles are irregular or absent.
• Medications for male hormone imbalances: Sometimes male-factor infertility is caused by hormone issues that can be corrected with medication.
• Intrauterine insemination (IUI): This is a minimally invasive procedure in which sperm is collected, washed in a laboratory, and then placed directly in the uterus using a catheter.
• Surgical interventions: Sometimes surgery is required. For example, laparoscopic surgery can be done to treat endometriosis, fibroids or scarring. Surgery for males may repair abnormalities or improve sperm quality.
• In vitro fertilization and other assisted reproductive technologies (ART): These are fertility procedures that are more extensive and require sperm and the egg to be handled outside the body.

Assisted reproductive technology (ART)

The most common example of ART is in vitro fertilization (IVF). However, there are other techniques that fall under this category that are sometimes used to make IVF more effective.

• IVF: This process involves using fertility medicines to help the ovaries produce eggs and then having mature eggs removed and fertilized with sperm in a lab. After those fertilized eggs, or embryos, grow for several days, one is selected to place in the uterus. Embryos can be frozen for future use.
• Preimplantation genetic testing (PGT): Embryos created through IVF can also be genetically tested for hereditary diseases, to see if the embryo has the right number of chromosomes, or to identify a health issue called balanced translocation.
• Intracytoplasmic sperm injection (ICSI): When sperm-related issues are present, we might do IVF with ICSI, which occurs when only a single sperm is injected to fertilize an egg in the lab.
• Donor eggs or sperm: IVF is often done with a couple’s own sperm and eggs, but sometimes, for a variety of reasons, you may opt to use donor sperm or eggs.
• Gestational carrier: Also known as a surrogate, this occurs when a couple’s embryo created through IVF is placed in the uterus of someone who agrees to carry and deliver their baby.

What’s the difference between IUI and IVF?

IUI and IVF are very different, especially in cost and invasiveness. IUI occurs in an office and involves placing collected sperm directly in the uterus with a catheter.

IVF is a process that takes place over several weeks or months, involving extensive medication to ramp up egg production and then an outpatient procedure to remove the eggs. It’s an ART procedure, meaning the sperm and egg are handled in a lab.

Why choose Ohio State for infertility care?

Since we partner with Ohio Reproductive Medicine, one of the state’s largest providers of ART, we’re able to help many families achieve a healthy pregnancy. Our success rates are high, and as an academic medical center, we’re able to offer innovative research and depth of medical expertise to bring the latest available technologies and treatments to people with infertility.

We also transfer care with ease from the obstetrics (OB) and gynecology team at Ohio State to the reproductive endocrinologists at Ohio Reproductive Medicine, and back to the OB team for prenatal care and safe delivery. That means accessing care is seamless and leaves you with more time to focus on your own needs.