Even though around 80% of women who try for pregnancy will become pregnant within 12 months, according to the CDC,, 10-20% of women of childbearing age will be diagnosed with infertility or subfertility this year. This can be devastating when planning for pregnancy, especially due to the tumultuousness of life and family planning.
Infertility is generally defined as 12 months of unprotected intercourse without conception, and actually only six months of unprotected intercourse without conception in women over the age of 35. While these are strict guidelines, it is sometimes useful to begin assessing fertility before reaching this point, especially if there are known factors that can cause subfertility (difficulty getting pregnant) that can be mitigated early on.
Gynecologists of Manhattan Women’s Health & Wellness offer comprehensive Obstetrics & Gynecology care in New York City for women of all ages. At our ob-gyn clinic, we provide a full range of gynecology services, from annual check-ups and routine pap smears to initial infertility workup and GYN procedures, surgeries performed in our office or the hospital. Our state-of-the-art gynecology NYC facility is equipped with the latest ob-gyn equipment.
Causes of Infertility
A multitude of problems can cause infertility or subfertility. Your NYC Midtown gynecologist, Dr. Fernando Mariz, will always start with taking your medical history to see if any clues might aid in knowing why you have not been able to achieve a pregnancy. After that, the gynecologist will likely investigate each of the major causes of infertility with different tools available to them:
- Hormonal causes – these are very common and can sometimes be corrected with medications. Clues to hormonal causes of infertility can include not having your period regularly every month, having irregular spotting or bleeding, or having male pattern hair growth, such as hair on your chin, chest, back, or belly. Polycystic ovarian syndrome, PCOS, is a common hormonal abnormality that can lead to difficulty becoming pregnant. When diagnosed with PCOS, it is important to see a gynecologist when planning pregnancies, as they may help increase your fertility.
- Uterine abnormalities – Anything that can distort the uterus in a way that would make it difficult for sperm to enter the uterus, or an embryo to implant within the uterus, or even take away blood supply from the uterus uterine lining can cause difficulty with pregnancy. Some of these issues can include but are not limited to polyps (small abnormal outpouchings of the inner layer of the uterus, essentially skin tags inside the uterus), fibroids (muscular tumors that can grow in any or multiple layers of the uterus), and septums (pieces of tissue that connect one side of the inner lining of the uterus to the other side, distorting the overall shape of the uterus). Luckily these can be corrected usually with office-based procedures.
Other important abnormalities can also include a misshapen uterus, two uteri, or no uterus at all. An ultrasound exam is an important step in diagnosing these abnormalities. In some cases, you may need a hysteroscopy, a small procedure where a tiny camera is introduced into the uterus to diagnose and potentially treat problems seen during the exam.
- Fallopian tube problems – The fallopian tubes function to carry an egg, once released, from the ovary into the uterus. This is done via rhythmic contractions of the tubes. Abdominal trauma, history of abdominal surgery, ruptured appendix, or even pelvic infections such as pelvic inflammatory disease (PID) can damage the fallopian tubes and even block them off completely. Your Midtown gynecologist may order special imaging such as a Hysterosalpingogram (HSG), a test where dye or fluid is placed into the uterus, and either with ultrasound or X-ray, the tubes are noted to see if they are open and communicate freely with the ovary.
- Male factor infertility – This relates to any problems that may affect male sperm. Sperm are important factors infertility as one sperm must combine with an egg to produce an embryo (early baby). Sperm can have several problems such as low count (not having enough sperm), low motility (not moving correctly), morphology (being misshapen). A sperm analysis can elucidate any of these issues. Ejaculatory problems can also cause infertility, i.e., the sperm not making their way into the vagina and uterus.
- Other – This includes medications you may be on, a prior medical history that can cause problems with fertility, obesity, or be severely underweight, current treatments you may be undergoing, perimenopause or premature ovarian failure, and even in the frequency of intercourse.
IUDs are generally considered to be a shallow risk during placement, maintenance, and removal. During placement, the risk of infection, perforation (poking a hole through the uterus and the IUD going inside the abdomen, which would require a small surgery to remove), or pain can all occur. Luckily, these are all very rare, and there are ways your gynecologist can mitigate these risks, such as using ultrasound during the IUD placement.
Many forms of infertility can be reversed or fixed.
Once you have had a full evaluation, your gynecologist will discuss the next best in treating infertility or subfertility. There are many ways to aid infertility that can be done in the office, such as ovulation induction (making you ovulate more) with medication, timed intercourse, fixing any uterine abnormalities with hysteroscopy, or more sophisticated management such as intrauterine insemination (IUI), or In Vitro Fertilization IVF.
Important Reminder: This information is only intended to provide gynecology guidance, not definitive medical advice. Please consult an OBGYN doctor about your specific condition. Only a trained, experienced gynecologist or certified gynecology specialist can determine an accurate diagnosis and proper treatment.
Have questions about Infertility evaluation? Please schedule an appointment with the best OBGYN in Manhattan, NY, Dr. Fernando Mariz, by calling our office today.
New York City Locations:
Manhattan Women's Health & Wellness (Upper East Side)
983 Park Ave, Ste 1D17
New York, NY 10028
Manhattan Women's Health & Wellness (Midtown)
51 East 25th St, Ste 451
New York, NY 10010
Manhattan Women's Health & Wellness (Union Square)
55 W 17th St, Ste 104
New York, NY 10011