Infertility is defined as the failure to conceive after one year of unprotected sexual intercourse.
In the United States approximately 15-20 percent of married couples will experience some degree of infertility.
This means that one in six couples will need professional assistance.
A diagnosis of infertility, however, does not mean that becoming pregnant is impossible.
To completely evaluate the reproductive potential of a couple, the physician must see the couple together to facilitate treatment.
Infertility can be a multi-factor problem, where several conditions when presented alone are not so important but when added together could markedly influence the reproductive potential of a couple.
Therefore, a systematic, simultaneous basic evaluation should be implemented on both spouses.
Alan Martinez, MD is here to discuss your fertility options and what is best for your individual situation.
Current Approaches to Fertility Treatment, "What is Best for You".
From the Show: RSC NJ - Fertility Talk
Summary:
Air Date: 2/23/16
Duration: 10 Minutes
Transcription:
Melanie Cole (Host): Since the origin of infertility could lie in either or both partners, evaluation becomes a crucial part in determining the treatment plan that is best for you. My guest today is Dr. Alan Martinez. He is a specialist in reproductive endocrinology and infertility at the Reproductive Science Center of New Jersey. Welcome to the show, Dr. Martinez. Tell us about evaluation. If a couple comes to you, what is the first step in evaluating so that you can develop a treatment plan that is truly best for them?
Dr. Alan Martinez (Guest): Thank you for having me on the show today. I appreciate the opportunity to talk. When a couple comes into my office, one of the first things we do is we take a thorough medical history and learn about if they have any medical problems, learn about how long they have been trying, what methods have they preceded with up to this point of presenting to the office. Then, they undergo an evaluation which usually includes laboratory blood work to do what we call “ovarian reserve testing.” From the male side, it involves a semen analysis to look to see if there is any sort of male factor. Then, it involves an ultrasound which will evaluate the female pelvic structures, including the ovaries and the uterus, as a potential source of infertility.
Melanie: What is it that you’re looking for when you’re looking at these things?
Dr. Martinez: We want to gauge and check how well are a woman’s ovaries working. Blood work can be performed at the beginning of her menstrual cycle – usually on cycle day 2, 3, or 4. That will give us an idea that answers the question, are her ovaries acting her age, older than her, or younger than her. That directly relates to the success of the fertility treatments that we have. That’s from the female perspective. We look to see if there are any structural reasons – a potential blockage of the tubes; there may be some structural legions within the uterus, like a fibroid that women commonly have or polyps in the uterus that can affect infertility. We look to make sure that there are adequate numbers of sperm, that the sperm move well, and that the shape of them is a certain normal percentage.
Melanie: Let’s talk about the ovaries for a minute. When ovarian reserve is involved, are you looking at the number of eggs that we’ve got left, or the quality of those eggs to see what her fertility situation will be?
Dr. Martinez: Through the transvaginal ultrasound that we do in our office, we can – depending upon the time of a woman’s cycle – we can look at her ovaries, observe them and count the number of follicles. Follicles are fluid-filled sacs that contain immature eggs. We can get sometimes what’s called an “antral follicle count “which can give us an idea about the reserve or robustness of the ovary. We also combined that with the blood work assessment. Commonly, the hormones that we use are FSH/LH – that is oftentimes a test that is performed. We are looking for, in an idea world, an FSH of less than 10 and an LH of less than 12. A newer test is called the “Anti-Mullerian” hormone – the AMH. To have normal ovarian reserves, we are seeking a level above 2. These, combined with ultrasound, can give us an idea of the number of eggs that remain and it can allude to the quality as well.
Melanie: In the endometrial lining, are hormones involved in this lining and how well it’s going to preserve the eggs?
Dr. Martinez: The endometrial lining would be for the purposes of an embryo implanting in the uterus. We can evaluate the lining of the uterus in a given menstrual cycle. We can also measure to see if a follicle, or eggs, are growing and then we kind of time out things and make sure that the hormonal preparation, which is estrogen and progesterone that the uterine lining seethes, that it develops nicely and that it will be consistent with the likelihood of an embryo implanting in the uterus.
Melanie: Where are our hormones also involved in this? Women – we have so many hormones and they fluctuate from month to month, Dr. Martinez. For some women, it can be really severe hormonal fluctuations. How do they get involved in our fertility?
Dr. Martinez: The brain sends very coordinated signals – hormonal signals – to the ovary and it comes in pulses or waves. If that gets altered at all through, say, increased body habitus, a person is obese, or through some diminished function of the ovaries, then what can happen in a slight alteration of these hormones which are normally perceived with very precise pulses, that can be enough to potentially disrupt the likelihood that an ovary is going to develop an egg in a given cycle. It can relate to an anovulatory cycle, which is when a woman does not release an egg. We can kind of look, depending upon where a woman is at in her particular menstrual cycle and then, we can guess and say, “How well is the ovary working?” Then, we can say, “What is your likelihood of releasing an egg?” That’s where the ultrasounds and the blood work kind of come into play to make that decision.
Melanie: When you’re looking toward a treatment plan, where does the man come into this? How much role does his fertility or infertility play in this?
Dr. Martinez: Overall couples—about up to 30-40% of couples--may have a male factor reason why they are not conceiving. It may be the sole factor in up to 20% of couples but the evaluation should proceed at the same time that you start to evaluate the female. I oftentimes have a referral to my office and some blood work has been done on the female and maybe some other discussions and some other testings but when they enter into our office, we make sure that we check the male side of things. It just takes a semen analysis to get a good glimpse and to evaluate and say, “Hey, maybe we have a male factor issue. Maybe we need more of an evaluation from the male side.” Or, everything looks good and then we focus elsewhere.
Melanie: If men have an issue, how do you go about planning that course of treatment? Men seem to be a little bit more hesitant to discussing these things and dealing with them than woman. Is that correct?
Dr. Martinez: Yes. That overall stands to be true. Luckily, when couples end up in our office, whether they’ve been referred or they made an appointment themselves, oftentimes we encourage them to bring their male partners. I think that a face-to-face visit in our office, comforts them and knowledge is power. They are learning that, hey, we are going to evaluate all aspects of this from the female side and from the male side. We’re going to walk you through this and kind of hold your hand and test you and then we can take it from there. If you have good results, we’re fine with that. If you have abnormal results then we’ll help guide you about what the next steps are. I think that just education and involvement--if we have a female that comes into the office--to bring their partner. I think that opens up doors and the men respond very well to that, in most cases.
Melanie: In just the last few minutes, Dr. Martinez, your best advice for being their own best advocate for fertility, for couples and why they should come to Reproductive Science Center of New Jersey for their care.
Dr. Martinez: Luckily, we are a practice with three physicians and, due to our size, we really pride ourselves in treating each individual couple – both the male and female. We sit down with you on a personalized visit, spend ample time with you and answer all your questions. I always like to say that it’s a team approach. From the front staff to the nursing staff to our office, we want to help guide our patients through the process because it can be daunting; it can be worrisome and many people are afraid but if I can alleviate some fears through education, through compassionate care, then that helps out tremendously. That’s what our practice is known for. We are a full service fertility center that offers all of the treatments from simple to advanced treatments. We look forward to the opportunity to meet on a one-on-one basis with each of our patients.
Melanie: Thank you so much for being with us today, Dr. Martinez. It’s really great information. You’re listening to Fertility Talk with the Reproductive Science Center of New Jersey. For more information you can go to FertilityNJ.com. That’s FertilityNJ.com. This is Melanie Cole. Thanks so much for listening.
Melanie Cole (Host): Since the origin of infertility could lie in either or both partners, evaluation becomes a crucial part in determining the treatment plan that is best for you. My guest today is Dr. Alan Martinez. He is a specialist in reproductive endocrinology and infertility at the Reproductive Science Center of New Jersey. Welcome to the show, Dr. Martinez. Tell us about evaluation. If a couple comes to you, what is the first step in evaluating so that you can develop a treatment plan that is truly best for them?
Dr. Alan Martinez (Guest): Thank you for having me on the show today. I appreciate the opportunity to talk. When a couple comes into my office, one of the first things we do is we take a thorough medical history and learn about if they have any medical problems, learn about how long they have been trying, what methods have they preceded with up to this point of presenting to the office. Then, they undergo an evaluation which usually includes laboratory blood work to do what we call “ovarian reserve testing.” From the male side, it involves a semen analysis to look to see if there is any sort of male factor. Then, it involves an ultrasound which will evaluate the female pelvic structures, including the ovaries and the uterus, as a potential source of infertility.
Melanie: What is it that you’re looking for when you’re looking at these things?
Dr. Martinez: We want to gauge and check how well are a woman’s ovaries working. Blood work can be performed at the beginning of her menstrual cycle – usually on cycle day 2, 3, or 4. That will give us an idea that answers the question, are her ovaries acting her age, older than her, or younger than her. That directly relates to the success of the fertility treatments that we have. That’s from the female perspective. We look to see if there are any structural reasons – a potential blockage of the tubes; there may be some structural legions within the uterus, like a fibroid that women commonly have or polyps in the uterus that can affect infertility. We look to make sure that there are adequate numbers of sperm, that the sperm move well, and that the shape of them is a certain normal percentage.
Melanie: Let’s talk about the ovaries for a minute. When ovarian reserve is involved, are you looking at the number of eggs that we’ve got left, or the quality of those eggs to see what her fertility situation will be?
Dr. Martinez: Through the transvaginal ultrasound that we do in our office, we can – depending upon the time of a woman’s cycle – we can look at her ovaries, observe them and count the number of follicles. Follicles are fluid-filled sacs that contain immature eggs. We can get sometimes what’s called an “antral follicle count “which can give us an idea about the reserve or robustness of the ovary. We also combined that with the blood work assessment. Commonly, the hormones that we use are FSH/LH – that is oftentimes a test that is performed. We are looking for, in an idea world, an FSH of less than 10 and an LH of less than 12. A newer test is called the “Anti-Mullerian” hormone – the AMH. To have normal ovarian reserves, we are seeking a level above 2. These, combined with ultrasound, can give us an idea of the number of eggs that remain and it can allude to the quality as well.
Melanie: In the endometrial lining, are hormones involved in this lining and how well it’s going to preserve the eggs?
Dr. Martinez: The endometrial lining would be for the purposes of an embryo implanting in the uterus. We can evaluate the lining of the uterus in a given menstrual cycle. We can also measure to see if a follicle, or eggs, are growing and then we kind of time out things and make sure that the hormonal preparation, which is estrogen and progesterone that the uterine lining seethes, that it develops nicely and that it will be consistent with the likelihood of an embryo implanting in the uterus.
Melanie: Where are our hormones also involved in this? Women – we have so many hormones and they fluctuate from month to month, Dr. Martinez. For some women, it can be really severe hormonal fluctuations. How do they get involved in our fertility?
Dr. Martinez: The brain sends very coordinated signals – hormonal signals – to the ovary and it comes in pulses or waves. If that gets altered at all through, say, increased body habitus, a person is obese, or through some diminished function of the ovaries, then what can happen in a slight alteration of these hormones which are normally perceived with very precise pulses, that can be enough to potentially disrupt the likelihood that an ovary is going to develop an egg in a given cycle. It can relate to an anovulatory cycle, which is when a woman does not release an egg. We can kind of look, depending upon where a woman is at in her particular menstrual cycle and then, we can guess and say, “How well is the ovary working?” Then, we can say, “What is your likelihood of releasing an egg?” That’s where the ultrasounds and the blood work kind of come into play to make that decision.
Melanie: When you’re looking toward a treatment plan, where does the man come into this? How much role does his fertility or infertility play in this?
Dr. Martinez: Overall couples—about up to 30-40% of couples--may have a male factor reason why they are not conceiving. It may be the sole factor in up to 20% of couples but the evaluation should proceed at the same time that you start to evaluate the female. I oftentimes have a referral to my office and some blood work has been done on the female and maybe some other discussions and some other testings but when they enter into our office, we make sure that we check the male side of things. It just takes a semen analysis to get a good glimpse and to evaluate and say, “Hey, maybe we have a male factor issue. Maybe we need more of an evaluation from the male side.” Or, everything looks good and then we focus elsewhere.
Melanie: If men have an issue, how do you go about planning that course of treatment? Men seem to be a little bit more hesitant to discussing these things and dealing with them than woman. Is that correct?
Dr. Martinez: Yes. That overall stands to be true. Luckily, when couples end up in our office, whether they’ve been referred or they made an appointment themselves, oftentimes we encourage them to bring their male partners. I think that a face-to-face visit in our office, comforts them and knowledge is power. They are learning that, hey, we are going to evaluate all aspects of this from the female side and from the male side. We’re going to walk you through this and kind of hold your hand and test you and then we can take it from there. If you have good results, we’re fine with that. If you have abnormal results then we’ll help guide you about what the next steps are. I think that just education and involvement--if we have a female that comes into the office--to bring their partner. I think that opens up doors and the men respond very well to that, in most cases.
Melanie: In just the last few minutes, Dr. Martinez, your best advice for being their own best advocate for fertility, for couples and why they should come to Reproductive Science Center of New Jersey for their care.
Dr. Martinez: Luckily, we are a practice with three physicians and, due to our size, we really pride ourselves in treating each individual couple – both the male and female. We sit down with you on a personalized visit, spend ample time with you and answer all your questions. I always like to say that it’s a team approach. From the front staff to the nursing staff to our office, we want to help guide our patients through the process because it can be daunting; it can be worrisome and many people are afraid but if I can alleviate some fears through education, through compassionate care, then that helps out tremendously. That’s what our practice is known for. We are a full service fertility center that offers all of the treatments from simple to advanced treatments. We look forward to the opportunity to meet on a one-on-one basis with each of our patients.
Melanie: Thank you so much for being with us today, Dr. Martinez. It’s really great information. You’re listening to Fertility Talk with the Reproductive Science Center of New Jersey. For more information you can go to FertilityNJ.com. That’s FertilityNJ.com. This is Melanie Cole. Thanks so much for listening.