Advanced Endometriosis Center NJ

Advanced Endometriosis Center NJ is one of the leading endometriosis treatment place in NJ areas.

What is “infertility”?

The definition of infertility, actually, is in the mind of the beholder (the couple having trouble getting pregnant). While the WHO and the CDC say it’s when no pregnancy occurs after a year of trying, that time limit is likely to be narrowed for women who are older, due to the notoriety of the dreaded “biological clock.”

In private practice, most specialists in infertility have no problem investigating possible reasons after 6 months of actively trying, without success, to get pregnant.

We were designed to have babies. What could possibly go wrong?

A lot. It’s a very complex process involving all of the tumblers of the lock to line up just right:

• Normal menstrual cycle with coordinated activity with your hypothalamus, pituitary, thyroid, and ovaries
• Ovulation of a mature egg
• Successful thickening of the inner lining of your uterus (“endometrium”)
• A clear passage between your ovary to your uterus—in your fallopian tube, which is where sperm meets egg and fertilization takes place
• Normal sperm count and normal sperm morphology (structure)
• Intercourse frequent enough (although just once may be enough)
• Timing of intercourse such that sperm can meet egg in the tube on its way to your uterus for implantation (the proverbial “fertile” days of the cycle)
• Successful fertilization (not interfered with by blockage in your tube or inflammation from endometriosis)
• Successful implantation of the fertilized egg into the lining of your uterus

One might think this set of dominoes would make it very unlikely that pregnancy would occur, but the fact is that most couples trying to get pregnant do so in four months or less. (That’s only 4 ovulations or 4 menstrual cycles!)

What could make things go wrong?

• Anything that disrupts the normal rhythm of your monthly menstrual cycle, such as thyroid disease, ovarian cysts (which delays or prevents ovulation), or pituitary problems (elevated prolactin that makes your body think you’re breastfeeding).
• Anything that alters the biochemistry of fertilization, such as infection or—more likely—endometriosis. Inflammatory substances play havoc with an egg’s ability to become fertilized and the immune system could even jeopardize an egg’s very existence each month.
• Anything that blocks the path from ovary-to-tube-to-uterus, the path of an egg through its ovulation (at the ovary), its fertilization (in your tube), and its implantation (in your uterus):
  • Endometriosis causes scarring that can cement your tubes to your bowel or in any other way kink the tube, making the free-floating migration of an egg impossible.
  • Infection can create an immunologically hostile environment that hampers the biochemistry of fertilization.
  • Uterine fibroids can bulge into the area where your uterus receives the egg’s passage from your tube.
  • A uterine fibroid can compete with blood supply to the area of implantation, interfering with that implantation.
  • An infection can make the lining unfit for successful fertilization.
• Anything that interferes with the delivery of sperm to the egg (the “male” factor):
  • Low or zero sperm count (from infection, low testosterone, some medications, hydrocele, or previous vasectomy)
  • Too many sperm in irregular shape (bad “morphology” which decreases function).
  • Low motility of sperm. Sperm have tails which help them swim against the physiologic “current” of your reproductive organs. If their motility is weak or defective, they just won’t make it.
  • Emotional issues, including low “libido” (sexual desire), from difficulties in the marriage/relationship, some medications (antidepressants), stress/worry, lack of privacy, or a history of sexual or physical abuse.

How much infertility is from you? How much is from the male?

Many studies have said that a strictly male or female cause of infertility can (each) be as much as 50%. This means there is just as much chance of this being your partner’s fault and not yours! And this is why an infertility specialist like Dr. Bozdogan of NJEndometriosis insists on a sperm count as well as an investigation into lifestyle and life choices of both members of the couple that could prove relevant. After all, the end-problem—infertility—affects everyone in the family, so it makes sense to approach it from a global perspective, lest something be missed.

How is a “male” factor corrected?

Dr. Bozdogan of NJEndometriosis says,

“Any gynecologist specializing in infertility will have a close working relationship with a urologist for problems with sperm, testosterone, or libido. It must be a team approach, exploring fully all contributions to infertility from each partner. Just finding that one partner is the cause isn’t good enough, because infertility can sometimes be a very unlucky combination of both male AND female factors; so, going after only one may not be enough, even when there is a serious or obvious problem with that one partner.”

How is the “female” factor corrected?

This, of course, depends on problem. The team approach cannot be overemphasized:

• A history becomes very important. Just because nothing is happening now doesn’t mean something in the past isn’t still haunting your fertility. For example, if you’ve had a sexually-transmitted infection that was treated successfully, there may be resultant scarring in your tubes, even in the absence of infection. (A previous chlamydial infection is famous for just this sort of thing.) Women who immigrate from areas where tuberculosis is endemic can have TB damage to their tubes. Leakage of milk or fluid from your breast could mean your pituitary gland has a small, benign tumor making prolactin (the milk letdown hormone), which your body misinterprets as your breastfeeding, a famous—although not guaranteed—cause of failure to ovulate.
• The physical exam is crucial. Dr. Bozdogan says,

“A complaint of infertility should tip off an infertility specialist for certain things to look for that might otherwise be ignored in an ordinary exam”:

• Subtleties in shape variation, indicating fibroids
• Pain on exam, indicating endometriosis or infection
• Anatomical changes that are genetic or are from medications
• Expressing fluid from your nipple(s)—see above
• Identifying polyp(s) or warty (HPV) tissue that block the cervix
• Even unusual mucus at the cervix
• Hormonal/endocrine problems with the menstrual cycle, ovulation, or thickening of the uterine lining for implantation needs a reproductive endocrinologist on the team.
• With or without a female contribution to infertility, the male part of the equation requires a urologist on the team.
• A thorough workup for infection is mandatory, especially to rule out gonorrhea (which is usually obvious) and chlamydia (which is often not obvious) in both you and your partner.

This involves cultures and—if positive—treatment. After that, it is essential to repeat the culture, which constitutes a “proof of cure.” Many infections are resistant to the first-line choices of antibiotics, which can cause continued infertility after what is considered adequate treatment (but no proof of cure). Unbeknown to you and your doctor, the infection continues, and so does the infertility

• Blockage in your tube(s) from infection or endometriosis can be identified with out-patient imaging using dyes.
• Pain, especially cyclic pain, requires that endometriosis must be ruled out. Much of infertility is due to “silent” endometriosis, so even when pain is not an issue, ruling it out may be prudent.
• A fibroid (or several) can interfere with the normal function of your uterus by occupying space and by competing for blood supply. This could produce a sensitization of the uterine muscle that could expel a fertilized egg or starve an implantation in an area where the fibroid gets more than its share of blood supply.

Do you have to wait a whole year before investigating your ability to get pregnant?

Although the WHO and CDC hang on to the one-year criterium before calling you infertile, any methods that don’t involve risk can be done at any time.

A history and physical is always a good idea—and quite harmless. Also, imaging via ultrasound or to check tube patency isn’t likely to involve any harm. (Tubal patency uses a dye and can theoretically have risk if you’re allergic, or the procedure can theoretically introduce infection. Ultrasound, however, is harmless.)

It’s when surgery is indicated that the risk creeps up higher on your list of things of concern. However, although you have no special protection from the complications of bleeding or infection, the track record of a specialist like Dr. Bozdogan indicates that such things are extremely unlikely to happen to you.

It’s your life, and in today’s age of having rights over your own body, you and your doctor can determine what’s the best timing for pursuing your fertility problems. (For example, a 39-year-old woman has more of an urgency than a 21-year-old woman: common sense should prevail!)

When the cause(s) of infertility have been identified…now what?

Again, depending on the cause(s), the team approach may include many specialists or focus on only a single problem. An infertility specialist like Dr. Ulas Bozdogan of NJEndometriosis is also an endometriosis specialist and a fibroid specialist, making him the pivotal member of the team if your problem is endometriosis or a fibroid uterus. These can be surgically treated as your best chance of restoring your fertility.

Dr. Bozdogan uses the superior technology of the da Vinci robotic system with its unparalleled visibility and exquisite dexterity that allows maximum surgical effort with the greatest respect for the tissue you were meant to keep.

Conclusion

Infertility is a complex problem that must be pursued diagnostically and therapeutically from a global perspective, honing in on the specific cause(s) as other causes are eliminated. This, therefore, requires a global approach by your specialist, and one like Dr. Bozdogan of NJEndometriosis leaves no stone unturned, out of respect for the condition and out of respect for you and your partner.