Infertility and miscarriages workup and consultation

As an ob-gyn, Dr Tisane investigates the causes of infertility and recurrent miscarriages.

Infertility is when a couple cannot conceive after having regular unprotected sex. We recommend that you seek the help of a gynaecologist if conception hasn’t occurred within 12 months. However, infertility evaluation may be started sooner in patients who are older than 35 or have medical risk factors for infertility.

Causes of infertility include polycystic ovarian syndrome, uterine abnormalities, tubal obstruction, cervical issues, or problems with ovulation. In general, a lack of ovulation is the biggest cause of infertility in women. In men, abnormal sperm production or function are some of the leading causes of infertility. In other cases, couples simply struggle with how to time intercourse with ovulation.

Recurrent miscarriages appear to be a natural process to protect a woman from a pregnancy that is abnormal. Most losses are due to a chromosomal abnormality of the embryo. However, a variety of other factors can contribute to continued failure to carry a pregnancy. In some cases, genetic factors can prevent an embryo from developing normally. In other cases, conditions affecting the uterus, metabolic causes, environmental factors, infections, hormonal disorders, and possibly clotting disorders can affect a woman’s ability to carry a pregnancy.

If you and your partner are having trouble conceiving or have experienced multiple miscarriages, then a visit to a gynaecologist is generally the first step in your journey to becoming parents,

Dr Tisane will conduct tests and provide advice on increasing your chances of conceiving and carrying a baby to full term. These tests include:

• Taking your medical history-you will be asked questions about your menstrual period, abnormal bleeding or discharge from the vagina, pelvic pain, and disorders that can affect reproduction such as thyroid disease
• Conducting a physical examination to help direct the evaluation
• Serum progesterone level measurements- these monitor ovulation on the 21st day of a woman's monthly cycle.
• Imaging procedures such as hysterosalpingography are used to view the inside of the fallopian tubes and uterus
• Hysteroscopy for intra uterine abnormality such as bands or fibriods
• Laparoscopy is recommended for patients with a history of endometriosis, pelvic infections, or ectopic pregnancy

Possible treatments include:

• Medication to induce ovulation: recommended for woman with anovulation (when ovulation doesn’t take place)
• Medication for related health issues such as diabetes, thyroid dysfunction, or high prolactin levels
• Injectable hormones
• Surgery for blocked fallopian tubes, problems in the uterus and fibroids
• Intrauterine insemination (IUI): sperm is placed into the uterus at the time of ovulation
• In Vitro Fertilization (IVF): this procedure combines the egg and sperm in a laboratory
• Examining lifestyle factors such as diet and exercise

Contact Dr Tisane’s office if you are experiencing any infertility issues or recurrent miscarriages for work up and referral where necessary.