As a woman ages, it’s natural for her eggs to do the same. After the age of 36, egg quality and quantity begin to decline significantly from year to year, which can make it more challenging for a woman to conceive. For women under 30, the estimated chance of conception ranges between 20-30% each month. After age 40, that probability can drop to 5%.

Here is how a woman’s eggs typically age:

• Women are born with a finite supply of eggs, which means that the body does not produce new eggs.
• Eggs are stored in the ovaries but in a precarious state which causes them to age more rapidly than most other cells in the body.
• Older eggs are more likely to have chromosomal abnormalities, making them unlikely to become viable embryos. A fertilized egg with abnormal chromosomes is the single most common cause of miscarriage.

Unfortunately, the older a woman gets, the less likely she will be to conceive and have a successful pregnancy using her own eggs. Of course, some women in their late 30's and even their early 40s conceive effortlessly and deliver healthy babies, but the chances of that happening without medical intervention becomes less likely as time passes. When a woman experiences difficulties conceiving in her 40s, it is a greater challenge to achieve a live birth using her own eggs even with the best technologies, as pregnancy loss rates increase. Some younger women may also experience difficulty conceiving due to premature ovarian failure, or early menopause.

We understand how difficult this can be and we are here to help in every way we can. It’s important to know that age-related infertility and diminished ovarian reserve can be treated. Our team of specialists are ready to assess your situation and guide you through the treatment process with sensitivity.

Treatment options include:

• Preimplantation genetic screening (PGS) and preimplantation genetic diagnosis (PGD)
• Egg donation
• Elective egg freezing in advance (before age 35)

Endometriosis is a common and treatable condition that affects about 5-10% of women worldwide. It occurs when tissue that normally lines the inside of the uterus (the endometrium) grows outside of the uterus. Endometriosis can vary in its presentation and nature. In some women, only a few small lesions are present and do not spread. In other women, endometriosis may become extensive and invasive, leading to blocked fallopian tubes and varying degrees of scarring in the pelvis and abdomen which can disrupt fertility. About 30% of patients who experience infertility issues are diagnosed with endometriosis.

Common symptoms include:

• Painful periods
• Pain with intercourse
• Excessive bleeding – like a heavy period

The good news is that treatment may increase the likelihood of conception. After receiving a diagnosis from your Ob/Gyn, our expert team of physicians will guide you through an individualized treatment plan.

Treatment options include:

• Hormonal management
• Laparoscopic surgery
• IVF

Polycystic ovary syndrome (PCOS) is a relatively common hormonal disorder in women of reproductive age, commonly involving elevated androgen hormones and/or insulin resistance. PCOS is the most common cause of ovulatory dysfunction, occurring in ~7% of women of reproductive age. During a normal menstrual cycle, the first half of the cycle usually yields a single dominant ovarian follicle, which subsequently releases an egg with ovulation. With PCOS, the hormonal imbalance results in ovulation not occurring.

Common symptoms include:

• Acne, weight gain, extra hair on the face and body, irregular periods, and infertility
• PCOS may also be associated with a variety of other health problems including diabetes, hyperlipidemia, and high blood pressure

Women with PCOS who are undergoing ovarian stimulation, specifically with the use of gonadotropins (used mainly with IVF), are at increased risk of developing ovarian hyperstimulation syndrome (OHSS). OHSS can lead to ovarian swelling and fluid around the lungs and in the abdomen/pelvis, dehydration (which may increase the risk of developing blood clots), and an increased risk of a high-order multiple pregnancy in non-IVF cycles. We encourage you to reach out to your Long Island IVF provider with any questions or concerns.

PCOS is highly treatable. Treatment can benefit women who are trying to conceive, help alleviate symptoms, and help prevent long-term health issues. After receiving a diagnosis from your Ob/Gyn, our team will recommend an individualized treatment plan.

Fertility treatment options for PCOS include:

• Diet and Exercise – for obese women with PCOS, weight loss as little as 5-10% of body weight may improve ovulatory dysfunction.
• Clomiphene citrate (Clomid) – selective estrogen receptor modulator (SERM); ovulation-induction agent.
• Letrozole (Femara) – aromatase inhibitor; ovulation induction agent.
• Gonadotropins (Gonal-F, Follistim, Menopur) – follicle stimulating hormone; ovulation induction agent.
• Glucophage (Metformin) – insulin sensitizer; improves insulin resistance, decreases glucose production. May be considered in obese women with PCOS and/or those women with PCOS who are resistant to ovulation induction agents.
• Ovarian drilling (Laparoscopic ovarian diathermy) – surgical procedure using laser or surgical needle with heat to destroy small areas of the ovarian stroma where androgen production occurs; decreased local androgen production may result in restoration of ovulation.

Fibroids (or myomas) are typically benign (non-malignant) muscle tumors that occur in various areas of the uterus. They can vary in number, size and location in the uterus.

Polyps are bulges of extra tissue inside the uterus, caused by an overgrowth of cells in the inside lining of the uterus (the endometrium).

Common symptoms include:

• Occasional cramping
• Heavy menstrual bleeding
• Spotting between periods
• Bleeding after intercourse

How can fibroids and polyps impact fertility?
Most fibroids have minimal or no effect on fertility and may be ignored. But in some cases, fibroids can have the following impacts on fertility:

• distort the tubo-ovarian anatomy, preventing egg retrieval by the fimbria (a finger-like projection at the end of a fallopian tube)
• obstruct blood flow to the endometrial lining; the more space occupied by the fibroids, the greater the likelihood of impact on blood vessels, which can prevent implantation
• irritating the uterine lining, which can prevent implantation; this only happens when all or part of the fibroid has grown into the inside cavity of the uterus. Endometrial polyps may have a similar effect.

The good news is that in most cases, fibroids and polyps are benign and don’t have any noticeable effects. However, if a fibroid or polyp is impeding fertility in any of these ways then they may be surgically removed by your physician in order to improve the chances for pregnancy. Many women who have fibroids and polyps go on to have successful fertility treatment.

Further evaluations can be performed to determine if a fibroid or polyp is affecting fertility. These tests include:

• Saline-Injection Sonogram - injection of salt water into the uterus to open up the inside cavity during a sonogram. This shows structures inside the uterus as well as in the walls of the uterus and how they affect the shape of the cavity.
• Hysterosalpingogram – injection of contrast fluid into the uterine cavity and backwards through the tubes while an x-ray is taken. This shows both the shape of the inside of the uterus and the tubes.
• Hysteroscopy – placing a camera through the vagina into the inside of the uterine cavity.

Fertility treatment options for fibroids and polyps include:

• Hysteroscopy
• Laparoscopic surgery

Learn more about fibroids and polyps from Dr. Kreiner:

During conception, a woman’s egg travels from an ovary and through the fallopian tube to the uterus. If a fallopian tube becomes blocked, infertility can result. When the obstruction occurs where the tube inserts in the uterus (proximal obstruction) IVF can still be an effective treatment. When the obstruction occurs at the ovarian end of the tube (distal obstruction) the tube can fill and swell over time into a condition known as a hydrosalpinx (tube filled with water). In these circumstances, the trapped fluid in the tube can intermittently discharge into the uterus and not only lead to infertility but also interfere with an embryo placed in the uterus after IVF.

Common symptoms include:

• Difficulty conceiving
• Pain in the lower abdomen or pelvic pain
• Some patients may not notice any symptoms

What is an ectopic pregnancy?
An ectopic pregnancy can occur when a fertilized egg grows outside of the uterus. According to the American College of Obstetricians and Gynecologists (ACOG), more than 90% of ectopic pregnancies occur in a fallopian tube. As the pregnancy progresses, it can cause the tube to rupture, which can be a life-threatening emergency that needs immediate surgery.

Treatment options for Hydrosalpinx include:

• Surgery to remove the affected fallopian tube with the hydrosalpinx or at least detach the tube from the uterus prior to an embryo transfer.

It may surprise you to learn that about 60% of infertility cases are related to male factor issues. This 60% figure is comprised of more than 30% in which the male factor is the single cause of infertility plus the more than 30% of the cases which have combined male and female contributing factors. In order to ensure a proper diagnosis and to help determine if and how male factors are contributing to infertility, it’s important for men to schedule a consultation. Male infertility can be overcome with medical, surgical, or assisted reproductive therapy. Our staff urologist Dr. Yefim Sheynkin will work with you to establish a diagnosis and determine the best treatment options.

There are several potential causes of male infertility, which can be identified by thorough evaluation and targeted tests.

According to the Centers for Disease Control (CDC), there are several potential causes of male factor infertility:

Hormonal disorders

• Oftentimes, the hypothalamus or pituitary glands in the brain do not function properly. These glands typically produce hormones that maintain regular testicular function. However, the production of too much prolactin by the pituitary gland (often due to the presence of a benign pituitary gland tumor) can result in low or no sperm production.
• Benign and malignant (cancerous) pituitary tumors, congenital adrenal hyperplasia, exposure to too much estrogen, exposure to too much testosterone, Cushing’s syndrome, and chronic use of medications that are called glucocorticoids can contribute.

Testicular dysfunction

• Varicocele is the most common condition in men who are infertile. It occurs when the veins on a man’s testicles are too large, causing them to overheat. The heat may affect the number, motility and shape of the sperm.
• Trauma to the testes
• Habits such as heavy alcohol use, smoking, drug use
• The use of certain medications and supplements including steroids and testosterone
• Cancer treatment including certain types of chemotherapy, radiation, or surgery for removal of one or both testicles
• Medical conditions such as diabetes, autoimmune disorders, renal insufficiency and certain types of infections may cause testicular failure
• Childhood diseases
• Endocrine diseases including testes, pituitary gland and adrenals

Obstruction( blockage)

• Previous vasectomy, hernia repair, infection and inflammation could cause blockage and absence of sperm in the semen.

Genetic disorders

• Genetic conditions that may affect the production of sperm include chromosomal abnormalities (e.g.Klinefelter’s syndrome), Y-chromosome microdeletions, and cystic fibrosis.

Sperm antibodies

• Sperm antibodies may be a relative cause of infertility in about 3-7% of cases. Treatments with intrauterine insemination (IUI) and with intracytoplasmic sperm injection (ICSI) have been successful.

Sexual dysfunction

• Sexual dysfunction contributes to male infertility in about 20% of cases. Decreased sexual drive, erectile dysfunction, retrograde ejaculation and inability to ejaculate are all conditions that can be treated.

Treatment options are cause specific and include:

• Medical treatment
• Surgical correction of varicocele or obstruction
• Hormonal manipulation
• Surgical sperm retrieval (TESE) for IVF with ICSI

Since treatment of infertility conditions is complex and different options may be available for each case, it is provided as an informed shared decision between the doctor and the couple. Learn about the available treatments for men.