UNDERSTANDING INFERTILITY
it is in the ovulatory range, but by how long the luteal phase lasts,
which should be greater than or equal to 12 days.
I also get a TSH and thyroid antibodies on my patients as there
has been literature stating that even in patients who are euthyroid by
TSH the presence of antibodies might impact fertility and pregnancy
outcome. There is other literature which disputes this, but I believe
that thyroid hormone supplementation that keeps the patient in
the euthyroid range is not detrimental and might be helpful. I also
check vitamin D as this has been shown to impact fertility, and low
vitamin D is associated with increased fibroid growth.
Therefore, collections can be done at home as long as the sample gets
to the lab within an hour and is kept close to the body to maintain
temperature. For some men, using a collection condom can also
decrease the stress factor. Unfortunately, sperm function tests are
not readily available to assess whether a sperm can penetrate an
oocyte, so for a lot of men fertilization ability is an unknown factor.
The fertility problem then determines the treatment, and nu-
merous treatments are available from ovulation induction drugs to
in vitro fertilization (IVF).
Dr. Archer is a practicing reproductive endocrinologist at Fertility First Kentucky.
Male factor fertility issues are seen in approximately 40-50%
of couples. Most women can provide an accurate history on their
male partner but, if the semen analysis is not what is expected, you
need to query the partner further. Though the traditional semen
analysis is correlated with fertility, it is not a 100% correlation
and other factors such as sperm DNA fragmentation can impact
fertilization, embryo development and miscarriages. In addition,
one abnormal semen analysis does not make a diagnosis of male
factor fertility, and it should be repeated two to four weeks later as
sperm are made in batches and you want to wait for another ‘wave’
to test. Stress collection can also result in a poor semen analysis.
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