Infertility

What it is

Infertility is difficulty becoming pregnant after 12 months of regular sexual intercourse without contraception — or after 6 months, when the woman is 35 or older. It affects about one in every six couples, and the causes are divided between female, male and combined factors. In women, the most common are ovulation disorders, such as in PMOS, endometriosis, blocked fallopian tubes, fibroids and polyps, thyroid disorders and reduced ovarian reserve with age. The investigation begins with the gynecological consultation, including the couple's history, hormonal tests, ultrasound, evaluation of the fallopian tubes and the partner's semen analysis. Many causes can be treated at the clinic itself — ovulation induction, treatment of endometriosis, removal of polyps and fibroids, correction of hormonal changes. When assisted reproduction is indicated, the couple is counseled and referred to a specialized service.

Most common symptoms

• No pregnancy after 12 months of trying without contraception
• After 6 months of trying, when the woman is 35 or older
• Irregular, very long or absent menstrual cycles
• Severe cramps or pain during intercourse, suggesting endometriosis
• History of pelvic infection, surgery or ectopic pregnancy
• Two or more pregnancy losses
• Wanting to become pregnant after age 35

Causes and risk factors

• Ovulation disorders, such as in polyendocrine metabolic ovarian syndrome (PMOS)
• Endometriosis and pelvic adhesions
• Blocked fallopian tubes, often after pelvic infections
• Fibroids, polyps and uterine abnormalities
• Thyroid and prolactin disorders
• Reduced ovarian reserve with age and male factor

How it is diagnosed

The investigation involves the couple and begins with the gynecological consultation, covering menstrual history, how long they have been trying, surgeries, infections and habits of both partners. The gynecological exam is complemented by hormone level testing, including assessment of ovulation and ovarian reserve, transvaginal ultrasound to evaluate the uterus and ovaries, and hysterosalpingography to check the fallopian tubes, along with the partner's semen analysis. Hysteroscopy or laparoscopy is indicated when uterine abnormalities, endometriosis or adhesions are suspected.

How we treat it at Femi Saúde

Treatment is directed at the cause found and defined together with the couple. The gynecology team at Femi Saúde treats many gynecological causes at the clinic itself: ovulation induction with ultrasound monitoring, correction of hormonal and thyroid changes, clinical or surgical treatment of endometriosis, and removal of polyps and fibroids by hysteroscopy or laparoscopy. Guidance on weight, habits and the fertile window is part of the plan, along with preconception planning. When assisted reproduction is indicated, whether due to a tubal factor, male factor or low ovarian reserve, the couple is counseled and referred to a specialized service, while continuing gynecological follow-up.

What we offer