Knowing your cycle is an essential part of any evaluation or treatment of infertility.  At Harmony Women’s Health, we can work with many types of charting systems, but recommend Creighton Model Charting to best understand and treat infertility.  

For most patients, a full hormone work-up including checking for ovulation is the first step.  Diagnosing and treating hormone imbalances is key to solving the puzzle of infertility.  We check hormone levels throughout an ovulation cycle so that we can best determine how to treat the patient.

Polycystic ovarian syndrome is a multi-faceted disease that can affect fertility in a lot of different ways.  We treat with supplements, medication, and sometimes surgical correction (ovarian wedge resection) to help our patients to conceive and reduce their risk of miscarriage.

Endometriosis is a very common cause of “unexplained” infertility.  The reason is that endometriosis can rarely be seen on any imaging (ultrasound or MRI).  Although anti-inflammatory diets, hormone balancing, and physical therapy can help patients with endometriosis, curing the disease often requires laparoscopic removal of the endometriosis itself in order to restore fertility and/or relieve pain.

A very overlooked part of infertility evaluation is the checking of cervical mucus.  Conception requires a healthy egg, healthy sperm, open fallopian tubes, and cervical mucus to transport the sperm and keep them alive.  Many patients chart their cycles, but often do not really pay enough attention to this important aspect of their fertility.  Unfortunately, many women have damage to their cervix from many years of taking artificial hormonal contraceptives.  We work with our patients to improve cervical mucus and increase their chances of conceiving.

Ovulation is the first key to fertility.  Some ovulation disorders can only be diagnosed by ultrasound observation of ovulation on the days before and after ovulation.  We offer our patients skilled ultrasound exams that can see if the ovulatory follicles are mature and whether or not the ovulation is complete enough to release the egg completely in order to give it a chance of being fertilized while it is still functional.

Scar tissue in the pelvis can cause infertility and is often difficult to diagnose without a laparoscopic evaluation.  This scar tissue can be caused by previous surgery such as a cesarean section, myomectomy, or even an appendectomy.  Any pelvic surgery can result in adhesions that need to be removed so that conception can occur.  Previous infection such as gonorrhea, chlamydia, and bowel/appendix infections can also contribute to pelvic adhesions.  Removing these adhesions and doing physical therapy are keys to pregnancy chances in the future.

Blockage of fallopian tubes is a fairly common problem and can usually be fixed with a selective hysterosalpingogram and/or fallopian tube surgery to open the tubes.  This is part of our standard fertility work up and is usually done in conjunction with a diagnostic hysteroscopy and laparoscopy to diagnose and treat all of the possible physical causes of infertility.

Women with fibroids do not always struggle with fertility, but large fibroids or those located in problematic places can definitely make conceiving difficult to impossible.  Myomectomy is the best treatment but should always be done in a minimally invasive approach and care should be taken to reduce scar tissue so that fertility remains a possibility after surgery.