The Science: Conception requires that viable sperm are present in the fallopian tubes during a short (~24-hour) window of ovulation. Timing intercourse is crucial.
Common Challenges: Irregular cycles that make predicting ovulation difficult, infrequent intercourse due to lifestyle or relationship factors, and medical conditions like erectile dysfunction or dyspareunia (painful intercourse).
Diagnosis & Treatment:
Diagnosis: Ovulation prediction kits (OPKs), basal body temperature (BBT) charting, and cycle tracking apps.
Treatment: Timed intercourse based on ovulation monitoring. For more precise timing, treatments like Intrauterine Insemination (IUI) can be recommended.
The Science: This is the failure to develop or release a mature egg from the ovary. Without ovulation, there is no egg to be fertilized.
Common Conditions: Polycystic Ovary Syndrome (PCOS), Hypothalamic Amenorrhea (caused by excessive stress, weight loss, or exercise), Diminished Ovarian Reserve (DOR), and Premature Ovarian Insufficiency (POI).
Diagnosis & Treatment:
Diagnosis: Day 3 hormone testing (FSH, Estradiol), AMH testing, antral follicle count (AFC) via ultrasound.
Treatment: Ovulation induction medications (e.g., Clomid, Letrozole). For more complex cases, In Vitro Fertilization (IVF) is the standard of care to retrieve eggs directly from the ovaries.
The Science: Egg quality refers to the egg’s genetic normality and its ability to fertilize and develop into a healthy embryo. Quality declines significantly with age, but can also be affected by genetics, environmental factors, and endometriosis.
The Impact: Poor egg quality is a leading cause of embryo implantation failure and miscarriage, as genetically abnormal embryos cannot develop properly.
Diagnosis & Treatment:
Diagnosis: There is no direct test for egg quality. It is inferred from age, and confirmed through IVF outcomes—specifically, high rates of embryo arrest or abnormal Preimplantation Genetic Testing for Aneuploidy (PGT-A) results.
Treatment: While quality cannot be reversed, IVF with PGT-A can help identify the few chromosomally normal embryos for transfer. When a patient’s own eggs are not viable, using donor eggs becomes the most effective path to a successful pregnancy, often used in conjunction with a gestational carrier if needed.
The Science: The fallopian tubes must be open and functional to allow sperm to meet the egg and transport the resulting embryo to the uterus. Blocked or damaged tubes prevent this natural process.
Common Causes: Pelvic Inflammatory Disease (PID), previous surgeries, endometriosis, and history of ectopic pregnancy.
Diagnosis & Treatment:
Diagnosis: A Hysterosalpingogram (HSG) is an X-ray test to check if the tubes are open.
Treatment: Depending on the location and severity of the blockage, surgical repair may be an option. However, IVF is the primary and most successful treatment, as it bypasses the fallopian tubes entirely by fertilizing eggs in the lab and transferring the embryo directly to the uterus.
The Science: This encompasses issues with sperm production, function, or delivery. Problems can include low sperm count (oligospermia), poor motility (asthenospermia), abnormal morphology (teratospermia), or a complete absence of sperm (azoospermia).
Diagnosis & Treatment:
Diagnosis: A semen analysis is the cornerstone test.
Treatment: Treatments range from lifestyle modifications and medication to surgical sperm extraction (e.g., TESE, microTESE). For many cases, IVF with Intracytoplasmic Sperm Injection (ICSI), where a single sperm is injected directly into an egg, is the recommended treatment to achieve fertilization.
The Science: The uterine cavity must be structurally normal and the endometrium (uterine lining) must be receptive to allow an embryo to implant and grow.
Common Issues: Uterine fibroids, polyps, scar tissue (Asherman’s Syndrome), congenital anomalies (septate uterus), or a thin endometrial lining.
Diagnosis & Treatment:
Diagnosis: Saline sonogram (SIS), hysteroscopy, or MRI.
Treatment: Many issues like polyps, fibroids, or scar tissue can be corrected surgically. If the uterus is absent, irreparably damaged, or has a condition that makes pregnancy dangerous (e.g., recurrent implantation failure, severe Asherman’s), gestational surrogacy becomes the recommended path. In this case, the intended parents create an embryo via IVF, which is then transferred to a gestational carrier who carries the pregnancy.
The Science: A delicate balance of hormones regulates the entire reproductive process. Imbalances in thyroid hormone (TSH), prolactin, and androgens can disrupt ovulation, implantation, and pregnancy viability.
Diagnosis & Treatment:
Diagnosis: Comprehensive blood hormone panels.
Treatment: Often highly treatable with medication to restore hormonal balance (e.g., Levothyroxine for hypothyroidism, Cabergoline for elevated prolactin).
The Definition: A diagnosis of exclusion given to couples where all standard testing (ovulation, tubes, sperm, uterus) returns as normal.
Expert Insight: This does not mean there is no cause; it means the cause is not detectable with current diagnostic tools. It may involve subtle issues with egg or sperm quality, fertilization, or implantation.
Treatment: Typically begins with less invasive options like IUI, but often progresses to IVF, which can both diagnose (e.g., revealing fertilization failure) and treat the underlying issue.
Comprehensive Evaluation: Schedule a consultation with a Reproductive Endocrinologist (REI) for a full diagnostic workup for both partners.
Review Diagnostics: Ensure you have completed baseline testing: Semen Analysis, HSG, Day 3 Hormones/AMH, and a uterine cavity evaluation.
Discuss Your Results: Based on the diagnosis, have a detailed conversation with your doctor about all treatment paths, including IUI, IVF, and when third-party reproduction (donor eggs, sperm, or surrogacy) should be considered.
Consider Surrogacy4all: If your diagnosis involves a uterine factor that prevents safe pregnancy, recurrent implantation failure, or a medical condition that makes pregnancy high-risk, contact us at Surrogacy4all to explore how gestational surrogacy can help you build your family.
Our job is to listen, to connect the dots between your needs, and to determine how we can best help you have your baby. If you’re asking how much does it cost for a surrogate, we’ll walk you through every step of the process to ensure there are no surprises.
To make an appointment with one of our counselors or physicians, please call (212) 661-7673 or email info@surrogacy4all.com. We look forward to hearing from you.
Surrogacy4All is a unique international surrogacy service targeted at providing state of the art IVF and surrogacy services to Intended Parents irrespective of age, sex or color, at the lowest possible cost in the world.
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