Chairman of Urology
Weill Cornell Medical Center
Former President, ASRM
Director, Male Reproductive Medicine
Mount Sinai Medical Center
Division Director, REI
Stanford University Medical Center
As we discussed, LatinX patients are inherently heterogeneous, and yet there are a few diagnoses that tend to seem more prevalent (e.g. male factor, tubal factor) and others that don’t show up in broad swaths of data (like below) but likely have an outsized impact on specific subgroups (e.g. PCOS amongst patients patients with mestizo heritage).
As for male factor infertility, this is a large and complex topic and we suggest you see our course dedicated to the subject here and pay attention to our guides on adjusting diet and lifestyle (here). For those small populations who may have exposure to toxicants and pesticides, we recommend also consulting our next lesson on environmental factors and mitigants.
As for a tubal factor diagnosis, you may remember from the first lesson on human reproduction (and can see in the diagram below), most women have two ovaries and each ovary has a fallopian tube connecting it to the uterus. If those fallopian tubes are scarred or blocked, it will make it difficult or impossible for the sperm and egg to meet, or for an embryo to reach the uterus.
Tubal factor issues can be caused by any number of issues, including sexually transmitted diseases like chlamydia or gonorrhea. When left untreated, each can cause damage within the uterus and fallopian tubes. In our videos, you’ll hear broader a perspective on how doctors think about addressing patients with a tubal issue.
If both fallopian tubes are blocked, IUI is not a viable treatment option—conception still won’t be possible with anything other than IVF.
If only one fallopian tube is blocked, artificial insemination, or IUI, can work. That said, the odds of success really depend upon where the blockage occurs.
If the blockage is found closer to the uterus, what’s known as proximally, after three IUIs, 36% of women will get pregnant. If the blockage is seen closer to the ovary, or distally, after three IUIs, success rates are closer to 12%.
IVF has the benefit of bypassing the fallopian tubes because eggs are surgically removed directly from the ovary, fertilized outside of the body, and then placed back into the uterus. In effect, IVF takes blocked fallopian tubes out of the equation.
Success rates for women with tubal factor issues are similar to most other IVF patients. As you can see below, for women under age 35, about 40%–45% of IVF cycles lead to a birth. However, with every passing 2 year interval, the odds of success drop by about 10 percentage points so that by the time a tubal factor patient reaches her early 40s, per cycle success rates approach single digits.
If the fallopian tubes aren’t just blocked but they’re also filled with liquid, your doctor may refer to this as a hydrosalpinx. As you can see here, when doctors remove the damaged tube, or tubes, IVF success rates can sky rocket.