Diminished ovarian reserve, a condition affecting nearly one-third of infertility patients, refers to a decrease in the quality and quantity of a woman’s eggs in her ovaries, which impacts her fertility.

Aging is the most common cause of diminished ovarian reserve, but it can be caused by disease, prior surgeries, certain medications and genetic conditions. Sometimes the cause is not known.

Diminished Ovarian Reserve Treatment: Why Choose Johns Hopkins

• The Johns Hopkins Fertility Center includes highly trained physicians, nurse practitioners and embryologists dedicated to providing personalized and compassionate care for individuals and their families on their path to parenthood.
• Through a multidisciplinary team approach, we use groundbreaking research and advanced technology in order to optimize fertility treatments.

Diminished Ovarian Reserve Treatment: What to Expect

To determine whether you may be affected by diminished ovarian reserve, our experts will perform a comprehensive evaluation, including laboratory tests to analyze hormone levels and ultrasound to examine your ovaries. After analyzing the results, we will tailor your treatment plan to maximize your chance of a successful pregnancy.

Endometriosis is a condition that occurs when the tissue that lines the uterus grows outside it. This can lead to infertility and hormonal dysfunction by causing scar tissue formation in or around the fallopian tubes, or cysts in the ovaries that can harm egg supply or quality, making it more difficult to conceive.

Endometriosis Treatment: Why Choose Johns Hopkins

• When you receive care at the Johns Hopkins Fertility Center, you may also be treated by our specialists in minimally invasive gynecologic surgery. The experts from our Department of Minimally Invasive Gynecologic Surgery use extensive research and continued advancements in technology to find cutting-edge solutions to endometriosis care, including minimally invasive and robotic surgery techniques to remove endometrial lesions while maintaining fertility.
• Our fertility specialists will draw on their extensive experience with endometriosis management and fertility treatment to develop a tailored treatment program to help you achieve a successful pregnancy.

Endometriosis Treatment: What to Expect

At your initial consultation, you will meet with a fertility specialist and discuss your personal health history, experience attempting to conceive and goals for fertility treatment. We will perform diagnostic tests to determine the extent that endometriosis is impacting your fertility — and rule out other potential causes.

Depending on the severity of your endometriosis and symptoms, we may recommend surgery before beginning fertility treatments. We will work closely with the highly experienced MIGS surgical team to determine the best course of action for managing your endometriosis while maintaining your fertility goals.

When the condition has been properly managed and you are ready to begin your fertility treatment, your team at the Fertility Center will review the treatment options available to you and begin the process of infertility treatment.

There are many different paths to parenthood, and the Johns Hopkins Fertility Center is proud to assist both individuals and couples on their journey towards family building. We provide preconception care, genetic carrier screening, services on achieving pregnancy through sperm or egg donation, fertility preservation services and resources on gestational carriers to families seeking these fertility services.

Family Building: Why Choose Johns Hopkins

• We regularly work with single women, single men, same sex couples, transgender individuals and couples and heterosexual couples to help people achieve the dream of parenthood. We are prepared to meet the diverse needs of these groups on their family building journey.
• We are aware that the cost of family building can be prohibitive for many couples and individuals. Our team of financial counselors will work with you to determine your insurance eligibility and estimate your out-of-pocket expenses to build the most appropriate plan for you.

Family Building: What to Expect

We will discuss your family building goals and review your medical history, the potential roadmap and financial options. Your physician will then perform diagnostic testing to evaluate your fertility, including blood work, ultrasound and/or semen analysis. If applicable, your partner may also undergo testing. Once the testing has been completed, we will work with you to develop the best plan for you and your family.

Fibroids are noncancerous growths that develop outside the uterus and can narrow the uterine cavity. They may affect fertility by blocking the uterus and fallopian tubes, which can make it difficult to conceive or may put any subsequent pregnancy at risk for miscarriage or early labor.

Fertility Treatment and Fibroids: Why Choose Johns Hopkins

• Our experts at the Johns Hopkins Fertility Center specialize in the evaluation and management of fibroids in patients experiencing infertility. We tailor our treatment programs to the specific needs of women with fibroids to maximize the chances of pregnancy. When you receive care at the Johns Hopkins Fertility Center, you may also be treated by specialists at the Johns Hopkins Fibroids Center.    
• If surgical treatment is needed, we work collaboratively with the surgeons of the Johns Hopkins Division of Advanced Minimally Invasive Gynecologic Surgery, who have specialized training in minimally invasive and robotic surgical techniques to treat your fibroids while maintaining your fertility. We also have a surgeon on our own staff specially trained in robotic myomectomy surgery for fertility preservation.

Fertility Treatment and Fibroids: What to Expect

At your initial consultation, you will meet with a fertility specialist and discuss your personal health history, experience attempting to conceive and goals for fertility treatment. We will perform diagnostic tests to determine the extent that fibroids are impacting your fertility — and rule out any other potential causes. Based on these results, your fertility specialist may recommend surgery prior to beginning fertility treatments.

If surgery is recommended, we will work closely with specialists in minimally invasive surgery to determine the best course of action for managing your fibroids while also supporting your fertility goals.

When your fibroids have been properly managed and you are ready to begin your fertility treatment, we will meet with you to review the treatment options available to you and customize a treatment plan.  

There can be many causes for male infertility, including low sperm count, undetected medical conditions, prior surgeries or birth defects among a variety of other factors. Approximately 15% of all couples are infertile, and around 50% of male partners will have an identifiable factor impairing their reproductive potential; 20% to 30% of couples will not be able to conceive naturally solely because of a male factor.

Male Infertility: Early Evaluation

Traditionally, couples sought evaluation after trying to conceive for one year. However, many couples are now postponing parenthood until they are older, so it is suggested that couples seek evaluation earlier if they have any concerns about their fertility.

Early evaluation of the male partner is important for the following reasons:

• To optimize overall fertility potential and maximize chances of natural or assisted pregnancy.
• To prevent unnecessary added delays, since many couples are now postponing parenthood.
• To screen for modifiable practices or lifestyle elements that might be affecting male fertility.
• To identify treatable causes of male infertility.
• To screen for undetected medical conditions that might be contributing to male infertility.

Male Infertility: What to Expect

We advocate a systematic approach which begins with a detailed history, followed by a thorough laboratory evaluation. The initial evaluation includes a semen analysis and hormonal testing if indicated. If sperm count and motility results are abnormal, we will refer you to a urologist, an expert in male infertility, for a complete urological evaluation. This will include a physical examination and bloodwork to evaluate for hormone imbalances or any other reversible causes of male infertility.

Depending upon these results, a more detailed evaluation may follow with:

• Repeat semen analyses
• Sperm function tests
• Additional hormonal studies
• Radiologic studies
• Genetic evaluation
• Testicular biopsy
• Urological evaluation

About 5% of women were born with reproductive tract abnormalities, also called Mullerian anomalies, that can negatively impact fertility, cause miscarriage and preterm delivery.

Mullerian anomalies form when a female fetus is developing during pregnancy when the two horns of the uterus do not fuse together properly to form a normal uterus. Common Mullerian anomalies include a septate uterus (uterine septum), bicornuate uterus, didelphic uterus, unicornuate uterus and absent uterus.

Reproductive Tract Abnormality Treatment: Why Choose Johns Hopkins

• Our fertility experts at the Johns Hopkins Fertility Center provide comprehensive care for Mullerian anomalies, from evaluation and imaging to surgical management.
• We have specific expertise in tailoring treatment in patients who have Mullerian anomalies, including surgery.
• We have extensive experience in surgical treatment of Mullerian anomalies, including hysteroscopic incision of uterine septums.

Reproductive Tract Abnormality Treatment: What to Expect

At your initial consultation, you will meet with a fertility specialist and discuss your health history and any prior evaluation of the reproductive tract anomalies. Imaging studies will be performed including pelvic ultrasound, saline ultrasound and MRI. It's also important to evaluate the kidneys and genitourinary system since they are affected 25% of the time.

Polycystic Ovary Syndrome (PCOS) is a common hormonal disorder that can cause irregular and infrequent ovulation, obesity, hirsutism, and the dysfunction of hormones that control ovulation to make it difficult to become pregnant.

PCOS Treatment: Why Choose Johns Hopkins

• The fertility experts at the Johns Hopkins Fertility Center provide comprehensive, patient-centered care for the management and treatment of PCOS.
• Our physicians have extensive experience with all advanced infertility treatment techniques and develop personalized treatment plans for each patient. If you do not respond to more standard treatment approaches, we will adjust our plan to help you achieve your goal of parenthood.
• As a patient within the Johns Hopkins medical system, you will also have access to specialists in associated conditions, including obesity, diabetes, high blood pressure and heart disease. Treating any complications of PCOS you may be experiencing before beginning infertility treatments will be important to having a healthy pregnancy.

PCOS Treatment: What to Expect

At your initial consultation, you will meet with our fertility experts and undergo a laboratory and physical evaluation to determine if you have any associated conditions that require treatment beyond your fertility care. We will also evaluate you and your partner for any additional causes of infertility.

If we recommend optimizing your health before treatment, we will refer you to other specialists across the Johns Hopkins network who can help you. After your treatment with those teams, we will treat your PCOS, and any other causes of infertility, to help you meet your family planning goals. For women with PCOS, weight gain is a common concern. The Healthy Weight Management Group at Hopkins works closely with the Hopkins Fertility Center to help women to achieve optimal health which will help to increase the chance of a successful pregnancy.

We typically start treatment with ovulation induction, a process that helps you release eggs in order to increase your chances of conceiving each month. This involves oral medication and ultrasound monitoring of your progress. If you are not responsive to this treatment method, we will pursue other options including injectable medications or in vitro fertilization (IVF) to maximize your chances of pregnancy.

Primary ovarian insufficiency (POI), also known as premature ovarian failure, is a condition in which a woman’s egg supply is depleted early in life, prior to age 40.

Women with primary ovarian insufficiency may experience infertility due to low egg supply and irregular or absent menstrual cycles.

Primary Ovarian Insufficiency Treatment: Why Choose Johns Hopkins

• The reproductive endocrinologists at the Johns Hopkins Fertility Center have decades of experience helping women with primary ovarian insufficiency achieve pregnancy.
• We develop treatment plans in line with each patient’s goals. If a woman with low egg supply wishes to attempt to become pregnant with her own eggs, we will counsel her on treatment options. If a woman cannot or prefers not to become pregnant with her own eggs, we offer oocyte donation, a treatment with a high rate of success.
• Even if you are not currently trying to conceive, we can help you manage the symptoms of primary ovarian insufficiency using hormone therapy. Low levels of the hormones estrogen (estradiol) and progesterone can cause hot flashes and vaginal dryness. Hormone therapy can lessen these symptoms and prevent other long-term health consequences such as bone loss.
• The research team at the Fertility Center is at the forefront of finding new ways to improve treatment options for women who have primary ovarian insufficiency.

Primary Ovarian Insufficiency Treatment: What to Expect

At your initial consultation, you will meet with your fertility specialist and share your treatment goals. Some women with primary ovarian insufficiency wish to become pregnant, while others wish to treat symptoms and prevent long-term health consequences. We want to first understand your goals before developing your treatment plan.  

We will review your medical records and order additional testing (if needed) to confirm your primary ovarian insufficiency diagnosis and develop a custom treatment plan.

You may require specialized treatment for other medical issues caused by primary ovarian insufficiency. We will work closely with experts across the Johns Hopkins medical system to provide a comprehensive approach to your care.

Fallopian tubal disease is one of the most common causes of female infertility and refers to any process or condition that leads to damage of the fallopian tubes.

These are scars or tissue that develop in the reproductive tract often due to pelvic inflammatory disease, prior STIs, or endometriosis.

Tubal Disease Treatment: Why Choose Johns Hopkins

• The fertility experts at the Johns Hopkins Fertility Center have specialty training in minimally invasive surgical techniques including laparoscopy. Most patients who receive this treatment are discharged home on the same day of surgery.
• After treatment for tubal disease, we will draw on our extensive experience with the management of tubal disease to create a tailored treatment program to help you achieve pregnancy.
• If more specialized care is needed, you will have access to the many subspecialties of the renowned Johns Hopkins medical system.

Tubal Disease Treatment: What to Expect

At your initial consultation, you will meet with a fertility specialist and discuss your personal health history, experience attempting to conceive and goals for fertility treatment. We will perform diagnostic tests to determine the extent tubal disease is affecting your fertility — and rule out any other potential causes.

If you are diagnosed with tubal disease, we will work with you to develop an individualized treatment plan to help you realize your fertility goals. Treatment can include removal of pelvic adhesions (scar tissue) and cysts with minimally invasive surgery (laparoscopy). In many cases, in vitro fertilization (IVF) will be recommended when it is expected to give the highest chance of a successful pregnancy.

Unexplained infertility occurs when women or couples are experiencing infertility for no obvious medical reason. About 20% of those who undergo a fertility evaluation will have no identifiable cause for the infertility.

Unexplained Infertility: Why Choose Johns Hopkins

• Our specialists treat many patients who have unexplained infertility, giving us a great deal of experience in providing the most effective treatment options.
• We understand the frustration you may feel and will work together to develop a personalized treatment plan that works best for you.

Unexplained Infertility: What to Expect

After your first consultation, you will undergo a complete fertility evaluation. For men, we test sperm count and motility. For women, we examine the fallopian tubes, uterus and ovarian reserve (egg supply) and determine if ovulation occurs regularly. Unexplained infertility will be diagnosed if the evaluation results are normal.

Patients with unexplained infertility have many options to help them have a baby. Treatments such as fertility medications combined with IUI (intrauterine insemination) or IVF (in vitro fertilization) can dramatically improve pregnancy rates for women/couples with unexplained infertility.