Insights from an Interview with Fertility Specialist Silvia Hecher from LEVY: Navigating the Path to Parenthood

Polycystic ovarian syndrome (PCOS) is, in fact, the most common cause of infertility in women, affecting 30% of those dealing with infertility. PCOS involves hormonal imbalance, leading to the frequent absence or irregularity of ovulation, complicating timing in conception.

Other factors contributing to female infertility include thyroid disorders – whether overactive, underactive, or inflamed – and often overlooked immunological aspects, The body’s immune response, especially during pregnancy, can impact fertility. For instance, an overactive immune system may perceive the fertilized egg as a foreign entity, hindering successful implantation.

There is still so much we do not know, but notably, while diagnosis can be challenging, treatment is often relatively straightforward. I believe these are the key points. Additionally, issues such as insulin resistance, anatomical factors like fused or blocked fallopian tubes due to conditions like chlamydia infection or ovarian inflammation, and the presence of adhesions and fibroids in the uterus or a uterine septum (a septum within the uterus) can significantly impact fertility.

These are crucial considerations, and there are many more, including genetic factors that I will not delve into now. However, the array of factors affecting women underscores the importance of a comprehensive diagnosis to understand the problem thoroughly and enable targeted treatment.

Dr. Nadine Rohloff: It is essential to emphasize this regarding endometriosis, as it can complicate pregnancy. However, it is crucial to recognize that it might not always be the sole or primary reason. A comprehensive approach with specialists is necessary. Which of these factors does LEVY cover, and where do you begin? Whom do you reach out to, and when does LEVY play a role?

Silvia Hecher: This is a crucial question because, in essence, we find ourselves still in the early stages of this journey. Recognizing that diagnostics should form the starting point so that individuals have a clear roadmap is integral to our approach. We have the capability to offer a comprehensive set of 24 potential diagnoses or suspected diagnoses. Endometriosis, for instance, is a preliminary diagnosis determined through an interactive questionnaire tailored to the woman’s situation. However, the definitive diagnosis and assessment of the severity of endometriosis must be conducted later in a clinic or by a doctor.

Beyond this, we can provide similar preliminary diagnoses in cases like polycystic ovary syndrome (PCOS) where ultrasound diagnostics may not be essential. Subsequently, we offer precise recommendations for additional diagnostics needed to reach a conclusive diagnosis. It is important to recognize that, as you mentioned, it is often not a singular diagnosis but a combination of factors. Our goal is to provide clarity on the issue within one to two months.

Dr. Nadine Rohloff: Do you collaborate with fertility clinics and gynecologists, or is this something patients can navigate independently?

Silvia Hecher: Currently, our primary focus is on women seeking online assistance, and there are many of them. However, we are actively establishing a network of gynecological practices and fertility clinics for collaboration.

Dr. med. Nadine Rohloff: Because it streamlines the process for them.

Silvia Hecher: Absolutely, and as an online fertility clinic, we do not cover ultrasound examinations and other imaging procedures, which are particularly crucial in endometriosis cases.

Dr. med. Nadine Rohloff: Exactly, and surgeries cannot be performed online.

Silvia Hecher: That is a valid point. We provide guidance to women with a suspected endometriosis diagnosis or those already aware of their condition. If they desire to have a child, determining the duration of attempting natural conception, when to opt for alternative treatment, and whether surgery would be beneficial becomes crucial.

Dr. med. Nadine Rohloff: Individualized assessments are essential. What are the symptomatic challenges that women desiring children face with endometriosis?

Silvia Hecher: Concerning the desire for children, pain becomes less prominent, and the focus shifts to understanding why conception is challenging. Although this is not groundbreaking information, endometriosis remains an insufficiently researched area. Physically, endometriosis lesions impact reproductive organs. Depending on the degree and size of the lesions, they can affect the uterus, fallopian tubes, and ovaries. They may hinder the release of a mature egg or impede its transit into the fallopian tube—a crucial step in the natural fertilization process.

If endometriosis is present in these locations, it can prevent the egg from being fertilized. Even if the egg enters the fallopian tube, issues may arise, such as the egg not being transported further or sperm cells failing to reach the egg due to fallopian tube movement limitations.

If the egg is successfully fertilized, there are numerous potential points of failure in the subsequent developmental stages. It is conceivable that because of endometriosis, the embryo might encounter challenges in implantation and subsequent growth. This complexity arises from the physical presence of endometriosis lesions and the potential influence of endometriosis on the immune system and inflammatory processes. In the field of medicine, we find ourselves at a juncture where the exact connections in this regard are not yet fully understood.

In the realm of fertility coaching and reproductive medicine, the challenges of conception often stem from a combination of factors. It is rare to pinpoint a single reason for unsuccessful attempts at pregnancy. Instead, there is typically a nuanced interplay of various elements contributing to the difficulties encountered in achieving conception.