Infertility

If you’ve been trying to conceive without success, you are not alone, and you do not have to navigate this journey alone either. At Lamorinda Women’s Health in Lafayette, California, board-certified gynecologist Karine Hajyan, DO, FACOG, provides compassionate personalized fertility evaluations and care in a boutique, unhurried setting. Every visit is directly with Dr. Hajyan because something this important deserves real time, real attention, and a physician who truly knows you. Call the office today or schedule an appointment online to learn more about infertility testing and treatment.

What is infertility?

Infertility is defined as being unable to become pregnant after one year of regular, unprotected intercourse. However, your age, health history, and individual circumstances can affect when to seek an evaluation. If you are 35 years or older, we recommend seeking an evaluation after six months of trying. Infertility can affect anyone and may involve factors related to ovulation, reproductive health, or both partners. 

When should I seek medical help for infertility?

If you’re under age 35, you may want to schedule an infertility evaluation after 12 months of trying to conceive. If you’re 35 or older, it’s often recommended to seek help after six months of trying because fertility can change with age.

You may also benefit from an earlier evaluation if you have concerns such as:

• Irregular or absent menstrual cycles
• A history of sexually transmitted or pelvic infections 
• Endometriosis or uterine conditions
• Previous pelvic or reproductive surgeries
• Recurrent pregnancy loss
• Known fertility concerns affecting you or your partner
• PCOS/PMOS (Polyendocrine Metabolic Ovarian Syndrome)-a newly recognized term that more accurately reflects the hormonal, metabolic and ovarian nature of this condition

At Lamorinda Women’s Health, Dr. Hajyan provides compassionate infertility evaluations to help identify what’s affecting your ability to conceive. She takes the time to listen to your concerns, review your health history, and recommend appropriate next steps based on your goals-never rushed, never handed off.

How is infertility diagnosed?

Infertility evaluation begins with a thorough conversation about your menstrual cycle, medical history, lifestyle factors, and reproductive goals. Dr. Hajyan may recommend diagnostic testing including: 

• Hormonal testing-FSH, LH, AMH, Estradiol, ovarian reserve assessment, testosterone, and Sex Hormone Binding Globulin (SHBG)
• Thyroid, prolactin, and metabolic lab evaluation
• Insulin resistance markers-fasting insulin, glucose, and HbA1c
• In-office 3D/4D ultrasound-for uterine and ovarian evaluation 
• Outpatient Hysteroscopy-to evaluate the uterine cavity for polyps, fibroids, or other abnormalities that may impact implantation or fertility
• Hysterosalpingogram (HSG)-imaging to evaluate the patency of the fallopian tubes
• Semen analysis-fertility concerns can involve factors affecting you, your partner, or both, and semen analysis is an important part of a complete fertility 

Testing is tailored to your individual history and goals. Dr. Hajyan reviews all results directly with you, explains what they mean, and uses them to build a personalized, evidence-based plan-never a one size fits all approach.

What can cause infertility?

Infertility is rarely one-size-fits-all. There are many possible causes, and often more than one factor is involved. At Lamorinda Women's Health, Dr. Hajyan takes a thorough, investigative approach, looking beyond the surface to identify the root cause so that treatment is targeted, effective and personal. 

• Ovulation disorders
  • One of the most common and treatable causes of infertility. When ovulvation is irregular, absent, or unpredictable, conception becomes significantly more difficult. Ovulation disorders are often linked to hormonal imbalance, thyroid dysfunction, stress or metabolic conditions. 
• PCOS/PMOS (Polyendocrine Metabolic Ovarian Syndrome)
  • PMOS is one of the leading causes of ovulatory infertility in women of reproductive age. It affects ovulation, cycle regularity, hormonal balance, and metabolic health. Dr. Hajyan specializes in comprehensive PMOS evaluation and treatment, addressing both the reproductive and metabolic dimensions of this condition. For our coplete PMOS care approach, please see our dedicated Metabolic Health & PMOS services page. 
• Hormonal Imbalances 
  • Elevated prolactin, thyroid dysfunction, insulin resistance, androgen excess, elevated free testosterone, abnormal Sex Hormone Binding Globulin (SHBG) levels, and low progesterone can all interfere with ovulation, implantation, and healthy pregnancy. SHBG plays a critical role in regulating the availability of estrogen and testosterone, and free testosterone is a key marker in the evaluation of PMOS and hormonal infertility. 
• Endometriosis/Adenomyosis
  • Endometriosis and adenomyosis can affect the uterine environment, fallopina tube function, and embryo implantation often silently, without obious symptoms. Dr. Hajyan has extensive experience evaluating and managing both conditions.

• Fallopian tube Factors
  • Blockage or damage to the fallopina tubes from prior infectios, endometriosis, or surgery can prevent the egg and sperm from meeting. Hysterosalpingogram (HSG) imaging is used to evaluate tubal patency when indicated. 
• Uterine fibroids or polyps
  • Structural abnormalities inside the uterine cavity, including fibroids and polyps can interfere with implantation and early pregnancy. Dr. Hajyan evaluates for and treats these conditions, including through outpatient hysteroscopy when indicated. 

• Age-related changes
  • Ovarian reserve-the quantity and quality of a women's eggs. Naturally declines with age, with the most significant changes beginning in the mid-30s. Early evaluation allows for informed decision-making and timely intervention.

• Prior Pelvic Infections or Surgeries 
  • A history of sexually transmitted infections, pelvic inflammatory disease, or previous pelvic surgery can affect the fallopin tubes, uterine cavity, or surrounding structures in ways that impact fertility. 

• Male Factor Infertility
  • Fertility concerns can involve factors affecting one or both partners. Semen analysis is a standard and importnat part of a complete fertility workup and is recommended early in the evaluation process.  

• Unexplanined Infertility
  • In some cases, standard evaluation does not indentify a specific cause. This does not mean there are no options. Dr Hajyan will work closely with you to determine the most appropriate and evidence-based path forward, Whether that means continuing evaluation, pursuing treatment, or coordinating with a reproductive specialist. 

What are my infertility treatment options?

Your treatment options depend on your diagnosis, health needs, and family-building goals. Dr. Hajyan may recommend medications, treatment for underlying gynecologic conditions, lifestyle changes, or referrals to fertility specialists when appropriate.

• Ovulation Induction
  • For patients who are not ovulating regularly, Dr. Hajyan offers medically supervised ovulation induction using Letrozole or Clomiphene citrate. Treatment includes personalized protocol design, cycle monitoring, and a thorough discussion fo benefits, risks, side effects, and realistic expectations. 
• PMOS & Hormonal Optimization
  • For patients with PMOS or hormonal imbalance contributing to infertility, Dr. Hajyan addresses the underlying metabolic and hormonal drivers, including insulin resistance, androgen excess, elevated free testosterone, abnormal SHBG, and thyroid dysfunction. This approach often improves natural conception rates and response to ovulation induction. See our dedicated Metabloic Health & PMOS page for our complete treatment approach. 
• Outpatient Hysteroscopy 
  • When the uterine cavity needs to be evaluated or treated, Dr. Hajyan performs outpatient hysteroscopy to identify and address polyps, fibroids, adhesions, or other abnormalities that may be impacting implantation or fertility. All with continuity of care throughout. 
• Hormonal Therapy
  • Progesterone, estrogen, thyroid optimization, and other targeted hormonal treatments to restore balance and support conception when indicated. 
• Lifestyle, Nutrition & Weight Management
  • A personalized preconception plan addressing nutrition, lifestyle, body composition, and metabloic health-foundational elements that significantly impact fertility outcomes and are ofen overlooked in traditonal fertility care. 
• GLP-1 Therapy 
  • For patients with PMOS, insulin resistance, or weight concerns impacting fertility, GLP-1receptor agonist therapy addresses the metabolic root causes that interfere with ovulation and hormonal balance. 
• IVF Referral & Coordination
  • When advanced reproductive treatment is indicated, Dr. Hajyan provides warm referrals to trusted reproductive endocrinology and IVF centers throughout the Bay Area with full coordination of care to ensure a seamless, supported transition. 

What makes our approach different is that fertility care at Lamorinda Women's Health is never a handoff. Whether your path leads to ovulation induction, lifestyle optimization, or IVF referral, Dr. Hajyan remains your physician, informed, involved, and by your side at every step. 

If you are ready to begin your fertility evaluation or simply have questions, we invite you to contact Lamorinda Women’s Health today to schedule an appointment with Dr. Hajyan. Call (925) 385-7023 or visit lamorindawomenshealth.com.