INFERTILITY

Infertility is defined as the inability to get pregnant using normal efforts over a period of one year for women under 35; or for 6 months for women over 35. If a woman is not pregnant after this time period, it is wise to start testing for infertility. Infertility is also the inability to stay pregnant, which includes women who have multiple miscarriages.

It is important to point out that infertility is different than sterility. Sterility means the man or woman has a physical problem that makes it impossible to conceive. Fertility means they have some kind of a problem, but it may be able to be treated. So getting pregnant may be more difficult, but not impossible.

Only about 15 percent of women get pregnant within a month of their first try. Over half will get pregnant within 6 months. Of the 10 to 15 percent of couples who do not get pregnant after a year, about one-third of the infertility is with the woman; one-third is with the man; and for the remaining one-third either both partners are the cause of the infertility or no cause is found.

There are many reasons a woman cannot get pregnant, which may include her age, weight, exercise, or smoking habits and caffeine or alcohol use. Other reasons include prolonged strenuous exercise, stress, depression, hormones, problems with the ovaries, blocked tubes due to past infections, past surgical problems, previous tubal pregnancies, medications, endometriosis, fibroids, DES Syndrome, and several medical conditions.

The most common cause for male infertility is too few sperm or no sperm at all. This can be caused by medical problems such as hormones, mumps as an adult or teen, infection that has caused scarring of the sperm ducts, or a genetic disorder. Other problems that can cause a decrease in the number of sperm are long hot baths or routinely wearing jockey shorts, exposure to toxic chemicals or radiation, and the use of drugs, tobacco, or alcohol. Sometimes the problem can be that the sperm are not formed right or there is difficulty getting the sperm into the woman's vagina.

Before seeking medical care, keep a calendar of your periods and sexual efforts for 2 to 3 months. When a fertility specialist is consulted, this information will be helpful. An evaluation of both partners includes lifestyle habits; medical, social, and sexual histories; physical examinations; and tests for infections and fertility. After gathering this information, the specialist will know what tests and procedures are needed. Most of the testing can be done in the office. Some outpatient surgery may be required.

There are many laboratory tests that can be done on both the man and the woman to find the cause of infertility. An ultrasound may also be done.

Fertility tests may include:

checking the number of sperm and their activity
examining the woman's fallopian tubes to make sure they are open and
making sure the woman produces eggs each month

Daily body temperature readings may be required of the woman. This is done every morning before getting up. A log is kept for daily temperature readings and menstrual periods. This helps determine the time of ovulation and the best days to have sex. Ovulation is the discharge of a mature egg from the ovary. When ovulation occurs, the woman is fertile.

After the initial testing, a review of the findings will help the couple choose an action plan. The treatment will depend on the cause. Any problems with the woman's period or cycle are treated. Treatment may require a change in sexual habits, artificial insemination, or assisted reproduction, like in vitro fertilization. Artificial insemination involves inserting sperm, either her partner's or a donor's, into the woman's uterus. A form of assisted reproduction is in vitro fertilization. This actually means "in glass". A woman's egg is removed, fertilized with sperm in a glass dish in the lab, and then put into the uterus. Surgery or other procedures may also be needed.

The good news is: 85 to 90 percent of infertility cases can be treated with some type of medication or surgery. But going through the testing and treatment is usually very stressful. Fertility treatments are expensive; may often need to be repeated; and may not be covered by health insurance. Concerns with fertility can be emotionally draining for couples. So it is important that you decide early in the process what kind of procedures you can afford, both emotionally and financially. You should discuss whether you would accept a donor's sperm or egg, your views on adoption, and when and how you could accept not having children, if that were to happen. Open, sensitive communications are important at all times between the woman, her partner, and the fertility specialist.

For more information on fertility, or choosing a clinic or specialist, contact your healthcare provider or one of these national organizations:

RESOLVE, formerly known as the National Infertility Association, at (617) 623-0744 or visit their website at www.resolve.org or
American Society For Reproductive Medicine at (205) 978-5000 or visit their website at www.asrm.com

Disclaimer: This content is reviewed periodically and is subject to change as new health information becomes available. The information provided is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional.

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