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Infertility
Basic Information

Infertility

Not everyone has the goal of becoming a parent, but for those who do, being unable to conceive a child is an exquisitely painful reality. Many of us spend a portion of our lives attempting to avoid unplanned pregnancies, and assume that once we are ready to conceive, it will happen with little difficulty. We tend to think that shifting gears from preventing pregnancy to planning conception and childbirth will proceed in a relatively smooth and orderly fashion. A failure to conceive, then, is a major life stressor, which can wreak havoc on otherwise well-adjusted couples.

Even in today's society, we tend to assume that individuals in committed relationships have the goal of procreation. Woman are often identified with their ability to give birth. Both men and women are supposed to pass on their genetic and generational legacies. Failure by either party to "fulfill their end of the bargain" can be devastating, humiliating, and emotionally destructive. The continuing taboo agai...

 

 
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What is infertility?

  • Infertility is typically defined as the inability to become pregnant after one year of sexual intercourse without contraception.
  • For women over age 35, this condition is diagnosed after 6 months of an inability to conceive.
  • In a lifetime, 10-15% of couples will experience infertility and this number jumps to 33% in couples when a woman is over 35 years of age.
  • In about 45% of cases there is a male-origin for the infertility, female-origin infertility accounts for 30% of cases, and 20% of the time both partners are the source of difficulties.

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What are the causes of male-factor infertility?

  • Fertility involves a complex set of coordinating biological process, all of which must work more or less perfectly, more often than not, in order to avoid infertility.
  • In the man, hormones that cause sperm to be produced act on the testicles and the testicles must be responsive to such hormones in order to begin or continue sperm production.
  • The prostate and other glands must produce seminal fluid that is nourishing and protective of the sperm. In order to send the sperm out of his body, a man must be able to obtain and sustain an erection (hardening of the penis) until he can ejaculate (when sperm mixed with other fluids exit the penis) inside the female.
  • Sperm that is released must be strong enough to swim up the woman's reproductive tract.
  • Along the way, many sperm will die trying to get to the egg, so it is also important that the sperm be numerous enough to allow some survivors after these casualties.
  • Male-Factor Infertility is most commonly due to low sperm count.
  • Men can also have damaged or blocked sperm ducts for several reasons or scarring from an untreated sexually transmitted disease.
  • Hormonal abnormalities that affect the development and maturation of sperm can also be an issue.
  • Testicles may also be non-responsive to hormones, and not listen to the signals that turn on sperm development.
  • About 10% of infertile men have antibodies (immune cells that attack other cells) to their own sperm.

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What are the causes of female-factor infertility?

  • Fertility involves a complex set of coordinating biological process, all of which must work more or less perfectly, more often than not, in order to avoid infertility.
  • A woman must produce specific hormones that cause eggs to mature and ovulate and her ovaries must be healthy and capable of responding appropriately to these hormonal signals.
  • Once an egg is mature enough to leave the ovary it must travel down healthy, unblocked fallopian tubes. The cervical mucous must change consistency to help facilitate the travel of sperm up the reproductive tract to the spot where it will meet the egg.
  • In addition, the woman's uterus must have a good lining and surface for the pregnancy to attach to and start developing.
  • Finally, her body must be able to "recognize" the developing embryo and not reject it as foreign matter.
  • Female-factor infertility is most commonly caused by lack of ovulation (e.g., the development and release of eggs from the ovary), which can be caused by hormonal deficiencies or lifestyle factors, such as obesity, alcohol intake, or being severely underweight.
  • Fallopian tube blockage is another common cause of infertility and is most commonly caused by scarring from a previous, and often untreated, sexually transmitted disease.
  • Endometriosis, which occurs when uterine tissue grows outside the uterus, can also contribute to infertility.
  • Anatomical abnormalities, such as fibroids or scar tissue, can contribute to the inability of sperm to meet the egg or cause the egg to fail to implant in the uterine wall.
  • Women have more difficulty getting pregnant as they reach "advanced maternal age," which is currently defined as over age 35, due to a decrease in the number of eggs which ovulate, as well as a decrease in the quality of eggs.

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What can my partner and I do to prepare for getting pregnant?

  • Before trying to become pregnant, there are many preparations you should make to ensure optimal health of your embryo and fetus.
  • It is important to quit smoking tobacco, drinking alcohol and using any other types of drugs (including marijuana).
  • You should review your medications with your doctor to make sure none of them are dangerous in pregnancy.
  • Your partner should evaluate his current health and lifestyle and make similar changes if necessary.
  • It is usually recommended that birth control pills be stopped two to three months prior to when you wish to become pregnant.
  • You should also begin taking a prenatal vitamin or another source of folic acid as folic acid helps prevent birth defects, specifically 'neural tube defects,' that can occur early in pregnancy.
  • Timing your sexual intercourse to occur on those days that you are most fertile can increase your likelihood of pregnancy.
  • In general, women who have 28 day cycles (the number of days from the start of one period to the start of the next) are most fertile 13 to 15 days after the start of their menses (period).
  • Tools such as ovulation predictor kits (OPK's), basal body temperature monitoring and cervical mucous monitoring can also help to time intercourse and increase the likelihood of conception in any given month/cycle.

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What does the doctor do to evaluate a couple dealing with infertility?

  • When a year (or six months, depending on your age) has gone by without conception, then you and your partner are considered to have an infertility problem.
  • Once the label "infertility" fits your situation, it is time to consult with an infertility doctor.
  • Because of the multiple possible causes of infertility, doctors will conduct a variety of tests and evaluations.
  • Often these procedures may seem embarrassing or uncomfortable and discussion will involve personal details, such as the timing and frequency of sexual intercourse, monitoring of vaginal secretions, and the like.
  • It is important to approach the interactions with doctors and medical personnel with the aim of being very honest and open, as this will allow doctors to better understand the problem, and tailor your medical care to meet your needs.
  • The doctor will conduct a thorough interview of you and your partner and will want to know how often you have a period, if it happens at regular intervals, and if you have ever had any problems with your reproductive system.
  • The doctor will ask for a health history for both you and your partner, including any history of sexually transmitted illnesses (STI's) as these can cause damage that can lead to infertility.
  • The doctor will also want to know if either of you have had exposure to large amounts of radiation.
  • In addition, the interview will involve a sexual history, including the frequency and timing of sex.
  • Your accurate responses to medical history questions will help doctors to select specific and relevant tests to help understand what is causing your infertility.

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How is infertility treated?

  • A variety of treatments may be pursued to help undo infertility.
  • The selection of a particular plan depends on the cause of infertility as identified by medical testing, as well as your own preferences, and the opinion of your physicians.
  • Women can increase their chances of getting pregnant by pursuing a weight loss (or gain) diet and regular exercise program until a healthy weight is achieved and then maintaining that healthy weight.
  • Other lifestyle choices that can increase fertility or chances of conception include stopping smoking of all types, as well as stopping alcohol consumption and recreational drug use.
  • Intake of caffeine (often present in coffee, many sodas, chocolate and over-the-counter diet and/or alertness pills) should also be kept to a minimum (1 caffeinated drink per day).
  • As much as possible, you should also minimize stress and emotional strain.
  • Hormone therapy may be used to stimulate ovulation or to make the lining of the uterus (called the endometrium) better prepared to hold a fertilized egg.
  • Intrauterine Insemination (also known as Artificial Insemination) is used when the male partner has a low sperm count or when the female's cervical mucosa is not adequate to assist the sperm on its travel to the egg. This procedure involves placing specially prepared sperm directly into the uterus via a flexible tube which is inserted into the vagina and through the cervix.
  • Surgery can repair damaged or blocked structures (e.g. fallopian tubes) or be used to treat endometriosis.

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What is Assisted Reproductive Technology (ART)?

  • Assisted Reproductive Technology is an umbrella term for multiple types of fertility treatment which use laboratory and other technology to help a couple get pregnant.
  • In Vitro Fertilization (IVF) is one type of ART and consists of harvesting a woman's eggs (usually after medications have been given to mature more than one egg), collecting a sample of her partner's sperm, and joining them in a laboratory.
  • Though IVF is the most well-known type of ART, there are others that may be useful to infertile couples:
    • Gamete Intrafallopian Transfer (GIFT) occurs when a laprosope, which is a fiberoptic surgical instrument requiring only a small incision to place, is used to place unfertilized eggs and sperm into a woman\'s fallopian tubes. In successful situations the egg and sperm then unite and an embryo implants into the woman\'s uterus.
    • Zygote Intrafallopian Transfer (ZIFT) is similar to GIFT except that the fertilization occurs in the laboratory and then the embryo is placed using laproscopic surgery into the woman's fallopian tube.
    • Intracytoplasmic Sperm Injection (ICSI, pronounced "ick-see") occurs when an individual sperm is directly injected into an egg, bypassing the usual struggle that sperm undergo to penetrate the egg's outer membrane. Fertilized embryos resulting from ICSI are then implanted into the woman's uterus as per IVF.
    • Embryo Cryopreservation is used to preserve embryos that have been created in the laboratory using harvested eggs and sperm but which have not been selected for implantation. These embryos are frozen so that they may be thawed and transferred to the woman's uterus at a later date, so that additional pregnancies may be produced from the single harvest of eggs and sperm. Freezing takes a heavy toll on embryos and only roughly 50% of thawed embryos are viable.
    • Egg Donation - Whenever possible, the eggs used for ART techniques are collected from the woman who is planning to become pregnant, but when this is not possible, eggs must be sourced from a third party known as an egg donor.
    • Sperm donation operates on the same basic principles as egg donation. Some couples cannot produce viable sperm and must reach out to a third party donor for such material.

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How can we cope with infertility?

  • The inability to conceive a child is emotionally difficult at best and can easily become devastating.
  • Infertility treatment itself is physically and emotionally demanding, expensive (and not typically covered by insurance) and offers no guarantees of success.
  • There are several things that can help you cope with these painful realities.
  • First, it is important to understand that a great sense of loss, disappointment, or the like, is completely normal in the face of infertility.
  • Throughout the process of discovering and trying to remedy infertility it is also important to use existing supportive relationships and there are also support groups in surrounding communities and online sites that can be attended for support.
  • If you are undergoing infertility diagnosis and treatment with a partner, it is especially crucial to use open communication and mutual support and not blame each other.
  • Frustration is the normal experience of infertile couples that want to become parents and both partners may experience a range of intense emotions, from hope to excitement and regret, as well as disappointment, guilt, sadness, and happiness.
  • One way to create good support between you and your partner is to take time away from the pressures of infertility and take part in a mutually-enjoyable activity; a mental and/or physical get-a-way or holiday.
  • While thinking about or undergoing fertility treatments, it is important to also maintain other past-times and hobbies to have balance in your life.
  • Serious conditions such as major depression can result, in part from the disappointments, which may be associated with infertility treatment.
  • It is appropriate to seek out professional mental health counseling in the event that your relationship deteriorates significantly, or if your own mental health or the mental health of your partner suffers.

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