Finding Hope in Infertility

If you and your partner stopped using birth control months ago after deciding you were ready to become parents, but each month’s menstrual cycle finds you more discouraged – take heart. You’re not alone, and there are hopeful solutions.

Ten to 15 percent of couples in the United States are infertile, according to the Mayo Clinic. “Infertility is defined as not being able to get pregnant despite having frequent, unprotected sex for at least a year.”  Although most couples will eventually conceive, with or without treatment, there are approximately 40 safe and effective therapies that significantly improve your chances of getting pregnant, explains Harvard Medical School.

The Centers for Disease Control and Prevention reports on this common condition:

• About 6 percent of married women 15 to 44 years of age in the United States are unable to get pregnant after one year of unprotected sex.
• About 12 percent of women 15 to 44 years of age in the United States have difficulty getting pregnant or carrying a pregnancy to term, regardless of marital status.

Harvard Medical School notes that with all the emphasis placed on physiological reasons for infertility, oftentimes the psychological and emotional components are overlooked. It’s important to acknowledge the heartache you might be experiencing, no matter how common and treatable infertility may be. Harvard Health explains:

“Individuals who learn they are infertile often experience the normal but nevertheless distressing emotions common to those who are grieving any significant loss — in this case the ability to procreate. Typical reactions include shock, grief, depression, anger, and frustration, as well as loss of self-esteem, self-confidence, and a sense of control over one’s destiny.”

Although the numerous medical interventions offer effective help and hope, research indicates that they may also add to the stressful emotions, strained relationships and anxiety-related conflicts some couples experience during this trying time. You might find great benefit in help from a mental health professional who is familiar with the emotional experience of infertility.

Causes of infertility

The issue interfering with pregnancy may lie with you, your partner or a combination of both you and your partner. Infertility in men can have many causes and is usually diagnosed with a semen analysis.

Causes may include:

Abnormal sperm production or function due to health problems, undescended testicles, genetic defects or enlarged veins in the testes.

Problems with the delivery of sperm due to premature ejaculation, structural problems, certain genetic diseases, or damage or injury to the reproductive organs.

Damage related to cancer and its treatment, including radiation or chemotherapy

Unhealthy habits such as smoking, heavy alcohol use, testosterone supplementation, anabolic steroid use, and illicit drug use.

Exposure to environmental toxins including pesticides and lead.

Exposure to heat, such as in saunas or hot tubs, raises the core body temperature and can affect sperm production.

Causes of female infertility may include:

Ovulation disorders including hormonal disorders, hyperprolactinemia, hyperthyroidism and hypothyroidism can affect the menstrual cycle or cause infertility.

Uterine or cervical abnormalities such as polyps or benign tumors (fibroids) in the uterine wall may interfere with implantation of the fertilized egg.

Fallopian tube damage or blockage often caused by the inflammation from pelvic inflammatory disease.

• Endometriosis caused when the tissue that lines the uterus and womb begins to entangle itself and impede the work of the ovaries, uterus and fallopian tubes. The good news is, “About one-third of women with endometriosis will readily conceive without any fertility treatment at all.”

Primary ovarian insufficiency, or early menopause, before age 40.

Pelvic adhesions, the scar tissue that restricts organs after appendicitis, pelvic infection or surgery.

Female reproductive cancers, radiation and chemotherapy.

Excessive physical or emotional stress that results in amenorrhea (missed periods).

Other lifestyle risk factors for both male and female infertility include smoking tobacco or marijuana, being overweight, being underweight and heavy alcohol use. Age also plays a large part in fertility for both men and women.

About 20 percent of women in the United States have their first child after age 35, reports the CDC, causing age to become a growing reason for fertility problems. A woman’s fertility drops rapidly after age 37, and “approximately one-third of couples in which the woman is older than 35 years have fertility problems.”

Men over age 40 may be less fertile than younger men are and may father children with higher rates of medical conditions such as certain cancers or psychiatric disorders.

Infertility testing

Tests for male infertility attempt to determine if the testicles are producing enough healthy sperm, that the sperm is ejaculated effectively into the woman’s vagina and is reaching the egg for a successful fertilization.

A man usually undergoes a semen analysis along with other specialty tests that may include blood hormone testing, genetic testing, a testicular biopsy, and in some cases imaging studies.

A woman typically begins with a regular gynecological exam followed by fertility tests that may include:

• A blood test to measure hormone levels to determine whether she’s ovulating.
• Hysterosalpingography to look for blockages in the uterus and fallopian tubes.
• Ovarian reserve testing to assess the quality and quantity of the eggs available for ovulation.

A woman may undergo hormone testing, genetic testing and other imaging tests such as a hysteroscopy or laparoscopy. But not everyone needs to have all – or even many – of these tests before the cause of infertility is found. You and your gynecologist will decide which tests are most appropriate for your unique situation.

Treating infertility

How you and your doctor proceed will depend on how long you’ve been infertile, your age and your personal preferences. Men can often improve fertility with lifestyle and behavioral changes such as reducing the intake of harmful substances or medications and establishing a program of regular exercise. Certain medications may improve a man’s sperm production and quality, and for some men, surgery is able to reverse a sperm blockage and restore fertility.

Some women only need one or two therapies to restore fertility, but others try several different types before they are able to conceive. Common options include:

Fertility drugs that regulate or induce ovulation.

Intrauterine insemination (IUI), or artificial insemination – healthy sperm are placed directly in the uterus around the time the woman’s ovary releases one or more eggs to be fertilized.

Hysteroscopic surgery to correct endometrial polyps, a uterine septum, or intrauterine scar tissue.

About 3 percent of patients make use of more advanced assisted reproductive technology such as in vitro fertilization (IVF), according to Harvard Medical School. IVF is the most common form of assisted reproductive technology (ART), defined as “any fertility treatment in which the egg and sperm are handled outside of the body.”

IVF involves stimulating and retrieving multiple mature eggs from a woman, fertilizing them with a man’s sperm in a lab dish and implanting the embryos in the uterus within five days of fertilization. In a gestational carrier procedure, the couple’s embryo is placed in the uterus of a pregnancy surrogate.

Other options couples can explore include:

Intracytoplasmic sperm injection (ICSI) – A single healthy sperm is injected directly into a mature egg.

Assisted hatching – Implantation of the embryo into the lining of the uterus by opening the outer covering of the embryo.

Donor eggs or sperm – Using eggs, sperm or embryos from a known or anonymous donor.

 

Do you and your partner need help understanding the causes for your possible infertility? For over 20 years, our Revere Health OB/GYN doctors, nurse practitioners and certified nurse midwives have cared for Utah Valley couples facing infertility. We can help you explore your treatment options and support you through your pregnancy. Your health and happiness, and the health of your unborn child, are our top priorities.

 

• Sources:
• Mayo Clinic: Infertility Overview
• Harvard Medical School
• Mayo Clinic: Infertility Treatment