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Infertility
Planning and hoping for a child can be a happy and exciting time, but the inability to conceive can be sad and frustrating. The situation however, even though it may seem so at the time, is not unique. According to the American Society for Reproductive Medicine (ASRM), infertility affects over 6 million people. That's about 10 percent of those who are at the right age to have a baby.
Infertility is diagnosed, according to the National Infertility Association (NIA), when a couple has well-timed, unprotected sex for a year without conceiving. This definition varies for women in their late 30's or early 40's or women with known medical conditions. For instance, women with multiple miscarriages are considered to have an infertility problem. A healthy, young couple in their 20's has a 20 percent chance of conceiving each month, according to the American College of Obstetricians and Gynecologists (ACOG). The odds decline the older a couple gets.
Infertility can be caused by one or many factors. It can be the result of a male factor or a female factor. In fact, the reasons for infertility are divided pretty equally between men and women. ASRM says that about a third of the time it's a male issue and a third of the time a female issue. Ten to 15 percent of the time it's a combination and some 20 percent of the time a cause can't be isolated.
The vast majority of cases, according to ASRM, are treated with conventional means such as surgery, medications or even things as simple as lifestyle changes. The definition of vast majority by the way is 85 to 90 percent. ACOG says you may be told to change the times or the frequency of your sexual relations or be told to lose weight and/or stop smoking. (Read about "Quit Smoking" "Losing Weight") A woman may in fact need to gain weight if she is underweight.
Male factors
The biggest cause of male infertility, according to ASRM, is no or too few sperm cells. Other major issues include inadequate sperm motility or movement and abnormally shaped sperm.
Lifestyle can influence the number and quality of a man's sperm. Alcohol and drugs - including marijuana, nicotine, and certain medications - can temporarily reduce sperm quality. (Read about "Alcoholism" "Addiction") Also, environmental toxins, including pesticides and lead, may be to blame for some cases of infertility.
The causes of sperm production problems can exist from birth or develop later as a result of severe medical illnesses, including mumps and some sexually transmitted diseases, or from a severe testicle injury, tumor, or other problem. Sometimes men have a condition called varicocele. (Read about "Swollen Testicles & Scrotum") This is caused by swollen or congested veins in the testicles. This enlarged vein produces a higher temperature than is normal for the testicles and can lead to decreased movement by the sperm and even fewer sperm. (Read about "STD's" "Testicular Cancer") Inability to ejaculate normally can prevent conception, too, and can be caused by many factors, including diabetes, surgery of the prostate gland or urethra, blood pressure medication, or impotence. (Read about "Diabetes" "The Prostate" "Hypertension: High Blood Pressure" "Erectile Dysfunction")
Men going to serve in a war zone or who are about to undergo chemotherapy or radiation can store frozen sperm no matter what their marital status. Sperm can be kept frozen for decades.
Female factors
For women, the most common cause is some sort of ovulation problem, according to the National Women's Health Information Center (NWHIC). Without ovulation, eggs are not available for fertilization. Problems with ovulation are signaled by irregular menstrual periods or a lack of periods altogether (called amenorrhea). (Read about "Menstrual Disorders" "Polycystic Ovary Syndrome") Simple lifestyle factors - including stress, diet, or athletic training - can affect a woman's hormonal balance. (Read about "Stress") Much less often, a hormonal imbalance can result from a medical problem such as a pituitary gland tumor or hypothyroidism. (Read about "Endocrine System" "Thyroid")
Another big issue is blocked fallopian tubes, which can be caused by any number of problems. If the fallopian tubes are blocked at one or both ends, the egg can't travel through the tubes into the uterus. Such blockage may result from pelvic inflammatory disease (Read about "Pelvic Inflammatory Disease"), surgery for an ectopic pregnancy (when the embryo implants in the fallopian tube rather than in the uterus), or other problems, including endometriosis (the abnormal presence of uterine lining cells in other pelvic organs). (Read about "Endometriosis")
Types of tests
To find out what a couple's issues are requires a number of tests. The exams include the following, according to ACOG:
- Physical exams, including full medical histories. That will include discussions of previous disease or injuries that could impact the reproductive systems of either person. Things such as pelvic injuries, STD's even vascular problems from heart or arterial disease. (Read about "Coronary Heart Disease")
- Semen analysis will be done to check the number of sperm, their shape and their mobility.
- Ovulation will be checked. For the woman, the first step in testing is to determine if she is ovulating each month. This can be done by charting changes in morning body temperature, by using an FDA-approved home ovulation test kit (which is available over the counter), or by examining cervical mucus, which undergoes a series of hormone-induced changes throughout the menstrual cycle. Checks of ovulation can also be done in the physician's office with simple blood tests for hormone levels or ultrasound (Read about "Ultrasound Imaging") tests of the ovaries. If the woman is ovulating, further testing will need to be done.
- A history of problems, if there are any, such as irregular bleeding or pain.
- An x-ray or "dye test" to check for blocked fallopian tubes or an abnormal uterus. (Read about "X-rays")
- A more advanced test called laparoscopy can be used to check a woman for scar tissue or endometriosis. This is usually done on an outpatient (same day) basis. The surgeon inserts a thin, lighted tube (called a laparoscope) through the abdominal wall, generally via the belly button and one or two other small incisions, to inspect the inside of the abdomen, remove tissue samples and treat the disease. (Read about "Endoscopy" "Biopsy")
Even with these tests, it may not be possible to identify a specific reason a couple has not been able to conceive. However, they may provide an answer and with proper treatment, a baby.
For information on types of treatment read about "Infertility Treatments"
All Concept Communications material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.
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