Infertility is one of the toughest challenges a couple can face, but by arming yourself with the right knowledge and a good doctor, you can increase your chances for having the family you’ve been dreaming of.
By Stacy Stapleton
Ask almost any couple coping with fertility issues, and they’ll probably tell you how alone and isolated their struggle makes them feel. But the truth is, infertility is far from uncommon: Recent research shows it may affect as much as 11 percent of couples of reproductive age. It’s also far from being a dead end: Finding out that you have fertility problems is frightening and overwhelming, but it certainly doesn’t mean you’ll never have a baby. In fact, reproductive endocrinologists at Overlook Hospital and at facilities like Reproductive Medicine Associates of New Jersey (RMANJ) have more methods than ever at their disposal to help infertile couples conceive.
What is infertility?
“In any given month, the average couple has a 20 to 25 percent chance of conceiving,” says Rita Gulati, MD, a reproductive endorcrinologist at Overlook Hospital and RMANJ, “and after a year of trying, 85 percent will have conceived on their own.” It’s after this one-year mark that doctors start suspecting there may be a problem.“Infertility is generally defined as one year of unprotected intercourse without a successful pregnancy,” explains Gulati. But that doesn’t mean you should wait that long to seek help if you’re beginning to worry. “If a woman is over 35, it’s best if she comes in for an evaluation after three to six months of trying to conceive, because her clock is ticking,” says Gulati, “but it’s also appropriate for a woman of any age to be examined early if she’s concerned about why she isn’t becoming pregnant.”
Thanks to basic human biology, creating a baby depends on four crucial factors: A woman and a man need to produce healthy eggs and sperm; a woman needs to have healthy fallopian tubes, not only so sperm can reach the egg to fertilize it, but so the embryo can travel to the uterus; a man’s semen needs to carry an adequate amount of quality sperm so that one can reach the egg and fertilize it; and a woman needs to have a hospitable uterus, so the fertilized embryo can attach there and be carried to term. While this all seems simple enough (and in most cases it is), the slightest issue with any of these factors can make it difficult to conceive without medical intervention.
“In 40 percent of diagnosed cases of infertility, the problem stems from an issue with the woman,” explains Gulati. “In another 40 percent it’s an issue with the man, and the remaining 20 percent are classified as unknown.”
In cases where a woman is found to have fertility issues, the problem usually stems from:
- Ovulatory problems (representing about 20 percent of cases), such as an irregular menstrual cycle. This is often caused by a female sex-hormone imbalance or conditions like polycystic ovarian syndrome (PCOS), in which the woman’s body produces excess testosterone (a male sex hormone) that hinders ovulation. “What’s more, weighing too much or too little or extreme dieting and exercise regimens can disrupt ovulation,” adds Gulati.
- Anatomical issues that inhibit fertilization or prevent an embryo from implanting properly in the uterus, such as scarred or blocked fallopian tubes (which accounts for about 30 percent of cases) due to pelvic inflammatory disease, STDs, endometriosis, or a previous ectopic pregnancy. Female fertility problems can also arise from uterine fibroids, polyps, or abdominal scar tissue from past surgeries, infections, miscarriages, or abortions.
- Kidney disease, immune system disorders, diabetes, and certain medications used to treat high blood pressure, asthma, or depression.
- Problems with male infertility usually stem from:
- A low sperm count or poor quality sperm. Although it takes only one sperm to make a baby, the chances of each individual sperm actually reaching an egg are pretty slim. That’s why a man needs multiple millions of sperm to have a decent chance of conceiving. Sperm also need to be healthy enough to make the long trip to a waiting egg, so if they are not properly structured, infertility can result. These problems are usually caused by factors like testosterone or other hormone imbalances, congenital defects of the testicles, certain medications (including steroids), STDs, and even chemotherapy and radiation treatments.
- Diabetes, cystic fibrosis (which can lead to structural problems of the vas deferens, the tube that carries sperm to the penis), or problems with the bladder or prostate.
Getting the facts
To accurately diagnose the reason a couple is having trouble conceiving is no small task; rather, it’s a long process that usually requires many visits to several doctors by both partners.During the first visit with your reproductive endocrinologist, he or she will ask a lot questions about your past medical and reproductive history and lifestyle. Although some of these questions can be difficult to answer, it’s important to be completely honest. Both partners will undergo full physicals, including a pelvic exam for the woman. The woman will also be required to undergo hormone tests to check her thyroid gland, prolactin levels, ovarian reserve (the number and quality of available eggs), and whether or not she is ovulating normally.
Your doctor may also want to perform a special X-ray of the uterus and fallopian tubes to examine their shape and condition, as well as a biopsy of the uterine lining to check for hormonal imbalances that can lead to irregular cycles, repeat miscarriages, or uterine bleeding.
Semen and hormone analyses will be performed on the male partner, and, if necessary, there will be an ultrasound of his reproductive equipment and a urine test to rule out diabetes and kidney disease.
In addition to this battery of diagnostic tools, Gulati refers all her patients for genetic counseling (see sidebar, “Why Genetic Counseling?”) to uncover any additional, valuable information. Although going through all these fertility checks can be frustrating, the upside, Gulati explains, is that 80 percent of fertility issues can be concretely diagnosed—which means treatment can begin as soon as possible. In fact, as hard as the process may be, many couples begin feeling better and more empowered once they actually begin treatment. To make this difficult time easier on both of you, consider these tips.
- Ask for test results as they come in, and have any abnormal results thoroughly explained.
- Talk to your partner about your fears and anxiety. If you need help communicating or begin to feel anger or resentment toward each other, your doctor can recommend a counselor or infertility support group in your area. It also helps to continue enjoying your time together without always focusing on your infertility. Go to the movies or get away for the weekend.
- If the tests and appointments you’ve been squeezing into your schedules start to feel overwhelming, remind yourself why you’re doing this. If handled properly, weathering the storm can make your relationship stronger.
Bundles of joy
The silver lining (or pink and blue linings!) to the cloud of infertility is that nearly two-thirds of couples who undergo treatment eventually succeed in making and having a baby. Every day, science is used to make miracles happen.- Fertility drugs, including Clomid and injectables, can be used to bring on ovulation, increase egg production, and make the uterus more hospitable. Fertility drugs are typically one of the first solutions a doctor will try since they are relatively inexpensive, minimally invasive, and carry little risk. The biggest drawback is the potential for multiples, which Gulati says happens in about eight to ten percent of cases.
- If a woman is capable of carrying a baby to term but is having trouble conceiving naturally or her partner cannot impregnate her, a doctor may turn to artificial insemination (AI). In this procedure the man’s sperm is inserted right into the cervical canal via a catheter. “In many cases,” adds Gulati, “a combination of insemination and fertility drugs is used.”
- In-vitro fertilization (IVF) requires that a woman’s ovaries be chemically stimulated to produce as many eggs as possible; these eggs are then extracted and fertilized with sperm in the lab. Three to six days later, a select number of embryos are then transferred to the uterus through a catheter. In cases of significant male infertility, doctors may pair IVF with ICSI (intracytoplasmic sperm injection); here, an individual sperm is injected directly into each mature egg. The effectiveness of IVF is greatly affected by a woman’s age and her ovarian reserve. “In a young woman, the success rate of IVF is as high as 75 percent,” says Gulati, “but as she ages, it starts to drop.”
- If a couple utilizing IVF has also experienced multiple miscarriages or has terminated pregnancies in the past due to genetic abnormalities, Gulati suggests a relatively new process called pre-implantation genetic diagnosis (PGD). “With PGD, doctors can examine all 23 of a high-risk embryo’s chromosomes, and identify genetic defects before the embryo is implanted in the uterus,” she explains.
- Egg and sperm donation are other options for success. A donor egg (usually from a younger woman) is fertilized with the man’s sperm and then implanted into the woman’s uterus. Donor sperm are used in conjunction with basic artificial insemination. Sperm and egg donation is a wonderful option for men or women carrying a genetic disorder, women with ovarian issues, or older parents.
For a referral to a fertility specialist, call (800) 247-9580.
May 2009
