Thứ Năm, 20 tháng 9, 2012

Pregnancy, Babies, and Birth: Infertility

Nothing is more frustrating for a couple that is trying to conceive than getting that negative on the pregnancy test each month, every month, for what seems like months on end.  After a while, couples may begin to wonder if there is something wrong with them.  One of the common fears at this point is infertility.  But what is infertility?  What does it mean?  What are our options if we are struggling with infertility?  Can it be treated?  Will we ever be able to have our own children?

What is Infertility?

Infertility is when a couple has been actively trying to conceive for 1 year or more without achieving a successful and viable pregnancy.  If the woman is over 35 years old, infertility is classified at 6 months or more of active trying with no success.  If you have been struggling with infertility, your are definitely not alone!  According to the Mayo Clinic, about 10-15% of couples in the United States struggle with infertility.

Possible Signs and Risk Factors of Infertility

Before listing possible signs of infertility, I have to make it clear that if you have experienced one or more of these symptoms, it doesn't necessarily mean you will be/are infertile.  These signs can be symptoms of something else entirely or have no bearing on your fertility at all.  However, if you are experiencing any of the following, meet with your doctor to discuss them:
  • You menstruate irregularly or not at all
  • Your periods are abnormally painful
  • You have been diagnosed with endometriosis or pelvic inflammatory disease
  • You have had more than 1 miscarriage
  • Your husband has a history of prostate or testicular problems
  • Your husband has a low sperm count
  • Either you or your husband has had a sexually transmitted infection
Additionally, there are some risk factors that may affect fertility:
  • Age: Women over the age of 30 start experiencing a gradual decrease in fertility.  Men over the age of 40 may be less fertile than younger men.
  • Smoking: Chances of infertility increase if either the man or the woman (or both) smoke.  Additionally, miscarriages are more frequent for women who smoke than for those who don't.
  • Alcohol use: Alcohol may make it more difficult for a woman to become pregnant.  There is no safe amount of alcohol use during conception or pregnancy.
  • Being overweight: One of the most common risk factors of infertility is obesity.  Being overweight can reduce a man's sperm count as well.
  • Being underweight: Women need to maintain a certain body fat percentage in order for the body to be able to menstruate.
  • Too much exercise: Excessive exercising can interfere with a woman's ovulation patterns.

Causes of Infertility

Doctors and researchers have pinpointed some causes for infertility for both men and women.  If you or your partner have experienced any of the following, talk to your doctor about the possible effects on your fertility:

Causes in Men
  • Abnormal sperm production or function: Can be due to genetic defects or repeated infections
  • Problems with delivery of sperm: Can be due to premature ejaculation, painful intercourse, retrograde ejaculation, cystic fibrosis, or blockage of the epididymis
  • General health or lifestyle issues: Can be due to poor nutrition, obesity, lack of exercise, tobacco use, drug use, or alcohol use
  • Overexposure to certain environmental factors: Can be due to exposure to pesticides or other chemicals or too much time spent in saunas or hot tubs
  • Damage related to cancer treatment: Can be due to chemotherapy or radiation
  • Age: Men over 40 may struggle with infertility more than younger men
Causes in Women
  • Fallopian tube damage or blockage:  Usually a result of Chlamydia
  • Endometriosis: When uterine tissue grows outside the uterus it affects the function or several reproductive organs
  • Ovulation disorders: Can be caused by injury, tumors, excessive exercise, or starvation 
  • Elevated prolactin: High levels may affect ovulation
  • Polycystic ovary syndrome: Too much androgen is released, affecting ovulation
  • Early menopause: Can be caused by immune system diseases, radiation or chemotherapy treatments, or smoking
  • Uterine fibroids: Interfere with proper implantation of the fertilized egg
  • Pelvic adhesions: Bands of scar tissue that can be caused by infections, appendicitis, or abdominal or pelvic surgery
  • Certain medications: Some medications can cause temporary infertility, but the issue can be addressed by the cessation of the medication
  • Thyroid problems: Too much or too little thyroid hormone can interrupt the menstrual or ovulation cycle.

What to do if you think you are struggling with Infertility

If you and your partner having been trying to conceive unsuccessfully, make an appointment with your primary care physician and/or your gynecologist.  Make a list of both your medical histories and create a list of questions that you want to ask your doctor.  If your doctor suspects fertility problems, he/she may make a recommendation for you and your partner to see a fertility specialist and have a full fertility examination there.  Some of these tests a fertility specialist may run include a general physical exam, a semen analysis (for men), transrectal and scrotal ultrasound (for men), hormone testing, ovulation testing (for women), ovarian reserve testing (for women), genetic testing, pelvic ultrasound (for women), laparascopy (for women), and hysterosalpingography (for women).  You may not have to undergo all of these tests before the specialist is able to identify the reason for the infertility.

Treatments for Infertility

There are a variety of treatments available for infertility.  Your infertility specialist will discuss the most viable options for treatment in relation to the results of your fertility examination.  The following list includes common treatments for infertility:
  • Hormone treatments: available for both men and women
  • Fertility drugs: most often used for women with ovulation disorders
  • Surgery: used to clear blockages or begin in vitro fertilization (IVF)
  • Assisted reproductive technology: procedures such as IVF, sperm and egg retrieval, ICSI, and assisted hatching
If you or your partner are considering any of these treatments, discuss in detail with your specialist the costs, procedures, and possible complications or side effects.

Coping with Infertility

One of the most frequently overlooked aspects of treating infertility is addressing the mental and emotional impact that infertility has on a couple.  It is vital to ensure that you are addressing your thoughts, feelings, and fears as you go through this difficult trial.  Talk about what options available to you are financially and emotionally feasible.  Consider alternatives like fostering, adoption, surrogacy, or having no children.  In addition to talking to your partner about your feelings, consider seeking outside support from friends, family members, your bishop, or a licensed counselor to cope with your experiences.  A great avenue for support is to find a local Infertility Support Group, either in your community or by joining an online community.


Disclaimer: The "Pregnancy, Babies, and Birth" blog series is meant as a source of general information only.  It's intended use is to encourage women to further consider and discuss reproductive and birthing decisions themselves with their partners and with their medical care providers.  Information included in this series is not intended to be professional medical advice or a substitution for a relationship with a licensed physician or practitioner.  Any serious questions or concerns about reproductive, prenatal, and/or perinatal health should be directed to your primary care physician or other licensed specialist.  Women's Services and Resources does not promote any particular brand, medical provider, birthing location, or any other specific birthing decisions.  We strongly encourage women to become as educated about their choices as possible so they are empowered to make educated decisions for themselves and their babies.

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