HealthSquare: Overcoming Infertility

lusive, unpredictable, demoralizing...the quest for fertility can be frustrating beyond words. Not only must both of you have smoothly operating reproductive systems, your timing must be impeccable as well. Intercourse has to take place when an egg is ripe for fertilization—and the window of opportunity is remarkably small.

In fact, after ovulation when an egg lies ready in the fallopian tube, it can be fertilized for only about 12 hours! This is why couples with no fertility problems whatsoever may still have difficulty conceiving quickly. Only 20 percent or so will succeed in the first month. For about half of the couples who've stopped contraception in order to conceive, it will take up to 3 months.

If you're having difficulty conceiving, you have plenty of company. Roughly 10 to 15 percent of American couples are having fertility problems at any given time. About 1 in every 5 married women in the U.S. seeks medical help to conceive at some point in her childbearing years.

Infertility, of course, can involve either or both partners. This chapter focuses on the difficulties you as a woman may face; but don't forget that it's essential for your partner to get a thorough check as well.

What Is “Infertility?”

Return to top

Infertility is hard to pin down. A couple with no known reproductive problems might try for years to have a baby but fail simply because their timing was off. Are they infertile? Not physically, but they would be classified as such because infertility is usually defined as the inability to conceive after 1 year of unprotected sex.

Types of Infertility

Hypofertile couples have trouble conceiving quickly. Their fertility may be less than ideal or they may be having problems with timing, but they can eventually conceive without special treatment. For example, the man might have a low sperm count, or the woman might have endometriosis—roadblocks, but not brick walls.

Sterile couples won't be able to conceive without medical or surgical treatment. For example, the man might not create enough sperm to fertilize an egg, or the woman might have blocked fallopian tubes.

Infertility's Many Causes

Return to top

A poorly functioning male reproductive system is the problem for 30 to 40 percent of couples seeking help for infertility. The man may have a low sperm count, sperm that move too slowly through the female reproductive system (low motility), semen that is too thick, or not enough of it.

Another 30 to 40 percent of fertility problems are caused by a malfunction in the female system. The most common, accounting for between 10 and 15 percent of all infertility, is the inability to release a healthy egg into the fallopian tube. Other problems include endometriosis, infection, or blocked tubes. In a significant percentage of couples (10 to 15 percent), sperm are unable to penetrate the mucus that lines the cervical canal leading to the uterus. About 10 percent of couples who seek help for infertility never learn the cause of their problem. Most turn out to be hypofertile and eventually do have children.

One important factor responsible for infertility in women is simply aging. Women tend to be most fertile in their early 20s. From then on, fertility declines rather slowly until about age 35, after which it becomes harder and harder to become pregnant. One in 7 couples is infertile if the woman is 30 to 34 years old; 1 in 5 is infertile if she is 35 to 40; and 1 in 4 can't conceive if she's 40 to 44.

Improving Your Chances

Return to top

The remainder of this chapter will discuss the methods that physicians use to help couples who are having trouble conceiving. But before spending your time and money on specialists, consider these basic facts:

• Ovulation—prime time for fertilization—occurs in mid­ to late morning, usually 12 to 16 days before your next menstrual period begins.
• The best time to have intercourse is on the day or evening before ovulation, so that sperm will already be waiting in the fallopian tube when the egg arrives.
• The missionary position (woman on her back, man on top) usually puts the uterus in the best position for receiving sperm. (For some women lying on the stomach is better. Your doctor can tell you which position is best for you.)
• You should lie still for about 10 minutes after intercourse to give the sperm that have entered the vagina enough time to proceed through the cervix.
• Since sperm can live in the fallopian tubes for 2 or 3 days longer, it is possible to have intercourse one day, ovulate the next day, and conceive on the third day—2 days after intercourse actually took place.
• Having intercourse at least 3 times during the week you expect to ovulate raises the odds that sperm will be present in the fallopian tubes when ovulation occurs.
• Fertility may be slightly impaired for a few months after you stop taking oral contraceptives or injectable or implanted hormones, but the effect will wear off.

SIGNS OF SUCCESSFUL OVULATION

Since failure to ovulate is the most common cause of infertility in women, it's one of the first possibilities that your doctor will check. A change in your basal body temperature is one tell-tale sign of normal ovulation. If the temperature drops briefly, then jumps to a higher plateau, chances are that an egg has been successfully released. An increase in progesterone, produced by the remnants of the follicle after ovulation occurs, is also promising. If tests show higher levels during the second half of your cycle, any problem you may have probably lies elsewhere.

next page Testing for Infertility