Infertility

Source: Adapted from Know Your Options: The Definitive Guide to Choosing The Best Medical Treatments, Reader

What is infertility?

Getting pregnant and carrying a baby to term may seem like the most natural thing in the world—until the requisite healthy machinery, exquisite timing, and luck aren’t on your side. Consider what’s involved. Well-shaped, active sperm must enter the uterus and swim up into the Fallopian tube(s) at a time when one of the ovaries releases an egg. A single sperm has to wiggle its way into the egg, fertilizing it. The newly formed embryo must wend its way down to the uterus and snuggle firmly into the uterine wall.

If this scenario doesn’t play itself out after 12 or more months of regular, unprotected sex, infertility is diagnosed. Having repeated miscarriages is also a form of infertility. The situation can leave you angry and heartbroken. In one in five cases no cause can be found, even after a full medical workup. Sometimes a problem with the male partner can be spotted and treated. Often—in a third of cases—there’s an issue with both partners. For women, age is always a factor. You’re born with a finite number of eggs that start to run out in a fairly predictable way after age 30.

In most cases of infertility, doctors eventually identify and treat the problem. Nearly 30% of women with infertility, for instance, have blocked Fallopian tubes, preventing the egg from traveling into the uterus. Pelvic inflammatory disease, a prior pregnancy in one of the tubes (called an ectopic pregnancy), endometriosis, or pelvic surgery can cause this kind of blockage. Another 20% of infertile women have an ovulation disorder, often infrequent ovulation because of hormonal imbalances, weight problems, heavy athletic training, or stress. Disorders of hormone-producing glands such as the thyroid and pituitary can also interfere with ovulation. In 20% of cases, fibroids or another disorder of the uterus disrupt embryo implantation or cause miscarriages.

Treatment for infertility

Whether you’ll conceive and carry a baby to term depends on many things, from what’s causing the problem to how severe it is. Proper timing of intercourse is crucial, of course. Hormone imbalance problems often respond to ovulation-promoting drugs. One in 10 women turn to high-tech options like in vitro fertilization (IVF). Surgery can repair damaged reproductive organs. Even if experts can’t pinpoint a cause, it’s extremely heartening to know that 60% of couples get pregnant within three years.

Medications for infertility

Hormonal problems such as irregular—or absent—periods or long cycles are treated with clomiphene citrate, which induces ovulation. To increase their odds, some women take it to stimulate multiple eggs (and 10% to 20% of births resulting from fertility drugs are multiples). If you still don’t ovulate, potent hormone stimulators can mimic natural steps leading to ovulation and encourage the development of egg-producing follicles on the ovaries. You may first be given continuous gonadotropin-releasing hormone agonists to turn off your natural hormones so that the artificial ones can take over.

Injected over several days, “super-ovulator” drugs are typically used in conjunction with various procedures. The menotropins act directly on the ovaries to stimulate follicle development. The follitropins (follicle-stimulating hormone, FSH), including Gonal-F, Follistim, and Bravelle, stimulate follicle and egg production. Chorionic gonadotropins mimic luteinizing hormone (LH) to release matured eggs, ripening prospects for implantation. Progesterone, taken after ovulation, primes the uterine lining. Many women ovulate after taking these drugs, but not all of them get pregnant, and the drugs are not risk-free. Be clear on benefits and risks. Other drugs can correct too much prolactin (a hormone that interferes with FSH and LH production) or a thyroid endocrine imbalance.

Lifestyle Changes

There are lots of simple things you can do to boost your odds of getting pregnant. You’re most fertile in the five days before you ovulate, so chart your menstrual cycle by recording your basal body temperature each morning (right after awakening) for several months. Look for vaginal discharge that has become copious, clear, and slippery; this happens just before ovulation. Stay attuned to the slight pinching sensation in your abdomen that signals ovulation. At-home ovulation tests can also help identify the key time.

Many medications you might not suspect (asthma drugs, for example) can compromise fertility, not to mention potentially endanger your pregnancy once it occurs, so review what you take with your doctor. Cut out alcohol. Even one drink a day has been linked to compromised fertility. Limit caffeine as well. More than one cup of coffee daily may dump enough caffeine into your system to up your risk of miscarriage. (Fancy coffeehouse brews tend to be particularly high-octane.) Cigarettes are also linked to fertility problems—yet another reason to stop smoking. It seems smokers inhale a toxin that can trigger ovarian failure.

More than one in 10 cases of infertility are linked to too much or too little body weight. Aim for a normal weight, with a body mass index (BMI) of at least 20 if you’re thin to start, and a BMI under 27 if you’re heavier. Exercise in moderation: Working out too vigorously reduces levels of estrogen and progesterone. That may inhibit ovulation or make it impossible for an embryo to implant in the uterine wall. Aim for the equivalent of a two-mile daily stroll. Eat a well-rounded diet and take basic prenatal vitamins.

Related Procedures for Infertility

With artificial insemination (AI), technology aids nature by injecting sperm directly into the uterus once or twice before ovulation, then during ovulation. The procedure is quick and relatively pain-free, and occasionally performed without drugs. With all other forms of assisted reproductive technologies (ART), egg-stimulating drugs are given to encourage multiple egg-containing follicles to develop. Ultrasound exams and blood tests identify when your follicles are large enough to contain mature eggs: Hormones made by the placenta—human chorionic gonadotropin (hCG)—are given to induce ovulation approximately 36 hours later.

For many procedures, surgeons guided by ultrasound retrieve eggs via a needle inserted through the vaginal wall. The egg(s) is fertilized with semen and incubated in a laboratory. Healthy embryos are then transferred into you. The developing embryos are transferred into your uterus through in vitro fertilization (IVF). In gamete intrafallopian transfer (GIFT) sperm and eggs are placed directly into your Fallopian tubes and fertilization occurs naturally. An IVF/GIFT hybrid and an option if GIFT fails is zygote intrafallopian transfer (ZIFT); here the laboratory-fertilized eggs are placed into your Fallopian tubes.

Major surgery to repair damaged ovaries, uterus, or Fallopian tubes is considered only if fertility prospects are good. If available, minimally invasive laparoscopic techniques are your best option.

Questions for Your Doctor

• What is the success rate of your fertility clinic? How does it compare with others?
• Are any of these hormones dangerous for me?
• I keep miscarrying. What are my options?
• How much will this therapy cost? Is any of the cost covered by medical insurance?

Living with Infertility

If you have been diagnosed with Infertility, here are a few quick tips to help you take control:

• Keep time on your side. Over age 30? If infertility is an issue, don’t wait a whole year before seeing a doctor. Go after six months if you’re over 35. Always go if you aren’t menstruating, have had three or more miscarriages, or have an infection of your reproductive organs.
• Don’t let money be the issue. Before seeking treatment, check out your medical insurance coverage. Companies vary widely in how much testing or treatment they’ll pay for—especially for a pre-existing condition.
• Express your feelings. Infertility can undermine your sense of womanhood, self-worth, and identity. You may feel sorrowful, angry, or withdrawn. Relationships can fray from the pressure. Don’t stuff these feelings away: Many other women are experiencing them too, and there are things you can do to ease your pain. Talk with your doctor about counselling or finding a support group.
• Be wary of dietary supplements. Traditional treatments, from chasteberry to false unicorn root, may not work. High doses of St. John’s wort, echinacea, and ginkgo may damage eggs, sperm, and the fertilization process.