Infertility is defined as not being able to get pregnant after at least one year of trying. Additionally, (1) women over the age of 35 who having been trying for less than one year and (2) women who are able to get pregnant but then have repeat miscarriages are candidates for infertility evaluation.
Pregnancy is the result of a complex chain of events. Infertility can result from problems with any of these steps:
Problems with ovulation account for most cases of infertility. Without ovulation, there are no eggs to be fertilized. Irregular or absent menstrual periods are a sign of no (or infrequent) ovulation. Less common causes of infertility in women include:
Many things can affect our ability to conceive: age, stress, diet, intense athletic training, being overweight or underweight, smoking, alcohol, sexually transmitted infections, hormone changes.
Sometimes we can find the cause of a couple’s infertility by doing a complete fertility evaluation. The process begins with physical exams and health and sexual histories. If there are no obvious problems, like poorly timed intercourse or absence of ovulation, further tests are needed. Finding the cause of infertility is often a long, complex, emotional process. It can take months to complete all the needed exams and tests.
For a man, we begin by testing semen. We look at the number, shape, and movement of sperm. For a woman, the first step in testing is to find out if she is ovulating each month.
Infertility can be treated with medicine, surgery, artificial insemination, or assisted reproductive technology. Many times, treatments are combined. Two-thirds of couples treated for infertility are able to have a baby. In most cases infertility is treated with drugs or surgery. Many fertility drugs increase a woman’s chance of having twins, triplets, or other multiples. Women who are pregnant with multiple fetuses have more problems during pregnancy. Multiple fetuses have a high risk of being born too prematurely. Premature babies are at a higher risk of health and developmental problems.
Assisted reproductive technology (ART) describes several different methods used to help infertile couples. ART involves removing eggs from a woman’s body, mixing them with sperm in the laboratory, and putting the embryos back into a woman’s body.
There is a small number of causes that are ‘preventable’. Reducing or eliminating life stressors, both emotional and physical, is important to increase the likelihood of conception. Also, eating healthy can make a difference. Being overweight or underweight can affect fertility potential. Also, for women who enjoy intense athletic training, reducing or altering workouts can make a difference in the body’s ability to produce healthy, viable eggs. Eliminating habits like caffeine, cigarette smoking, alcohol, drugs and even some over-the-counter and prescription medications can increase chance of conception. If you are using prescriptions medications, do not stop these medications abruptly without consulting your medical provider. Men and women can optimize their immunity and health by incorporating food or supplements rich in antioxidants, monounsaturated oils and omega 3’s. Additionally, protecting oneself from exposure to sexually transmitted infections and getting immediate treatment if exposed to an infection, can reduce infertility.
Additionally, if you do not want to have children until later in life, consider freezing eggs. By doing this, you can eliminate poor egg quality, that comes with advancing age, as a reason for infertility. Likewise, if a man or woman has cancer and requires chemotherapy or radiation, consider freezing sperm or eggs in the event cancer treatments destroy egg/sperm quality and/or quantity.
Being mindful of the above can certainly reduce the likelihood of infertility, but there are so many other causes that are not preventable. For this reason, it is nearly impossible to ‘prevent’ infertility.
As indicated above, some women will turn to freezing eggs and sperm to increase likelihood of conceiving if planning to conceive later in life or receiving medical treatments that may destroy eggs and sperm.
Other infertility treatments include (1) initiating fertility and hormone medications (for both men and women) to correct hormonal imbalances, improve sperm health, enhance the ability to make good quality eggs and ensure ovulation, (2) hysteroscopic or laparoscopic surgical interventions to remove anatomical abnormalities, scar tissue or other blockages that affect females and male reproductive structures, (3) hysteroscopic or laparoscopic surgeries to remove fibroids or polyps or other uterine abnormalities that restrict adequate implantation of fertilized eggs, (4) surgical interventions to reverse vasectomies or tubal occlusions, (5) intrauterine insemination (IUI) to help sperm with decreased motility get to an egg for fertilization, (6) and more complex and technical procedures like in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) where sperm is directly injected into the egg to allow fertilization. Additional options include sperm and egg donation and using gestational carriers/surrogates.
There are a variety of struggles when it comes to infertility. The most obvious hurdle is the financial cost of infertility treatments. Some insurance plans cover infertility treatment, but coverage varies and is often not enough to cover all expenses or treatments. Out of pocket expenses can often lead to fights or resentments if spouses disagree on cost effectiveness or either is pressured to go through with costly treatments.
Couples also deal with emotional/psychological hurdles. A lot of couples feel shame and don’t want anyone to know they are having trouble conceiving naturally. Also, couples with infertility often feel like others cannot relate to what they are going through. These factors can cause couples to feel isolated as they compare themselves to family and friends who are parents. Because of this, they feel embarrassed and avoid family and friends for fear of judgement or criticism. Additionally, couples often try to avoid being questioned by family, friends and strangers. Insensitive inquires like: ‘Why don’t you have children?’ or ‘Which one of you has the problem?’ can take an emotional toll. Not to mention unsolicited comments and recommendations that couples are often given.
Another difficulty is that couples can undergo many treatments before they achieve success (assuming they ever achieve success). Fertility treatments have become more advanced, but couples still often face multiple disappointing failed treatments along the way. Multiple treatments and failures can lead to both physical and psychological stress. In addition to this, side effects of fertility treatment drugs, hormones and injections can cause mood swings, sleep disturbances, problems focusing, depression and anxiety. Overall, there is often a rollercoaster of emotions. It is hard enough when both partners are affected the same way. Unfortunately, emotional factors often affect each partner differently, which can cause resentment, misunderstanding and arguments that can either bring couples closer together or take a significant toll on the relationship. On top of this, sex often becomes a chore that has to be timed perfectly in order to optimize success. Sex loses its association with pleasure and intimacy.
Infertility has taken on a new face, with added struggles, with the emergence of same-sex couples and single individuals wanting to become parents.
At Tree of Life Medical we will perform a thorough evaluation of all the possible causes that are making it difficult for you to conceive. We will prescribe some medications and make lifestyle recommendations to assist you in your attempt to conceive. If more in-depth evaluation and management is needed, we will make sure you are referred to the appropriate specialists. We will help coordinate your care and stand by you as you go through every step of the process.