Fertility Problems

What are fertility problems?

You may have fertility problems if you have not been able to get pregnant after trying for at least 1 year. Another word for this is infertility. Infertility may not mean that it is impossible to get pregnant. Often, couples conceive without help in their second year of trying. Some do not succeed, but medical treatments help many couples.

Age is an important factor if you are trying to decide whether to get testing and treatment for fertility problems. A woman is most fertile in her late 20s. After age 35, fertility decreases and the risk of miscarriage goes up.

• If you are younger than 35, you may want to give yourself more time to get pregnant.
• If you are 35 or older, you may want to get help soon.

What causes fertility problems?

Fertility problems can have many causes. In cases of infertility:

• About 50 out of 100 are caused by a problem with the woman’s reproductive system . These may be problems with her fallopian tubes or uterus or her ability to release an egg (ovulate).
• About 35 out of 100 are caused by a problem with the man's reproductive system . The most common is low sperm count.
• About 5 out of 100 are caused by an uncommon problem, such as the man or woman having been exposed to a medicine called DES before birth.
• In about 10 out of 100, no cause can be found in spite of testing.

Should you be tested for fertility problems?

Before you have fertility tests, try fertility awareness. A woman can learn when she is likely to ovulate and be fertile by charting her basal body temperature and using home tests. Some couples find that they simply have been missing their most fertile days when trying to conceive.

If these methods don't help, the first step is for both partners to have some simple tests. A doctor can:

• Do a physical exam of both of you.
• Ask questions about your past health to look for clues, such as a history of miscarriages or pelvic inflammatory disease.
• Ask about your lifestyle habits, such as how often you exercise and whether you drink alcohol or use drugs.
• Do tests that check semen quality and both partners' hormone levels in the blood. Hormone imbalances can be a sign of ovulation problems or sperm problems that can be treated.

Your family doctor can do these tests. For more complete testing, you may need to see a fertility specialist.

How are fertility problems treated?

A wide range of treatments is available. Depending on what is causing the problem, you may be able to:

• Take a medicine that helps the woman ovulate.
• Have a procedure that puts sperm directly inside the woman (insemination).
• Have a surgery that corrects a problem caused by endometriosis or blocked fallopian tubes.
• Have a procedure that might increase the man’s sperm count.

If these options are not possible or don't work for you, you may want to consider in vitro fertilization (IVF). During an IVF, eggs and sperm are mixed in a lab so the sperm can fertilize the eggs. Then the doctor puts one or more fertilized eggs into the woman’s uterus. Many couples try IVF more than once.

Treatment for fertility problems can be stressful, costly, and hard on your body. Before you start testing, make some decisions about what you want to do. You may change your mind later, but it’s a good idea to start with a plan.

• Learn all you can about the tests and treatments, and decide which you want to try. For example, some couples agree to try medicines but don't want surgery or other treatments.
• Find out how much treatments cost and whether your insurance will cover them. If you don't have insurance coverage, decide what you can afford.

Treatments for infertility can increase your chances of getting pregnant. But they also increase your chance of having more than one baby at a time (multiple pregnancy). Be sure to discuss the risks with your doctor.

Fertility problems can put a lot of strain on a couple. It may help to see a counselor with experience in infertility. Think about joining an infertility support group. Talking with other people with the same issue can help you feel less alone.

References:

 Bets Davis, MFA