The Truth About Infertility

The term 'infertility' refers to the inability to conceive a child by traditional methods or means. For women, this term can also include the inability to carry a pregnancy to full term. While there are many biological and other factors that can disrupt this natural process of fertility, there are also many treatment methods and non-medical options that couples can take into consideration. If you and your partner are faced with the possibility of infertility, there is light at the end of the tunnel.

Types of Infertility

Generally speaking, infertility often refers to the condition of a couple together, rather than specifically singling out either the male or female partner. There are several different types of this condition, each one having its own definition and set of treatment options.

• Primary infertility refers to couples who have never successfully achieved pregnancy.
  
• Secondary infertility involves a couple who has conceived at least one child, and is currently having trouble achieving a second or subsequent pregnancy.
  
• Combined infertility is considered when each partner contributes individually to the condition. In this case, both partners may be infertile, or both may be separately able to conceive, but together they produce conditions which make pregnancy impossible or unlikely.
  
• Unexplained infertility is diagnosed when conventional methods are unable to detect any cause for the inability to have children. There is a wide range of possibilities that can lead to unexplained infertility, such as poor egg quality, interruption in timing or a disturbance in the transportation of the sperm to its destination.

Symptoms of Infertility

The main symptom of infertility is quite obviously the inability to successfully become pregnant after some months of regular, unprotected sex. The number of months involved for diagnosis, however, differs based upon several factors. Age may come into play, as well as lifestyle, change of partners or certain health issues. Doctors may also have differing opinions on the matter, even where the same couple is involved. It is generally considered that if a period of 1 year has passed, and a couple is unable to conceive, that couple is regarded as infertile.

Causes of Infertility

There are several different factors that can cause or lead to infertility, and different specific causes can affect males, females or both. In males, infertility is usually caused by low semen quality, but can also result from a prior mumps infection, varicocele (a form of varicose veins in the scrotum) or a history of orchitis or epididymitis. Females experience a range of factors that can contribute. These may include any of the following:

• problems with ovulation
• endometriosis
• previous infections resulting in damage to the fallopian tubes
  
• previous tubal ligation
• tubal blockage
• problems with the uterus
• sexually transmitted disease
• eating disorders
• some chronic diseases

Factors that can contribute to infertility in both men and women include genetic factors, such as Robertsonian translocation, diabetes, thyroid problems, adrenal disease, hypothalmic-pituitary problems or exposure to toxins, such as certain glues, chemical dusts, pesticides or tobacco smoke.

Seeking a Diagnosis

Specific conditions are necessary to result in a successful pregnancy. Timing must be right, sperm must be mobile, hormones must be balanced, and all systems (both male and female) must be at optimum levels. Because of this, it isn't necessarily advised to seek a diagnosis of infertility until some time has passed, as pregnancy may result only after several attempts over a long period of time. Women who are over the age of 35 may seek consultation after six months of attempting pregnancy. Younger women should wait at least 1 year before discussing the situation with a professional.

Boosting Fertility

If you suspect possible infertility for yourself or your partner, or you just want to give your chances of a healthy pregnancy a jump start in the right direction, there are many ways that you can boost fertility using simple dietary and lifestyle changes. Doctors will often make these suggestions to you before offering any medical or prescription treatments. Conception is a delicate matter and anything you can easily do to increase your chances will be beneficial; likely in more ways than one.

Weight Control is Essential

Issues with weight can cause an imbalance in hormones, ultimately leading to infertility. Being overweight or underweight can significantly lower the chances of getting pregnant. Overweight women may have irregular cycles, causing ovulation to happen less often. Women who have eating disorders or are underweight for other reasons may not produce sufficient hormones to ovulate at all, or to sustain a pregnancy if conception does occur. Keep in mind that exercise can help to maintain a healthy weight, but aggressive exercise may also lead to problems.

Intake of Beverages

One could easily assume that intake of too much alcohol could disturb normal functioning of many bodily systems. So too is this true for conception. Alcohol can decrease estrogen levels, which may disturb the egg implantation process. Caffeine can also disrupt the systematic process of conception, so coffee, soda and other caffeine drinks should be strongly limited while attempting to achieve a healthy pregnancy.

Track Your Monthly Cycles

Popular belief suggests that the best time to get pregnant is during ovulation. Studies have shown that your 'fertile window' actually shows up 3 to 5 days prior to ovulation. If you're waiting to have sexual intercourse only during ovulation, you may be missing out on the best chances to conceive. Once you begin tracking your cycles, it will be easier to tell when ovulation begins. Get started early by tracking cycles with a calendar or a special kit sold at drugstores. You are advised to figure somewhere between days 9 and 14 of your monthly cycle are the days when you are likely to be most fertile.

Eliminate Stress

One of the top stresses when trying to get pregnant is the issue of fertility itself. Especially if you and your partner are having trouble conceiving, it may be easy to become panicked about when to have sex, how often, whether or not it's working and how things should be done the same or differently. Since stress can adversely affect your chances for getting pregnant, it's imperative that you find ways to relieve that stress. It just so happens that sex is an excellent stress reliever, but only if you have it from a place of passion, rather than a place of expectation. Enjoy your partner, spice up the romance and have sex for the sake of having it. Try to forget about planning it for the purposes of creating a child. You might be surprised that a pregnancy results from the best night of unplanned spontaneous lovemaking.

Don't Forget His Health

If you are a couple struggling with infertility, his health and well-being are just as important as yours. Just as eating well and providing the body with necessary nutrients could boost your fertility, the same goes for the male partner and his contribution. Likewise, intake of too much caffeine, nicotine or alcohol can also reduce sperm production or limit sperm mobility. Advise your partner to think ahead. It takes most males about three months to make new sperm. Have him get into the habit of taking a multivitamin daily. Sufficient intake of vitamin C, vitamin E and selenium help to produce sperm which are healthy and vital.

Other Ways to Boost Fertility

Being in good health, eliminating stress and improving certain negative lifestyle habits are all very important things to do when looking to boost fertility. In addition to the general suggestions, there are also some very specific things that you might try:

• Don't douche: regular douching can destroy the normal protective bacteria in the vagina. This can disrupt your hormonal balance and put you at risk for infection.
  
• Use natural lubricants: many lubricants on the market include spermicides in the ingredients list. It might be obvious that you'll want to avoid those, but water-based lubricants can inhibit sperm mobility and any type of soap can kill sperm quickly. Choose natural oils that are safe to use and won't cause infection.
  
• Try some new age tactics: Yoga, meditation, acupuncture and many herbal remedies can all lead to increased fertility. Yoga and meditation are great ways to get centered and focused while relieving superficial stress. Acupuncture can help to balance hormones, and many herbal remedies are shown to help a woman conceive naturally.
  
• Sexual positions: having sex 'missionary style' has proven to be the best position to choose when trying to get pregnant. In addition to making love with the man on top, 'doggy style' sex can also have a profound effect on women with a tipped uterus. In this position, as the man enters from behind, sperm may have more direct access to the cervix, thus resulting in faster pregnancy.
  

Infertility Options and Alternatives

For many couples, none of the tips, tricks or suggestions for boosting fertility seem to help make any progress toward having a baby. If you and your partner are indeed infertile, there are many alternatives to getting pregnant the old-fashioned way. Once you have come to terms with the fact that it's not safe or possible for you to become pregnant by normal intercourse, you might want to look into one or more of the following options. Studies show that nearly 90% of infertility cases can be overcome using medical, surgical or other treatment techniques.

Fertility Drugs

There are a number of pills and injections available through traditional medical science that can help women to become pregnant. This treatment option, referred to as ovulation induction, is the first choice for women with fertility issues caused by ovulation disorders, because it's the least invasive and is very effective in many cases. The majority of these medications work to regulate or stimulate the release of hormones that cause ovulation. These drugs can be used alone, in conjunction with one another or together with other types of treatment for increased success rates. These success rates will vary from 10% to 80% effective, depending upon the type of infertility problems present and the level of ovulation induction performed. Side effects can include multiple births, ovarian cysts or OHSS, a rare syndrome which causes severe pain, nausea, bloating and difficulty breathing.

IVF - In Vitro Fertilization

IVF is a procedure where eggs are removed and fertilized outside the body. After taking hormones to control and stimulate ovulation, the eggs are extracted and placed into a fluid solution. The partner's sperm is then added and allowed to fertilize the egg. Once this has taken place, the egg is then transplanted back into the uterus in an attempt to establish a successful pregnancy. This procedure is usually used in conjunction with one or more fertility drugs, and the success rate depends upon a number of factors; the patient's age being one. Side effects vary depending upon which stage of the procedure is involved. During ovarian stimulation, hyperstimulation is possible, resulting in swelling and pain. During egg retrieval, bleeding, infection or damage to the bowels and bladder hold a slight possibility. When the embryo is being transferred, patients may achieve multiple pregnancies leading to multiple births, running the risk of premature delivery and other complications. If the fertilized egg develops outside the uterus, an ectopic pregnancy may occur, resulting in the need to immediately destroy the fetus.

IUI - Intrauterine Insemination

With an IUI, a concentrated dose of washed sperm is injected directly into the uterus or fallopian tubes using a catheter. Sperm must be collected within a half hour of ejaculation for washing, a procedure where select sperm are separated from the seminal fluid. This procedure is fairly short and best suited for patients who have a problem with cervical mucus, or where the male partner has problem sperm. Success rates depend heavily upon sperm count and follicle count. Side effects with the procedure are minimal, and when present, are usually related to use of fertility drugs in conjunction with the procedure.

Other Surgical Procedures

Different surgical procedures are often available for both men and women who struggle with infertility. In most cases, surgery is available to treat any structural problems that are contributing to the inability to become pregnant. There are a number of options that coincide with different blockages or growths in the reproductive area.

For Women

It may be advised for a woman struggling with infertility to undergo any one of the following surgical procedures:

• Hydrosalpinx removal: a hydrosalpinx is a fallopian tube blocked with fluid. Pelvic inflammatory disease or tubal tuberculosis can lead to hydrosalpinx, as can IUDs, endometriosis and prior abdominal surgeries. As a reaction to injury, the body compensates by loading inflammatory cells into the fallopian tubes, causing possible closure of the tube. When one tube is affected, the other is likely to also be hindered. Removal of the hydrosalpinx may be advised before proceeding with an in vitro fertilization procedure.
  
• Laparoscopic ovarian drilling: though not commonly used, ovarian drilling may be beneficial to women who are unable to ovulate due to PCOS (polycystic ovary syndrome). If fertility drugs and weight loss fail to properly stimulate the ovaries, a small incision may be made at the belly button, called a laparoscopy. Lasers can then be inserted to destroy parts of the ovaries which may be inhibiting ovulation.
  
• Hysteroscopy: much like a laparoscopy, a hysteroscopy is a way of going into the reproductive system and checking for problems. Doctors will go through the vagina and cervix to view the uterus for any signs of growths, such as fibroids or polyps. If found, these growths can be removed during the procedure.
  
• Other surgeries related to infertility and the reproductive system may include fallopian tube sterilization reversal, myomectomy for uterine fibroids and laparoscopic surgery for endometriosis.

For Men

Men with infertility issues can also be advised that surgical procedures may be necessary. Quite commonly, a vasectomy reversal surgery is performed to reconnect the vas deferens. Other possibilities may include:

• Testicular biopsy: this procedure is necessary to detect fertility problems when hormone tests are returned within the normal range, but a man's semen is devoid of sperm. A small sample of tissue will be removed from one or both testicles, and sperm may also be retrieved at this time for use in an IVF procedure.
• TESA or PESA (testicular or percutaneous sperm aspiration): for male patients with azoospermia, sperm extraction can be performed using the TESA or PESA technique. These are fairly non-invasive procedures and can be quite effective. When sperm is not available due to prior vasectomy, congenital absence of the vas deferens or low to no sperm count, sperm can often be harvested from the testes using this method.

Non-Surgical Options

For many infertile couples, medical, surgical or other procedural treatment options are not feasible This can be due to major health concerns, financial limitations, religious reasons or simple, personal preferences. For these couples, there are still many options for welcoming children into a family.

Sperm Donation

When sperm is donated to a sperm bank or clinic, it is done so under the agreement that it will be used by a woman to become pregnant. While the donor is still the biological father of any children that his sperm may produce, he is usually not considered as such in legal terms. Women may also choose to accept a sperm donation privately, via a known party. Artificial insemination will be the likely procedure performed when donor sperm is used.

Egg or Embryo Donation

Egg donation is possible when one woman provides eggs to later be fertilized by donor sperm or sperm of the male partner. Once an embryo is developed, it is placed inside the patient's uterus to be carried through the pregnancy. Similarly, embryo donation results when healthy embryos are available to be used and are selected by women wishing to become recipients. This process also carries some risk and should involve legal and custodial agreements among the parties involved.

Surrogacy

In some cases, infertile couples may wish to arrange for a carefully selected woman to carry and deliver their child. This is called surrogacy. Surrogacy is usually performed using artificial insemination, and conditions surrounding the agreement vary widely. Infertile couples may choose a surrogate that is already well-known the to family, or they may select a surrogate based upon face-to-face meetings, exchange of personal data and written legal agreements. Considering this as an option should be regarded with care. Performing in-depth research into possible religious, ethical and legal issues should be a priority when considering this method.

Adoption

Adoption is available to couples who cannot or do not wish to consider any of the other available options. An infertile couple may find that adoption has many advantages, and is a win-win situation for all involved. There are countless babies in many different countries currently available for adoption. Likewise, couples can choose to speak with a local agency to find a woman who is currently pregnant and considering adoption as her own alternative. Legal issues can be involved with adoption as well, but the legal processes involved usually transfer all rights from the biological to the assuming parents.

The Next Steps

Infertility doesn't have to stop wanting couples from having a family of their own. With the information, options and treatment methods available today, couples can make the best choices available for their personal circumstances. When welcoming the bright, new family member into the world, the method by which he or she arrived there is sure to pale in comparison.