|INFERTILITY: Causes & Treatments|
|Many couples who want a child face the problem of infertility - they have tried to conceive but have not been able to do so. Couples are considered infertile if they have not been able to conceive after 12 months of having sex without the use of any form of birth control. About 14% of couples in the United States are infertile.|
Infertility may be due to many problems. More than one factor may be causing the infertility. Some causes are easily diagnosed and treated, while others are not. In some cases, no cause can be found in either partner.
If you and your partner are infertile and you want to have a child, you should think about having an infertility evaluation. This is done by a doctor to find out what is causing the infertility and what can be done to correct it.
At the peak of a woman's fertility - around her early to mid-20s - the odds are only 20% that she will conceive during any one menstrual cycle. This figure starts to decline in her late 20s and early 30s and drops even further around 35. A man's fertility also declines with age, but not as quickly.
Certain events must take place in order for conception to occur:
There are many possible causes of infertility. A single cause may not be linked to either the man or the woman. Often the problem stems from a combination of factors in either or both partners. You and your partner will be diagnosed as a couple to determine the best treatment for you.
A man may be infertile because he does not have enough sperm; because the sperm are not active enough; because the passage, or vas deferens, is blocked; or because of problems with ejaculation. A number of factors can cause or contribute to male infertility:
A woman may be infertile because of hormone imbalances or problems in the reproductive tract. Factors that can cause or add to female infertility include:
|In the female reproductive system, the egg is released from the ovary at ovulation (1), is fertilized by sperm in the fallopian tube (2), and moves through the tube to the lining of the uterus (3) where it become implanted and grows.|
Testing may be done after a couple has had 12 months of sex without birth control and conception has not occurred. Testing may be begun sooner, though, depending on age and other factors.
Testing the Man. A semen analysis is an important part of the basic workup. The doctor may tell the man not to ejaculate for 2-3 days before he gives his semen sample. Sometimes he is asked to produce the semen sample at the lab, since sperm have a fairly short life span outside of the body and quickly lose their ability to fertilize.
Testing the Woman. Most tests used to detect infertility in a woman check if and when ovulation has occurred. These tests may be performed before, during, or after ovulation. Others check for any structural abnormalities in her reproductive system.
Urine Test. A way to predict ovulation is by using a urine test kit at home. This test measures luteinizing hormone (LH), which is released by the pituitary gland to cause ovulation. If the test is positive, it indicates that ovulation is about to occur. Sometimes these kits are used to supplement basal body temperature charts.
Basal Body Temperature. After a woman ovulates, there is a rise in body temperature - as much as 1 degree F - that can happen suddenly in one day or slowly over several days. To record her basal body temperature, a woman takes her oral temperature every morning before she gets out of bed and records it on a sheet of graph paper. This record usually has to be kept for 2-3 months. This test may suggest whether ovulation has occurred and whether it occurs on a regular basis. It may be helpful in planning the timing of other tests.
Progesterone Test. After a woman ovulates, the ovaries produce progesterone, a hormone produced in the ovaries that prepares the lining of the uterus to nourish a fertilized egg. A blood test, taken 5-10 days before a woman's period is due, can be used to test for ovulation by measuring progesterone.
Endometrial Biopsy. Sometimes this test is performed to find out whether and when ovulation has occurred and whether there are problems with how the lining of the uterus responds to ovulation. The procedure is done a few days before a woman's period is due. A thin, hollow tube is inserted into the vagina and through the cervix to remove a small piece of the uterine lining. This sample is later examined under a microscope. This procedure is done in the doctor's office.
Postcoital Test (PCT). The postcoital (after sex) test examines the ability of sperm to enter and move into the cervical mucus just before time of ovulation. The couple has intercourse close to the time of ovulation, and the cervical mucus is examined a few hours later. A PCT can also show if there is a reaction between the sperm and cervical mucus that could be causing infertility.
Hysterosalpingography (HSG). This test is an X-ray that examines the inside of the uterus and fallopian tubes. It is usually performed right after the menstrual period in a radiologist' office or the X-ray department of a hospital. A small amount of fluid is placed in the uterus through a thin tube inserted through the cervix, and an X-ray is taken. The fluid outlines the inside of the uterus and shows (by a spill of the fluid out of the tubes) whether they are open.
Ultrasound. Ultrasound uses sound waves to produce images of internal structures. This test can check the ovaries and uterus, as well as the thickness of the uterine lining. It can also be used to show the development of the egg in the ovary.
Hysteroscopy. For this procedure, the doctor places a telescope-like instrument, called a hysteroscope, through the cervix. The inside of the uterus may be filled with a gas or liquid. With the hysteroscope, the doctor can see the contents of the uterine cavity, including the opening of the tubes on the inside of the uterus. During this procedure, the doctor can correct minor problems, get a biopsy sample, or determine whether another operation is needed. Hysteroscopy is performed under local or general anesthesia.
Laparoscopy. A light-transmitting, telescope-like instrument, called a laparoscope, is inserted through a small incision (about 1/2 inch or less) at the lower edge of the naval. The abdominal cavity is filled with gas so the uterus can be seen. With this procedure, the doctor can look for pelvic disease, such as endometriosis, that may interfere with conception. The fallopian tubes can also be examined and tested to determine whether they are open by injecting a fluid into the uterus and tubes. It usually is performed under general anesthesia and does not require an overnight hospital stay.
Treatment for the Man
Treatment for the Woman
Treatment for the Couple
Artificial Insemination. Artificial insemination - insemination by means other than intercourse - is one option. Usually the sperm are treated to enhance the chances for successful fertilization. Around the time of ovulation, the sperm are placed in the vagina, cervix, or uterus, or sometimes the tubes or pelvic cavity.
In Vitro Fertilization (IVF). In vitro fertilization also involves using fertility drugs that cause multiple eggs to mature. These eggs are removed from the ovary just before ovulation is due. The eggs are removed by laparoscopy or by inserting a needle through the abdomen or the vagina, and withdrawing the eggs through the needle. The eggs are fertilized with sperm in a dish in the lab. A fertilized egg is then placed in the woman's uterus through her vagina. The unused fertilized eggs can be frozen and stored for later use.
Gamete Intrafallopian Transfer (GIFT). A variation of the IVF procedure is gamete intrafallopian transfer, or GIFT. A woman must have at least one healthy fallopian tube for this technique to be tried. As in IVF, drugs are used to produce multiple eggs in the woman's ovaries. The eggs are collected, usually by laparoscopy, just before ovulation is to occur. Two or three eggs are mixed with the man's sperm. The eggs and sperm are placed in the woman's fallopian tube for fertilization to take place there. Some fertility centers use a combination of IVF and GIFT.
Zygote Intrafallopian Transfer (ZIFT). Yet another variation of IVF and GIFT is zygote (fertilized egg) intrafallopian transfer, or ZIFT. As in IVF, the egg is fertilized in a dish before placement in the tube.
It is important for a couple to think very carefully about the decision to go through an infertility workup. It can be an expensive and time-consuming process that requires a big commitment from both partners. There are no guarantees that the cause of the infertility will be found or that pregnancy will be achieved.