Although the process of sperm-meets-egg is natural and easy for most couples, some couples who want to conceive a child struggle with infertility. Approximately 6.1 million American women and their partners (which is about 10 percent of the people in the reproductive age bracket) are affected by infertility.
Infertility is the inability to conceive after a year of unprotected intercourse, or the inability to carry a pregnancy to a live birth.
The reasons for this heartache are many and uncertain. Some feel that the age of free sex in the 1960s passed around sexually transmitted diseases that now years later cause both male and female reproductive problems. Others point to the environmental toxins caused by the breakdown of certain pesticides and plastics that are linked to reduced sperm count, endometriosis, and fibroids. Abortions have caused many scarred fallopian tubes, which blocks the sperm from meeting up with the egg. And the increasing numbers of women who postpone having children until their 30s or 40s, when their eggs are no longer top quality, naturally reduces the fertility pool.
In many cases the cause of infertility in females is rooted in a treatable medical condition. The top two reasons for female infertility are (1) tubal factors (such as damaged fallopian tubes) and (2) ovulatory disorders (such as an irregular or absent menstrual cycle). A smaller percentage of women suffer from endometriosis (a condition in which tissue from inside the uterus grows outside the uterus), which can cause infertility if left untreated.
Some women who do get pregnant but then repeatedly miscarry the baby might also have a medical problem that can be corrected. Similar to other types of infertility, repeat miscarriages might be caused by hormonal problems, ovulatory problems, or structural problems in which the uterus won't support a pregnancy. In a few rare cases, an abnormality of the chromosomes might be the cause. But unfortunately, in the majority of cases, the reason for repeat miscarriages is unknown.
Infertility in males is due to problems with their sperm. The number of sperm might be low (viability), the sperm might be abnormally shaped (morphology), or the sperm might move too slowly or sluggishly (motility).
Although the causes of these problems are many and varied, the most common reasons are as follows:
Although estimates vary, infertility is unexplained in approximately 20 percent of cases. When this happens, there is no medical answer to the problem. Some couples opt to increase their chances of conceiving by trying various assisted reproductive techniques such as fertility drugs, artificial insemination, or some form of in vitro fertilization. Others decide to keep trying the old-fashioned way and investigate other factors that can influence fertility and which they have some personal control over; these include changes in lifestyle, exposure to environmental toxins, positions during intercourse, and reducing the amount of stress in their lives.
Before you jump into fertility testing, it's best to take time to look where you're going. The first step is to carefully choose the physician who will guide you through this process. Start with your gynecologist. Together, the two of you will assess your fertility and then decide if you should also consult a fertility specialist.
If you do decide to go to a fertility specialist, choose this person carefully. Because there is no regulation, licensing, or certification required for advertising this specialty, any physician can be listed as a fertility specialist. Just because someone is listed in the telephone yellow pages under "fertility specialist" or has certificates on the office wall announcing membership in the American Society for Reproductive Medicine doesn't necessarily mean that he or she is qualified to help your particular situation. Before you make your first appointment, call and ask if the physician is board-certified or board-eligible in reproductive endocrinology (meaning that he or she has passed a national board examination to specialize in fertility).
Don't forget that males need a specialized health-care provider, too. It is unlikely that his general practitioner (GP) can adequately perform the necessary diagnostic tests, and if the GP does perform the tests, he or she will likely refer the patient on to a specialist when the results are in anyway.
Most often men are referred to an urologist, but keep in mind that not all urologists are adequately trained to handle fertility problems. It's best to see an andrologist. Andrology is a specialty within the field of urology that focuses specifically on fertility. Andrologists are the physicians most highly qualified to deal with all aspects of male-factor infertility. These doctors have completed a one- to two-year fellowship and have passed an examination to become a board-certified andrologist.
Excerpted from The Complete Idiot's Guide to Pregnancy and Childbirth © 2004 by Michele Isaac Gliksman, M.D. and Theresa Foy DiGeronimo. All rights reserved including the right of reproduction in whole or in part in any form. Used by arrangement with Alpha Books, a member of Penguin Group (USA) Inc.
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