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  • Infertility

    Infertility is a fairly common medical condition that affects over 6 million Americans (15% of couples of reproductive age), with over 9 million women currently using infertility services. It is typically defined as the inability to conceive and become pregnant after 12 months of regular, unprotected sex, regardless of cause. Although if a woman is over 35, after only about 6 months of trying without any success, fertility problems can start to be suspected. A broader view of infertility includes not being able to carry a pregnancy to term, in other words if the woman suffers from repeated miscarriages.

    Infertility is not the same as sterility. Being sterile means that it is impossible for a person to conceive a child. A diagnosis of infertility simply means that becoming pregnant may be a challenge rather than an impossibility.

    Conception is a complicated process that depends upon many factors. First a woman must be able to release an egg from one of her two ovaries (ovulation). Second, the egg must be able to travel through a fallopian tube that is unblocked, towards the uterus, to reach the man’s sperm for fertilization. Third, the man must be able to produce a significant number of healthy sperm that have the ability to penetrate and fertilize the egg when they meet up in the fallopian tube. Fourth, the fertilized egg must be able to implant itself inside the uterus, attaching to the endometrial lining. Lastly, the fertilized egg must be able to adequately grow and develop without any interference inside the uterus to continue to full term. When just one of these factors is impaired, infertility can result.

    If a couple has been trying to conceive for more than a year, there’s a good chance that something may be interfering with their reproductive function. Infertility may be due to a single cause or a combination of factors that may prevent a pregnancy from occurring or continuing. Infertility can be male or female related. About 1/3 of infertility is due to problems with the man (male factors) and 1/3 is due to problems with the woman (female factors). Other cases are due to problems in both partners or are due to unknown causes that cannot be explained.

    Infertility has a strong impact on self-esteem and often creates one of the most distressing life crises that a couple has ever experienced together. Suddenly their lives, which may have been well planned and successful, seem out of control. Coping with the multitude of medical decisions and the uncertainties that infertility brings can create great emotional upheaval for most couples. Facing the disappointment of not becoming pregnant month after month can lead to depression and significant feelings of loss. These feelings are perfectly normal responses, which everyone has as they pursue infertility treatment. For many, the life crisis of infertility eventually proves to be an opportunity for life-enhancing personal growth.

    Infertility and Women
    Infertility and Men
    Treatment of Infertility

  • Women: Infertility

    The most common female infertility factor is ovulation disorders. Disruption in the part of the brain that regulates ovulation can cause deficiencies in luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Even slight irregularities in the hormone system can affect ovulation. Along with hormonal imbalance, medical problems such as a pituitary gland tumor can cause ovulation problems. Age is another important factor in female infertility. The ability of a woman’s ovaries to produce eggs decline after age 35. About 1/3 of couples where the woman is over 35 have problems with fertility. Without ovulation, eggs are not available to be fertilized. Signs of ovulation problems include irregular periods or no periods.
    Other causes of female infertility include blocked or damaged fallopian tubes, which may occur when a woman has had pelvic inflammatory disease, sexually transmitted diseases (especially Chlamydia), an ectopic pregnancy, prior surgeries or endometriosis (a painful condition causing adhesions and cysts). If the fallopian tubes are blocked at one or both ends, the egg can’t travel through the tubes into the uterus.

    Uterine problems and abnormalities can interfere with embryo implantation. Adhesions, scar tissue, fibroids and defects in the shape of the uterus can all result in repeated miscarriages. A condition called Asherman’s Syndrome, where the walls of the uterus adhere to each other is another problem that can lead to infertility. Exposure to diethylstilbestrol (DES), used in the 50s and 60s to prevent miscarriage, can cause abnormalities in women’s reproductive organs such as deformities of the vagina, uterus or cervix, as well as many other complications.

    Cervical problems can cause your cervical mucus to be of poor quality. Sometimes your cervical mucus may even contain antibodies which immobilize or kill the sperm. Usually around the time of ovulation, your cervix produces clear, stretchy mucus, which allows sperm to penetrate the cervix on their journey to meet up with the egg. If you have poor quality mucus or not enough mucus, sperm cannot get through your cervix.

    There are many causes that can lead to temporary infertility in women including obesity and certain medications. In most cases, fertility is restored when the medication is stopped. Excess weight can lead to elevated estrogen levels which may prevent a woman from ovulating. Thyroid problems (either too much or too little thyroid hormone) can interrupt the menstrual cycle and cause infertility.

    Infertility and Men
    Treatment of Infertility

  • Diagnosis and Treatment of Infertility

    Most couples are advised to wait until they have been trying to conceive for at least a year, before seeking medical help, with the exception of couples over 35. Those that are over 35 or those that have reason to believe there may be a fertility problem should not wait a year before consulting a doctor.

    Infertility testing and treatment can be difficult and expensive. Before starting infertility testing, it’s best for couples to discuss how far they would be willing to go with testing and treatment. Only have testing for conditions that they are willing and financially able to have treated would help them move on to other options such as adoption.

    Diagnosis of infertility may take the use of a special doctor called an infertility specialist or a reproductive endocrinologist. Infertility is diagnosed after an infertility workup, which includes a physical exam of both partners to determine their general state of health. Many times, laboratory tests are conducted and sometimes both partners are interviewed about their sexual habits in order to determine whether intercourse is taking place properly for conception. If no obvious cause can be determined at that point, like improperly timed intercourse or absence of ovulation, more specific tests may be recommended.

    Depending on the test results of those tests, different treatments can be suggested. About 90% of infertility cases are treated with medication or surgery. Various fertility drugs may be used for women with ovulation problems. It’s important for couples to talk with their doctor about the drug to be used, so they understand the drug’s benefits and side effects. An x-ray of the fallopian tubes and uterus may be done after dye is injected, to show if the tubes are open and to show the shape of the uterus. An exam of the tubes and other female organs for disease may be done, using an instrument called a laparoscope to see inside the abdomen. If needed, surgery can be done to repair damage to a woman’s ovaries, fallopian tubes, or uterus.

    For a man, testing usually begins with a semen analysis, which looks at the number, shape, and movement of his sperm. Because semen is rather variable in quality, the test may be repeated. Sometimes other kinds of tests, such as hormone tests, are done.

    Depending upon the degree of abnormality, the treatment may range from relatively simple artificial insemination of the woman with the man’s semen (AIH), through conventional in-vitro fertilization and embryo transfer (IVF-ET), to the latest techniques of assisted fertilization by microinjection (ICSI). In infertile couples where women have blocked or absent fallopian tubes, or where men have low sperm count, in vitro fertilization (IVF) is an option. In IVF, eggs are removed from the ovary and mixed with sperm outside the body in a culture dish. After about 2 days, the eggs are examined to see if they have become fertilized by the sperm and are dividing into cells. These fertilized eggs (embryos) are then placed in the women’s uterus.

    Infertility and Women
    Infertility and Men

  • Physical Fertility Signs

    Besides changes to your cervix around the time of ovulation, you may also notice other physical changes. Spotting and bleeding may occur mid-cycle, indicating possible fertility, due to hormonal changes leading up to ovulation. Backaches, breast tenderness or changes, feeling sick to your stomach, softer clearer skin, abdominal bloating, rectal pain and water retention all show that your hormonal levels are rising and falling. Headaches can sometimes accompany ovulation as well. Occasionally women notice that there is a pattern to when they get headaches during their cycle. Make sure you chart all the additional physical signs that you notice, so you can more easily identify your fertile and infertile times.

    Some women actually feel ovulatory activity every month or occasionally. Pain in your lower abdomen or pelvis during ovulation (or just before or after) is fairly common, although some women don’t feel anything. This usually happens midway through your menstrual cycle, about 2 weeks before your next period. This condition is often called mittelschmerz (MITT-ul-shmurz), which is a medical term that comes from the German words for “middle” and “pain.” It usually lasts only a short time, anywhere from a few minutes to a few hours, but it may continue for an entire day.

    Mittelschmerz occurs during ovulation, when an egg is released from your ovary. No one knows for sure what causes it, but it’s quite possible that just before ovulation, follicle growth stretches the surface of your ovary, causing you pain. It’s also possible that blood or fluid released from the ruptured follicle irritates the lining of your abdomen, leading to discomfort. Slight bleeding or spotting is not uncommon and may also occur during this time, accompanying pain.

    Ovulatory pain can happen on either side of your abdomen or even in the middle, although it is more commonly experienced on the right side. It may be felt on one side one month, then switch to the opposite side the next month, or it may be felt on the same side for several months in a row. The pain typically radiates from whichever ovary is ovulating. Some women notice cramping on one side or pain resembling menstrual cramps. The pain may be described as a nagging pain that begins as a sharp twinge and diminishes to a dull ache or tenderness or discomfort near the ovaries. It can be intermittent or constant, but is rarely severe although it can sometimes be aggravated by intercourse, working out or other physical activity.

    Pain during ovulation is usually easy to recognize because of its timing and location. If you notice cramping or pain, be sure to record this on your chart. Ovulatory pain can be a useful guide for some women and may help you further understand your cycles and also assist you in monitoring when you ovulate.

    Emotional Fertility Signs

  • Your Physical and Emotional Symptoms

    In addition to cervical changes, temperature fluctuations, and changes in your cervical mucus during your monthly cycle, many women experience other fertility signals as well. Sometimes these additional symptoms are referred to as “secondary” fertility signs, because they don’t occur in all women, or even in every cycle in individual women. You can increase your chances of conceiving by familiarizing yourself with your emotional and other physical changes that occur each month and recording them on your chart in addition to your BBT, mucus and cervix signals. By doing this, you will get a more accurate picture of when you are most fertile.

    —Physical Fertility Symptoms
    —Emotional Fertility Signs

  • Teen Options

    Being a teen and pregnant may seem like a difficult experience now, but with the right support and information, you will be able to make a decision and feel that you can feel good about. There are crisis pregnancy centers (most likely in your town or very close by) that can help support you in your pregnancy decisions, as well as offer many other valuable services. They have trained counselors that can help you sort through the pros and cons of each option and explore the solutions that would work best in your life. There are 24-hour crisis pregnancy hotlines you can call and countless crisis pregnancy sites to help you on-line.

    You have three basic options: parenting, adoption or abortion. In order to make the right decision for you and your baby, you need to know everything about each of these options. This is a decision no one else should make for you. You can consider other people’s thoughts and ideas, but don’t make a decision because you think it will please your parents, your baby’s father or anyone else. Ultimately you are the one who has to live with the final decision. This may be the biggest decision you have to make, so take plenty of time to think things through carefully. Whatever you decide, please remember that your choice will affect you for the rest of your life – physically and emotionally.

    Parenting

    Parenting is a difficult but extremely rewarding experience that requires both patience and strength. If you choose to continue your pregnancy and parent, not only will you be able to watch your child grow up, you will be preparing yourself for one of the greatest and most rewarding experiences ever. However, a lot of responsibilities come with parenting, which you must realize now and accept. Parenting is a lifelong commitment to your child, promising him or her the best care possible, undying love, financial, physical, emotional, and spiritual support. It takes time and hard work to be a good parent, but it can happen. There are many resources available to help you, if you choose to parent your child.

    Read more on teen pregnancy:

    —Teen Options (continued)
    —Teen Pregnancy
    —Teen Statistics

  • Teen Adoption

    When a teen becomes pregnant, some very serious decisions need to be made and those decisions should not be made lightly as they will affect her for the rest of her life rather she realizes it or not.

    Adoption

    For many teens facing an unplanned pregnancy, adoption is a positive option. Adoption can give you the freedom to pursue your goals and know that you have made a caring decision for your child. Choosing life for your baby and giving a wonderful gift to another family is a very courageous and wonderful thing. There are many couples that can’t have their own children and are waiting to adopt a child. Counselors and support groups are available through most adoption agencies to help with the emotions surrounding adoption. If you decide on adoption, you can choose to have it open or closed. An open adoption is when you get to choose the parents who will be raising your baby and a closed adoption is when everything is kept private.

    Abortion

    Many pregnant teens decide to have an abortion because they believe it will be a quick resolution to a difficult situation. Often teens who give in to the idea of abortion are pressured into it by their partners. In a survey taken of women who have had abortions, 63% of them felt “forced” by other people into the abortion, and 74% of the women surveyed said they would not have the abortion again. Make up your own mind based on factual information. You have time. Don’t make any quick decisions based on fear, panic or pressure.

    Read more on teen pregnancy:

    —Teen Pregnancy
    —Teen Statistics

  • The Second Stage of Labor

    During the second stage of labor, your cervix is fully-dilated to 10 centimeters and as your baby makes his or her way down the birth canal, your contractions may actually space out to about 2-4 minutes apart and become more regular. This may allow you to rest and take a breather briefly between contractions. Although it may be difficult, rest and save your strength for pushing.

    Pushing and Delivery

    At this point, the pressure on your rectum increases and the urge to push becomes overwhelming, as your baby descends. You may feel more in control once pushing begins, as well as a sense of relief to be able to play a more active role in the birth process. You may also experience a burst of renewed energy as delivery draws ever-so-close. The urge to push usually feels the strongest at the peak of a contraction, then fades toward the end.

    Positioning and breathing will impact your pushing. Unless you are making significant progress, you may be advised to change positions about every half hour, which may enhance progress. Allow your partner (or support person) to help you into a semi-sitting or a semi-squatting position, which allows gravity to work for you, not against you. Squatting utilizes gravity, helping your pelvis to open up and make more room for your baby. It can also take some pressure off your back. Some hospitals even have squat bars that you can hold onto, or you can use your partner for added support.

    The side-lying position may also help ease back pressure, if you are experiencing “back labor” during pushing. For this position, you or your partner may hold up your top leg. A common position for pushing is having your feet in stirrups, while lying on your back. This position is most convenient for your doctor or midwife if you need an episiotomy, although gravity doesn’t help you out much while using this position.

    Whatever position you choose when pushing, take a deep breath, hold it in, bear down and concentrate. Curl into the push as much as you can, rounding your shoulders, putting your chin to your chest, allowing all of your muscles to work to help ease your baby into the world. Don’t be alarmed if you pass small amounts of urine or feces during the pushing stage, because many women do and it’s completely normal. It can even mean you are pushing effectively. Remember, every push brings you that much closer to holding your baby in your arms.

    Birth

    Some women want to use a mirror to see their baby’s head and may want to touch it as well. Seeing or feeling your baby’s head crown may give you added inspiration to keep pushing. Just before your baby is born, you may feel a burning, stinging or stretching sensation at the opening of your vagina. This often happens as your perineum widens to allow your baby’s head to descend (often called “crowning”) and your baby to pass through the birth canal.

    As your baby’s head emerges, it typically turns to one side to allow the shoulders to align. Once your baby’s head is delivered, you may be asked to stop pushing, so his or her airway can be cleared of excess mucus, by suctioning your baby’s nose and mouth. After that’s done, your doctor or midwife may assist the rest of the body out, usually with one last push. Congratulations! You have a brand new baby!

    Back to Labor Stages

  • Signs of Labor

    It’s not known what brings labor on, but it’s believed that hormones such as prostaglandins stimulate uterine activity and trigger oxytocin release, softening and thinning the cervix. Your body goes through a series of changes when it’s preparing for labor. Although the signs vary from woman to woman (as well as from pregnancy to pregnancy), once your labor has begun, the strong, painful contractions will ultimately give you a clue that it’s time for your little one to be born.

    At first, especially if this is your first pregnancy, you may not know the difference between true labor and false labor signs, making you unsure of what exactly you are experiencing. Becoming familiar in advance with the signs of labor will help you to distinguish the difference when the time comes. If you think you may be going into labor, don’t feel embarrassed to call your doctor or midwife to ask questions, no matter what time of day or night, or go to the hospital.

    Diarrhea, Nausea, Increased Energy

    Labor can start out with signs as simple as experiencing frequent diarrhea and nausea/upset stomach. Some women find themselves suddenly flooded with energy, when the nesting instinct kicks in full-force. Lower back pain and abdominal cramping aren’t uncommon either.

    Rupture of Membranes

    If you’re water breaks, that’s a definite sign that your time is drawing near of holding your little one. When your membranes rupture, it can feel like a little trickle or a big gush of fluid. This is the amniotic fluid that has surrounded your baby in the amniotic sac for nine months. Many times, your water won’t break until later stages of labor, or may even have to be broken manually by your doctor or midwife at the hospital. If you think your water has broken, call your doctor or midwife, because they will most likely want you to come to the hospital. The longer between when your water breaks and when delivery occurs, the greater chance of infection. Use a towel or pad to make you feel more comfortable, never use tampons while pregnant.

    Loss of Mucus Plug

    You may experience the loss of your mucus plug or “blood show” at the onset of labor, although it can occur as early as 2-3 weeks before delivery. This mucus-like discharge may be thick, bloody and stringy. This “plug” is the barrier that seals the opening of your cervix throughout pregnancy, preventing infection. Sometimes it dislodges as your cervix begins to thin and dilate (open). Make sure to let your doctor or midwife know if this happens, especially if it’s heavy and bright red, which could indicate something serious.

    Contractions

    Labor contractions start out similar to Braxton-Hicks contractions, beginning mild and relatively painless. But unlike Braxton-Hicks, they progressively get stronger and longer in duration. Also, true labor contractions will not let up by changing positions or resting, which false labor contractions tend to do. They continue and don’t go away, no matter what you do, they may even get stronger and intensify with activity. When you are really in labor, your contractions gradually become more regular and typically develop a pattern. They commonly begin in your lower back and radiate forward, like waves. False labor contractions are usually just centered in your abdomen and stay there. Your abdomen will feel very hard (usually much harder than Braxton-Hicks), like a basketball during these contractions, which you can feel by placing your hand on your belly. And unlike false labor contractions, real contractions will dilate and efface your cervix.

    Back to Labor Stages

  • Stages of Labor

    Every woman’s labor is different, following it’s own pattern (even from pregnancy to pregnancy) and there are some things that can’t be anticipated. Although every labor and birth is unique and your labor will unfold in a very special way, the process is remarkably and beautifully constant. You can expect a sequence of events, when everything goes smoothly.

    Labor is typically divided into three distinct stages. The first stage being when your cervix softens, dilates and thins out (effacement), ending in full dilation.

    The first stage can be divided into three “phases”: the early (or latent phase), the active phase and the transition phase. The second stage of labor is when your baby passes through the birth canal and is born. During the third stage, the placenta (afterbirth) is delivered.

    —Signs of Labor
    —Preterm Labor
    —Preterm Complications
    —Preterm Labor Causes
    —Preterm Prevention and Treatment
    —First Stage: Phase I
    —First Stage: Phase II
    —First Stage: Phase III
    —Second Stage
    —Third Stage
    —Induction of Labor
    —Induction of Labor Procedures
    —Labor Induction Risks
    —Do It Yourself Labor Induction

  • Infertility Causes in Men

    Infertility affects men and women equally. In both men and women, multiple factors can account for difficulty with fertility. Male factors attribute to about 1/3 of infertility problems, while another 1/3 are caused by female factors. The remaining 1/3 of infertile couples have problems caused by a combination of factors in both partners or have unexplained causes. No obvious problem is found in around 10% of couples investigated for infertility. This is when no physical, hormonal or immunological cause for infertility is found in either partner.

    Sperm Abnormalities

    More than 90% of male infertility is caused from sperm abnormalities. Sometimes sperm are malformed and improperly shaped, which makes it difficult for the sperm to reach the egg. Abnormal shape and structure can lead to impaired mobility. If sperm cannot move rapidly and accurately towards the egg, fertilization cannot occur.

    Some men produce too few sperm. A sperm count of 13.5 million per milliliter of semen or less indicates low sperm concentration. Mild to severely impaired sperm production can be caused by undescended testicles, which occurs when one or both testicles fail to descend from the abdomen into the scrotum during fetal development. This affects sperm production, because the testicles are exposed to higher temperatures. Genetic causes, such as a chromosomal abnormalities can affect fertility, as well. Klinefelter’s syndrome, which is a disorder of the sex chromosomes, causes abnormal development of the testicles, resulting in low or absent sperm production. Cystic fibrosis is a genetic factor that can cause men to have missing or obstructed vas deferens.

    There are several reasons and causes for fertility issues in men. A few men produce no sperm at all, though this is rare, affecting less than 5% of infertile men. When no sperm are produced, it is impossible for conception to occur. If this is the case, reproductive organ damage may be to blame. A varicose vein in the scrotum (varicose) could be the cause of infertility, if sperm are being produced but die. Varicose veins can prevent normal cooling of the testicles and prevent sperm from surviving, due to raised testicular temperature.

    Problems with the delivery of sperm from the penis into the vagina can keep sperm from getting to the egg, including Retrograde ejaculation. This occurs when semen enters the bladder rather than emerging out through the penis. Also, some men are born with blockage of the ejaculatory ducts (the part of the testicle that contain sperm). Infections may temporarily affect fertility, including sexually transmitted diseases (STDs). These infections can cause scarring and block sperm passage. If mumps (a viral infection) occurs after puberty, inflammation of the testicles can impair sperm production.

    A man’s general health and lifestyle may affect fertility. Alcohol, smoking, drugs, emotional stress, vitamin deficiencies, age, heat (hot tubs included) and obesity can all temporarily reduce sperm count and quality. Overexposure to certain environmental elements, including pesticides, lead and toxins reduce sperm count by affecting testicular function or by altering the male hormonal system. Medical conditions such as a severe injury, surgery and certain diseases (including diabetes) can be contributing factors to male infertility.

    Infertility and Women
    Treatment of Infertility

  • Pregnancy Illness

    It is bad enough being sick when you’re not pregnant, but when illnesses such as colds, the flu, virus’ and sometimes food poisoning occur during pregnancy, they can make you feel absolutely miserable. It’s rare for a woman to go through 9 months of pregnancy without coming down with some type of illness at least once.

    Boost Your Immune System

    Your immune system is affected during pregnancy, which can make you more vulnerable to infections, such as coughs, colds and the flu, as well as make your symptoms persist longer than usual. You can boost your immune system by eating a healthy well-balanced diet including plenty of fresh fruit and vegetables, which contain certain antioxidant vitamins, including vitamin C. These help to fight infections and may help keep you from getting sick in the first place. Also, make sure you are taking your prenatal vitamins daily. Since prevention is so important, staying away from people who are sick may be your best bet for staying well.

    To help alleviate some of the discomforts that can accompany colds or the flu, drink plenty of fluids to maintain your nutritional intake (most important if you have diarrhea or are vomiting). Water, chicken broth, fresh juice, warm tea, jello, and even popsicles are all good options. Freshly squeezed juice is better than juice from concentrate, since it contains more vitamins, minerals and enzymes, as well as less sugar. Herbal teas may be helpful, especially ginger, Echinacea and peppermint. It is best to speak with your doctor or midwife before taking any herbs, because some may be harmful during pregnancy. A drink made up of hot water, honey and lemon may soothe a sore throat, as well as gargling with a warm salt water solution.

    If your nasal passages are dry, help moisten them by using a steam vaporizer or a humidifier. You can have one going in your bedroom, close to your face when you sleep at night. During the day, you can make a tent out of a towel draped over your head and stay underneath it for 15 minutes, three or four times a day. If you don’t have a humidifier, you can also use a pan of steaming water. Saline drops or saline nasal sprays (found at most drugstores) can help, if you are bothered by nasal stuffiness. A warm shower may be an even better way to clear mucus out, if you are congested (besides being relaxing!).

    Sleep helps the body to heal itself. Rest as much as possible when you’re coming down with the flu or a cold. If you have trouble with nasal symptoms, sleep in a recliner or elevate your head with lots of pillows, so you are in a semi-upright position. Also, you might try rubbing a mentholated product on your chest, following the directions on the package carefully.

    Dealing with Fevers

    If you have a fever, you should carefully monitor your temperature by taking it twice a day and if it rises to over 100 degrees Fahrenheit, contact your doctor or midwife. You should also call, if you begin to cough up green or yellow mucus, experience a severe sore throat, if your symptoms last for more than a week or if you’re worried about certain symptoms that seem unusual.

    The good news is that while a cold can make you quite miserable, it poses no special risks during pregnancy. The flu, however, can be more serious in pregnant women and may sometimes lead to pneumonia. Since flu shots are safe for both you and baby, it’s wise to get one during flu season if you’re past the first trimester. Sometimes medications are necessary, but you should never take over-the-counter cough or cold remedies without checking with your doctor or midwife beforehand, since some contain substances that may be harmful in pregnancy, including alcohol.