Pregnancy Lounge

Tag: fertility

  • 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

  • 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

  • Fertility Charting Tools

    To chart your fertility, the only tools you need are a ‘calendar’ or fertility chart/graph and a basal body thermometer. Basal thermometers are more accurate than regular thermometers and are ultra-sensitive, tracking your body’s slightest temperature shift. Most digital basal thermometers come with a sample graph that can be enlarged and duplicated on any copy machine, or you can even download a printable chart on-line. Some women prefer to do their charting completely on-line, it’s just a matter of person preference.

    Record your observations and findings on your chart each day. If you tend to have very regular cycles each month, your charts may look strikingly similar. If your monthly cycles are irregular, you may gain a wealth of information by charting for an extended period of time.

    –Tracking your basal body temperature (or BBT)
    –Observing changes in your cervical mucus
    –Monitoring your physical and emotional symptoms
    –Checking the position and shape of your cervix

  • Dizziness and Fainting

    When your blood sugar level becomes low, because you’ve gone too long without eating or when your blood suddenly shifts, causing your blood pressure to drop rapidly, you may experience some light headedness or dizziness and feel like fainting. Another common cause in the last half of pregnancy can be the extra pressure of your uterus on blood vessels and arteries. Make sure you don’t go for long periods of time without eating. Take snacks (especially those high in protein and iron) with you when you go places. Always remember to change positions and stand up slowly after sitting or lying down to avoid feeling dizzy and don’t stand for extended periods of time.

    More Pregnancy Discomforts

    —Backaches
    —Breast Discomfort
    —Braxton Hicks Contractions
    —    Constipation
    —Dizziness and Fainting
    —Fatigue
    —Hand Numbness
    —Headaches
    —Heartburn and Indigestion
    —Hemorrhoids
    —Increased Discharge
    —Itchy Abdomen
    —Leg Cramps
    —Nausea and Morning Sickness
    —Overheating
    —Pelvic Pressure
    —Sleep Trouble
    —Swelling
    —Urinary Problems
    —Varicose Veins

  • Fertility Charting

    Fertility charting is basically a pregnancy achievement technique. It requires recording all of your fertility signs on a chart; allowing you to track ovulation, predict the most fertile time in your cycle, understand your own personal fertility patterns and increase your chances of becoming pregnant.

    Besides rapid pregnancy achievement, charting can also be helpful in diagnosing and resolving many fertility issues, such as hormonal imbalance or ovulation problems. Potential complications that charting may be able to alert you on include anovulation (when no egg is released), low estrogen, low progesterone, thyroid conditions and even possible miscarriage.

    For couples having difficulty in conceiving, fertility charting can be a very valuable tool. Charting can help you identify your most fertile days, so you can make love on those days to increase your chances of conception. A woman is only fertile for a few short days (the egg lives and can be fertilized for 12-24 brief hours after ovulation) during each menstrual cycle, so timing when you make love is critical part of conception.

    In addition, many doctors and naturopaths strongly encourage fertility charting because it’s completely safe, natural and does not rely on drugs or medical procedures and there are no health risks or side effects. Plus, by charting your fertility, you will also become more aware of the patterns unique to your body, along with gaining a better understanding of how pregnancy is achieved. Once you understand these patterns and changes (and with a little patience), you can begin to anticipate ovulation through a combination of methods:

    –Tracking your basal body temperature (or BBT)
    –Observing changes in your cervical mucus
    –Monitoring your physical and emotional symptoms
    –Checking the position and shape of your cervix

    Read more on Fertility

  • Getting Pregnant

    One can increase their chances of getting pregnancy and increasing fertility. Most people believe the most fertile days during their cycle is 14 days after the beginning of their period, when really ovulation usually takes place about 14 days before your period begins. This is most accurate only if your periods are very regular. Say you have a 32-day cycle, then your most fertile day is most likely about day 18. Or if you have a 27 day cycle, day 13 is your most fertile day. It’s best to have intercourse starting a few days before ovulation, to heighten your chances of conceiving and improving fertility.
     

    Your Man and Conception

    Toxic chemicals can also cause deformed or low numbers of sperm. The following substances can potentially interfere with both men’s and women’s fertility: alcohol, caffeine, some drugs (including over-the-counter, prescription and “recreational”), cigarette smoking, marijuana, radiation, and chemicals such as lead, pesticides, polystyrene, benzene, mercury, and anesthetic gases. With regard to fertility, removing the problem usually allows the generation of new healthier sperm, but it may take up to 3 months for the quality and quantity to improve the chances of getting pregnant.

    Wearing tight underware or pants may push the testicles against the body, causing excessive heat- lowering a man’s sperm count. Have your partner trade in is tighty-whiteys for boxers at least 2 to 3 months before trying to get pregnant. Also, hot tubs, saunas, long distance bike-riding, a high fever as well as working around hot furnaces or ovens may also cause a man’s sperm count to drop dramatically.

  • More on Episiotomies (continued)

    Many recent studies have shown that routine episiotomies shouldn’t be performed, because they are not helpful to the majority of women, although there are certain circumstances when they are needed. Having an episiotomy can increase pain during the postpartum period, leading to a longer recovery time. In addition, women who have episiotomies may have weaker pelvic floor muscles as well as more pain when resuming intercourse postpartum.

    Episiotomy rates have declined over the years, but the number still remains high. Despite all the evidence against routine episiotomy use, close to 50- 80% of first time moms end up with an episiotomy in the U.S. The majority of women having them done are young white women, who have private insurance, according to a recent study.

    There are a few situations when an episiotomy may be medically necessary. If there is a sign that your baby is in distress while in the birth canal, such as slowing of your baby’s heart rate, an episiotomy may be unavoidable for the sake of your baby’s well-being. If your baby’s shoulders get stuck, if your baby has a very large head that cannot fit through the vaginal opening or if delivery happens too quickly for the skin of your perineum to stretch naturally, you may need an episiotomy.

    Perineal message helps reduce the chance of tearing during birth and the need for an episiotomy. It can make the perineum more flexible and increase elasticity, in preparation for birth. It’s a good idea to start doing perineal massage around the 34th week of pregnancy or before. To perform perineal massage, wash your hands thoroughly (or your partner). Place K-Y jelly, vitamin E oil or another mild lubricant on one or two fingers and gently stretch the lower part of the vagina until you feel a slight burning sensation. Hold the pressure steady for about 2 minutes or so. Repeat this daily for about 8-10 minutes.

    Warm compresses during labor (especially during the pushing stage) encourage the stretching and relaxing of the perineum. Make sure they are only warm, but not hot, which can cause some swelling. Positioning during labor and birth may contribute to whether you need an episiotomy or not. Squatting can help reduce tearing. Avoid laying directly on your back, if possible and keep changing positions if you can. Talk to your doctor or midwife early about your feelings regarding episiotomies, especially if you wish to avoid one.

  • Emotional Fertility Signs

    For fertility, charting your mood swings, thoughts, emotions and energy level along with your cervical mucus and changes, your other physical changes and your BBT, you may discover that they are closely linked to possible conception. On the other hand, some women don’t notice cyclic mood and energy variations whatsoever.

    Estrogen rises and peaks as ovulation approaches, therefore many women experience increased sexual feelings, heightened desire, and more feelings of affection. This may be due in part to the increased slippery-feeling cervical mucus (which is similar to arousal fluid, but more watery) that is produced as ovulation draws near, causing increased libido on your most fertile days. It’s no coincidence that the word “estrogen”, the fertility hormone, stems from Latin roots which mean “creating mad desire.”

    Other secondary signs you may notice as ovulation approaches may include: increased energy level, heightened sense of vision, smell or taste, easier concentration and mood swings. After ovulation, as your fertile phase ends, you may suddenly feel depressed or let down. Many times you may experience a drop in your libido as well. These feelings are important signals and are good to note on your chart.

    —Physical Fertility Symptoms