Pregnancy Lounge

Tag: 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

  • 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

  • CDC Recommendation on PreConception

    (continued “preconception”)

    These special preconception recommendations, developed through a consultation process with a select panel of specialists, include maximizing public health surveillance and monitoring which includes improving health programs and policies, the offer of pre-pregnancy checkups for women/couples who are planning a pregnancy, increasing the public’s knowledge and awareness of the importance of preconception health and encouraging everyone to have a reproductive life plan that focuses on drawing attention to reproductive health to reduce unplanned pregnancies, fetal exposure to teratogens, age-related infertility and to improve pregnancy outcomes.

    Other new recommendations include augmentation of research, additional interconception (the time between pregnancies) care and intervention for women who had a previous pregnancy that resulted in infant death, preterm birth or birth defects to reduce future risks, provide preventive visits along with primary care visits for risk assessment and educational counseling related to reproductive health risks, integration of preconception health components into existing public health programs, increase the number of women who receive timely interventions following preconception risk screening and increase public as well as private health insurance coverage for low-income women to improve preventative and preconception health access and affordability.

    Preconception care is a good idea, making a difference in the lives of future babies and helping them have the healthiest start possible, but will be difficult to include as part of standard medical appointments, according to some doctors. In addition, most health insurance companies don’t even have a billing code to allow doctors to begin billing for it. CDC is requesting the American Medical Association (AMA) develop a billing code for preconception care to allow doctors the opportunity of offering these additional preconception services to women. Preconception care recommendations should be implemented over a period of time within the next 2-5 years.