We seem to hear the word infertility all the time these days. But what exactly does it mean, what do you need to know about getting treatment, and how effective are the treatments?
The official definition of infertility is one year of unprotected intercourse not resulting in a healthy pregnancy. If you are under the age of 35, consider seeing your ob/gyn or an infertility specialist for an evaluation after one year of trying. Because of the age-related decline in fertility, the increased incidence of medical issues that can impair fertility and the higher risk of miscarriage, women older than 35 years should consider having an evaluation after six months of trying. If you have a significant medical history — such as irregular or absent periods, a ruptured appendix, pelvic inflammatory disease, cancer therapy or a known diagnosis of endometriosis — or if your partner has had an undescended testicle, cancer treatment or mumps as an adult, see your ob/gyn for preconception planning, to maximize pregnancy health and to minimize the chance of infertility.
Some women become concerned after a month of two of trying to get pregnant without success, and may be highly distraught by the three-month point, while others appear to not even notice as the time flies by with no pregnancy. If you have been trying for a few months without success, you might find the following statistics helpful: Only 25 percent of couples actively trying to conceive become pregnant after the first cycle, and 60 percent become pregnant after six months of trying to conceive.
In many cases, an ob/gyn can help resolve the difficulty of getting pregnant. Sometimes the problem is as simple as timing intercourse with ovulation, which may be more accurately tracked by using an over-the-counter urine ovulation predictor test. An ob/gyn can provide the basic evaluation for couples with infertility, and can treat simple causes like lack of regular ovulation. More complex problems are best handled by specialists in Reproductive Endocrinology and Infertility, physicians who have been certified by the American Board of Obstetrics and Gynecology as having special knowledge and proficiency in the specialty of Obstetrics and Gynecology and in the subspecialty of Reproductive Endocrinology and Infertility (REI). However, REI specialists are not available throughout the country, and not all insurance will cover this specialty service, so you might need to see an ob/gyn with experience and expertise in infertility care.
Several basic tests for infertility include:
1. A blood test for a woman to assess her hormone levels. One test needs to be done on the third day of your menstrual cycle.
2. HSG, a radiological procedure involving injecting dye into the uterus to determine if it is normal and the Fallopian tubes are open.
3. Semen analysis, which looks at three parameters of the sperm: (a) concentration, the number of sperm per millimeter; (b) motility, the sperm’s ability to swim normally; and (c) morphology, the percentage of sperm with a normal shape.
You should not start any treatment until you and your partner have both been assessed. A diagnosis of male-factor infertility is as common as one of female-factor infertility. Sometimes, both partners have an infertility issue.
Ovulatory dysfunction is very common in women with irregular menstrual cycles, and can often be treated successfully with medication that stimulates more regular egg release.
Uterine abnormalities include polyps, a septum or fibroids. Depending on their size/ location, they can be treated surgically.
Endometriosis occurs when implants of the endometrium — the lining of the uterus — are found in the pelvis and abdomen. Endometriosis can be treated surgically when a woman is trying to become pregnant. In some cases the patient might be referred straight to high-tech treatment.
Tubal issues: The Fallopian tubes can be blocked by scarring. If both tubes are blocked, the only treatment is surgery to attempt to reopen the tubes, or IVF (in vitro fertilization), which bypasses the tubes.
Hormonal issues: Abnormal levels of male hormones, prolactin, thyroid hormones and other hormonal abnormalities can occur.
If your partner is found to have a count of less than 20 million/ml, motility less than 50 percent or the morphology is below the testing laboratories’ normal range, there is a male factor. He should see an andrologist, a urologist who specializes in infertility.
Unexplained infertility: There is a significant chance you will have a completely normal evaluation when checking for infertility. Many specialists believe unexplained infertility is truly “not yet known infertility,” since diagnostic tests may not be able to identify all causes. Twenty years ago, half of all infertility was unexplained, so we have made significant progress in determining causes and treatment. Even with unexplained infertility, treatments for infertility still work.
Treatments for infertility may include oral medication, injectable medication and in vitro fertilization. Depending on your age and diagnosis, some treatments can have up to a 60- to 80-percent chance of pregnancy per cycle.
In fact, given that the average couple has about a 15- to 20-percent chance of conceiving each month when they first start trying, science is doing a good job. Insurance coverage for infertility services varies by state and by insurance plan, so be sure to check your coverage, as this can determine your treatment options.
Most couples seeking help for infertility do indeed get pregnant with a healthy baby. When the time feels right for both of you, choose a doctor, make an appointment — and always be sure to take good care of yourself along the way.
Bestselling author Alice D. Domar, Ph.D., is Executive Director of the Domar Center for Mind/Body Health, Director of Mind/Body Services at Boston IVF, Assistant Professor of Obstetrics, Gynecology and Reproductive Biology at Harvard Medical School and Senior Staff Psychologist at Beth Israel Deaconess Medical Center.