| What is Infertility? |
You and your partner have tried for months, perhaps for even more than a year. But despite frequent, unprotected intercourse, you've been unable to conceive a child.
If you've been trying to conceive for more than a year, there's a good chance that something may be interfering with your reproductive function. Infertility — the inability to conceive a child within 1 year — may be due to a single cause in either you or your partner or a combination of factors that may prevent a pregnancy from occurring.
Infertility differs from sterility. Being sterile means you're unable to conceive a child. In sterility, you or your partner has a physical problem that precludes the ability to conceive a child. A diagnosis of infertility simply means that becoming pregnant may be a challenge rather than an impossibility.
The human reproductive process is complex. Because of the intricate series of events required to accomplish a pregnancy, many factors may cause a delay in starting your family.
Every month the pituitary gland in a woman's brain sends a signal to her ovaries to prepare an egg for ovulation. The pituitary hormones — follicle-stimulating hormone (FSH) and luteinizing hormone (LH) — are involved in a delicate interaction with the ovaries to bring an egg to the point of ovulation. A large boost in LH carries a message to the ovarian follicle to release its egg (ovulate). A woman is most fertile at the time of ovulation — around day 14 of her menstrual cycle — although ovulation varies among women with different lengths of menstrual cycles.
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The overall national success rate for IVF is about 20 percent. Many programs exceed a 40 percent chance of success within one cycle. IVF is now recommended more often as a first-line therapy and is the treatment of choice if both fallopian tubes are blocked. It's also widely used for a number of other conditions such as endometriosis, unexplained infertility, cervical factor infertility, male factor infertility and ovulation disorders.
- Zygote intrafallopian transfer (ZIFT). In this procedure, a fused egg (zygote) is placed into a fallopian tube the day after removal. The zygote moves naturally down the tube and into the uterus. This requires a surgical procedure that is not required in IVF.
- Gamete intrafallopian transfer (GIFT). Unfertilized eggs and sperm are placed directly into the fallopian tube. The eggs are fertilized while in the fallopian tube and then move naturally down the tube into the uterus. The success of these different techniques is comparable. Individual circumstances may make one or the other preferable. Some programs have more success with GIFT than with IVF. Considerable differences exist between program techniques, patient backgrounds and the way that success rates are measured. Because IVF, ZIFT and GIFT haven't been compared in the same series of patients, it isn't possible to say that one technique yields a higher pregnancy rate than another. This procedure also involves a major surgical procedure.
- Electroejaculation. Electric stimulus is used to bring about ejaculation so that semen can be obtained. This procedure can be used in men with spinal cord injury who can't otherwise achieve ejaculation.
Aspiration. This technique involves removing sperm from part of the male reproductive tract such as the epididymis, vas deferens or testicle. - Intracytoplasmic sperm injection (ICSI). This new technique consists of a microscopic technique (micromanipulation) in which a single sperm is injected directly into an egg to achieve fertilization in conjunction with the standard IVF procedure. This has been especially helpful in couples who have previously failed to achieve conception with standard techniques and in men with low sperm concentrations. ICSI dramatically improves the likelihood of fertilization.
The risks associated with ART involve the medications and the procedure used to remove the eggs. These risks include hemorrhage, infection, damage to adjacent organs and overstimulation of the ovaries, which causes ovarian enlargement and abdominal discomfort. In addition, there is an increased chance of multiple pregnancy. However, research shows that there is no higher risk of genetic abnormalities in a child conceived with ART.
| Prevention |
Most types of male infertility aren't preventable. Excessive alcohol or drug use may contribute to male infertility and should be avoided. High temperatures can affect sperm production and motility. Although this effect is usually temporary, hot tubs and steam baths also should be avoided.
If you're uncertain about whether you would eventually like to become a father, don't undergo permanent sterilization, such as a vasectomy. Although surgery to reverse this condition may be possible, risks are involved that could affect your fertility in other ways.
A woman can increase her chances of becoming pregnant in a number of ways:
- Exercise moderately. Regular exercise is important, but if you're exercising so intensely that your periods are infrequent or absent, your fertility is likely to be impaired.
- Avoid weight extremes. Being overweight or underweight can affect your hormone production and cause infertility.
- Avoid alcohol, tobacco, caffeine and street drugs. These substances may impair your ability to conceive or produce a healthy child. Don't smoke, limit your caffeine intake to one soda or cup of coffee a day, and avoid illegal drugs such as marijuana and cocaine.
- Limit medications. The use of both prescription and nonprescription drugs can decrease your chance of getting pregnant or keeping a pregnancy. Talk with your doctor about any medications you take regularly.
| Coping skills |
The reproductive process is a roller coaster of emotions that are present in both failure and success. There is no true way to predict which couples will eventually conceive and which will not. Some couples with infertility problems overcome great odds, while other seemingly fertile couples fail to conceive. Many of the new treatments for infertility are remarkable advances in medical technology, but a live birth is never guaranteed. The emotional burden on a couple is considerable and plans for coping can help.
Planning for emotional turmoil
Set limits. Decide in advance how many and what kind of procedures will be emotionally and financially acceptable for you and your partner and attempt to determine a final limit. Fertility treatments are expensive and often not covered by insurance companies, and a successful pregnancy often depends on repeated attempts. Some couples become so focused on treatment that they continue with fertility procedures until they are emotionally and financially drained.
- Consider other options. Determine alternatives — adoption, donor sperm or egg, having no children — as early as possible in the fertility process. This can reduce anxiety during treatments and feelings of hopelessness if conception doesn't occur.
- Talk about your feelings. Locate support groups or counseling services for help before and after treatment to help endure the process and ease the grief should treatment fail.
Managing emotional stress during treatment
Practice relaxation. Cognitive behavior therapy, which uses methods that include relaxation training and stress management, has been associated with higher pregnancy rates. Studies show that as many as 42 percent of infertile couples became pregnant without medical intervention while practicing this type of therapy.
- Express yourself. Support groups also have been associated with better pregnancy rates. Research indicates that pregnancy rates were twice as high in women who coped with infertility-related depression by reaching out to others rather than repressing guilt or anger.
- Stay in touch with loved ones. Talking to your partner, family and friends can be very beneficial. The best support often comes from loved ones and those closest to you.
- Try a little luck. Almost half of women seeking fertility treatments practice good-luck rituals, including wearing charms or special jewelry. There is no evidence that suggests these tactics increase fertility, but they may help reduce anxiety and enhance a sense of control.
Failure. The emotional stress of failure can be devastating even on the most loving and affectionate relationships and those who've prepared well for the possibility of failure. Neither the man nor the woman should hesitate to seek professional help if the emotional burdens become too heavy.
- Success. Some studies have indicated that even if successful, women experience increased stress and fear of failure during pregnancy. Other research suggests that women who achieved pregnancy using fertility treatments felt increasingly better and had higher self-esteem and less anxiety as the pregnancy progressed than women whose pregnancies did not involve medical intervention.
- Multiple births. A successful pregnancy that results in multiple births introduces new complexities and emotional problems. The risk of depression is higher in women who have multiple births.
- Parenting. Once a child arrives, parents are more likely to be more anxious and have less confidence and self-esteem. Discuss becoming parents with your partner and plan for the many changes — challenging and rewarding — that a child will bring to your lives.