Infertility is a subject that no person wants to hear when they are trying to conceive, have a family. It is one of the hardest news to hear. It is so hard to bear. After you hear that word all those after that are far away, it’s sort of a bad dream. You feel devastated and you start asking yourself questions.
Why is this happening to me? What did I do wrong? Could I have avoided this? The worst thing is that you start feeling that you are inadequate, incapable of being whole, you feel incomplete. No one knows how that feels unless you have been in that situation.
At first, having a child may not be on your mind. Many women today are so busy with careers, enjoying life, being with a partner and having no other responsibilities. Many say to themselves, I don’t want children but if it happens, it happens. I believe that is something we tell ourselves to put that out of our minds for a while. Of course that thought does not last forever for the unexpected happens, you are pregnant. At first it is a shock but then all those feelings come rushing through and you are ecstatic. You can’t believe it, what a wonderful feeling to know you have a life growing in your body. You fall in love with that child without even knowing if it’s a girl or a boy.
Then the worst thing happens, you have a miscarriage, now you are left with an empty feeling, a void you must fill that you did not know you had before. Now you try to conceive and nothing, why?
Infertility does not happen to women only, men also suffer from infertility. If you think it is hard for a woman to deal with infertility it is worse for a man. In society women are taught as they grow up that they are to get married, be a good wife and and have children. As for a man, he must show he is worthy of the title man, he must prove he can bear children. If women feel incomplete, men feel as though they are not macho enough. All of this is because of our cultures, our upbringing. The more children he has, the more man he is. In men, their ego plays a big role. So we must understand both sides and there must be no blame.
For those of you trying to conceive and a year has passed by, try finding a fertility doctor. You are not alone in this quest. About 10% of women in the United States from the ages of 18-44 have difficulty getting pregnant or staying pregnant. As mentioned before, not all fertility problems are always women. One third of infertility cases are women problem, one third are due to men. The other cases are a combination of both female and male problems.
One thing you must remember, all hope is not lost. There are reasons for the infertility and there are also solutions for these problems. A regular doctor or gynecologist can’t help you; you have to visit an infertility specialist. You have to go in with an open mind. In one visit they are not going to tell you this is the problem. There are a series of tests, x-rays, blood work and visits that you must go through. There are times that you may have to have one, two or three surgeries. Men will have to do a sperm sample and many of them are not comfortable doing this. There may be other test too, and again, it’s not good for their ego, they can’t handle all of this.
Why do we tell you this? Before you decide to take this step and visit a fertility specialist, sit and talk about what you are going to do. Be prepared, this will take a toll on you and your relationship. There are ups and downs; it is not an easy road to take. There may be times that you will be told we can’t do this. We can’t help you. At that point you have to decide, do I take this or do I go on and get a second opinion. There are medications you have to take that will make your moods fly off the handle. It is nothing like pre-menstrual syndrome; it is as though you are on a roller coaster ride. Sometimes after all the test and medications, you want to give up, you get tired.
What you have to remember is that some couples go in; the problem is found and solved. They conceive whether on their own or by invitro fertilization. Others have to go through more test, may take months or a year. Are you ready for this; are you ready to take this path? You have to remember what is at the end of this, your goal, a child. You have to be ready for it all and if you really want that child then you can't lose hope. There will be times you feel you have to struggle with yourself and your partner but for this you have to persevere and be dedicated. If you can do this then you can handle all that is given to you. One thing, it's ok at times to feel beaten but just get yourself back up on your feet and go at it again.
INFERTILITY IN WOMEN
There are many things that can cause infertility, such as age, smoking, excess alcohol use, stress, weight (over or under), athletic training, stress, sexually transmitted diseases or hormonal problems. These are only a few of the reasons why.
AGE
Age is a big reason. As you get older, your egg reserve gets lower, you don’t produce as much. Today, many women are waiting after the age of 35 to have children. Doctors recommend that if you are over the age of 35 and have been trying to conceive for six months without success you should see a specialist. If you are over the age of 30 and have tried for one year without success, you should also see a specialist.
MENSTRUAL CYCLES
Health problems such as these can also be a reason for infertility, irregular periods or no periods, very painful periods, endometriosis, pelvic inflammation or more than one miscarriage. Don’t wait until this situation is worst before seeing a specialist. By waiting, it can cause more damage and they may not be able to help you. Be aware of what your body is doing, if you notice that something is not right, see a doctor.
OVARIES
PCOS (polycystic ovarian syndrome) is a hormonal imbalance problem that interferes with normal ovulation. POI (primary ovarian insufficiency) is another cause of ovulation problems. It is where an ovary stops working before she is 40; this is not the same as early menopause.
UTERUS AND FALLOPIAN TUBES
Less common reasons for infertility are blocked fallopian tubes due to pelvic inflammation, endometriosis or surgery for an ectopic pregnancy.
Uterine Septum is an abnormality in the uterus itself. They have found that this can increase the risk of miscarriages and can be a factor in recurring miscarriages. Once detected, the doctors will perform laparoscopic surgery to correct this problem. This is not something that happens later on in life, you are born with this condition. They find out by doing a laparoscopy or a hysterosalpinogram.
Uterine fibroids can also cause infertility. Fibroids are non-cancerous clumps of tissue and muscle on the walls of the uterus. It is said that at least 50% to 80% of women will develop at least one fibroid. Many never have any problems because they tend to be small in size and never cause any problems. Others suffer greatly, heavy menstrual periods, long periods, pelvic pressure, bloating, backaches and leg pain. If the fibroid is too large, it can block the fallopian tubes, preventing the sperm to fertilize an egg. Certain types of fibroids can disrupt the uterine lining, making it difficult for proper implantation. Fibroids can also prevent the embryo from increasing in size causing a miscarriage.
These are only a few reasons as to why there can be a problem with fertility. They can also include health problems such as diabetes, maybe even genetic. The one thing to be prepared for is that you will be tested for things you never knew existed. It is a thorough exam and after all that, hopefully a solution.
INFERTILITY IN MEN
Just as in women, men also suffer from infertility. For a very long time it was always said it had to be the woman, she is the reason why the couple can’t conceive. That is not true. Due to the way cultures are, a man supposedly shows signs of weakness to admit such a thing. If he is honest about this, he is not man enough. Just as women, they also have to deal with these feelings. Many feel as though this problem takes away their manhood, that it emasculates them and when pressured, their ego becomes involved. Once this happens it becomes harder for them to deal with this. Just as a woman, it has to be approached carefully to a man.
Men should realize that having this problem does not emasculate them, on the contrary, the fact that they too are pushing to find a reason, shows them to be more of man. This is nothing to be ashamed of, many men suffer from this and they just keep it quiet. It is hard for them to share their feelings about this; it is not as easy as it is for women. Women can open up to their friends and family, they are consoled and understood. A man feels he has no one to speak to, he feels he has to carry this burden with him. This is where the couple should be closer, share their feelings, understand each other and under no circumstances, blame each other. That will only drift you apart and the relationship can come to an end as many others have when pursuing the road of parenthood.
SPERM
They can have a low sperm count; this can be due to long exposure to high heat. Studies have shown that when trying to conceive they should avoid hot baths, hot showers, laptops on their laps, etc. Smoking, alcohol and drugs can also affect the sperm, it weakens it. They can also suffer from hormone deficiency or too much of a hormone. Other causes can be due to previous chemotherapy, age, surgery, trauma, certain prescription drugs, impotence, etc. One reason of infertility which can be found in 10% to 15% of the males is Azoospermia, which is lack of sperm.
If the man’s testicles are too large, it may be due to a condition called varicocele, which heats up the testicles and affects the shape and number of sperm. Stress can affect their fertility, just as it can in women.
For both women and men, just wondering why there is a problem can cause you to stress, making it even worst. Don’t put yourself through all that stress. Relax, think clearly and together come up with a solution. See a specialist, get the tests done, get checked; let them tell you what the cause may be.
It can be as simple as medication for her or him, maybe even both. Wondering, pondering, blaming, stressing over this problem does not help and will not get you anywhere. Actually it will just prolong the situation.
CLOMID (for women)
Once you see a specialist, just put it in their hands. Do what they say. First thing they will do is blood work and in the men’s case they will also ask for a semen analysis. Hormones are a big problem in women and that is the only way they can find out what they are. Once those analysis are done, if it’s just a hormonal problem, they will be prescribed hormone pills. Some within a few months become pregnant immediately.
Now, this type of treatment is easy, only because surgery is not involved but it’s not that easy. Intercourse can become more like a job than fun for the couples. It is basically timed. Between the 10th and 16th day after your cycle, you must be intimate. Usually on the 15th to 16th is your highest peak. Planned intercourse can be boring and a chore. Since you know this is something that will have to happen, make it fun, interesting, sensual, romantic, that eases the tension and both can enjoy the intercourse. Remember you are trying to bring a child into this world, make love part of it.
Clomid does however have certain side effects, it can produce cysts, so your doctor will do an ultrasound once a month, monitor you to make sure this does not happen. Should they occur, they will try every way possible to eliminate them before considering surgery.
Another side effect is vaginal dryness, which makes intercourse painful and unbearable. Do not buy over the counter lubricants, they have certain chemicals that will trap and destroy the sperm. Ask your doctor to recommend or prescribe a lubricant that is specifically used for this problem and will allow sperm to travel without obstacles.
SURGERY
At times they find that the causes are cysts, fibroids, endometriosis, etc. They will perform an outpatient surgery; you are out of work a couple of days max. Once enough time has gone by, you will get the all clear to try to conceive. At times, to help it faster they may give you hormone pills such as clomid, to speed up the process.
No matter what they say, once you have surgery in the pelvic area, for whatever reason, take it easy. Don’t overdo it, ask for help. Don’t pick up heavy things, don’t bend down too much, don’t do strenuous exercise, take it slow; give your insides time to heal. It takes much longer to heal in the inside then it does on the outside. The less stress you give that area after the surgery, the better, you will lower your chances of scar tissue. Remember, you want to keep it as healthy as possible for that baby you want so much.
TESTS
Sometimes the blood work analysis will come out fine, no problems whatsoever. So what’s next you ask? Will they will do ultrasounds to see if they find any abnormalities. With the ultrasound they can detect fibroids and cysts. They can measure them and decide if surgery is the answer. There are two other tests they will perform besides the ultrasound.
Hysterosalpingography is an x-ray of the uterus and fallopian tubes. They insert a small catheter through the vagina into the uterus. Through that catheter they will inject a dye that will show up on the x-rays. The purpose of this dye is that it will highlight the uterus, letting them see any type of abnormalities that may be there, such as a septum, cysts, or fibroids. At times these are not very visible on an ultrasound. They also inject this dye and see if it goes through the fallopian tubes. This will let them know if they are blocked. At times during this test if they see it is blocked they may inject more dye, there are times it will open up the fallopian tube but be ready it can be uncomfortable. When this is being done, remember the goal, which is what keeps you going.
Laparoscopy is a minor surgery to see through the abdomen (outpatient procedure). A slender tube with a fiberoptic camera is inserted into the abdomen through a small incision near the belly button. The laparoscope allows him to see the extent of the abnormalities he may have found in previous exams and the extent of the problem. During this time he will take care of any abnormalities he may have found. They can remove fibroids, cysts, treat endometriosis, open blocked tubes, remove septum, and reconstruct the reproductive organs by placing a hysteroscope placed into the uterus.
There are times that after they have done surgery, you are still unable to conceive a child on your own. All hope is not over, there are other ways. Luckily, science and technology combined have come up with new ways to help couples conceive a child.
FERTILITY DRUGS
Some women are infertile due to ovulation problems. Today there are medications that help regulate or stimulate ovulation. Commonly used fertility drugs include:
Clomiphene (Clomid) – It is taken orally and it is used to stimulate ovulation in women who suffer from PCOS or other ovulatory problems. It causes the pituitary glands to release more FSH and LH, which stimulate the growth of ovarian follicle containing an egg.
Human Menopausal Gonadtropin or hMG (Repronex) – This is injected in women who don’t ovulate on their own due to failure of the pituitary gland to stimulate ovulation. Unlike clomiphene, this medication directly stimulates the ovaries. This drug contains FSH and LH.
Follicle-stimulating hormone, or FSH (Gonal-F, Bravelle) – FSH works by stimulating the ovaries to mature egg follicles.
Human chorionic gonadtropin, or HCG (Ovidrel, Pregnyl) – This in combination with bravelle or clomiphene is used to stimulate the follicles to release its egg (ovulate).
Gonadtropin-releasing hormone (Gn-RH) – This is used for women with irregular ovulatory cycles or who ovulate prematurely – before the follicle is mature enough – during hMG treatment. This medication delivers Gn-RH constantly to the pituitary gland which alters hormone production so that a doctor can induce follicle growth with FSH.
Metformin/Actos – This is taken orally to boost ovulation. It is used when insulin resistance is suspected. Insulin resistance may play a role in the development of PCOS.
There are many others but these are some of the most commonly used. Fertility drugs do have side effects and before they are given to you, the doctor will explain them to you. Please be sure to read everything carefully.
Fertility drugs that are injected increase the chance of multiple births. Oral fertility medication such as Clomiphene can also increase the chance of multiple births but at a lower rate. While on these medications, there is constant monitoring. The doctors will request blood tests, hormone test, and ultrasounds to measure follicle size. They also do the ultrasounds to make sure there are no other abnormalities. With some of these medications the ovaries can become enlarged and at times can cause cysts.
The risk of multiple pregnancies can be reduced. If a woman requires an HCG injection to trigger ovulation and an ultrasound shows there are too many follicles, the doctor and the patient can decide not to use this medication. However, the desire of having a child will override concerns.
What you must remember, the higher the number of fetuses, the higher the risk of premature labor. The risk is high for triplets than twins or single births. These are topics couples should discuss before considering fertility drugs. Later on, the couple may be challenged with decisions that, to them, can be ethically and morally challenging. The reason this is noted is because when too many babies are conceived, removal of one or more fetuses can improve the survival odds for the surviving fetuses. They will suggest this to give you the chance of conceiving a healthy baby.
If medication alone does not work then again, all hope is not lost there are options to help you conceive a baby. When you can’t conceive on your own, even with the help of medication; then ART is techniques are used.
ART (Assisted Reproductive Technology)
In Vitro Fertilization (IVF) – This is the most effective ART technique used. The doctor retrieves mature eggs from a woman, fertilize it with the man’s sperm in a dish in a laboratory. Three to five days later, after fertilization, the embryos are implanted in the uterus. This is used when the fallopian tubes are blocked. It is also used for conditions such as endometriosis, unexplained infertility, cervical factor infertility, and male infertility or ovulation disorders. IVF definitely increases your chance of multiple births because multiple fertilized eggs are implanted into the uterus so that there is a greater chance one will develop into a baby. This treatment requires frequent blood test and injections.
Intracytoplasmic Sperm Injection (ICSI) – This is a technique which directly injects sperm into an egg to achieve fertilization in conjunction with IVF. This procedure has been extremely helpful for couples that have been unable to conceive with standard techniques also for men with low sperm concentration. ICSI dramatically improves the chances of fertilization.
Surgical sperm aspiration – This technique involves removing sperm from part of the male tract if the ejaculatory duct is blocked.
Assisted Hatching – This technique attempts to assist implantation of the embryo into the lining of the uterus.
It is said that ART works better when the woman has a healthy uterus, responds will to fertility drugs, and ovulates naturally. The man should have healthy sperm. Many will say that ART is less successful after the age of 35. Remember this, each case is different; do not be turned away because of this. Many doctors will tell you that many couples over the age of 35 have had great success with these treatments. No two cases are the same. You really won’t know what can be done until you actually see the specialist.
COMPLICATIONS OF TREATMENTS
Always remember that with any type of treatment some complications and/ or risks may occur. These include:
Multiple Pregnancies – This is the most common of the ARTs treatments. If too many babies are conceived, the doctor will speak to you about considering the option to remove one or more fetuses. This would give the others a better chance of survival. Ultimately, the decision to keep the embryos to mature fetuses and ultimately birth is up to the couple.
Ovarian hyperstimulation syndrome (OHSS) – Overstimulation of the ovaries can cause them to get enlarged, cause pain and bloating. The symptoms can be moderate to mild and are often resolved without treatments. There have been some rare accounts that fluid accumulates in the abdominal cavity and chest, causing shortness of breath. This can also deplete the blood volume and lower blood pressure. Severe cases will require emergency treatments. This occur more in younger women and those that suffer from PCOS.
Bleeding or infection – As with any invasive treatment, there can be a slight chance of bleeding or infection.
Low Birth Weight – In multiple pregnancies, there is a chance of low birth weight. There have been cases that low birth weight has occurred in single pregnancies due to the ART treatments. Keep in mind that the percentages of these happening are not extremely high. They must let you know of all possible situations so that you are ready for any challenges that may come along. This information makes sure we are aware of all that can happen and when we decide to take these steps, we are willing and ready to deal with them, whatever the challenge may be.
This information given is just the tip of the iceberg, there is so much more to learn. The best way to get to know more on this information is to visit a fertility specialist. Don’t be afraid to ask any question, that is what they are there, to help you understand what you are going to get into.
When taking this step you must be ready for anything and don’t give up so easily. There will be times that the challenges you face are so difficult that it’s easier to give up then continue. You may have to go through so many tests, maybe surgeries and even different types of treatments to help you achieve your goal, have a baby. Of course there are times, that no matter what treatments, surgeries or therapy they do, it will not take, it is not possible. Again, this is not the end. They have other options to offer you and that you can consider.
Donor Eggs – You can opt to use a donor’s egg. Women around the world donate their eggs to give other women a chance to have a child. The cost can be from $5,000 - $10,000 and of course, they would be implanted via IVF. You can also use the egg from a close friend or family member that is willing to help in these situations.
Adopt an Embryo – These are fertilized eggs from couples that went through the IVF procedures and donate their embryos if they decide they will not be using them. This gives couples a chance to have a child of their own. These embryos are implanted in the uterus.