A Practical Guide to Understanding Infertility
Updated: Aug 14, 2020
During this trying time, we know all of you are working your hardest, running your households, taking care of the kids, safeguarding your families, and providing all the warmth and comfort. I actually found myself nesting a bit, trying to make my home like a safe haven. We are here with you and we support you – you’ve got this mama!
In honor of this year’s Infertility Awareness Week (April 19th-25th), we are here to share some important information regarding infertility. This is an important and sensitive issue that couples often struggle with for many years, and we know that infertility and the realities surrounding this issue can take both a physical and mental toll on individuals. This blog comes in two parts. Here we will talk about exactly what infertility is, how many people it affects, how it is diagnosed, and some of the common risk factors. In the next edition, we will discuss how infertility affects mental health and tell you about some of the latest treatments for infertility.
DISCLOSURE: This information is not meant to be ALL encompassing and should NOT replace seeking advice from your health care provider for specific questions, solutions, and concerns about your health! The purpose is to spark curiosity and gain some insight into your health.
Infertility is defined as the inability to conceive after 1 year or more of having unprotected sex. Now in cases where the woman is 35 years or older, your OBGYN might evaluate and/or treat for infertility after only 6 months. Our ability to conceive declines as we age, and when we reach the age of 35, we are considered geriatric – which I first realized when I got pregnant with my second at the age of 35. Some physicians are now using the term “advanced maternal age” as a more sensitive option! At the advanced age of 35, the risk for pregnancy-related complications significantly increases (compared to your 20s and early 30s).
Infertility is a common problem, affecting approximately 9% of couples around the world, with some rates reaching up to 30% in some underserved regions including South Asia, sub-Saharan Africa, the Middle East, and North Africa, Central and Eastern Europe and Central Asia. Considering that 95% of adults express interest in having a child, this is a true universal issue.
These statistics on infertility highlight the idea that having a baby is a complicated issue. This is because conception is a biologically complex endeavor and every step in this journey must work perfectly for your little cherub to come into being. Let’s look at this process in a simplified manner:
The woman’s ovaries must release an egg.
To fertilize this egg, the man’s sperm must join with this egg.
The fertilized egg (now called the zygote – a single cell that includes all of the genetic information needed to create a human) must travel through the fallopian tubes to the uterus.
The fertilized egg must then securely attach to the inside of the uterus.
The embryo then begins to develop through the process of cellular division and differentiation.
Finally, 9 weeks after fertilization, the fetus comes into being, which is a stage of development characterized by the presence of all major body organs.
The fetus continues to develop through birth, which happens around 10 months or 40 weeks in a woman’s pregnancy.
Unfortunately, problems can go awry at any of the developmental stages above. It is actually quite common for developmental errors to occur, especially in the early stages of pregnancy. In fact, as many as 50% of all pregnancies end in miscarriage, with 80% of these miscarriages occurring within the first 3 months of pregnancy. The majority of miscarriages occur before a woman even knows that she is pregnant and the bleeding associated with these events will often be mistaken as a normal menstrual period.
If I suspect that I am infertile, what should I do?
One of the first steps is to seek out a Reproductive Endocrinologist. You can try googling “Reproductive Endocrinologist” or “Reproductive Medicine & Fertility” and see what comes up as a resource in your area.
What will happen when I go to the doctor’s office?
The initial visit to the doctor’s office may involve a physical exam that includes a pelvic exam or pelvic ultrasound. In addition, a blood test will be conducted to look for an imbalance of hormones, such as progesterone or follicle-stimulating hormone. An x-ray hysterosalpingogram might be performed to check for blockages of the fallopian tubes. For this procedure, radiographic dye is injected into the cervix and movement of the dye is imaged with x-ray fluoroscopy. Alternatively, to view the fallopian tubes, the doctor may perform a laparoscopy where a fiber-optic instrument is inserted through a small cut in the abdomen. If a blockage is identified, the doctor will be able to surgically treat it with instruments attached to the device. Additionally, the doctor may examine the inside of the uterus with a transvaginal ultrasound or a small camera known as a hysteroscope.
What puts me at risk for infertility?
The process of conception requires such fine-tuning of hormones (such as estrogen and progesterone); therefore, when hormones are out of balance, ovulation may not occur properly. Some issues that alter hormonal level and put you at risk for infertility include the following:
Polycystic ovary syndrome (PCOS): Women with PCOS have elevated levels of testosterone and as a result either do not ovulate or have irregular ovulation. PCOS is the most common cause of female infertility.
Hormonal issues related to the hypothalamus and pituitary gland: These glands produce the hormones that regulate normal ovarian functioning, such as prolactin. When the hypothalamus or pituitary gland are functioning improperly, ovulation may either not occur or occur irregularly.
Age and menopause: As we age, the hormones that regulate ovulation decrease. At around age 50, most women will experience menopause, which is characterized by the lack of a menstrual period for at least 1 year and is associated with changes in mood, hot flashes, and difficulty sleeping.
Functional hypothalamic amenorrhea (FHA): Women with FHA have irregular hormones due to extremely low body weight (underweight BMI) caused by extreme stress, dieting, or exercise. FHA is often associated with disordered eating issues such as anorexia.
Fallopian tube obstruction (known as tubal occlusion) is yet another risk factor for infertility. Blocked tubes can be caused by a history of pelvic infection, ruptured appendicitis, abdominal surgery, sexually transmitted disease (such as gonorrhea or chlamydia), or endometriosis. Yet another possibility is anatomical abnormalities associated with the uterus, such as fibroids, which are benign tumors that grow in and around the wall of the uterus.
Other factors that may be indicative of infertility are irregular or no menstrual periods, very painful periods, endometriosis, pelvic inflammatory disease, or a history of multiple miscarriages.
Is infertility just a woman’s problem?
The resounding answer is NO. This is a birds and the bees problem. In fact, about 25% of infertility issues are due to issues with the male’s sperm, with some estimates as high as 50%. Some factors that increase the risk of male infertility include history of testicular trauma, hernia surgery, or chemotherapy. The diagnosis of infertility in men is mainly based on the non-invasive procedure of semen analysis where the sample is analyzed for semen concentration, shape, and movement.
What should we do as a couple to help increase our ability to get pregnant?
Quit smoking or vaping
Avoid excessive alcohol use
Eat a healthy diet
Get regular physical aerobic activity (at least 150 minutes per week of moderate-intensity physical activity and at least 2 or more days of strength training)
Maintain a healthy weight (i.e., a normal BMI; you can calculate your BMI here: https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm)
Decrease stress: try yoga, meditation, or other stress-reducing techniques.
Track your fertility using an ovulation tracker or app
Consistently have sex during your fertile periods
In the next blog, we will discuss how infertility affects your mental health and the myriad of options that couples have to treat infertility. Exciting new technologies are emerging to help couples who are infertile, and we are excited to share this information with you. Stay tuned for our next blog and our upcoming online webinar on infertility!