Infertility is generally defined as the inability to conceive after one year of unprotected intercourse. It is a very common problem affecting approximately 10% of couples worldwide. For many people this results in great anxiety and puts a tremendous amount of stress on their relationship. The God given desire and ability to reproduce is one of life’s greatest joys and rewards. “Children are an heritage of the LORD; and the fruit of the womb is his reward.” When this ability is hindered, it can set off years of heartache and frustration.
Options For Infertile and Sub-Fertile Couples
[fusion_builder_container hundred_percent=”yes” overflow=”visible”][fusion_builder_row][fusion_builder_column type=”1_1″ background_position=”left top” background_color=”” border_size=”” border_color=”” border_style=”solid” spacing=”yes” background_image=”” background_repeat=”no-repeat” padding=”” margin_top=”0px” margin_bottom=”0px” class=”” id=”” animation_type=”” animation_speed=”0.3″ animation_direction=”left” hide_on_mobile=”no” center_content=”no” min_height=”none”][fusion_imageframe lightbox=”no” style_type=”bottomshadow” bordercolor=”” bordersize=”0px” stylecolor=”” align=”right” link=”” linktarget=”_self” animation_type=”0″ animation_direction=”down” animation_speed=”0.1″ class=”” id=””][/fusion_imageframe]Luckily, the vast majority of infertile or sub-fertile couples can conceive with patience and medical intervention as I’ve seen from experience as an OBGYN. The classic evaluation for infertility consists of 5 basic steps or tests. They are:
- Documentation of ovulation,
- Semen analysis,
- Post coital test,
- HSG (or hysterosalpingogram)
The post coital test is generally now not performed and is of very limited value. The first two of the tests can be performed quickly by an OBGYN and at very minimal cost. Ovulation kits are now readily available at most drug or grocery stores at very low cost. They simply demonstrate when there is surge in the hormone that causes ovulation to occur. Contrary to popular belief, you should not wait for ovulation to occur prior to having intercourse. The reason for this is that the egg–which is the largest cell in the body by the way and is the only cell you can see with the naked eye–only lives for about 12 to 24 hours once it is released. The sperm, on the other hand, which are very small and over 60 million are usually in 1 ml of seminal fluid, actually can live up to 5 or 6 days in the female genital tract. Therefore it is generally best to start having sex 4 or 5 days prior to ovulation. Keeping track of several cycles can help you predict when your chances of conception will be the greatest and to see if you are indeed ovulating on a regular basis.
In fact, the most frequent cause of infertility is generally considered to be “polycystic ovary syndrome” in which a woman fails to ovulate on a regular basis. This can typically be remedied by prescribing a fairly simple and low cost medication called “Clomid.” Prior to embarking on clomiphene therapy however, an OB/GYN would recommend you to have some simple blood tests. These might include a thyroid stimulating hormone or TSH, a follicle stimulating hormone or FSH, a luteinizing hormone or LH, and a prolactin level. In addition your doctor may order a day 3 FSH to check for ovarian reserve especially if you are over 35. Approximately 40% of infertility arises from ovulation malfunction in the female partner.
The Male Partner’s Contribution
Another 40% of infertility arises out of inadequate or malformed semen production in the male partner. The second step is therefore a simple semen analysis that can be easily ordered by your OB/GYN and performed at the local hospital or lab. This needs be done in a proper manner and instructions can be obtained prior to taking the sample in for evaluation. Men often have something called a varicocele, which can typically be surgically repaired by an urologist if they have inadequate numbers of sperm. Generally at least 20 million are necessary for conception to occur. Even if the man only has a few sperm you may still be able to have children through ICSI or Intra Cytoplasmic Sperm Injection that can only be performed by a highly trained reproductive endocrinologist. This is when a single sperm is directly injected into a single egg.
The third step is performing an HSG to verify that both fallopian tubes are open and functioning properly. Prior infection with Chlamydia is the most common reason for tubal obstruction, but a ruptured appendix, prior abdominal surgery, and endometriosis are also common etiologies. This is the main reason why IVF or In Vitro Fertilization was originally invented.
More Options for Infertility Care
The last basic step in evaluating reproductive health is a laparoscopy and requires in hospital or at least outpatient surgical evaluation of the abdomen or pelvis. This is done by placing a camera directly into the abdominal cavity and visualizing the uterus, ovaries, and fallopian tubes. This is mainly to check for endometriosis. Although minimal and mild endometriosis do not typically hinder fertility significantly, moderate or severe disease definitely do and it is a major reason for the inability to conceive. If endometriosis is present, the surgeon can usually excise or cauterize the lesions. A GnRH agonist can also be prescribed post operatively if necessary.
There are numerous causes of infertility and this article only is intended to give a very basic approach to some of the more common etiologies. Your OB/GYN can perform most of these steps prior to referral to a reproductive endocrinologist.
If you have further questions about infertility or would like to set up an appointment with Dr. Saunders, you may do so by calling his American Fork office at 801-692-1429.[/fusion_builder_column][/fusion_builder_row][/fusion_builder_container]