Infertility Issues

When should a couple seek a medical opinion if they can’t conceive?

Ability to conceive depends not so much on the frequency of intercourse as its timing. If a couple has been aware of the woman’s ovulation cycle and been sexually active around the time of ovulation, they will probably want to seek a medical opinion if they have not conceived within twelve months.

How are fertility problems diagnosed in men, and how are they treated?

An estimated 90% of all cases can be diagnosed by a combination of physical exam, medical history, and analysis of sperm. A medical history looks at such things as onset of puberty, past infection, physical injury, and current medications. The physical should include an examination of the size and texture of the testes in order to determine their ability to produce sperm properly.

If no problems are evident from the routine exam, it will be necessary to determine the number of viable sperm cells in the ejaculate. The single most common male fertility problem is low sperm count (oligospermia). In rare cases, men will not be able to produce sperm at all.

Beyond the absolute numbers of sperm present in the ejaculate, a fertility specialist also may need to assess whether if the sperm are formed normally and are capable of movement. For this reason, a man being evaluated for fertility generally will be asked to ejaculate into a specimen jar and deliver the sample to a lab within an hour or two. The sample is considered to be on the lower limit of the normal range if it has fewer than 20 million sperm per mL and if fewer than than 50 % of them are properly formed and motile (capable of spontaneous movement).

Another method is to take a sample of cervical mucous from the woman immediately after the man has ejaculated into her vagina (postcoital test). In addition to counting viable sperm, the postcoital test can determine whether the cervical mucous is receptive to sperm. Sometimes the mucous is not of the proper consistency to facilitate the movement of sperm into the reproductive tract.

How are male fertility problems treated?

Compensating for male fertility problems generally depends on the number and viability of the sperm. If sperm count is on the low end of the normal range, a couple may want to take extra measures. For example, they should be careful to time intercourse as closely as possible to ovulation. And the man should avoid ejaculating for three or four days in order to allow his sperm count to rise.

If natural conception is not possible, a couple may want to try artificial insemination. In this technique, sperm is removed from the semen and introduced into the woman’s reproductive tract through a special catheter during ovulation. If the male does not produce any sperm, the couple will need to rely on a sperm donor.

What are the common causes of female infertility, and how are they diagnosed?

The most common causes of female infertility include lack of ovulation, blockage of the fallopian tubes, and inability of the fertilized egg to implant in the wall of the uterus.

Measuring progesterone levels in the blood is one of the most effective ways to determine if a woman is ovulating properly. Progesterone levels normally rise during ovulation.

Three techniques are generally used to check for blockage of the fallopian tubes and other physical damage to the reproductive system. The first, hysterosalpingography, is a procedure in which a physician injects a dye through the cervix and then follows the spread of the dye with an x-ray to see if it disperses throughout the reproductive organs. The second technique, laparoscopy, is a surgical procedure done under anesthesia and involves the insertion of a fiberoptic camera through the navel. The physician looks not only for blockage but also endometriosis and pelvic scarring. A third technique, transvaginal ultrasound, places a probe in the reproductive system and then follows its movements with ultrasound. To check if the uterine lining is suitable for implantation of a fertilized egg, a small sample of the uterine lining is taken (endometrial biopsy) on the 26th day of the 28-day menstrual cycle. This is analyzed for the presence of sufficient progesterone to induce the necessary monthly uterine changes. Along with these exams, blood work should be performed on the woman to check her hormone levels.

How are these female fertility problems treated?

Problems with ovulation can usually be treated effectively with drug therapies. The two most common are clomiphene citrate, which reduces the ovulation-suppressive effect of estrogen, and bromocriptine, which helps keep the ovulation-suppressive effects of prolactin in check. Blockages in a woman’s reproductive system often require surgical procedures, depending on the exact nature of the problem. Finally, progesterone will help make the uterus more receptive to implantation.

If these methods do not produce results, medical science has devised two other ways for impregnating the woman. Gamete intrafallopian tube transfer (GIFT) places eggs and sperm directly into the fallopian tube. It is used primarily for unexplained infertility, where the fallopian tubes appear to function normally. This procedure is 29 percent successful per treatment cycle. In vitro fertilization (IVF) combines a sperm cell and an egg in a laboratory tissue culture. Once the zygote (combined sperm and egg) has gone through six to eight cell divisions, it is transplanted into the woman’s uterus. The pregnancy rate using this method is 19 percent per treatment cycle.

The final option for a couple unable to bear children is to engage a surrogate mother to carry the zygote, which has been started in vitro, and ultimately give birth to the child.

If a woman has sex during pregnancy, does she put her baby at risk?

In a normal pregnancy, sexual activity–including sexual intercourse–poses no health risk to the baby, even in late stages of pregnancy. A mucous plug seals the sac of amniotic fluid and prevents contamination of the fetus. Also, contrary to popular belief, a woman’s orgasm cannot trigger early labor.

A couple’s sexual relationship may change during pregnancy, but there is seldom any health reason for a couple to stop sexual activities.

Male infertility