CWC - Article on Infertility

Infertility

By: Bradley G. Goldberg, M.D.

Infertility is defined as the inability of a couple to become pregnant after one year of intercourse without using contraception. A couples chance of obtaining pregnancy in any one given month is only 20%. After one year of actively trying to become pregnant, 85% of couples will be successful and the remaining 15% are defined as infertile.

The rate of infertility in this country has been increasing over the last 25 years. Suggested explanations include: delaying the age of childbearing due to career goals (a woman’s fertility peaks in her mid-20’s, and decreases significantly after the age of 35), increased frequency of sexually transmitted infections, and increased public awareness of infertility and its treatment which has led to more couples seeking therapy. In this country alone there are almost 2 million visits annually for infertility related problems.

To understand the potential causes of infertility, we should first understand the factors involved in becoming pregnant. First of all, the female must be ovulating (releasing eggs), preferably monthly. Ovulation occurs 14 days before the start of the woman’s next period, so couples who are trying to become pregnant should focus on this time for maximum fertility. The egg, once released must be able to travel through the fallopian tubes and into the uterus. Equally important, the male must be producing a normal amount and quality of sperm. These sperm must be able to travel through the female reproductive tract to reach the egg in the fallopian tube, which is where fertilization occurs. A problem with any one of these steps can lead to infertility.

In almost one-half of infertile couples, the problem can be attributed to the male. This is why semen analysis is one of the first steps in the evaluation of these couples. The remainder of the causes are related to the female, or to a combination of both partners together.

Further investigation into this problem includes confirming that the woman is ovulating. Failure to ovulate is one of the most common causes of female-related infertility. This can be assessed by checking a blood test for the female hormone progesterone on the 21^st day of the woman’s menstrual cycle, or by using home ovulation kits, or basal body temperature charts. Your doctor may also wish to ensure that the fallopian tubes and uterus are normal by performing a special X-ray called an HSG (hysterosalpingogram). This test involves injecting a dye into the uterus while the doctor watches the X-ray to make sure that the fallopian tubes are open. In some cases laparoscopy, or "belly-button surgery" will be performed on the woman for both diagnosis and treatment.

After a thorough evaluation the cause of the infertility can be identified in about 85% of these couples, the remainder are classified as "unexplained infertility". Several effective treatments are available, especially if the cause is related to the female. These range from oral medications to the more complicated in-vitro fertilization, or "test-tube babies". The more advanced treatments require the services of a doctor who specializes in infertility.

In summary, although the amount of people experiencing infertility is increasing, effective treatments are available. If you are having problems getting pregnant, remember that time alone could be the remedy. For the 15% of couples who have not become pregnant after one year, half of them will be pregnant if they continue to try for another year. If you have further questions, please consult with your physician.

Bibliography

1. Novak’s Gynecology, Twelfth Edition, Jonathan S. Berek, MD, Williams &Wilkins, Baltimore, 1996.

2. Clinical Gynecologic Endocrinology and Infertility, Fifth Edition, Leon Speroff, MD, Williams & Wilkins, Baltimore, 1994.

3. Precis, Reproductive Endocrinology, The American College of Obstetricians and Gynecologists, 1998.