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Understanding Infertility:
Myth or fact: If a couple is having trouble conceiving a child, the man should try wearing
loose underwear? That's a fact, according to a study on "Tight-fitting Underwear and
Sperm Quality" published June 29, 1996, in the scientific journal The Lancet. Tight-fitting
underwear--as well as hot tubs and saunas--is not recommended for men trying to father
a child because it may raise testes temperature to a point where it interferes with sperm
production.
But couples having difficulty getting pregnant can tell you the solution is almost never as
simple as wearing boxers instead of briefs. Lisa (who asked that her last name not be
used) tried for more than two years to get pregnant without success. "Everyone gave me
advice," she says. "My mother said I should just go to church and pray more. My friends
said, 'Try to relax and not think about it' or 'You're just overstressed. You work too
much.'"
Actually, psychological stress is more likely a result of infertility than the cause,
according to Resolve, a nonprofit consumer organization specializing in infertility.
"Fertility problems are a huge psychological stressor, a huge relationship stressor,"
says Lisa Rarick, M.D., director of the Food and Drug Administration's division of
reproductive and urologic drug products.
So, while going on a relaxing vacation may temporarily relieve the stress that comes
with fertility problems, a solution may require treatment by a health-care professional.
Treatment with drugs such as Clomid or Serophene (both clomiphene citrate) or
Pergonal, Humegon, Metrodin, or Fertinex (all menotropins) are used in some cases to correct a woman's hormone imbalance. (See "Drug Supply Restored.") Surgery is
sometimes used to repair damaged reproductive organs. And in about 10 percent of
cases, less conventional, high-tech options like in vitro fertilization are used.
Will the therapies work? "Talking about the success rate for fertility treatments is like
saying, 'What's the chance of curing a headache?'" according to Benjamin Younger,
M.D., executive director of the American Society for Reproductive Medicine. "It depends
on many things, including the cause of the problem and the severity." Overall, Younger
says, about half of couples that seek fertility treatment will be able to have babies.
A Year Without Pregnancy
 Infertility is defined as the inability to conceive a child despite trying for one year. The
condition affects about 5.3 million Americans, or 9 percent of the reproductive age
population, according to the American Society for Reproductive Medicine.
Ironically, the best protection against infertility is to use a condom while you are not
trying to get pregnant. Condoms prevent sexually transmitted diseases, a primary cause
of infertility.
Even a completely healthy couple can't expect to get pregnant at the drop of a hat. Only
20 percent of women who want to conceive become pregnant in the first ovulation cycle
they try, according to Younger.
To become pregnant, a couple must have intercourse during the woman's fertile time of
the month, which is right before and during ovulation. Because it's tough to pinpoint the
exact day of ovulation, having intercourse often during the approximate time maximizes
the chances of conception.
After a year of frequent intercourse without contraception that doesn't result in
pregnancy, a couple should go to a health-care professional for an evaluation. In some
cases, it makes sense to seek help for fertility problems even before a year is up.
A woman over 30 may wish to get an earlier evaluation. "At age 30, a woman begins a
slow decline in her ability to get pregnant," says Younger. "The older she gets, the
greater her chance of miscarriage, too." But a woman's fertility doesn't take a big drop
until around age 40.
"A man's age affects fertility to a much smaller degree and 20 or 30 years later than in a
woman," Younger says. Despite a decrease in sperm production that begins after age
25, some men remain fertile into their 60s and 70s.
A couple may also seek earlier evaluation if:
The woman isn't menstruating regularly, which may indicate an absence of ovulation that
would make it impossible for her to conceive without medical help.
The woman has had three or more miscarriages (or the man had a previous partner who had had three or more miscarriages).
The woman or man has had certain infections that sometimes affect fertility (for example, pelvic infection in a woman, or mumps or prostate infection in
a man). The woman or man suspects there may be a fertility problem (if, for example,
attempts at pregnancy failed in a previous relationship).
The Man or the Woman?
Impairment in any step of the intricate process of conception can cause infertility. For a
woman to become pregnant, her partner's sperm must be healthy so that at least one
can swim into her fallopian tubes. An egg, released by the woman's ovaries, must be in
the fallopian tube ready to be fertilized. Next, the fertilized egg, called an embryo, must make its way through an open-ended fallopian tube into the uterus, implant in the uterine
lining, and be sustained there while it grows. (See diagram.)
It is a myth that infertility is always a "woman's problem." Of the 80 percent of cases
with a diagnosed cause, about half are based at least partially on male problems
(referred to as male factors)--usually that the man produces no sperm, a condition called
azoospermia, or that he produces too few sperm, called oligospermia.
Lifestyle can influence the number and quality of a man's sperm. Alcohol and
drugs--including marijuana, nicotine, and certain medications--can temporarily reduce
sperm quality. Also, environmental toxins, including pesticides and lead, may be to
blame for some cases of infertility.
The causes of sperm production problems can exist from birth or develop later as a
result of severe medical illnesses, including mumps and some sexually transmitted
diseases, or from a severe testicle injury, tumor, or other problem. Inability to ejaculate
normally can prevent conception, too, and can be caused by many factors, including diabetes, surgery of the prostate gland or urethra, blood pressure medication, or
impotence.
The other half of explained infertility cases are linked to female problems (called female
factors), most commonly ovulation disorders. Without ovulation, eggs are not available
for fertilization. Problems with ovulation are signaled by irregular menstrual periods or a
lack of periods altogether (called amenorrhea). Simple lifestyle factors--including stress,
diet, or athletic training--can affect a woman's hormonal balance. Much less often, a hormonal imbalance can result from a serious medical problem such as a pituitary gland
tumor.
Other problems can also lead to female infertility. If the fallopian tubes are blocked at
one or both ends, the egg can't travel through the tubes into the uterus. Such blockage
may result from pelvic inflammatory disease, surgery for an ectopic pregnancy (when the
embryo implants in the fallopian tube rather than in the uterus), or other problems, including endometriosis (the abnormal presence of uterine lining cells in other pelvic
organs).
A medical evaluation may determine whether a couple's infertility is due to these or other
causes. If a medical and sexual history doesn't reveal an obvious problem, like
improperly timed intercourse or absence of ovulation, specific tests may be needed.
Tests for Both
The man's evaluation focuses on the number and health of his sperm. The laboratory first
examines a sperm sample under a microscope to check sperm number, shape and
movement. Further tests may be needed to look for infection, hormonal imbalance, or
other problems.
Male tests include:
X-ray: If damage to one or both of the vas deferens (the ducts in the male that transport
the sperm to the penis) is known or suspected, an x-ray is taken to examine the organs.
Mucus penetrance test: Test of whether the man's sperm are able to swim through a drop of the woman's fertile vaginal mucus on a slide (also used to test the
quality of the woman's mucus). Hamster-egg penetrance assay: Test of whether the
man's sperm will penetrate hamster egg cells with their outer cells removed, indicating
somewhat their ability to fertilize human eggs.
For the woman, the first step in testing is to determine if she is ovulating each month.
This can be done by charting changes in morning body temperature, by using an
FDA-approved home ovulation test kit (which is available over the counter), or by
examining cervical mucus, which undergoes a series of hormone-induced changes
throughout the menstrual cycle.
Checks of ovulation can also be done in the physician's office with simple blood tests for
hormone levels or ultrasound tests of the ovaries. If the woman is ovulating, further
testing will need to be done.
Common female tests include:
Hysterosalpingogram: An x-ray of the fallopian tubes and uterus after they are injected
with dye, to show if the tubes are open and to show the shape of the uterus.
Laparoscopy: An examination of the tubes and other female organs for disease, using a
miniature light-transmitting tube called a laparoscope. The tube is inserted into the
abdomen through a one-inch incision below the navel, usually while the woman is under
general anesthesia. Endometrial biopsy: An examination of a small shred of uterine
lining to see if the monthly changes in the lining are normal.
Some tests require participation of both partners. Samples of cervical mucus taken after
intercourse can show whether sperm and mucus have properly interacted. Also, a
variety of tests can show if the man or woman is forming antibodies that are attacking
the sperm.
Drugs and Surgery
Depending on what the tests turn up, different treatments are recommended. Eighty to
90 percent of infertility cases are treated with drugs or surgery.
Therapy with the fertility drug Clomid or with a more potent hormone
stimulator--Pergonal, Metrodin, Humegon, or Fertinex--is often recommended for women
with ovulation problems. The benefits of each drug and the side effects, which can be
minor or serious but rare, should be discussed with the doctor. Multiple births occur in
10 to 20 percent of births resulting from fertility drug use.
Other drugs, used under very limited circumstances, include Parlodel (bromocriptine
mesylate), for women with elevated levels of a hormone called prolactin, and a hormone
pump that releases gonadotropins necessary for ovulation.
If drugs aren't the answer, surgery may be. Because major surgery is involved,
operations to repair damage to the woman's ovaries, fallopian tubes, or uterus are
recommended only if there is a good chance of restoring fertility.
In the man, one infertility problem often treated surgically is damage to the vas deferens,
commonly caused by a sexually transmitted disease, other infection, or vasectomy
(male sterilization).
Natural Treatments:
Doctors agree that eating a healthy
balanced diet is the first step toward successful conception. But in
some cases where conception is difficult, nutritional supplements may
prove helpful. Here's what is recommended.
NUTRIENTS, DAILY AMOUNTS, AND APPLICATIONS
For Men
For Women
- Vitamin
E: 400-800 international units
- Plus a prenatal multivitamin/mineral supplement containing the
Daily Values of all essential vitamins and minerals
MEDICAL ALERT!
- More is not necessarily better. Experts say that a too-high amount
of any nutrient can impair fertility.
- Some doctors recommend that women start taking prenatal
supplements a few months before they stop using birth control.
- Consult your doctor before taking more than 600 international
units of vitamin E daily. If you are taking anticoagulant drugs, you
should not take vitamin E supplements.
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