INFERTILITY

Ø Inability to conceive; Unable to get pregnant.

Ø Primary infertility describes couples who have never been able to become pregnant after at least 1 year of unprotected sex (intercourse).

Ø Secondary infertility describes couples who have been pregnant at least once, but have not been able to become pregnant again. 

          In healthy couples both under age 30, having sex regularly, the chance of getting pregnant is only 25 - 30% per month. A woman's peak fertility occurs in her early 20s. As a woman ages beyond 35 (and especially after age 40), the likelihood of getting pregnant drops to less than 10% per month. When to seek help for infertility depends on your age. For women under age 30, it is generally recommended to try to conceive for at least a year before seeking testing.

Causes, incidence, and risk factors:

          Causes of infertility include a wide range of both physical and emotional factors. A couple's infertility may be due to female factors, male factors, or both:

Female Infertility:

Female infertility may be due to:

·   Problems with a fertilized egg or embryo being able to survive once it is attached to the lining of the uterus.

·   Problems with the fertilized egg being able to attach to the lining of the uterus.

·   Problems with the eggs being able to move from the ovary to the uterus.

·   Problems with the ovaries producing eggs.

Female infertility may be caused by:

·   Autoimmune disorders such as antiphospholipid syndrome (APS).

·   Clotting disorders.

·   Defects of the uterus and cervix (myomas or fibroids, polyps, birth defects).

·   Excessive exercising, eating disorders, or poor nutrition.

·   Exposure to certain medications or toxins.

·   Heavy use of alcohol.

·   Hormone imbalance or deficiencies.

·   Long-term (chronic) disease, such as diabetes.

·   Obesity.

·   Pelvic inflammatory disease or Pelvic infection.

·   Ovarian cysts and polycystic ovary syndrome (PCOS).

·   Scarring from sexually transmitted infection or endometriosis.

·   Tumor.

Male Infertility:

Male infertility may be due to:

·   A decrease in the number of sperm.

·   Sperm being blocked from being released.

·   Sperm that do not work properly.

Male infertility can be caused by:

·   Environmental pollutants.

·   Exposure to high heat for prolonged periods.

·   Genetic abnormalities.

·   Heavy use of alcohol, marijuana, or cocaine.

·   Hormone deficiency or taking too much of a hormone.

·   Impotence.

·   Infections of the testes or epididymis.

·   Older age.

·   Previous chemotherapy.

·   Previous scarring due to infection (including sexually transmitted diseases), trauma, or surgery.

·   Radiation exposure.

·   Retrograde ejaculation.

·   Smoking.

·   Surgery or trauma.

·   Use of prescription drugs, such as cimetidine, spironolactone, and nitrofurantoin.

Symptoms:

          The physical symptom of infertility is the inability to become pregnant. Experiencing infertility can bring on a range of painful emotions in one or both members of the couple. In general, having at least one child already tends to soften these painful emotions.

Signs and tests:

          A complete medical history and physical examination of both partners is essential.

Tests in women may include:

·   Blood hormone levels.

·   FSH and clomid challenge test to check ovarian reserve.

·   Hysterosalpingography (HSG).

·   Pelvic ultrasound.

·   Laparoscopy (especially if endometriosis is suspected).

·   Luteinizing hormone urine test (ovulation predictor kit).

·   Pelvic exam.

·   Progestin challenge if periods are infrequent.

·   Serum progesterone.

·   Temperature first thing in the morning to check for ovulation (basal body temperature charting).

·   Thyroid function tests.

Tests in men may include:

·   Semen analysis.

·   Testicular biopsy (rarely done).

General Management:

          It is important to recognize and discuss the emotional impact that infertility has on you and your partner, and to seek medical advice from your health care provider.

First Steps to Fertility:

          If you are interested in improving your fertility, one of the most important steps is to monitor for when you are most fertile. Many couples have difficulty getting pregnant because they are having intercourse at times when the woman isn't ovulating. This can make it surprisingly difficult to conceive. There are a number of different ways that you can monitor your fertility. It is a good idea to start by monitoring your basal body temperature. This will help you to determine exactly when you are ovulating - your basal body temperature will increase when you are ready to release an egg. Keep a fertility calendar so that you know when you are ovulating. It is important to have sexual intercourse just before an egg is released, in order to maximize your chances of becoming pregnant. There are a number of natural family planning methods that can also help you to become pregnant. Keeping track of your cervical mucus and using the rhythm method will help you to become more aware of your body's natural cycle. Try keeping a fertility chart - this will raise your fertility awareness, allowing you to pinpoint when you are actually ovulating. You may also want to look into purchasing a fertility monitor, which can help you keep track of your conception calendar and dates.

Sexual Positions:

          If you are having difficulty becoming pregnant, you and your partner may want to experiment with different conception positions during intercourse. In order to become pregnant, your partner must deposit his sperm as close as possible to your cervix. Certain positions will allow this to happen more easily. Avoid having sex while standing, sitting, or with you on top, as this can cause semen to leak out of your body. Instead, try the missionary position, which allows for deeper penetration. Rear entry intercourse is also effective, as it allows your partner to deposit semen closer to your cervix. To keep any extra semen from leaking out of you, try elevating your hips for fifteen minutes or so after your have sex.

Eating Right:

          Though you may not believe it, eating right plays an important role in your body's fertility. A balanced diet helps to regulate hormones and nourish your reproductive system. A good diet also helps you to maintain a healthy weight, which can greatly impact fertility. Women who are underweight or overweight may have a harder time becoming pregnant because body fat levels impact the production of sex hormones. It is especially important to include certain vitamins and minerals in your diet. Try to include:

·         Vitamin C and Antioxidants: these vitamins prevent sperm defects and boost sperm motility. They also reduce stress on your eggs and reproductive organs.

·         Zinc: zinc deficiencies have been linked with reduced testosterone and semen levels.

·         Calcium and Vitamin D: A daily therapeutic dose of these nutrients have been shown to help increase male fertility.

Certain foods and chemicals should be avoided if you are having troubles becoming pregnant. Cut back on:

·         Alcohol: alcohol can reduce your fertility levels by up to 50%. It can also decrease sperm count and increase the production of abnormal sperm.

·         Caffeine: caffeine, found in coffee, teas, cola, and chocolate, has been shown to reduce both male and female fertility levels. As little as one cup of coffee a day can cut your chances of conception in half.

·         Xenoestrogens: xenoestrogens are estrogens found in environmental chemicals and pesticides. Produce and other foods can have high levels of xenoestrogens, which, if ingested, may disturb your balance of hormones. Imbalaced hormones are often the cause of fertility issues.

Exercise:

          Moderate exercise can also be a good natural fertility treatment. When combined with a balanced and nutritious diet, exercise can help you to maintain a healthy body weight. Excess body fat can increase the amount of estrogen in your body, throwing the female fertility cycle out of balance. Exercise helps to burn off this excess body fat, allowing hormone levels to return to normal. It is best not to overdo exercise though - over exercising can actually impair fertility. Try low impact aerobic workouts like walking, swimming, and cycling.

Treatment:

          Increase your chance of becoming pregnant each month by having sexual intercourse at least every 3 days in the weeks leading up to and through the expected time of ovulation. Ovulation occurs about 2 weeks before the next period starts. So, if you get your period every 28 days, you should have sexual intercourse at least every 3 days between the 10th and 18th day after you get your period, and concentrating on the 72 hours before ovulation occurs.

Treatment depends on the cause of infertility. It may involve:

·   Education and counseling

·   Medical procedures such as intrauterine insemination (IUI) and in vitro fertilization (IVF)

Medicines to treat infections and clotting disorders, or promote ovulation