Infertility affects approximately 15% of couples in the U.S. and similar rates are noted in other developed countries. The causes are multifactorial but older age is the primary risk factor. With increasing life expectancy and more women pursuing careers, couples have delayed starting a family. The result is an increased demand for assisted reproductive services.
Consultation with an experienced fertility provider is recommended if you desire to reproduce and have been unable to conceive. Spontaneous conception typically occurs within 1-2 years in normal couples; however 85% of the pregnancies occur within the first year. You should seek advice if you are less than 35 years of age and have had regular intercourse without success for 1 year. If you are over 35 you should seek care after 6 months and sooner if you are 40. Treatment options are varied and dependent on the results of the medical evaluation.
Below is a summary of some of the standard recommendations and treatment of infertility.
Monthly ovulation occurs at an ideal body weight and this range can be variable and specific ot each individual. There are certain weight extremes however that are recognized as unhealthy. A body mass index of less than 19 and greater than 30 is considered to be abnormal. If the body mass index is >40 then this is called morbidly obese. In many cases these extreme weights can cause amenorrhea or irregular cycles. In either situation, ovulation is not occurring and therefore pregnancy will not occur. If you are over or underweight then weight modulation would be indicated to get to the ideal body weight which usually leads to return of ovulation. The additional benefit of getting to an ideal body weight is a healthier pregnancy.
Most couples donít realize that the egg is only around for 48 hours and the sperm life is approximately 3-5 days. Ovulation occurs exactly 14 days prior to the first day of menstruation. If your cycle is exactly 28 days then ovulation occurs on day 14, with day 1 being the first day of bleeding. If you have a 30 day cycle then ovulation occurs on day 16. If you are trying to conceive, then it is best to have intercourse 2 days before ovulation, the day of ovulation and 2 days afterwards. If your cycle is variable then you can extend the time of intercourse to cover those days of probable ovulation. Skipping a day allows time for your husband to build an adequate volume of semen. If you are not having intercourse at the appropriate time, then timed intercourse can increase the likelihood of the egg and sperm meeting.
This is a process by which the semen is placed directly into the uterus, by-passing the cervix. This procedure is helpful if there is a cervical factor contributing to the infertility. In addition this process decreases the distance that the sperm will have to travel and therefore maybe helpful in cases where there is decreased sperm motility. It is a straightforward procedure that is relatively inexpensive.
There are a number of medications that are used to increase the likelihood of successful pregnancy. Most of the medications are designed to encourage or induce ovulation. Metformin is used in women who have insulin resistance. It was initially designed to treat Type 2 diabetes mellitus. It has also been found to facilitate weight loss in women who are overweight. In either case, it has proven benefits.
There are agents designed to induce ovulation. Selective estrogen receptor modulators are one class.
Clomiphene is the most commonly used. It is prescribed for 5 days, usually day 5-9 of the cycle and is typically successful in inducing ovulation within 3 months if the dose is adjusted accordingly. Aromatase inhibitors are another category that is being utilized. The brain produces gonadotropins, which are the main messengers to the ovary, telling it to produce an egg. These can be given in the form of injections, simulating or supplementing those that should have been produced naturally.
Assisted Reproductive Technologies
Assisted reproductive technologies are utilized when all of the above have failed or if there are other factors that suggest that this method would be the most efficient. In vitro fertilization is a method by which eggs are retrieved and then placed in a dish with the sperm. Since the egg and sperm are in close proximity then fertilization typically occurs. The dividing cells are then placed in the uterus where implantation occurs. Intra cytoplasmic sperm injection is a procedure by which the sperm is injected into an egg, which is an active method of fertilization.
These methods all have their pros and cons. It is important to have a thorough understanding of the risks, benefits, costs and chance of success prior to making any decisions. This is why choosing the right physician is vital. You deserve to have care delivered by an experienced provider so that you are able to achieve your goal in the most efficient and effective way possible.