What is Endometriosis?

Endometriosis is the appearance of tissue similar to the tissue that lines the uterus (endometrium) in other parts of the body.  Endometrial growths, also called implants, can develop on the ovaries or fallopian tubes, the outer surface of the uterus, the bowels, or other abdominal organs. In rare cases, they may even adhere to organs outside of the abdominal cavity.  During a woman’s menstrual cycle, her uterine lining (endometrium) first grows, and then if there is no fertilized egg during that cycle breaks down and is expelled from the body as menstrual blood.   For a woman with endometriosis, the implants that are located outside of the uterus go through that same growing, breaking down, and bleeding process.   Sometimes the growth of these implants causes pelvic pain, pain during intercourse or pain during urination or bowel movements.  Birth control medication is often used as a therapy to relieve the pain of endometriosis because the hormones in the birth control pills shrink the endometrial growths.

What’s the Infertility Link?

While a diagnosis of endometriosis doesn’t mean that you are infertile, up to 40% of women with endometriosis do have problems getting pregnant.   The reason endometriosis interferes with fertility is not fully understood, but there are several hypotheses.  One is that the adhesions of endometrium on other reproductive organs interfere either with proper ovulation or with the necessary movement of a fertilized egg from the fallopian tubes into the uterus.  Women with endometriosis also over-produce prostaglandins,  and some have theorized that this leads to a hormonal imbalance that interferes with fertilization and implantation of an embryo.

Why endometrium sometimes shows up elsewhere in a woman’s body remains a bit of a medical mystery, but it does look like there is a genetic link.  If you are having trouble getting pregnant and one of your female relatives has been diagnosed with endometriosis, let your doctor know so that he or she can determine whether you might also have the disease.   Sometimes endometriosis is first uncovered as part of the diagnostic process for a woman with fertility problems when laparoscopy, a surgical procedure that gives the physician a magnified view of the abdominal cavity, reveals endometrium growths in other parts of the abdomen.

What about Treatment?

Of course the standard treatment for endometriosis of birth control hormones is not the strategy a woman wants to use if she is trying to get pregnant.   Sometimes a physician can remove adhesions of endometrial tissue surgically (sometimes even during the same laparoscopic procedure that diagnosed the endometriosis).  If removing adhesions is not by itself enough to permit a woman to become pregnant, many of the advanced reproductive technologies available can be the solution for a woman with endometriosis.

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Since infertility affects both men and women the first step is to find out which one of you has a condition that could shed light on reasons for infertility. In some cases it may be both of you having some type of condition that combined is working against you as your reasons for infertility. Many problems can be solved quite simply, therefore the sooner you find out the reasons for infertility the faster you can move on. Keep in mind that even though some problems can be corrected, occasionally the reasons for infertility are not known.

Photo of primitive infertility doll by Daquella Manera

Diagnostic Tests

Reasons for infertility are most commonly uncovered by the following tests:

(1)Physical exams, including full medical histories, will be made to investigate possible reasons for infertility. This will include discussions of previous disease or injuries that could impact the reproductive systems of either person and therefore be reasons for infertility. Things such as pelvic injuries, STD’s, and even vascular problems from heart or arterial disease may be an important part of the history that could help uncover reasons for infertility.

(2)Semen analysis will be done to check the number of sperm, their shape and their mobility. Ideally two to three analyses should be performed over a period of two to six months since sperm quality can change over time. These tests will help give doctors a broader overview of any reasons for infertility related to the man’s sperm.

(3)Ovulation will be analyzed because problems with ovulation are among the most common reasons for infertility in women. The first step in testing is to determine if the woman 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 appears to be ovulating normally, further testing will need to be done to determine other possible reasons for infertility.

(4)An x-ray or “dye test” may be conducted to check for blocked fallopian tubes or abnormalities in the uterus that may be reasons for infertility.

(5) A more advanced test called laparoscopy can be used to check for scar tissue or endometriosis in a woman’s reproductive organs, another of the more common reasons for infertility. Although it is a surgical procedure, laparoscopy is is usually done on an outpatient basis.

Sometimes reasons for infertility cannot be diagnosed with these preliminary tests. However, they often do uncover reasons for infertility and can suggest the most appropriate interventions to take to maximize the chances of bringing home a baby.

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Infertility Stress:  An Overview — What Is Stress?

Stress is one of the most over-used and poorly understood words in our vocabulary.  Stress in its widest sense is defined as any event that a person perceives as threatening.  When a person perceives such a threat, the body responds with the classic “fight or flight” response to protect itself.  This “fight or flight” response originated eons ago as a critical tool for survival, when threats were typically direct and required an immediate reaction, like an attack by a predator. However, stress can come from just about anything that a person feels is threatening or harmful. Stress might be generated by a single event, or by the cumulative power of any number of small worries that abound in our current modern lives.  Even the worry that we feel about a stress can, itself, be a source of stress.   Stressors that arise these days include internal stress such as the inability to achieve what we set out to do, or external stress arising from pressure applied by family, coworkers or even strangers in the grocery line.   Some forms of stress are within our control (we can avoid the long grocery line), while others are not (we can’t escape all of our obligations at work or at home).

Stress may also be acute or chronic.  Under acute stress, a person’s heart beat faster, his  blood pressure rises, he breathes harder, his skin becomes cool and clammy and he may sweat.   Under chronic stress, a person might develop depression, changes in sleep habits, and a reduced ability to fight off illness.

The biological  cause of these stress symptoms is as follows.  When a stress trigger is present, the hypothalamus produces a hormone called corticotropin releasing factor (CRF).  CRF activates the hypothalamic-pituitary-adrenal (HPA) system, causing it to release neurotransmitters called catecholamines, as well as cortisol, the primary stress hormone.

Why is Understanding Stress Important for People Dealing with infertility?

Couples undergoing treatment for infertility will experience stress. In fact, some studies indicate that many women who are being treated for infertility have as much stress as women who have cancer or heart disease.  The stress felt by an infertile couple changes in form over the course of each month – from pressure to perform sexually when the woman is ovulating, then to from hope that the woman is pregnant, and finally to disappointment if she is not.

While there is little doubt that infertility causes considerable stress, the question whether stress can cause infertility remains controversial.  No clinical studies have demonstrated clear evidence that stress causes infertility.  Anecdotally, some women who exhibit considerable stress also have changes in hormone levels that affect ovulation, but this may not be true of all women.  Stress could interfere with pregnancy through direct hormonal effects, or indirectly by impairing a couple’s capacity to have effective sexual intercourse or to follow the complex instructions and sexual prescriptions involved in medical treatment.

Regardless of the clinical evidence, many couples themselves will begin to believe that it is the stress they are experiencing which is prohibiting them from becoming pregnant.  That feeling that stress and/or the inability to manage it well (to be a “trooper”) is contributing to a couple’s fertility problem is increasingly prevalent because of new thinking about the mind-body connection, including some unfounded but hard to dislodge beliefs that even patients with cancer can cure themselves by the power of positive thinking.  Whenever a fertility treatment fails, it is easy to believe it was because the patient was “too tense.”   It’s no big surprise that that kind of pressure only increases stress.  Therefore stress and infertility end up in a circular relationship. Infertile couples, who are under stress because of their infertility, start blaming themselves for their infertility. This increases their stress levels and potentially further aggravates hormonal changes, sexual dysfunctions and other possible ways in which stress might be contributing to the fertility problem.  For these reasons, it’s important to consider stress-reduction as a necessary part of any program or protocol for treating infertility.

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Infertility means those couples have been unable to get pregnant after 1 year of consistent sexual activity with no contraception.  Primary infertility means they have never had a child. Secondary infertility means that the infertile person or couple has had one or more children previously, but a health-related condition is now impairing fertility. A number of people could be infertile during their reproductive years, but may be ignorant about this since they’re not trying to get pregnant.  Accidental pregnancies are rarer than you might think — on any one occasion of unprotected sexual intercourse, the likelihood of pregnancy is just one percent.

To understand why infertility happens to some couples, it helps to understand just how complex the act of human reproduction is.  A problem with any one of the many steps outlined below could be the source of the fertility problem.

The Female Reproductive System

Five essential hormones activate the reproductive system of a woman:  gonadotropin-releasing hormone (GnRH), luteinizing hormone (LH), follicle stimulating hormone (FSH), estrogen and progesterone. Here is the way those hormones are generated.  The hypothalmus, a part in the human brain, first releases GnRH.  GnRH will then cause the pituitary gland to generate two additional hormones– LH and FSH.  These hormones then instruct the ovaries to secrete estrogen and progesterone.

A female’s ovaries have got 200,000 to 400,000 egg follicles.  These follicles are little sacs that include the materials essential to develop eggs. During a two-week time period in a woman’s monthly menstrual cycle, FSH will cause several follicles in the ovaries to ripen and grow. FSH also orders the ovaries to create estrogen, which launches the creation of large quantities of LH hormone.  This “surge” in LH hormone induces the secretion of an egg from the biggest follicle into the fallopian tubes – a process known as ovulation. LH hormone additionally stimulates the follicle to deliver corpeus luteum – a arrangement of yellow tissue which will make progesterone. Progesterone and estrogen interact to thicken and prepare the lining of the womb to host a fertilized egg. Jointly, these hormones swell the cellular lining of the uterus with blood vessels, helping to make it less difficult for a fertilized egg to embed itself there.

The Male Reproductive System

Men have four essential hormones required in reproduction. They are: gonadotropin-releasing hormone (GnRH), follicle stimulating hormone (FSH), luteinizing hormone (LH) and testosterone. Here’s how the hormones are made in a male.  Just as with the female, in a man the brain’s hypothalmus first produces GnRH, and the GnRH induces the pituitary gland to make FSH and LH.  These hormones manage the generation of sperm and the secretion of the male hormone testosterone in the male testes, located in the scrotal sac.

Sperm begin life in the testicles in tissues called Sertoli cells. At the beginning of a sperm’s life, hormones produce its head and tail. The sperm then escapes from the Sertoli cell into the epididymis, which is based behind the testes. For three weeks, a sperm moves through the epididymis in an energizing substance containing fructose. As the sperm swims through this fluid, it develops and acquires the means to move back and forth. A mature sperm has a head that contains the man’s DNA – his genetic material – and a tail that quickly shifts from side to side, propelling it forward.

The Act of Conception

When a man ejaculates in the course of intercourse, muscular contractions push the sperm out of the epididymis to channels named the vas deferens. The sperm then progress to the ejaculatory ducts and out the urethra( the passage through which urine and semen are passed from the body). Just before ejaculation, the sperm in the ejaculatory ducts blend with bodily fluids that originate from the prostate gland and from glands called the seminal vesicles, creating semen. In the course of male orgasms, the seminal vesicles drive the semen vigorously out into the urethra. A muscle in the bladder also locks shut to stop the semen from journeying backward into the bladder and combining with urine. The semen moves from the urethra to a storing area at the bottom of the penis, where muscles propel it out of the penis.

Of the 100 to 300 million sperm discharged when a male ejaculates, only about 40 survive the trip through the acidic surroundings of the vagina and cervix. The woman’s thick cervical mucous can also be a buffer. But in the course of ovulation, the woman’s mucous thins to enable the sperm to journey more freely.  Soon after a sperm bores through the cervical mucous, it triggers a special membrane located on the head of the sperm called the acrosome.  The acrosome dissolves and produces special enzymes. These enzymes enable the sperm to penetrate the tough covering surrounding the egg in the fallopian tubes. Only one sperm eventually fertilizes the woman’s egg.

An egg is fertilized by sperm only if the couple has sexual activity near the moment the egg is released. Sperm can live for six days upon entering a female’s vaginal area and may fertilize the egg at any time during this period. Having said that, studies show that fertilization is more likely to come about two days before or at the time the egg is released. The fertilized egg then moves on to the uterus, where it implants and develop into an embryo, creating a pregnancy.

When There is No Conception

If the egg is not permeated by sperm, it thrives for 12 to 24 hours. The egg and the bloody cells lining of the uterus then slough off, traveling away through the uterus, the cervix and vagina – this is what causes a woman’s menstrual period.

As you can see, even when broken down in it’s most straightforward terms, the process of becoming pregnant is complex and involves many steps both in the woman’s body and the man’s.  A breakdown in any one of these steps in either the man or the woman can be a cause of infertility.

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If you’re considering in-vitro fertilization (IVF) as a treatment option, it’s important to have a good understanding of the costs involved before you proceed.  In the US, the cost of one typical IVF cycle ranges from $10,000 to $15,000 and averages around $12,000.  If you have frozen embryos from a previous cycle and want to use them, doing so is significantly cheaper than doing a complete IVF cycle with fresh embryos, because the surgical step of egg retrieval from the woman’s ovaries can be skipped.  It’s not uncommon for a woman to produce 8 to 10 viable embryos in an IVF cycle, but only 2 or 3 will be implanted so as to avoid the risk of carrying multiples.   Many couples choose to freeze any embryos that are not implanted during the initial IVF cycle.  Those embryos can be used if the first cycle did not result in a pregnancy, or if the first cycle was a success, frozen embryos can be used if the couple wants to try for another child.  The average cost for a frozen embryo transfer (FET), is only about $3,000.

If you plan on using an egg donor, the cost will be significantly higher, and may be up to $30,000 for a single cycle. Using a sperm donor is not as expensive as using an egg donor, but will nonetheless increase the cost anywhere from $200 to $3,000 extra for a single cycle, or between $13,000 and $17,000 per IVF cycle.  Another option to investigate if you plan to use donor material is embryo donation.  This is by far the least expensive of the donor options, and it’s often cheaper than a regular IVF cycle, for the same reason that frozen embryo transfers of one’s own embryo is less expensive.  Overall an embryo donor cycle costs anywhere between $5,000 and $7,000.

Keep in mind that you may need additional assisted reproductive technologies along with your IVF cycle, which will add to the cost.  For example, ICSI treatment (where a single sperm is injected directly into an egg) may be an additional $1,000 to $1,500, and genetic testing of embryos may be around $3,000 or more.  Embryo freezing, including the initial freezing and later storage, may cost an additional few to several hundred dollars.

As you research costs further and “comparison shop” with different clinics, be cautious of any fertility clinic that tells you that an IVF cycle at their facility less than $10,000. Chances are, they are leaving something out from their price quote.   For any clinic you call regarding costs, be sure to ask if their price quote includes everything, including fertility drug purchases, ultrasound and monitoring costs, blood work, and any options they might consider “extra”.  That way, when you compare clinic price quotes you can be sure you are comparing apples to apples.

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What is Acupuncture?

While acupuncture originated centuries ago in Asia, it is only recently that the practice has begun to gain acceptance by western medical practitioners.  Acupuncture involves inserting and sometimes manipulating very thin needles into very specific points in the body.  While many advocates claim that acupuncture can relieve almost any medical condition, it is now commonly accepted that acupuncture can at least temporarily relieve pain and even regulate blood pressure by stimulating the central nervous system.  These effects are achieved because the use of acupuncture causes the body to release endorphins which inhibit pain and gives the body the feeling of wellness.   Endorphins may also release certain neurotransmitters and neurohormones, which some say encourage the body to heal itself.

What are Some of Acupuncture’s Uses in Fertility Treatment?

Because acupuncture appears to increase blood flow to vital organs, it may help in the regulation of hormone levels, and even improve ovarian and follicular function.   Because blood flow is critical for the creation of a thick, rich lining for the endometrium where a fertilized egg must implant, it may also help to increase the chances of implantation and reduce the risk of early pregnancy loss.   For these reasons, it is not unrealistic to assume (and a few studies even seem to suggest) that acupuncture may improve the success rate of medical interventions such as in vitro fertilization (IVF).   As a result, an increasing number of fertility centers have begun to offer it as an option as part of an IVF treatment protocol.

Another potential application for acupuncture in treating fertility problems is the special case of spasmed fallopian tubes.   Fallopian tubes must remain open to permit an egg to travel past the cervix where it can be either inseminated or harvested.  Although completely blocked tubes will not respond to acupuncture, spasmed tubes are often de-spasmed (and therefore opened up) with acupuncture.

Best Practices

If you plan to use acupuncture as part of your overall treatment plan, whether you are relying on herbal remedies or pursuing technical procedures like IVF, it’s generally accepted that it is better to do more than less.   Consider beginning treatment three to four months before a medical procedure like artificial insemination or (IVF).   Then, continue treatments both before and after insemination or embryo transfer.  It seems that many women benefit from a long-term commitment to acupuncture during fertility treatments as it is an excellent stress-reducer, regardless of any other potential benefits, and stress can interfere with a woman’s ability to conceive and maintain a pregnancy.    However, do be sure to use an acupunturist with experience treating fertility so that inadvertent mistakes in the placement of the needles (rare as they may be) do not contribute to a miscarriage.

Although there is no clinical evidence that supports the notion that acupuncture or herbal medicines can, by themselves, reverse infertility, these treatments do seem to increase success rates when used as an adjunct to traditional medical interventions.

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What is PCOS?

Polycystic Ovarian Syndrome (PCOS) is a syndrome in which a woman’s body produces excessive insulin, and as a reaction to that extra insulin her body also produces high levels of androgens (male hormones).   It is those high levels of androgens that create infertility problems for women with PCOS.  Women with PCOS are also at higher risk for developing diabetes because their bodies are resistant to insulin.   As a woman gets older, PCOS can become worse. While five to ten percent of women of childbearing age have PCOS, most are unaware that they have it.  In fact, less the twenty-five percent of women with PCOS have been diagnosed.

The Effect of PCOS on the Menstrual Cycle

First let’s examine what happens in a typical menstrual cycle for women without PCOS.    In the early part of her cycle, a woman’s body develops multiple follicles within her ovaries, each of which contains an egg.   As her cycle progresses, most of the follicles fail to develop further, but one follicle will grow and mature.  The mature follicle holds the egg that the woman’s body will release during ovulation.   Ovulation occurs when the mature egg bursts from the follicle.  LH hormones control this ovulation process; when a woman’s LH levels reach their high point in the menstrual cycle, ovulation occurs and an egg is released.

For women with PCOS, their bodies do not produce enough female hormones necessary for a typical menstrual cycle.  Without enough female hormones, the follicles produced early in the menstrual cycle are not able to mature and produce eggs.   These undeveloped follicles may even turn into cysts within the ovary, and additional small cysts may develop on the outside of the ovaries.  Because the woman with PCOS cannot develop mature follicles that produce eggs, she will not ovulate.  A further complication is that, without ovulation, her body will not receive the signal to produce progesterone, the hormone that causes the lining of the uterus to thicken in preparation for carrying a fetus.

Symptoms of PCOS

Of course, the most apparent symptom of PCOS is either an irregular menstrual cycle or the absence of menstruation altogether.   (For those women who do menstruate at least some of the time, a few might even conceive during an irregular cycle during which ovulation actually occurs.)   Often women with PCOS experience pelvic pain.  Other symptoms, attributable to the increased production of androgens, include increased hair growth on the back, chest or face, acne, and thinning hair.  Women who are obese, have high insulin levels or type two diabetes, are at risk for PCOS and should consider getting tested if they are planning on starting a family.

Treatment Options

Obviously PCOS affects a woman’s ability to conceive because of a lack of ovulation.   But, there are several steps that can be taken to correct the problem.    Among the most useful (and inexpensive) is weight control.  Some women who are able to reduce their weight themselves through diet and exercise can actually eliminate PCOS, because weight loss helps correct.

A first-line medical treatment for PCOS is Metformin.  Metformin is a drug that improves the body’s ability to absorb insulin.   It is considered safe to use on women who do not have diabetes because it affects insulin levels and does not actually lower blood sugar directly.   If you are considering requesting Metformin, consult your physician and be sure to get screened for diabetes or other risk factors first.

If weight management and/or Metformin do not eliminate PCOS and a woman remains unable to ovulate regularly, fertility drugs should be considered.  Clomid, among the most common of the fertility drugs, bocks estrogen receptors in the brain, “tricking” the body to believe that it needs to produce more of the hormones necessary for ovulation (in particular FSH and LH) to combat low estrogen levels.  Even when Clomid succeeds in making a woman ovulate, only thirty to forty percent of those women will actually become pregnant.  Thus, Clomid may be augmented with procedures intended to facilitate egg fertilization, such as IUI.

For some women with PCOS, in vitro Maturation (IVM) or in vitro fertilization (IVF) may turn out to be the most useful treatment options.   If a woman’s eggs are not maturing properly because of lack of appropriate hormones, then IVM allows immature eggs harvested early in a woman’s cycle to mature in  laboratory conditions.  Those properly matured eggs may then be used for fertilization.   IVF, on the other hand, harvests eggs after they are already mature and therefore is best suited for women responding well to medications that encourage ovulation.    The mature eggs are then fertilized in the laboratory with sperm collected from the male partner, and once the fertilized eggs have developed into blastocysts one or more are implanted direclt in the woman’s uterus.   IVM is helpful for women who do not respond to drug therapy.

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For many couples facing infertility, the largest hurdle is how to finance costly infertility treatments. Luckily, there are products now that provide infertility insurance as part of a general health insurance package.

Out of Pocket Cost

When you examine the costs behind the high technology infertility treatments, it becomes evident why paying out of pocket may be out of reach. The most effective clinical treatment, in-vitro fertilization, can cost tens of thousands of dollars for a single attempt. While some get lucky, most couples will need to undergo more than one cycle of in-vitro fertilization to become pregnant. Even more “intermediate” infertility procedures such as IUI can run upwards of $4000. On top of that, fertility medications themselves, whether used alone to increase a woman’s ovulation or in conjunction with IVF can cost around $1,000 a month.

Clearly these costs are out of reach for many couples. Even if your general health insurance plan does not include coverage for infertility treatments, there are supplemental infertility insurance packages for couples that can make treatment much more affordable. Often these supplemental policies are “riders” to your general health insurance policy, sold and underwritten by the same insurance company. Supplemental infertility insurance can vary widely in scope of coverage and required preconditions, so it is worthwhile to investigate multiple insurance options before committing to one if you believe you may need infertility treatment.

What’s Covered by Infertility Insurance

The insurance companies offering supplemental infertility insurance charge a separate a monthly premium for a range of fertility treatments that typically include include diagnostic fertility tests, artificial insemination, and other types of assisted reproductive technology. Some policies require that a couple be married for some period of time and have tried to get pregnant without success, as documented by reports to the woman’s OBGYN or primary care provider. Most plans will also require that a couple attempt less involved treatments like medication or IUI before considering coverage for IVF.  Once a couple is pursuing IVF, their insurance plan will probably limit the number of IVF attempts that can be made — typically between three and five. It’s important to understand at what point an IVF cycle is determined to have commenced by the insurance company, so as to avoid having aborted cycles counted against them. It’s also important to be aware that most plans will not cover the use of donor eggs or donor sperm.

3 Most Common Forms of Infertility Insurance

There are three different types of infertility insurance. First, there is standard health insurance. This type of insurance requires that you pay a monthly premium in exchange for specific fertility coverage.

Second are refund programs offered by clinics. Under these programs a couple pays upfront a lump sum of money for a set number of treatment attempts, and receives some percent of the money returned if the couple does not conceive as a result of the treatments.   Of course, the down side of these programs is that the couple is typically required to pay up front for more than one IVF cycle, and if that couple succeeds in getting pregnant, no money is refunded.  (Usually the happiness that accompanies such a success eases the sting of some of that “lost” money.)

Finally, loans financing infertility procedures may be available under which the couple is not required to pay back the loan in full if they are ultimately unable to have a baby.   Lenders may require that a couple satisfy a number of prerequisites before approving a loan, many similar to those described for a standard premium-based plan as described above.

Finding the right insurance policy can require a lot of research, and even advance planning in case a policy requires that premiums be paid for a year or more before treatment can commence.

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Couples who are going through infertility problems can feel isolated, and watching friends and family having babies creates additional stress and frustration. (Believe me, I know!)  It is easy to forget how many couples in the US alone experience infertility.  Once you realize the staggering nature of infertility statistics, you may feel less alone and more able to reach out to other couples and learn about their own experiences and frustrations in trying to get pregnant.

Infertility statistics for women of childbearing age (between 15 and 44) in the US suggest that approximately 7.3 million of those women have some impairment to their ability to have children. Many of these women don’t even know that they have a problem until they try to start a family.   Many couples upon learning that they face fertility challenges opt to undergo fertility treatments — in fact, a significant percent of the babies in your circle of friends and family may well have been conceived with the help of some form of infertility treatment in order to conceive.

Women Receiving Infertility Services

Nearly 12% of women between 15 and 44 years of age have impaired fecundity, which means that not only might they have problems with getting pregnant, they may also have trouble carrying a baby to term. Our ability to identify clinical pregnancies earlier and earlier with blood tests and sophisticated over-the-counter tests means that many women who may not have realized in generations past that they were failing to carry to term are now acutely aware of early miscarriages. As a result of this high rate of impaired fecundity, in 2002 11.9% of women between 15 and 44 years of age have received some sort of infertility services.  (That’s about 7.3 million women.)   The form of infertility services these women received is varied.  6.1% of women of childbearing age received professional advice regarding their fertility, and 5.5% of women of childbearing age have received some sort of medical help to prevent a miscarriage.  Close to 5% of women of childbearing age have undergone a fertility test.   When you consider that not every woman in this age group is trying to conceive, the actual percentage of women who are trying to start a family and undergo a fertility test is even higher.  Nearly 4% of women have received ovulation drugs, and 1.1% of women have received artificial insemination.

It is commonly known that as women age their ability to become pregnant decreases with the loss of their eggs. As a result, of course the percentage of women receiving some form of fertility services increases in higher age brackets.    Any woman age 35 or older is considered to be of “advanced maternal age.”  The percent of childless women between the ages of 35 and 39 who have received infertility services is 15.2%, whereas for women between the ages of 15 and 29 the rate is only 2.9%.    Interestingly, the highest rate of childless women who have received any infertility service occurs in the bracket of women between 30 and 34 years of age, at 17.3%. Very likely this high statistic arises from both the added fertility problems that come with age and the fact that many women are now choosing to start their families in their early 30s.

Women Diagnosed as Infertile By Age Bracket

The following table illustrates the increase in infertility, as diagnosed by physicians, as a woman’s age increases.

IVF Success Statistics

Of course, a diagnosis of infertility does not mean that bearing a child is impossible.   IVF, a very effective fertility treatment, has a rate of producing live births about 38% of the time for women of  31 years. The rate of live births per each IVF treatment decreases by age, such that by 39, the percentage of live births is around 22%. and after age 43 the percentage of live births drops to less than 10%. Even for women in their 40′s, the dream of a family is not out of reach. Although the IVF success rate is less than 10% at age 40 using the mother’s own eggs, women who opt to use an egg donor have a success rate of about 45%.

Hopefully these statistics have created some optimism regarding your ability to get pregnant, and help you to feel less alone.   Because of many women’s poor understanding of their own fertility, pregnancy results can be even higher if a woman takes charge to get herself educated about her options.

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Overview

Infertility affects men and women.  One or both may show signs of infertility before the couple begins its family planning, or it may be that neither the woman nor the man are aware of any fertility problems until they start trying to conceive.   Technically speaking, “trying” to conceive means unprotected intercourse about three times a week for one to two years.  It is only then that many doctors will officially pronounce that the couple has an infertility problem.    This does not mean that a woman should wait for two years before seeing a doctor or making preliminary lifestyle changes if she has been trying to become pregnant and has concerns or shows a sign of infertility.  The initial consultation if a woman suspects infertility should be made either her OBGYN or primary care physician.  If that physician suspects or diagnoses a fertility problem, he or she may then refer the couple to a specialist.

Nonetheless, a couple should not jump too quickly to the conclusion that they are infertile, because it is possible that they are simply not having intercourse during the appropriate time of a woman’s menstrual cycle.   A couple trying to conceive can and should take steps to make sure they are having intercourse when the woman is ovulating.  The woman can track her basal body temperature (making sure to use a basal thermometer that measures very small changes in temperature) or use an over-the-counter ovulation kit to see when she is ovulating.  If the couple continues to have trouble conceiving, look for the following possible signs of infertility.

Signs of Infertility in Women

Among the many possible signs of infertility, the most common for women is an irregular menstrual cycle.  However, an irregular menstrual cycle can indicate a variety of issues and so, although it may be a sign of infertility, it does not necessarily mean that the woman is infertile.  Another sign of infertility can be a weight problem on either end of the spectrum.  Women who are far too thin, whether from an eating disorder or simply dieting too aggressively, may lack the proper nutrients necessary for conceiving.  On the other hand, obese women often experience hormonal problems that affect the reproductive system.

Signs of Infertility in Men

For men, anatomic or physical problems may be signs of infertility.  Undescended testicles can be a factor of infertility.  Overexposure to heat in the scrotum and gonad area can also cause a man to be unable to produce children.   Additionally, very tight underwear or pants can affect a man’s ability to produce viable sperm for conception.  As with women, obesity in a man can affect the systems of the body necessary for producing children.  Obesity may be a factor leading to the inability of the man to produce the right amount of sperm (a “low sperm count”).  Obesity in a man may also affect the body in such a way that the sperm it does produce are not properly formed.  Malformed sperm are often unable to penetrate the woman’s eggs, a critical part of conception.

Conclusion

Weight concerns, smoking, excessive drinking or substance abuse, or, in the case of men, wearing inappropriate clothing are all factors that can be controlled and therefore make fertility treatment unnecessary.  Even an irregular menstrual cycle, so long as the woman is in fact ovulating, can be overcome by timing intercourse properly.   It is a good idea to make the necessary changes in diet and other habits and to begin tracking the ovulation cycle before determining that intervention is needed.

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