INFERTILITY

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During this month, there is much love to celebrate. Naturally, Valentine’s Day is a time when many find themselves mourning the loss of a loved one or wrapped in the inability to have children. Many couples begin their journey to have children full of excitement. But some meet challenges they never saw coming. Doubt, worry and stress set in. They wonder why they can’t get pregnant. There are many factors that influence a successful pregnancy.

Here are just some to consider:

  1. Is ovulation occurring?
  2. Are there enough eggs in the ovaries?
  3. Are enough required hormones being produced to hold the pregnancy?
  4. Is there a blockage in the cervix, the uterus or fallopian tubes that doesn’t allow the sperm to reach the egg?
  5. Is there enough normal sperm?
  6. Are there genetic abnormalities that either partner may have, or don’t even know they have?

The first thing is to realize that in a normal menstrual cycle, there are only about three days when it is even possible for a woman to conceive. When that window of time exists depends on how long her cycle lasts. To calculate fertile days, document the first day of each menstrual cycle. Then, count how many days pass from the first day of one cycle to the first day of the next cycle. Do this for several months to see if the cycle is regular. Do 28 days, 30 days, 35 days consistently pass from day one of one cycle to day one of the next? If the cycle is consistent, no matter the number of days, ovulation is likely occurring each month

WHAT IS OVULATION?

Ovulation is when an egg leaves an ovary and is sent to the fallopian tube where it lives for a maximum of three days waiting for a sperm to reach it. If the sperm does not reach the egg within those three days, the egg dissolves and the next chance of conception is the next month’s ovulatory window. The female reproductive system consists of two ovaries, but typically women don’t ovulate from both ovaries each month. It’s most common to ovulate from one ovary one month and the other ovary the next. However, it is possible that ovulation from one ovary occurs more often than from the other.

In general, sperm live for approximately two days and within those days it needs to travel through the channel of the cervix, into the cavity of the uterus and finally into the fallopian tube where the egg is waiting. The sperm will typically go to the right and left tubes randomly as they do not know which tube is holding the egg. Even if all goes correctly, there is only a 20% chance of conception with each try.

To complicate the issue, women do not necessarily ovulate every month. It’s actually possible for the body to experience menses but not have ovulated in that month. If ovulation has occurred, menses will begin 14 days after ovulation, unless the egg was fertilized.

When trying to get pregnant, timing and knowledge of predicted ovulation days are critical. Couples should start trying to conceive a few days before to a few days after calculated ovulation. Because an egg can live up to three days on its own and sperm can live up to two days, the overlap of efforts around the day of ovulation tends to be successful. For example, if a couple tries to conceive two days before the woman ovulates, it is possible that by the time the sperm reach the fallopian tubes, the egg may have just arrived to meet it. In the same sense, if the egg were to be released early from the ovary, the sperm still have time to reach it.

NOW DO YOU HAVE ENOUGH EGGS IN THE FIRST PLACE?

We’ve all heard of the saying “her clock is ticking.” This is because women are born with all the eggs they will ever have in their lifetime. Every day, the eggs undergo a process of dying, called cell atresia. When a woman was still in her mother’s womb, at about 32 weeks of the pregnancy, she had nearly 7 million eggs present. At the time of her birth, she was down to about 2 million. By the time she grew up to have her first period, she was down to 500,000. The eggs continue to die off after that. Unlike men who make sperm daily, for women the situation is the complete opposite!

Obviously, the process that takes place in order for pregnancy to occur is very complex and intricate. There are many steps that couples can take to help achieve a normal pregnancy. However, there are many factors that are far beyond their control. When you think of it, pregnancy truly is a miracle.

Not ovulating is the most common reason couples are infertile. Thankfully, a gynecologist can assess a woman’s hormone levels at specific times during the menstrual cycle to answer any questions regarding ovulation times and egg count. An ultrasound to see the developing egg can also be done in order to have the full picture of the process.

The second most common problem is with sperm, which is why a semen analysis is important. It is recommended that this be done at least two different times in order to have a good idea if the results reflect what is consistently happening.

In screening other reasons for infertility, we also evaluate if the patient has or has had:

  1. A sexually transmitted disease or pelvic inflammatory disease;
  2. Endometriosis;
  3. Fibroids;
  4. Polycystic ovarian syndrome;
  5. Certain medical conditions or medications for either partner; or
  6. If either has or is a carrier of a genetic mutation; or
  7. If either is a nicotine smoker.

The answers to these questions guide the testing that needs to be done. For example, if the answer is yes to the first on this list, it can mean that there is a blockage in the path of the sperm before it meets the egg. The uterus and ovaries can be evaluated by ultrasound. The fallopian tubes can be evaluated by a special X-ray test. Also, a hysteroscopy can be done for direct evaluation of the inside of the uterus where a baby would grow.

There are exceptions to every rule, but if both parents-to-be are younger than 35 without any risk factors, it is normal to take up to a year to get pregnant. Whether a couple has been trying to conceive or is planning to do so, it is important that the woman see her gynecologist for a consultation to help identify and correct factors to help you not only get pregnant, but have a healthy baby.