Life seems unfair sometimes doesn't it? As you walk through the park you ask yourself why that couple playing with their son on the swing were able to have a child. You question why that woman sitting on the park bench was able to conceive.
You and your partner, on the other hand, have been trying to have a baby for more than a year now -- and there is still no pitter patter of little feet in your house.
Of course you're frustrated, confused and downright angry! Who wouldn't be! And of course you have questions -- it seems like an infinite list of questions -- about the whole process.
Doctor, why can't I get pregnant? Is it me? Is it my husband? Is it temporary? Will I ever be able to have children?
For many women, getting married and having children is the center piece of a life well lived. For many couples, the desire and joy of having a baby, raising them, watching them grow and sharing a natural, extended love, is something they have dreamed about for years.
But that dream for about 10 to 15 percent of all couples in the United States is just an empty promise. These couples are infertile. Try as they might, they are unable to conceive.
The medical community defines infertility as the inability to get pregnant after at least one year of repeated, frequent attempts. In other words, if you and your partner are not using any type of birth control, have had sex for at least a year and you still have no child, medically speaking you're considered infertile.
Is it a death sentence? Does it mean that you'll never be able to have a child? Even though you may think so right at this moment, actually nothing could be further from the truth.
In reality, you actually stand a good chance of conceiving a child in the future. Many medical experts tell couples that very often what's preventing a conception is a condition or problem that is quite treatable.
Let's take a quick look at some of the normal conception statistics. You may be shocked to see that even for healthy couples, the odds of getting pregnant in any given month are really stacked against them.
The success rate of achieving conception in any given month for a healthy couple hovers between 15 and 20 percent. Surprised? Many are. You can see then that it may take several months - to say the least -- to overcome these seemingly dismal odds.
Generally speaking, about 70 percent of couples conceive after they've been trying for six months. Eight-five percent of couples are successful at the end of one year or 12 months.
But now, here's the surprising part. After two years of trying, nearly 95 percent of couple are successful and have gotten pregnant. Two years! So, in some ways, if you've only been trying to one year and have not conceived, it's not . . . well, inconceivable that you can still have a baby. In fact, the odds are very much in your favor.
I've presented more detailed statistics in a chart that maps out these statistics quite clearly. Included in this table are not only the number of months a couple has been attempting to have a baby, followed by the percent who have not conceived during this time period.
The table, though, also reveals the percent who have conceived. And it also shows the percentage of couples who can expect to conceive within the next 12 months.
Even though the table can be found easily in Appendix I, I can't help but cite this one statistic for you. At the end of five years of trying, statistics show that only 0.6 percent of couples have not gotten pregnant.
That means 94 percent of them have. The success rate per month is low at this point -- a measly four percent. But, looking to the future, the proportion of those couples who can still look forward to conceiving in the following 12 months is still a rather healthy figure of 36 percent.
Now, let's look at the definition of infertility again. You can clearly see that after only a year of trying all hope is not really lost. Some medical experts, after viewing these conception statistics want to call the problem subfertility instead of infertility.
Barring any physical disorder on either the woman or man's side, conception is still a distinct possibility. The problem lies more in the timing of the pregnancy than in the lack of it. The event just isn't happening as quickly as you would like.
That's not to say that at the end of a year of trying you shouldn't visit your doctor. At this point it's wise. At the very least, you can exclude the possibility of some insurmountable health problem preventing the event.
Your infertility may very well be due to one simple, single cause present either in your system or that of your partner. Or, the fact that you can't conceive may be the result of several factors that when discovered and treated will allow you to enjoy all the delights of parenthood!
All of this becomes much clearer once you understand infertility better.
Of course! It almost seems stupid to say it, now doesn't it? But the main and overriding symptom of infertility is the inability to get pregnant. But beyond that there are telltale signs that may indicate your infertility -- whether you're a woman or a man.
For example, many infertile women have irregular menstrual periods. This symptom alone would make it difficult to conceive. Men who are infertile may exhibit signs indicating hormonal problem. This condition could appear as a change in hair growth or even sexual function.
For most couples, the time to visit a doctor about this problem is after a year of struggling to have a baby. There are several exceptions to this suggestion though. Don't wait until a year has passed if you're a female older than 30 and have had no menstrual periods for six months. Visit your doctor as soon as you can.
Similarly, visit your physician before the completion of the year of trying to conceive if, as a woman, you've had a history of irregular or painful periods. This would include pelvic pain, pelvic inflammatory disease (PID), endometriosis, and even a history of repeated miscarriages.
Men should visit their doctor prior to that one year mark if they know they possess a low sperm count or have a history of testicular or prostate problems or sexual problems in general.
For any of these conditions, there's no need to wait for a year of failed attempts. The sooner you enlist the aid of your physician, the sooner he can discover the root cause -- and hopefully -- send you on your way, one step closer to family bliss.
When people refer to the miracle of birth it really is more than just a phrase -- it's a fact. The human reproductive system is miraculously complex. If one considers everything involved in getting pregnant, you're in awe that anyone of us was born at all.
A possible pregnancy starts anew every month when the pituitary gland in a woman's brain signals her ovaries to prepare an egg for ovulation. This releases the follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Once the pituitary gland secretes these, thus stimulating the ovaries, a woman is fertile.
Generally speaking, this occurs about midway through a woman's menstrual cycle. If you have a 28-day cycle, this event happens at approximately day 14.
Once the hormones have prepared the ovaries, the woman's egg travels through her fallopian tube in anticipation of being fertilized. The window of opportunity here is usually 24 hours. The odds of conceiving are higher when intercourse takes place one, even two days, before the actual ovulation occurs.
While the female is fertile, it's necessary for the sperm to unite with the egg in the fallopian tube. The sperm, by the way, is capable of fertilization for up to 72 hours following its release. Obviously, the sperm need to be in the tube at the same time the egg is there.
But that's not all (and here's where Mother Nature gets real particular!), not only does there need to be a significant amount of sperm present to ensure conception, but the sperm needs to be just the right shape . . . and it needs to move in the proper way. Those are the requirements on the man's part.
For the woman, she needs to have a healthy vagina and uterus in order for the sperm to travel to the egg!
It's only when all these criteria are met that the egg is fertilized. .You would think that's the end of the story, but no, the process isn't quite complete, yet. This fertilized egg now must move into the uterus. Here it attaches itself to the uterine lining. And that's when the nine months of growth begin. Finally!
Whew! As you can see, both the sperm and the egg are working on rather a tight schedule here -- a matter of hours really. The miracle of birth is a rather appropriate description of the entire process. Seen in this light, you have the inclination to look around you, thinking that any of us was able to show up in this world is pretty amazing!
You can easily see how a small "malfunction" in any one of these steps can result in the failure of the egg to get fertilized.
It's customary when you think of infertility to automatically assume that the problem lies with the female reproductive system. But, you may be surprised to learn that the cause of infertility on average is equally found in females and males alike.
In about 40 percent of the cases, in fact, the failure to get pregnant lies with the man. In another 40 to 50 percent, the problem is with the female reproductive system. And surprisingly, for up to 20 percent of the couples, the problem involves both partners in some way.
And yes, to answer that question that is undoubtedly on the tip of your tongue right now, there are certain risk factors, as the medical community likes to call them, that would make some individuals more susceptible to this condition than other individuals. And some of them may be rather surprising and -- at the very least -- eye opening to you!
The first risk factor is age. Once a woman reaches a certain age, her fertility potential gradually declines. And believe it or not, it's at a relatively young age -- 30! That's not to say that you'll never get pregnant once you hit this magic marker. That's far from the truth. But it does make the process harder for some people.
This tendency toward age-related infertility may be due to a higher rate of problems with the chromosomes occurring naturally in the eggs as they age. But, consider also that as a woman ages, she may have more general health problems which interfere with the ability to conceive.
Another fact to keep in mind as well is that as a woman ages her risk of miscarriage increases.
While I've only mentioned women, the same can be said for men. As a man ages, he may be less fertile than his younger counterparts. For men, this seems to occur once he reaches his fortieth birthday.
Another risk factor for infertility involves smoking tobacco. Both men and women who smoke cigarettes appear to reduce the odds of getting pregnant. Not only that, but if they smoke while they are receiving fertility treatment, this also affects the chances of the treatments effectiveness.
And along those same lines, miscarriages more frequently occur in women who smoke than those who do.
Alcohol may also play a role in contributing to infertility. I'm not going to beat around the bush here. Once you're pregnant there is absolutely no "safe" limit on drinking. Even a little alcohol is too much.
The same, you may be surprised to learn, goes for the period in which you're trying to get pregnant. If you've been attempting to conceive, but you haven't sworn off drinking yet -- even if you drink only a little -- give it up completely to increase your chances of having a baby.
And I'm not just talking overweight here! If you're either overweight or underweight, this may indeed interfere with your chances of getting pregnant. For many women -- especially in the United States - infertility is, in part, due to the sedentary lifestyle and the corresponding problem of being overweight.
The same though can be said for men. A man's sperm count may be adversely affected by his carrying extra pounds.
If you're underweight, you may also experience problems with conception. This is especially true of women who are plagued with eating disorders like anorexia nervosa or bulimia.
But you may also find it difficult to get pregnant if you've put yourself on any severe, calorie-restrictive diet as well.
Even women who are vegans seem to be at a greater risk of not being capable of getting pregnant. For these women, it's very often the lack of a specific nutrient, like vitamin B-12, folic acid, zinc, or iron which is causing the problem.
Okay! Okay! You say. If I sit around all day and eat candy increase my risk of not being able to get pregnant. Now, you tell me that if I exercise too much, I may not be able to conceive, too!
As confusing as it may sounds, yes! But, let's get this straight, it's not that half hour walk that you should be taking daily that's hindering your ability to have a baby.
Several clinical studies indicate that a woman who spends more than seven hours a week exercising may have problems with ovulation. If you exercise that much, consult your physician to see if that could be an obstacle.
Currently, this seems to be an ongoing debate within the medical profession. Could too many caffeinated drinks be associated with a greater risk of infertility? It's still an open question.
On the one hand, several studies have shown that fertility decreases when caffeine intake climbs. Other studies have shown no such correlation. One thing seems fairly certain: if there is a correlation, it affects women more than men. And, no, increased caffeine consumption, but the way plays no part in the incidence of miscarriages.
It's natural after a year of trying to make an appointment with your gynecologist or your husband's urologist about your infertility problem (or sooner if you have any extenuating medical issues!). But before you even set your appointment, you should prepare for it.
Your medical advisor undoubtedly will ask you some questions. Anticipating these and having other details ready for her will make your session less awkward and flow smoother.
For example, prior to your office visit, list the details concerning your attempt to have a baby. This information is vital if your doctor is to help you and to get at the root cause of your problems.
He'll ask you things like when you first started trying to conceive, how often you have intercourse, and how are they planned in relation to menstrual cycles. Don't be embarrassed. These are natural questions that he only has a purely medical interest in.
In fact, below is a list of potential questions he may ask you. By preparing ahead of time, you're providing your physician with the most accurate information possible.
Your physician will then turn to each of you individually and ask you certain questions. For the woman, these questions may include:
You can see how this list is asked to evaluate you for the risk factors involved in infertility. Similarly, he'll ask the male a few questions as well.
When you walk into your doctor's office two things will happen, guaranteed. He'll ask you some of the questions we've just covered. And you'll have a head full of questions of your own to ask him.
When it comes to the second part, I'll give you one piece of advice -- write your questions down on a piece of paper. Oh, yes! I don't know what it is about a doctor's office, but once we step foot in there, our brains disengage so that we can't think of even the simplest question we had for him.
Then, once we walk out, get in our cars and head home, all the questions come flooding back. It happens every time.
So, even though you think you'll never forget to ask this question or another, you just might. But if you write it down -- even the most obvious -- then not only can you get your questions answered, but you don't have to strain to remember them in the first place.
Here are only a few of the questions that most couples ask when they walk in for a consultation. Some of these questions no doubt are already on your mind, but others might not be yet.
That about sums up what to expect on your visit to the doctor's visit. If you're serious about conceiving then you need to know that the process of attempting to decipher what exactly is wrong and if it can be overcome may be a long tedious process. The ordeal certainly will test your level of commitment to having a baby.
You also need to know that the outcome in about one third of the cases is that there is no specific cause -- at least none that your physician can discern. If you turn out to be a part of this one-third you may very well feel cheated and lied to. That would be a natural reaction. But you must work past that.
And if you're still serious about having children, then look at all the options that are available to you in an entire gambit of settings.
Another word of caution with regard to the tests you are about to undertake: none of this comes cheap. Evaluation, even today, is still very expensive. In many cases, your doctor may be performing tests not covered by your insurance.
As you can see just by this small peak that testing for infertility is not something to be entered into casually. Indeed, it requires a degree of commitment on several levels, including time, money and emotions.
Both partners are evaluated during this process. For a man to be fertile, his testicles must be healthy enough to produce sperm. Not only that but the sperm must be ejaculated effectively into the woman's vagina. That's basically what your doctor will be evaluating.
It all starts with a general physical examination. In addition to questions about your medical history, any illnesses you may have had in the past, as well as any disabilities, your doctor may also ask you questions about any medications you're taking and your sexual habits.
One of the first tests you're likely to undergo a semen analysis. This particular test is considered one of most important exams. Don't be taken aback if your physician requests more than one semen specimen in order to get an accurate reading from this test.
One of the most common ways of obtaining this specimen is through masturbation. Another often-used method is through the interruption of intercourse and ejaculation into a clean container.
The semen specimen is then delivered to a laboratory which analyzes it for several criteria, including quantity, color and the presence of infections or blood.
In addition, the lab closely examines the sperm itself. The process determines the number of sperm present as well as the possible presence of any abnormalities in both the shape and the movement of the sperm. At times, two samples are requested simply because it's not unusual for sperm counts to fluctuate from one specimen to the next.
The doctor also requests a blood test aimed at determining the level of testosterone as well as a variety of other hormones.
You may also be put through an ultrasound test as well. A transrectal and scrotal ultrasound helps your physician find any possible evidence of conditions like retrograde ejaculation and ejaculatory duct obstruction.
And lest you complain about the tests you're going through as a man, your female partner is enduring a battery of her own. A woman's fertility depends on the release of healthy eggs -- on a regular basis -- as well as a reproductive tract that allows both the eggs and the sperm to pass into her fallopian tubes to get fertilized. Her reproductive organs, naturally, then must be healthy and functional.
To this end, the woman undergoes ovulation testing. This is a simple blood test that measures hormone levels that ultimately determine whether she is ovulating.
As a woman you undoubtedly will go through a test with an excruciatingly long name -- hysterosalpingography. This particular exam evaluates the condition of both your uterus and your fallopian tubes. In this exam, fluid is injected into your uterus, an x-ray is then taken to determine whether the fluid actually travels out of your uterus and into your fallopian tubes, the natural path the egg and sperm must travel.
If the fluid doesn’t travel down this "path" it could signal a blockage or related problems. Sometimes, if this is determined to be the cause of your infertility, this blockage can be easily corrected with a simply surgery.
Another test, a bit more invasive and requiring a general anesthesia, is a laparoscopy. In this, a thin viewing device is inserted into your abdomen and pelvis for the purpose of examining your fallopian tubes, ovaries as well as uterus.
A small incision, usually eight to 10 mm in length is made right beneath your navel. A needle is then inserted into your abdominal cavity. The attendant then injects a small amount of gas -- usually in the form of carbon dioxide into the cavity which creates space for the entry of the laparoscope. This is an illuminated, fiber-optic telescope which can detect such problems as blockages or irregularities in both the uterus and the fallopian tubes.
One of the most common problems this test picks up is the presence of endometriosis and scarring. More of often than not this test requires outpatient status.
Women, like their partners, also undergo hormonal testing. Used as a tool to check levels of hormones basic to ovulation, the tests also cover the thyroid and pituitary hormones.
A test that actually reviews the potential effectiveness of the eggs after ovulation, the ovarian reserve test, often includes a hormone test at the initial stages of your menstrual cycle.
Genetic testing may also occur simply to determine if there's a genetic defect presence that could be at the cause of your infertility. And finally, most women also endure a pelvic ultrasound. This particular procedure specifically looks for diseases in either the uterine or fallopian tubes.
Now before you start running in the other direction from the doctor, take solace in knowing that you may not be required to undergo all of these tests. It may be that the first test you take reveals the nature of your infertility.
The exact tests you actually take, as well as their specific order, depend on the various discussions you and your physician have as well as the agreement the two of you have made.
These tests also tell the doctor what kind of treatment would be best for your particular problems. Those tests form the basis of an entire chapter later in the book.
In the meantime, your mind is probably swirling in a hundred different directions -- many of which are wondering if there were anything else you can do.
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