It probably comes as no surprise to learn that the number one reason for infertility among women is some type of ovulation disorder. If you're experiencing a menstrual cycle, or if your period is irregular, it's difficult for those sperm to find an egg.
Problems with your menstrual cycle -- and in turn your ovulation on a monthly basis -- could be due to any number of factors. It takes several areas of your system to actually pull off a regular period month after month. One small slip up can send a chain reaction through your entire body.
The problems start simply enough. One portion of your system which affects reproduction fails to function properly. Now, this could be any number of glands, including the hypothalamus, which is, by the way, located in your brain, pituitary gland, the adrenal glands, thyroid glands or your genital organs.
We've covered a wide range of organs and endocrine glands, with a vast array, as it were of hormones. Getting to the root of the problem, as you can see, is not as simple as diagnosing a tonsillitis or even the influenza.
Your doctor needs to look at every one of these areas. And of course that means some type of testing in these areas? But what exactly could go awry that would cause you to become infertility.
Well, for starters, let's just look at your ovaries. They may not be creating enough progesterone. This is the female hormone that stimulates the thickening of the uterus lining on a month basis. This thicken occurs in anticipation of the arrival of a fetus.
Or ovulation may not be occurring because you hypothalamus isn't secreting enough gonadotropin-releasing hormone. This is the hormone which signals your pituitary gland to produce two more hormones -- follicle-stimulating and luteininzing. Both of these are essential for continued, regular menstrual cycles.
An overproduction of prolactin may also disrupt your period. This problem originates in the pituitary gland.
Modern medicine is simply amazing. Yes, the technology, the ability to take an ill system and make it whole. But in this instance, I was thinking that modern medicine is amazing for bringing us a whole array of initials for terms . . . phrases . . . and disorders that we never would have been able to talk about because we couldn't pronounce them.
And PCOS is one of them. Have you been told you have it? Is this the reason you can't get pregnant? Do you know what these letters stand for?
PCOS is the medical community's shorthand for polycystic ovarian syndrome. See what I mean by the wealth of acronyms, here?
Once thought to be caused by a thickening of the ovaries, we now know the root cause of this women's disorder is a hormonal imbalance. If you have PCOS, then first and foremost you've noticed that your menstrual cycle doesn't follow the "classic" model taught in medical school and health classes across the country.
Physically, your ovaries have small cystic structures, each about two to nine millimeters in diameter. With this disorder, these structures -- you may also hear them called antral follicles -- make the ovaries look as if they have a polycystic appearance when viewed on an ultrasound.
The ovaries do, indeed, contain follicles with eggs, the follicles don't develop and mature as they should. This means that your system isn't experience ovulation as it should.
If you have PCOS, your body is probably only producing one -- and only one -- mature follicle every month.
About eight to 10 percent of women in their reproductive years are afflicted with this disease. Do you even know if you have PCOS? It could be that you have it and not realize it. Perhaps it's even the cause of your infertility.
In making a definite diagnosis, you physician looks for two of the following three criteria:
1. The presence of male hormone. This can be determined easily enough through a simple blood test.
2. Irregular menstrual cycles
3. Presence of the many small follicles indicative of PCOS as seen with the aid of an ultrasound.
While these are the criteria necessary for an accurate diagnosis, there are other signals and signs that you may have developed PCOS. Among the symptoms are: obesity, skin tags and dark, velvety patches called acanthosis nigricans, which are usually located on the inner thighs or neck.
Another symptom which may indicate the presence of PCOS is that of excess hair. This is due to the abundance of the male hormones testosterone and androstenedione in your system. Depending on when you develop these cysts, the excessive hair may appear when you're as young as 20 years of age. You may also notice the problem worsens as you get older.
Would it surprise you to learn the cause of PCOS is actually rooted in the problem of insulin resistance? When I said that this disease is caused by a hormonal imbalance, your first thought, no doubt, was that your sexual hormones were the ones out of kilter here. And you can see that the criteria for definite diagnosis, it's true.
But since nothing in your body ever acts in isolation, you shouldn't be too surprised to realize that the problem may extend back even further -- to your master hormone, insulin.
You're probably already familiar with this term, since it's part of the larger health problems of today's society: obesity.
Insulin resistance is the precursor and biological marker of Type II Diabetes, normally found in individuals who are overweight and lead a sedentary lifestyle (which unfortunately include far too many of us).
Of course, you already know that insulin aids in the storage of sugars in your bloodstream. But you may not have known that it also signals both your pituitary gland and reproductive system when and how much hormones to release. These include the hormones response for your monthly ovulation.
And now we came to the crux of your PCOS disorder. Without a monthly cycle, it's next to impossible to get pregnant.
Thankfully, your doctor can treat this disorder with relative ease so your chances of giving birth increase. If left untreated, your chances of having a baby are slim.
Looking at the statistics, you may still think the odds are stacked against you -- even when you use fertility drugs like Clomid. According to one estimate, women 35 years of age and younger have a 10 to 15 percent chance of getting pregnant each month while under treatment.
If, after trying Clomid for several months, you're not ovulating properly, your physician has other medications he can prescribe for you. One of them is. The next choice for most physicians is to prescribe injectable gonadotropins or FSH hormone.
Statistics show that this specific treatment works for about 90 percent of the women experiencing infertility due to PCOS. Many of these, then, eventually get pregnant. Now, you may wonder why your health care practitioner didn't just cut to the chase at the very beginning. Skip the Clomid, doc, you're thinking. Hook me up with some of the gonadotropin!
Well, there's a very good reason why he didn't. And it comes down to two words: multiple births.
That's right! In a nutshell, the hormone works too well if you can believe that. Right now, in your baby-deprived state, you may be secretly saying to yourself "bring it on! Bring it on!"
But you need to realize that the presence of multiple births -- and we're not just talking twins or even triplets here -- can place your babies' health at risk from the very beginning. In fact, high-order multiple pregnancies, as their called in the medical community, can put the very life of the baby at risk. It may also result in birth defects and eventual disabilities for your babies.
Because of these distinct possibilities, your doctor may not even prescribe these gonadotropins for you. He may simply move you along from Clomid, the fertility medication to recommending IVF -- in vitro fertilization.
It has been a question on more than one woman's mind: Are my uterine fibroids causing my infertility?
The questions lingers. And quite frankly without a detailed investigation of your type, size and location of fibroids, it's a question that is near impossible to answer.
Uterine fibroids are common in women -- very common it seems. And many women conceive, have healthy pregnancies and give birth to spectacularly healthy children without the least bit of thought to their fibroids.
And then . . .
It's good to become clear before we go any farther exactly what a fibroid is. It's a tumor -- yes, a benign tumor. This means it's non-cancerous. And it's found in various areas within your uterus. If you have one, you usually have more than one. They occur mostly in women of child bearing age. And, not surprisingly, their growth appears to be hormonally driven.
Many women actually have fibroids but experience absolutely no symptoms. Others have symptoms such as irregular bleeding, the need to urinate frequently, constipation pelvic pressure and pain.
Why are some women plagued with these symptoms and others don't even know they're carrying these fibroids around with them? The difference lies in not only the size of the fibroids, but also the location of them.
For most individuals, the fibroids they have are small - very small. For others, their fibroids developed in areas which don't disrupt the reproductive process.
Medical experts explain there are three general locations fibroids can be found within your uterus. The first is on the outside surface of the reproductive organ. If you have fibroids here, they would be classified, in medical jargon as subserosal. The second possible location is within the muscular wall of the uterus and they're called intramural fibroids.
The third classification is fibroids called submucous. These are the fibroids that are bulging into the uterine cavity itself.
Medical experts now believe that the only kind of fibroids that could interfere with pregnancy is the submucous variety. Now, having said that, it is possible that the other two could cause some infertility if they were large enough and if they were very numerous.
Curiously, very little research has been performed in this area so much of this knowledge is based on observation and quite frankly speculation on the part of the medical community.
However, very recently a study was published that seriously looked at the literature that did exist on fibroids and infertility. Called a meta-analysis, it attempted to determine the role fibroids played in infertility based on what little research we do have.
Specifically, the work examined 23 different projects that dealt with fibroids and their effects on the reproductive system. Overall, the analysis suggested that fibroids -- regardless of location -- were actually associated with a 15 percent reduction in pregnancy rates.
Not only that, the presence of these tumors -- again regardless of where they could be found -- also correlated with a 30 percent reduction in live birth rates as well as a 67 percent increase in the rate of miscarriages. All these statistics are compared to controls who had no fibroids.
Now, you may be wondering if the submucous fibroids -- those that were taking all the blame originally for infertility -- play any type of heightened role in all of this? That's an excellent question. And here's the eye opening answer.
Yes, the presence of submucous fibroids actually increased a woman's chances of developing infertility. When just these fibroids were analyzed, the reduction in pregnancy rates jumped to an unbelievable 64 percent. Similarly, the live birth rate plummeted by 69 percent and the miscarriage rate soared to 67 percent increase.
So you've been told you have fibroids, but these non-cancerous tumors aren't the cause of your infertility. But you're wondering if they are going to impair your treatments in any way.
You have every right to wonder about that. That question seems to be up for open discussion in the general medical community at large. One of the difficulties in answering that with any certainty involves the issue of fibroids themselves.
Since little is know about how they actually may prevent embryo implantation, it's difficult to know how fibroids may affect you during this treatment.
One thing that seems to be a given is that if the fibroids that either enlarge or actually distort the uterine cavity seem to diminish your chances of a successful embryo implantation.
If, on the other hand, the fibroid doesn't distort the uterine in any way, then in all likelihood it shouldn't disrupt the treatment.
Here is an interesting study that doesn't prove that fibroids cause infertility, but it certainly helps to establish a link to the two. Researchers gathered data from 1,200 women who underwent fibroid surgery.
Going into the surgery more than a quarter of them -- 27 percent to be exact -- experienced infertility. Another 3 percent of them at the outset of this study had a history of miscarriage.
What's more, of these 1,200 women more than three-quarters of them -- specifically 76 percent -- had no other explainable cause for their failure to get pregnant.
Following the surgery to remove the tumors, the conception rate of these women rose dramatically. A full 40 percent of them were able to conceive. Since the result of this study has been published other research has appeared showing similar results, some of which put the post-surgery conception rates as high as 60 percent.
Nearly a quarter of all women have uterine polyps. These are overgrowth of tissue in the endometrium, or the lining of the uterus. For many of these women, the presence of these polyps goes undetected, because they cause no symptoms.
For others however, they may notice abnormal uterine bleeding as the first and major symptom of these polyps. This doesn't mean it's the only symptom. If you have these polyps, you probably are already experiencing some of these signs and signals:
These small, bulb-shaped masses of endometrial tissue are attached to the uterus by a stalk. Right about now, you may be wondering how these polyps differ from uterine fibroids. Fibroids are usually larger than cysts and are made of hard muscle.
Uterine polyps can indeed contribute to your infertility. They act much like a natural intrauterine device or an IUD. Their presence prevents the fertilized egg from implanting itself in the uterine wall.
Uterine polyps can also cause a woman's infertility by blocking the entrance to the uterine. They can grow in the specific spot where the fallopian tube connects to the uterine cavity itself. If this happens, the sperm is unable to travel from the tube to "meet" the egg. (Talk about unrequited love!)
For some women, the presence of polyps also plays a major role for the occurrence of miscarriages.
Several years ago a study on the presence of polyps and infertility was published in the professional journal Human Reproduction. It showed that following removal of the polyps, women got pregnant at about twice the rate of those who did not undergo the removal.
In fact, the study noted, once the polyps were removed many got pregnant without the aid of artificial insemination.
Your doctor may recommend that you get officially diagnosed for the presence of polyps, but that if you have any that they be removed in order to help your chances of conceiving a baby. Your physician has several methods at his disposal to just determining if you have polyps.
The first of these is called a hysterosalpingogram. (Ad now you know why most people just refer to it as a HSG!) In this exam, a radiologist injects a contrast dye into your uterus and fallopian tubes. Then you're given an x-ray. The dye, by the way, makes it easier to detect the presence of any possible polyps.
Another way of determining if you have polyps is through the use of an ultrasound machine. Your health professional will place a wand-like device into your vagina. The wand-like instrument emits high-frequency sound waves and converts them to images. From this the presence of any polyps can be detected.
A specific kind of ultrasound, referred to as a sonohysterogram, may also be used to detect the presence of these growths. In this procedure, a radiologist fills your uterus with saline via a narrow catheter.
Naturally, the saline distends the cavity, much like a balloon is filled with air. This distention helps to make the polyps easier to see. Polyps usually overlooked with a traditional ultrasound procedure can be observed in this manner at times.
If none of those procedures are right for your particular case, your physician may recommend that you undergo a test called a hysteroscopy. This test inserts a scope through your vagina and into the uterus. From here, the operator has a good view of the size as well as the extent of any polyps.
This particular procedure also has the advantage of being used for removal of the growths, too. Either part of an entire polyp may be removed for further microscopic examination simply by inserting instruments through the hysteroscopic tube.
Finally, there's the tried and true, old-fashioned method of review and removal through an excision. In this way, a sample of the polyp may be obtained through the procedure called curettage -- or scraping).
Or, your physician may request a biopsy of the polyp. He would remove a portion of the tissue though an instrument that resembles a drinking straw to determine if it's cancerous.
Viewing the tissue through microscopic means is the only reliable way to determine whether a polyp is benign or cancerous.
Believe it or not, some polyps simply disappear on their own -- without any help at all from modern technology. Again, the medical community has no idea why this occurs.
As your doctor investigates possibilities of your infertility, he inevitably will examine the health of your fallopian tubes.
In fact, it may actually be one of his first concerns. Injury or damage to this area of the reproductive system is the most common cause of female infertility. Your fertilized eggs won't be able to revel the length of these tubes to nestle themselves cozily in the uterus if the tubes are blocking their passage.
To answer the first question on your mind: Yes. Fallopian tubes really are "tubes" -- and a pair of them at that. As you read and investigate the topic further, you may see -- or hear -- them called either the oviducts or uterine tubes. They are all the same thing.
Located in the pelvic cavity, your fallopian tubes stretch the length between your uterus and your ovaries. They're approximately three to four inches long and surprisingly not physically attached to the ovaries (What was Mother Nature thinking here?). The tubes actually open into the abdominal cavity, within very close proximity of the ovaries.
Your fallopian tubes assume a major role not only in ovulation, but the eventual conception of a child as well. For conception to occur, it's vital for an egg to get fertilized and the resulting embryo to reach your uterus. And this just won't happen on it's one without the help of the fallopian tubes.
When your egg breaks out of its follicle, it's released from your ovary. At this time, your fallopian tubes "grab" this egg with a set of projections that act very much like fingers. It's then pushed into the tubal structure itself.
While in the tube, the egg is continually being nudged along the tube by tiny hairs. Here your partner's sperm may fertilize it while it's traveling through the tubes. Its final destination: your ovaries.
Your fallopian tubes, by the way, are coated with a special lining to ensure the fertilized egg -- now technically your embryo -- remains safe and healthy during its travels (Pretty miraculous, eh?)
Several conditions may cause a blockage of the tubes including complications from a previous surgery, endometriosis, pelvic inflammatory disease or even an ectopic pregnancy.
Your physician will probably want to perform a series of tests to officially diagnosis your tubal blockage. One such test is called a hysterosalpingogram or HSG. We talked about this already in the treatments chapter. The method, and we discussed this one as well, is a laparoscopic surgery.
No, blocked fallopian tubes certainly aren't the end of your chances of having a baby. Your physician may decide that your best chance for conception is through in vitro fertilization. Discussed in more detail in another chapter, in vitro fertilization -- or IVF -- as it's commonly referred to is the most common way to treat tubal factor infertility.
In this procedure, your egg is fertilized outside of your fallopian tube. The resulting embryo is then implanted inside your uterus. While the success rate of this process varies from couple to couple, overall, the average success rate averages about 35 percent.
If your doctor doesn't recommend IVF, he may tell you that surgery is the best option in your particular case. In some instances, surgery repairs the damaged tubes. This is especially true if the damage is caused by adhesions or scar tissue. Here again, pregnancy success rates with surgery do vary.
Another cause of infertility for some women is a condition called endometriosis. Yes, it's a mouthful to say and it can play havoc with your attempts to have a baby.
The name of this disorder comes from "endometrium," which is the lining of your uterus. In endometriosis, the lining, which normally grows on the inside of the organ, is actually growing outside of the uterus. Most commonly, this lining grows on the fallopian tubes, ovaries or even on the tissue lining your pelvis.
And while it's there, it acts just as it would if it were inside your uterus. During your menstrual cycle, the lining of the uterus thickens, breaks down and then sheds. That's what causes the menstrual bleeding every month.
But when that endometrium is not in the uterus and tries to shed, it becomes trapped. And it can irritate the surrounding tissue. The result of this irritated tissue could be the formation of cysts, scar tissues or even adhesions, abnormal tissue binding organs together.
You may end noticing as a result certain symptoms, including pelvic pain. You may especially notice this pain during your period.
But beyond that, endometriosis may cause fertility problems for you.
As with most disorder and health conditions, you can experience varying degrees of severity from mild to severe. The truth is some women have endometriosis and experience absolutely no symptoms. Some of these women have discovered they have the condition only when they undergo an unrelated operation.
During that procedure the surgeon may discover bits of endometrial tissue outside of the uterus.
Other women experience a few or all of the symptoms of endometrius. They include the following:
Now, I can hear you saying something like, "It's my period, it's just supposed to be painful." But that's not necessarily so. If you have pain even before your period begins and it extends several days past the ending of it, you may be experiencing endometriosis symptoms.
And how badly it hurts -- or the severity of the pain -- isn't necessarily a telltale sign of the full extent of the condition either as you might guess.
Some women with a mild version of endometriosis have very painful periods. Others with little or no pain may have severe scarring.
If you experience pain in the pelvic area at times other than your period, you may also be experiencing endometriosis. Pelvic pain may flare up during ovulation, or you may experience pelvic pain during intercourse. Some women say they also get pains during bowel movement or urination.
Heavy periods -- called by medical personnel menorrhagia or even bleeding between periods (known as menometrorrhagia) can also be a sign of endometriosis.
It's true. Some women never knew they have endometriosis until they try to conceive. Only after the doctor performs all the tests and tells them do they know about the condition.
And in fact, the major complication of endometriosis is reduced fertility. Between one third to one half of those women who have this condition also have difficulty conceiving.
Remember those adhesions we just recently talked about in connection with endometriosis? They can trap the egg near the ovary. Or if the presence of the lining outside the uterus may inhibit the mobility of the fallopian tube. This means it may impair its natural ability to obtain the egg and push it along its way.
Many women with endometriosis, on the other hand, experience no fertility problems at all. If you have been told that you have this condition don't automatically assume that you are infertile, because you very well could conceive.
Many physicians tell their patients who do have this condition that if they are considering having children, then do so with all deliberate speed. Endometriosis, in many cases, worsens the longer a woman has it. So you may still be able to conceive. But if you wait three or four years, your chances of getting pregnant are likely to worsen.
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