Fertility
Fertility Overview
The human reproductive system is a complex one. The intricate and detailed processes involving ovulation and fertilization have to coordinate just right in order for pregnancy to occur.
Within every 28-day menstrual cycle, the ovaries in a woman’s body prepare eggs for release, a process called ovulation. For a pregnancy to occur, a sperm must unite with an egg in the fallopian tube within about 24 hours after the egg’s release. If fertilized, the egg must move into the uterus where it attaches to the uterine lining and begins a nine-month growing process.
Many factors can affect the process and prevent pregnancy. On the male side, infertility can be due to impaired production or function of the sperm, impaired movement of sperm, low sperm concentration, genetic defects and infections, or impaired delivery of the sperm due to abnormal ejaculation, the absence of semen or blockage of ejaculatory ducts. A man’s general health and lifestyle may also affect his fertility.
As for women, their fertility can be affected by fallopian tube damage or blockage, ovulation disorders, early menopause, abnormal hormone production or health and lifestyle issues. Some women may contract endometriosis, a condition in which uterine tissue grows outside of the uterus, affecting the function of the ovaries, uterus and fallopian tubes.
Symptoms
The main sign of infertility is the inability of a couple to get pregnant. In some cases, an infertile woman may have abnormal menstrual periods. An infertile man may exhibit signs of hormonal problems such as changes in hair growth or sexual function.
Risk Factors
Many of the risk factors for women and men are similar. These include:
- Age. For women, their fertility begins to gradually decline after about age 32 with older women more likely to experience health issues involving fertility. Men over age 40 tend to be less fertile than younger men.
- Tobacco smoking, caffeine consumption and alcohol use.
- Being overweight or underweight.
- Too much exercise. Some studies show that women who exercise more than seven hours a week may experience ovulation issues.
Infertility Prevention
Many causes of infertility are not preventable, but health and lifestyle options can help to improve fertility in men and women.
Reduce Your Risk of Infertility
Although many forms of male infertility are not preventable, men should avoid drug and tobacco use and excessive alcohol consumption. In addition, high temperatures can affect sperm production and mobility, so men should avoid hot tubs and steam baths during attempts to conceive.
Women can increase their chances of becoming pregnant by maintain a healthy weight, avoiding alcohol and tobacco, limiting medications and caffeine consumption, avoiding street drugs and exercising in moderation.
Tests and Screenings
Tests and screenings for fertility issues can involve long, expensive and uncomfortable processes for both men and women. For men concerned about their fertility, they can expect to undergo a general physical examination, a semen analysis and, if necessary, hormone testing or a transrectal and scrotal ultrasound.
Women undergoing tests for fertility will also undergo a general physical examination, a regular gynecological examination and specific fertility tests that include:
- Ovulation testing: A blood test to measure hormone levels to determine whether you are ovulating.
- Hysterosalpingography: An X-ray examination with a contrast that evaluates the condition of your uterus and fallopian tubes.
- Laparoscopy: A procedure performed under general anesthesia that involves inserting a thin viewing device into your abdomen and pelvis to examine your fallopian tubes, ovaries and uterus.
- Hormone and genetic testing
- Ovarian reserve testing: A procedure to test the potential effectiveness of the eggs after ovulation.
- Pelvic ultrasound: An ultrasound to look for uterine or fallopian tube disease.
Infertility Diagnosis
If screening tests or check-ups reveal abnormal results, your Wellstar OB/GYN or other physician may perform further evaluations regarding infertility.
Procedures
For Women:
- General physical examination
- Regular gynecological examination
- Ovulation testing
- Hysterosalpingography
- Laparoscopy
- Hormone and genetic testing
- Ovarian reserve testing
- Pelvic ultrasound
For Men:
- General physical examination
- Semen analysis
- Hormone testing
- Transrectal and scrotal ultrasound
Infertility Treatment
Treatments for infertility typically depend upon the cause, the duration of infertility, the age of the partners and other issues.
Treatment for Couples
For couples, treatment may involve therapy and education. If intercourse is too infrequent, the physician may suggest the couple has intercourse at least two or three times a week. Conversely, the intercourse may be too frequent, thus lessening the quality and count of sperm.
Treatment for Men
Treatment for men with infertility issues may address impotence or premature ejaculation with medication or behavioral modification. If the infertility issues involve the lack of sperm or poor sperm movement, surgery or hormones may correct the problem. Sperm can also be taken directly from the testicles and injected into an egg.
Treatment for Women—Fertility Drugs
For women, fertility drugs are the first and often main treatment methods. These medications work like natural hormones to regulate or induce ovulation. Fertility drugs, particularly injections, can lead to multiple births. Common fertility drugs include:
- Clomiphene (Clomid®, Serophene®): This oral medication stimulates ovulation in women who have polycystic ovary syndrome (PCOS) or other ovulatory disorder. It causes the pituitary gland to produce more hormones designed to stimulate ovulation.
- Human menopausal gonadotropin (Repronex®): This injected medication directly stimulates the ovaries to ovulate and helps women whose pituitary glands fail to produce hormones that typically stimulate the ovaries.
- Follicle-stimulating hormone or FSH (Gonal-F®, Bravelle®): FSH is designed to stimulate the ovulation.
- Human chorionic gonadotropin or HCG (Ovidrel®, Pregnyl®): Used in combination with other fertility drugs, this medication stimulates the ovary to release the egg (ovulate).
- Gonadotropin-releasing hormone analogs: These medications are designed for women with abnormal ovulation cycles.
- Metformin (Glucophage®): An oral medication to boost ovulation when insulin may be a factor in infertility.
- Bromocriptine (Parlodel®): A medication for women whose ovulation irregularities are due to elevated levels of prolactin, the hormone that stimulates milk production in new mothers.
Treatment for Women—Surgery
In some cases, surgery might be the necessary treatment. Laparoscopic procedures can be employed to surgically repair fallopian tubes.
Assisted Reproductive Technology (ART)
Thousands of babies are born each year due to medical advances in assisted reproductive technology (ART). The most common and effective form is in vitro fertilization, a procedure that involves retrieving mature eggs from a woman, fertilizing them with a man’s sperm in the laboratory and implanting them in the uterus. This procedure is often used when a woman’s fallopian tubes are blocked or if she has a series of other conditions affecting her fertility. Because several eggs are implanted during each procedure, the changes of multiple births are much greater. Other ART procedures include stimulation methods to encourage sperm production and ejaculation, surgery and procedures to remove sperm from a man’s testicles and microscopic techniques in which a single sperm is injected directly into an egg to achieve fertilization.
Which Treatment Is Right For You?
In every case, your Wellstar OB/GYN will help you weigh the benefits of each treatment approach and make an experienced recommendation for the best outcome. You can feel confident your decision will be based on both your input and the expertise and recommendations of your experienced physician.
Ongoing Care for Infertility
Wellstar’s world-class, community-based physicians utilize state-of-the-art medical centers and hospitals with the latest technologies and medical resources. Our clinicians are dedicated to:
- Helping you create and maintain healthy lifestyles
- Offering advice to prevent illness and injuries
- Providing early and appropriate care of acute illness to prevent its progression