Infertility can be devastating, especially for couples who endlessly field questions about when they're having children. Sadly, infertility often remains in the shadows. A combination of shame, denial, and a deep sense of failure conspire to leave many people grappling with infertility alone.
It doesn't have to be this way. The Center of Reproductive Medicine offers comprehensive infertility treatment, a compassionate approach, and a deep understanding of the unique challenges facing people who struggle with infertility issues. You are not alone. As many as 1 in 8 couples, and up to 15% of individual men and women, struggle with fertility issues. You're not broken, and the problems you encounter can very likely be fixed.
Here are the basics you need to know about infertility.
It Starts With an Egg
Every month, a woman's body devotes time and resources to creating a single precious egg. This egg is released during ovulation, which is usually the midpoint of a woman's menstrual cycle—on average, day 14, but can be much earlier or later. Many fertility problems center around the egg. Some common issues include:
- Low quality eggs: Women with health problems, infections, and older women may release eggs with genetic defects or of otherwise low quality, thus reducing the odds that the egg will become an embryo, and that the embryo will be viable.
- Absent or delayed ovulation: A number of medical conditions can cause a woman's body not to release an egg, or to do so only intermittently. Delayed ovulation reduces fertility because it means you have fewer chances to get pregnant each year. Nonexistent ovulation completely eliminate the chance to get pregnant without assistance.
- Diminished ovarian reserve: A man's body continually produces sperm, but a woman is born with all of the eggs she will ever have in her life. As a woman ages, she has fewer eggs, and those eggs may be of lower quality, making rapid intervention vital for women over the age of 35 who wish to get pregnant.
The Role of Sperm
Couples trying to get pregnant often assume the problem is with the woman, and may subject the woman to a number of invasive tests before even considering the man's role. The truth, though, is that infertility is just as likely to be due to male factors as it is to female factors. Quality sperm are vital for pregnancy:
- The sperm must be free of major genetic defects, and must be properly formed. Poor morphology suggests that many of a man's sperm are incorrectly formed.
- The sperm count must be sufficiently high. If a man produces no sperm, there is no chance of pregnancy. If his sperm count is low, his chances of impregnating his partner are greatly reduced.
- The sperm must be able to swim to the egg. Sperm analysis tests label this ability sperm motility.
- A man must be able to ejaculate into his partner. Blockages, erectile dysfunction, and similar issues can impede this ability.
- A number of medical conditions can undermine sperm quality, and sometimes the reason for sperm issues is unclear. A semen analysis is an easy, noninvasive procedure, so if you're having trouble getting your partner pregnant, consider pursuing this option early.
When Sperm Meets Egg
It's not enough to produce quality sperm or a quality egg. The two have to be able to meet one another. A range of issues can undermine this process. Scar tissue or endometrial tissue that has traveled in the body can trap sperm. Likewise, sperm motility issues can be a problem. And if the man's and woman's chemistry don't work well together, they may have trouble getting pregnant. Some women, for example, have cervical fluid that actually damages their partner's sperm. Other women don't produce sufficient cervical fluid to aid the journey of the sperm to the egg.
The Journey to Implantation
Fertilization is the moment that the sperm meets the egg, but a woman is not technically pregnant until implantation occurs. Implantation is the process of an egg traveling down to the uterus and embedding itself in the uterine walls. When this occurs, the body begins producing pregnancy hormones and working to sustain the zygote.
Some genetic mutations in the sperm or egg may impede the process of implantation. Other issues that can affect implantation include:
- Hormonal imbalances that cause the uterine lining to shed too early.
- Defects in the uterus or fallopian tubes.
- Scar or endometrial tissue that interferes with the egg's journey.
Getting -- and Staying -- Pregnant
For some couples, the journey out of infertility doesn't end with a positive pregnancy test. More than a quarter of pregnancies end in miscarriage. These miscarriages are usually due to factors outside of your control, such as crippling defects in the developing embryo. And while a single miscarriage doesn't mean you'll have another, some couples struggle with recurrent miscarriage. This can be due to a range of factors, including the mother's health, sperm quality, genetic mutations in the sperm or egg, chronic infections and diseases, and hormonal imbalances that make it impossible to sustain a pregnancy.
Sometimes the miscarriage happens even before you know you're pregnant, so careful monitoring of your menstrual cycles makes it more likely that you and your partner will detect this issue.
Fertility for Single Parents
If you don't have a partner but know you want to become a parent, genetic parenthood is still an option. Much depends on your health and fertility, but if you're otherwise healthy, you may be able to parent a child in just a few months. A few options include:
- Donor sperm
- Donor eggs
- Donor uteruses in the form of surrogate pregnancy
If you have trouble getting pregnant or getting a surrogate pregnant, you may need to undergo additional treatment for fertility issues.
The Importance of Timing
Making a baby might seem like a simple endeavor: simply stop using birth control and hope for the best. But pregnancy depends on a complex array of chemical and biological interactions. If any are even remotely “off,” a pregnancy might not be possible. So don't think for a second that frequent intercourse is enough. Intercourse has to be properly timed to immediately before ovulation or immediately after. For some couples, timing alone is a problem. We can help you pinpoint your peak fertility window. If you are still struggling with pregnancy, we'll work with you to determine why.
Pregnancy is a challenge for many people, but being unable to get pregnant right away does not mean it's impossible! Fertility specialists deal with these issues every day. You deserve our expertise. Remember, family doctors and other providers may not have up-to-date training on fertility issues, so if a consultation with your usual doctor hasn't gotten you results, it's time to come see us.