Infertility
Not being able to get pregnant, or not being able to carry a pregnancy to term is very difficult for most couples. There is the physical, psychological and financial stress of infertility testing and treatments. HMOs may or may not pay for infertility testing or treatment. There is the stress on the couples' relationship as they undergo testing and face the diasappointment of not getting pregnant.
We consider a couple infertile if they have been unable to achieve pregnancy in 12 months of having sex without using any birth control. This is a fairly common problem; about 14% of couples in the United States are considered infertile.
In order for a pregnancy to result, the woman must release an egg (ovulate) and the man must release an adequate number of well-formed, well-moving sperm. The egg and sperm must meet in the fallopian tube, and then implant in a uterus which has the proper hormonal environment. Causes of infertility may be related to problems in the woman, problems in the man, problems with both partners, or unknown causes. Testing of you and your partner will be undertaken in order to determine if there are problems which might be treatable.
Infertility in the woman may be due to
* hormone problems which prevent ovulation or prevent implantation of the fertilized egg in the uterus
* physical problems such as scarring of the tubes due to pelvic infections or endometriosis
* genetic problems such as Turner's syndrome
* congenital abnormalities of the uterus or cervix
* being overweight which can prevent normal ovulaton
* abnormalities in the cervical mucus
* production of antibodies which attack the sperm
* smoking, alcohol or marijuana use
* thyroid disease, diabetes, or tumors of the pituitary gland
Infertility in the man may be due to
* sexually transmitted diseases
* varicose veins of the scrotum
* fevers or infections such as mumps which may have damaged the testes
* medications used to treat high blood pressure or diabetes
* hormonal problems
* high temperatures affecting sperm production; this may be work related or due to wearing tight underwear
* use of alcohol, cigarettes or marijuana
* low sperm count, or abnormal sperm motility
Tests which might be done (not all tests are done in all couples)
* basal body temperature or ovulation predictor kits to see if the woman is ovulating
* semen analysis to determine if the male partner is producing normal sperm
* post coital test to evaluate whether the sperm are able to move through the cervical mucus
* hysterosalpingogram to see if the woman's tubes are open
* progesterone test to see if a woman is ovulating
* endometrial biopsy to determine if the uterus has responded to the hormonal effects of ovulation
We have provided a collection of internet links which address each of these issues in depth; in addition, the issues of assisted reproductive technology (ART) such as in-vitro fertilization, ovulation induction, and artificial insemination are discussed.
We know this is an overwhelming and stressful time for you. Please don't hesitate to come to us with your questions and concerns. Our goal is a healthy pregnancy for you.