Fertility
Fertility
What does an American woman in the 1990s do for a fertility rite? Well, she probably starts playing the numbers.
We''''re not talking lottery, here. No, the name of this "game" should be Calendo.
It involves using a yearly planner and a red pen. Circles get drawn around certain days, a particular month or a landmark year. Then a few whispered words or silent prayers are made for the circled dates to be the lucky pick.
Women who are actively trying to get pregnant focus on the days of the week: They count out 14 days since their last period and schedule sex. We have to do it on Thursday, they insist. Don''''t be late!
Others--waiting as long as possible before getting pregnant--find themselves counting the years. How many left before I turn 35? they ask. How much longer after that can I push it before my time runs out?
Either way, it can all feel like a gamble.
Conception Concepts
Fertility basically refers to our ability to conceive. That ability generally begins shortly after we get our first period--which on the average happens around the age of 12. Fertility lasts until our periods cease at menopause, which usually occurs around age 51.
While that makes it sound like we have 40 years of time to get pregnant, we actually have less. That''''s because women are not fertile on every day of the month, every month of the year. Instead, an egg can be fertilized 12 to 72 hours after it''''s released. That really adds up to about 4 years of fertility.
When are those fertile days? It all has to do with your menstrual cycle. In the first half of your cycle, your brain signals your body to release hormones, triggering eggs in your ovaries to start growing. One egg will go on to develop fully and be released by the ovary in the process known as ovulation. Some theories suggest that when this egg is released--usually midway through your cycle, about 14 days after the start of your last period--that''''s when you are fertile.
There are other theories, however, that suggest your fertile time ends with ovulation. One study found that pregnancies occurred when intercourse took place--within six days prior to ovulation. "The data indicates that sperm can live in the reproductive tract three to five days prior to conception," says Allen Wilcox, M.D., Ph.D., chief of epidemiology at the National Institute of Environmental Health Sciences in Research Triangle Park, North Carolina, and investigator in this study. He found that after ovulation there''''s a drop in the probability of pregnancy. According to Dr. Wilcox, this may be because the egg lives for a short time after ovulation, or because a change in the cervical mucus after ovulation prevents the passage of new sperm.
For conception to occur, the egg must be released, but it also must travel into the fallopian tube. If the egg encounters a sperm there while the egg is still alive, and if the sperm is able to penetrate the egg, conception takes place. Then the fertilized egg has to travel down the fallopian tubes and into the uterus, where it implants in the uterine lining.
So fertility basically requires several things: Your ovaries must produce healthy eggs, your partner''''s sperm must be healthy and able to reach and fertilize an egg, the fallopian tubes must be clear so that sperm can reach an egg and the sperm must reach an egg in time.
The Big Threats
Given the intricate timing involved in making babies, the last thing you want to do is throw anything into the equation that''''s going to make it harder for you to get pregnant.
Every woman should be aware of the significant threat to fertility posed by sexually transmitted diseases (STDs), says Randall Barnes, M.D., chief of reproductive endocrinology and fertility at the University of Chicago. He points to chlamydia and gonorrhea as major threats--both diseases that can migrate into the upper reproductive tract to cause damage.
Time (read "aging") can pose another challenge to your fertility. Basically, the older you get, the less fertile you become. This is true more so for women than men because, as we all know, our fertility tapers off more dramatically at an earlier age. What many women don''''t realize, however, is how sharply fertility can decline before menopause.
In women there is a slight decline in fertility between the ages of 25 and 35. "The decline is sharper after 35 and then falls off precipitously after 40," says Dr. Barnes. About a decade later (for most women), menopause puts an end to menstrual cycles and with them, our fertility.
While on the average women go through menopause at age 51, some women have premature menopause putting an unexpected halt to their childbearing years. Premature menopause can occur as early as the late twenties or early thirties.
Here''''s what you can do to safeguard your fertility.
Fend off invaders. One of the main things you can do to preserve fertility is purely preventive. Avoid getting sexually transmitted diseases, advises Dr. Barnes. Being monogamous, using condoms and having yourself and your partner tested for STDs are all things you can do to keep STDs from taking a toll.
Don''''t wait too long. While women certainly shouldn''''t rush to conceive before they''''re ready to take on the demands of parenthood, doctors urge us not to wait too long. If you know that you want to get pregnant and have a baby, it''''s probably best to get started before the age of 35, says Dr. Barnes. Certainly try to do it before 40, he advises.
Talk to Mom. To figure out when you''''re likely to go through menopause, check with your mother. Women tend to go through menopause around the same age that their moms did, says Dr. Barnes.
If your mother went through menopause early, then you may be at greater risk of doing that too, he says. If she''''s in her mid or late forties and still hasn''''t gone through menopause, or if she had it around the average age of 51, then you''''re less likely to have premature menopause.
Don''''t fear the Pill. "Taking the Pill does not make you infertile," says Dr. Barnes. It may take a few months for you to start ovulating again after you stop Pill use, but generally, ovulation will resume, and you''''ll be able to get pregnant.
Understand the IUD. While doctors deem the intrauterine device (IUD) safe and effective for women in disease-free, monogamous relationships, the method can be risky for women who are at risk for sexually transmitted diseases.
If you are exposed to an STD, the IUD may help bacteria travel up into the uterus and fallopian tubes where they can cause damage, says Dr. Barnes.
Go clean. Give up those cigarettes, experts say. Kicking the cigarette habit is really important, because nicotine can be poisonous to sperm, and high quantities of it have been found in the cervical mucus of women who smoke.
When Trouble Strikes
Maybe you''''ve been trying to get pregnant but haven''''t been having any luck. Does that mean you''''re infertile?
If you''''ve been having unprotected intercourse for over a year and haven''''t conceived, doctors would say that the answer is yes, as a couple, the two of you are infertile. That doesn''''t necessarily mean that you won''''t or can''''t get pregnant, but if you want that to happen, you''''ll probably have to identify the cause of infertility. Often tests can determine whether the cause lies with you, with your partner or with both of you. But sometimes the cause remains unknown, even after medical testing.
| Spare the Stressand Start the Child We''''ve all heard the stories. A woman tries over and over--unsuccessfully--to get pregnant. Then she quits her job. Bam! Child on the way. What''''s going on here? "Scientifically and medically, it has been demonstrated beyond doubt that stress can be a cause of infertility," says Reed Moskowitz, M.D., medical director of the Stress Disorders Services at New York University Medical Center in New York City. Studies show that high levels of emotional stress can contribute to infertility through several mechanisms, says Dr. Moskowitz. In addition to causing hormonal changes and irregular ovulation, stress can cause fallopian tubes to spasm as well as disrupt the implantation process of a fertilized egg, he says. Doctors can''''t find a specific medical cause for infertility in about 10 percent of women who have it, says Dr. Moskowitz. But between one-third and one-half of the women with "unexplained infertility" will be able to get pregnant if the stress in their lives is removed. Some simple and effective techniques that women can use help decrease their stress, says Dr. Moskowitz. Here''''s what he recommends. Recognize it. The first step is to become aware of your stress, says Dr. Moskowitz. First, heighten your awareness physically by doing a body scan. With your mental focus move down your body and ask yourself, "Where do I feel tension? In my neck? In my abdomen?" Once you''''ve identified the physical area, focus on "letting go" there to release the built-up tension. Then think back, reviewing the nature of the emotions you felt throughout the day. Are they negative or positive? If they are negative, what triggers them? When you''''ve identified the triggers, it then becomes easier to deal with them. Relax your body. You can work on physical relaxation by doing some deep-breathing exercises or yoga, says Dr. Moskowitz. For deep breathing, simply lie down on a couch, rest one hand on your abdomen and begin breathing slowly and deeply in and out, he says. You should see your hand rise and fall. Visualize the calm. Try using visualization, says Dr. Moskowitz. Take a few minutes each day to visualize a calm scene--maybe the beach, the mountains or the countryside. Visualize a scene that is relaxing and try to get into it with all your senses. See a mind-body specialist. "If a woman gets diagnosed as having unexplained infertility, then that should cause a lightbulb to go off: This might be a stress-related problem," says Dr. Moskowitz. You should ask your doctor to refer you to a stress specialist. |
Doctors estimate that 30 percent of infertility cases are attributed to the woman, 30 percent are attributed to the man, and 30 percent are from some combination of the two. The remaining 10 percent are unexplainable.
Helping the Hormones
If you''''re having trouble getting pregnant, maybe it''''s because you''''re not ovulating. That happens in about 30 percent of infertile women. Producing and releasing a mature egg requires signals from the brain to the ovaries to produce estrogen and progesterone hormones. Insufficient amounts of these hormones can cause a breakdown in the chain of command, and ovulation can be foiled.
| How They Inject Some New Life A time may come when your doctor recommends moving on to high-tech assisted reproduction methods. Here are some of the options. In vitro fertilization (IVF). Eggs and sperm are united in a petri dish and incubated until fertilization takes place. The fertilized egg is then transferred into the uterus for implantation. Zygote intrafallopian transfer (ZIFT). Again, the eggs and sperm go into a petri dish. Once an egg is fertilized, it''''s moved into the fallopian tube. From there it travels down to the uterus. This technique may enhance the chances of implantation. Gamete intrafallopian transfer (GIFT). Eggs are removed from the woman, sperm from the man and the doctor places them directly in the fallopian tube. If the sperm penetrates the egg in the tube, the fertilized egg will then move down to implant in the uterus. Subzonal sperm injection. Doctors use a thin needle to inject a single sperm just under the outer layer of the egg. This procedure begins in a petri dish, and the fertilized egg is then transferred into the uterus. Introcytoplasmic sperm injection (ICSI). This is the same as subzonal sperm injection, except the sperm is injected deeper--into the middle of the egg cell, rather than just beneath the surface. |
Your doctor can test to see if you are ovulating by giving you a basal body temperature (BBT) test and thorough blood tests. During the BBT test you track your body temperature across your menstrual cycle. The blood tests help your doctor assess whether or not your body has the hormone levels necessary to trigger ovulation.
If you''''re not ovulating because of inadequate hormone levels, most likely your doctor will try treating you with some drugs--such as clomiphene citrate (Serophene)--that help induce ovulation. The drugs basically trick your body into producing more of the hormones needed to stimulate the ovaries. If those drugs don''''t work, your doctor will probably recommend some other, stronger drugs aimed at inducing ovulation.
Fallopian Troubles?
Another trouble spot could be your fallopian tubes. They might be damaged or blocked, which appears to be the cause in about 50 percent of infertile women.
Damage can be the result of pelvic inflammatory disease that developed when STDs such as gonorrhea and chlamydia migrated up into the fallopian tubes, says Cheryl Walker, M.D., assistant professor of obstetrics and gynecology at the University of California, Irvine. When this type of infection invades, the tubes become damaged or blocked, making it impossible for a sperm to reach an egg and fertilize it or for a fertilized egg to travel down into the uterus and implant.
Fallopian tubes can also be affected by endometriosis, a disease in which tissue similar to the lining of the uterus is located outside the uterus. This growth can cause infertility by interfering with the natural movement of the ovaries and fallopian tubes, says Paula Bernstein, M.D., Ph.D., attending physician at Cedars Sinai Medical Center in Los Angeles.
Your doctor can check out the condition of your fallopian tubes with a test called hysterosalpingography, says Dr. Barnes. Dye is injected through the cervix, and from there it travels up into the uterus and fallopian tubes. The doctor then takes an x-ray of the fallopian tubes, enabling her to see whether the tubes are blocked or free. Sometimes surgery can clear the tubes.
Occasionally, there''''s trouble in the uterus. Some women can have fibroids--benign tumors that poke into the cavity of the uterus, says Dr. Barnes. Or infertility could be associated with an infection of the uterus called endometritis, or even endometrial cancer. All of these uterine conditions can interfere with a fertilized egg''''s ability to implant in the uterine wall. For some women, doctors recommend surgery to correct the problem.
Or the culprit behind infertility could be the immune system. By mistake, the bodies of some women react to sperm as if they were unwelcome invaders. If your body produces antibodies to attack the sperm, they obviously don''''t have much of a chance. Your doctor can tell if you are producing these antibodies through blood tests and may recommend some other conception method if this is what''''s going on.
Sometimes the reason you can''''t get pregnant has to do with your partner''''s sperm rather than your own reproductive system. Most infertile men have a low sperm count, says Dr. Barnes. If your man has enough sperm, the problem may be that the sperm aren''''t shaped properly or that they don''''t swim fast enough to reach the egg in time.
What You Two Can Do
If you think that you or your husband may be infertile, here''''s what you can do.
See a specialist. If you''''ve been trying unsuccessfully for a year to get pregnant, it may be time to see an infertility specialist. Look for a doctor who is board certified in obstetrics and gynecology, reproductive endocrinology or urology. You can also ask if the doctor specializes in fertility and is a member of the American Fertility Society.
Other things to find out are the doctor''''s hospital affiliation, how many infertile couples she has treated and what her overall success rate is for live births. If you''''re to the point where you are considering using high-tech methods to conceive, look for a center or institution that is registered in the Society of Assisted Reproductive Technology, says Dr. Barnes. For a list of registered clinics in your area, write to the American Society for Reproductive Medicine, 1209 Montgomery Highway, Birmingham, AL, 35216.
Don''''t go it alone. "I encourage people to use support groups," says Dr. Barnes. For some women and men the groups can be very helpful. To locate an infertility support group in your area, contact RESOLVE at the RESOLVE National Office, 1310 Broadway, Somerville, MA 02144-1731.
See also Menopause, Reproductive System, Sexually Transmitted Diseases
