Understanding Infertility By Todd A.

Hoover, MD, DHt In the United States, approximately 12% of all women have some impairment in their ability to become pregnant, and over 7 million have consulted fertility specialists for this problem.i This number rises to over 16% for married women who are currently childless and having difficulty getting pregnant. Because the process of producing an egg in a woman and having fertilization of the egg by a mans sperm is so complicated, there are many potential causes of infertility. The source of the problem may be either with the man or with the woman. Male infertility is easier to evaluate, and if you are undertaking a fertility evaluation, many experts suggest that you should start with the male partner. The basic test is a sperm count and examination for quality. If the sperm are functioning well and are adequate in numbers, then the problem most likely is either with the timing of intercourse or some issue with the female partner. Causes of female infertility can be broken out into several groups: 1. 2. 3. 4. Blockage of the movement of the egg from the ovary to the womb (uterus). Hormonal problems stopping normal egg production Genetic factors Environmental factors

The female anatomy of reproductive organs includes the ovary where eggs are produced, the womb or uterus lined by the endometrium where the egg is implanted to grow, and the fallopian tubes which connect the ovary to the uterus. Blockage of the fallopian tubes is a common cause of infertility. This blockage can be caused by: Infection (called pelvic inflammatory disease or PID) Endometriosis (a condition where menstrual tissue gets misplaced into the tubes and causes cysts and scarring) Ectopic pregnancy where an egg gets implanted in the tube instead of the womb (usually requiring surgery) Scarring from abdominal surgery of any kind Birth defects where the uterus or tubes were not normally formed Polyps or benign tumors (fibroids) of the uterus Mucus in the opening of the uterus that is too thick or inadequate in amount

Hormonal problems are a complicated matter. The brain, the pituitary gland, the adrenal glands, and the ovaries all get involved in the egg development process. Any imbalance in hormones or signals produced in these glands can cause failure of eggs to be released from the ovary. These are called anovulatory menstrual cycles. Anovulatory cycles tend to be either too short or too long, with menstrual bleeding that may be abnormal in amount or duration.

Genes carry information for every part of our bodies from our hair color to our blood type. Our genes are carried on chromosomes in every cell of the body. When eggs are made, these genes and chromosomes are shuffled in a very complicated process that results in unique combinations of genes that are like our parents, but not exactly like them. (Otherwise we would all be carbon copies or clones of each other). When eggs are produced, the genetic shuffling process can make mistakes resulting in a chromosome or gene pattern that is not compatible with life. This tends to be more common in women over the age of 40 years. If many eggs are produced in this way, pregnancy may happen, but the tiny embryo will not survive. Certain environmental factors can also affect the menstrual cycle, the ability to produce viable eggs, and the ability to have normal fertilization of the eggs. Poor diet, lack of exercise, drug and alcohol use, and smoking may all lower the likelihood that you will become pregnant. Stress has also been associated with infertility. Getting pregnant is a complicated process. Most of the time all that is required is a little patience and the right timing. If you have been trying to get pregnant without success for 12 months or more, you should consider a consultation with a fertility expert. Standard infertility evaluation can be a long and complicated process. If the problem is primarily due to a blockage of the female anatomy, you may eventually need to consider surgery to correct the issue. Most of the time the problem is due to hormonal imbalance or a combination of hormonal and lifestyle issues. Conventional approaches usually involve taking certain hormones that can stimulate the release of many eggs at one time. The hope here is that at least one of the eggs will be successful when you try to get pregnant during that cycle. In Vitro fertilization involves taking eggs from your body, and then combining them with sperm in the laboratory, and then harvesting any newly formed embryos (that are just being formed) to implant them back into your womb. This process can be complicated and expensive to undertake, but there have been many successful results. You might also consider one of the complementary medical disciplines. Many integrative medicine specialists report success in treating infertility. Acupuncture and homeopathic medicine particularly are used to help balance the body and promote a healthier functioning of your system. The notion here is that as your stress is decreased, and your become more balanced in your health, your hormonal function will be better regulated leading to a greater possibility for normal release of eggs. These approaches are less likely to be helpful if there is scarring or complete blockage of the fallopian tubes. While they tend to be very safe, and some research has been done to show they may be helpful, more research is still needed to know how effective they may be. More information on these types of treatment can be found in the wellness section. If you are facing the difficult process of infertility evaluation, consider consulting one of our wellness experts or wellness coaches through the wellness portal. You may find the unbiased support of these experts to be of considerable value as you work your way through the often complicated process of fertility evaluation.

A. Chandra, G.M. Martinez, W.D. Mosher, J.C. Abma, and J. Jones. Fertility, family planning, and reproductive health of U.S. women: Data from the 2002 National Survey of Family Growth. National Center for Health Statistics. Vital Health Statistics 23(25). 2005.
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