Fertility Concerns

Maximizing Pregnancy Rates
If you are healthy, have no fertility problems, and want to conceive a baby, you can dramatically improve your chances of becoming pregnant by tracking when you ovulate and having sex near this time. There are several tools available to help you determine the appropriate time to have sex each month.

Timing Sex
The first and easiest step to improving your chances of getting pregnant is to chart your menstrual cycle so that you can have sexual intercourse as close as possible to ovulation. Begin by keeping track of the intervals between day one of your period and day one of your next period. The number of days between the first days of each of your periods is known as your cycle interval.

Once you know your cycle interval, subtract 14 from that number to determine when in your cycle you will likely ovulate. For example, if you have a typical 28-day cycle, by subtracting 14 from 28 you can feel confident that you ovulate around the 14th day of each cycle.

To increase your chances of getting pregnant, have sex every other day around the day you ovulate. For example, if you are on a 28-day cycle, you should have sex on days 10, 12, 14, 16, and 18 of your cycle to maximize your chance of pregnancy. Because sperm can live two to three days, this every other day approach helps to ensure that sperm will be available when eggs are released at ovulation.

There are web sites such as www.webmd.com and www.BabyCenter.com that will help you calculate the day within your cycle when ovulation occurs.

Using Your Basal Body Temperature
If you are not sure if you are ovulating, charting your morning temperature can help you determine if and when ovulation occurs. Simply take your temperature before you get out of bed each morning and plot it on a chart. When you see a shift of at least 0.4 degrees Fahrenheit, you know that ovulation occurred. Most women have a lower body temperature right before ovulation and a higher body temperature right after ovulation.

Because the basal body temperature method can only tell you after the fact that ovulation occurred, it is not an optimum way to maximize your chances of pregnancy. It is, however, useful over the long-term for understanding when you ovulate so you can determine the optimum time for having intercourse.

Ovulation Predictor Kits
Ovulation predictor kits test your urine for signs of those hormones that indicate that ovulation is about to occur. These kits usually detect levels of lutenizing hormone (LH), which triggers ovulation and generally rises 12 to 36 hours before you ovulate.

To increase your chances of pregnancy, have sex every other day around the day you ovulate.

To properly use ovulation predictor kits, you should start testing your urine three days before you think you ovulate. For example, if you think you have a 28-day cycle, you ovulate on day 14 so you should begin testing your urine on day 11 of your cycle. This approach allows you to clearly see a negative result, indicating the lack of LH, and then clearly see a positive result, indicating the presence of LH. You should ovulate about 36 hours after a positive test result. To improve your chance of getting pregnant, you should have intercourse the day that you see a positive result as well as the day after a positive result.

There are also ovulation predictor kits that test saliva rather than urine. These kits include a glass slide and a microscope that allow you to look for a certain visible pattern in your saliva sample that indicates you will ovulate within the next several days. While these tests are not as accurate as those ovulation predictor kits that test urine, they are less costly and reusable.

According to the National Center for Health Statistics, you have a 96% chance of conceiving within one year if you're under 25; an 86% chance if you're between 25 and 34; and a 78% chance if you're between the ages of 35 and 44.

Do-It-Yourself Semen Analysis
Many drugstores now sell male infertility tests that help measure sperm concentration. While the test does not provide the same specific information indicated by a medical semen analysis, it can tell if the minimum number of motile sperm is present. These tests are useful for helping couples identify if there are problems with the male partner's fertility so that they can seek professional treatment early in their quest to become pregnant.

Testing for Infertility
Infertility occurs when a couple is unable to conceive after 12 months of having intercourse without the use of birth control. The male partner, the female partner, or both partners may have a problem with their fertility. Men and women are equally likely to have fertility problems.

In men, the most common reasons for infertility are sperm disorders such as low sperm count, low sperm motility, malformed sperm, and blocked sperm ducts. The main causes of infertility in women are anovulation, or lack of ovulation, and the inability of the fallopian tubes to carry eggs from the ovary to the uterus.

It is generally recommended that you have an infertility evaluation after you have tried unsuccessfully to become pregnant for 12 months or more. In cases, where the female partner is over 35, it is recommended that you have an infertility evaluation after 6 months of unprotected sex. The infertility evaluation will determine the reasons you have been unable to conceive so that a treatment plan can be developed.

The Basic Infertility Workup
If you have not been able to conceive after 12 months of having sex without the use of birth control, you may want to have an infertility evaluation.

Since men and women are equally likely to have fertility problems, the infertility evaluation includes both partners. The basic infertility workup includes:

• Physical exam for both partners

• Medical history of both partners

• Semen analysis

• Check for ovulation

• Tests to check for a normal uterus and open fallopian tubes

• Discussion of how often and when you have sexual intercourse.

Testing for the Male Partner
A semen analysis is a key part of the basic infertility workup. This analysis may need to be done more than once. The semen sample is obtained by masturbation. Sometimes the semen sample can be obtained at home, other times it is obtained in a lab. Your doctor will give you instructions and make sure you feel as comfortable as possible about the semen analysis.

The semen sample is sent to a lab, where it is analyzed for:

• The number of semen present

• The shape of the semen

• The movement of the semen

• Any signs of infection.

If any potential problems with the urinary tract are found, the male partner most likely will be referred to a urologist for further testing.

Testing for the Female Partner
For the female partner, the infertility evaluation begins with a physical exam and a comprehensive health history. The health history will focus on four key points:

• Menstrual function, such as irregular bleeding or pain

• Pregnancy history

• Sexually transmitted disease (STD) history

• Birth control.

Another important part of the evaluation is determining whether or not and when you are ovulating. Here are some of the tests that may be performed:

• Urine test: This test is performed at home and indicates if ovulation is about to occur.

• Basal body temperature: You take your temperature every morning before you get out of bed and record it on a chart. Keeping this body temperature chart for two to three menstrual cycles will show whether or not you are ovulating.

• Blood test: The blood test measures progesterone, which can indicate whether or not you are ovulating.

• Endometrial biopsy: Because the lining of the uterus changes during ovulation, analyzing sample tissue from the uterus can determine if ovulation occurs.

Infertility can often be treated with lifestyle changes, medication, surgery, or assisted reproductive technologies. The treatment recommended depends on the cause of your infertility.

Other tests may be used to examine your reproductive organs. These tests check the appearance of your uterus and determine if your fallopian tubes are open. Your individual circumstances and symptoms determine which of these tests are performed.

• Hysterosalpingography (HSG): This test is an x-ray that shows the inside of your uterus and fallopian tubes. A small amount if dye is placed in the uterus through a thin tube inserted through the cervix. An x-ray is then taken.

• Transvaginal Ultrasound: A device is inserted in the vagina that uses ultrasound waves to produce images of your ovaries and uterus.

• Hysteroscopy: A thin telescope-like device is placed through the cervix. The inside of your uterus may be filled with a harmless gas or liquid so that the doctor can correct any problems and obtain a tissue sample if needed.

• Laparoscopy: A small telescope-like device is inserted through a small cut at the lower edge of the navel. The doctor looks for pelvic problems in the fallopian tubes, ovaries, and uterus.

Treating Infertility
Infertility is a condition in which a couple has been unable to get pregnant after 12 months of having sex without using any form of birth control. Before being treated for infertility, a couple needs to be evaluated by a doctor to pinpoint the cause of their infertility. The type of treatment you receive depends on the cause or causes of your infertility.

Infertility may be caused by a problem with the woman, the man, the couple, or your lifestyle. Infertility can be caused by more than one factor. In some cases, the cause of infertility cannot be identified.

To treat infertility, your doctor may recommend lifestyle changes, medication, surgery, or assisted reproductive technologies. In some cases, treatments may be combined to improve results. For example, medication and insemination may be used at the same time.

Whether infertility lies with one or both partners, a number of treatment options can be considered. Before you begin treatment for infertility, talk with your doctor about the expected success rates for each treatment and how success is defined. Also talk with your doctor about the cost of each treatment and whether or not it is covered by insurance.

The Centers for Disease Control and Prevention (CDC) lists the success rates for most fertility clinics in the United States on their web site: www.cdc.gov.

Ovulation Induction
If your infertility evaluation determines that you have a problem with ovulation, you may be given medication to cause ovulation or to cause more eggs to be released at ovulation. Most women who take ovulation induction medication begin to ovulate regularly. If there are no other problems, more than half of these women become pregnant within 6 treatment cycles. In some cases, the ovulation medication results in a multiple pregnancy.

Surgery
Infertility affects about 15% of the couples in the United States.

Sometimes, surgery can correct the problem that has been causing infertility. If your fallopian tubes are blocked, surgery may be done to open the tubes. Surgery may also be performed to:

• Remove growths such as uterine fibroids or polyps

• Remove scarring from a previous surgery, infection, or endometriosis

• Treat endometriosis.

Surgery can also sometimes be used to correct a problem with the male partner's sperm. The success of this kind of surgery depends on the type and extent of the problem.

Lifestyle changes such as losing or gaining weight, increasing or decreasing exercise, stopping smoking, or changing when and how often you have sex may help increase your chances of becoming pregnant.

Assisted Reproductive Technologies
Assisted reproductive technologies (ART) involve medically processing human eggs or sperm or both to help an infertile couple conceive a child. This process is done in a laboratory. Sometimes, ART treatment uses donor eggs or donor sperm. The sperm may also be obtained through masturbation or with a special condom that is used during intercourse. In some cases, sperm may be obtained surgically.

Here are some of the assisted reproductive technologies that can be used by couples trying to conceive.

With insemination, sperm is placed in your uterus by means other than sexual intercourse. In most cases, the sperm are treated in a lab to decrease the risk of infections and to increase the chance of fertilization. Around the time you ovulate, the sperm are placed into your uterus by your doctor. The sperm can be supplied by your partner or by a donor, whose sperm is frozen and checked for certain genetic disorders and sexually transmitted diseases.

When In Vitro Fertilization (IVF) is used, sperm from the male partner are used to fertilize your eggs in a lab. Eggs are removed from your ovary just before ovulation. In most cases, medication is given to cause more than one egg to mature. Your eggs are removed with a needle that is inserted through your vagina. Either your partner's or a donor's sperm can be used for IVF.

The eggs are combined with healthy sperm and watched in the lab to see if they become fertilized. One or more of the fertilized eggs (embryos) are placed in your uterus. This process is called embryo transfer. Your unused fertilized eggs can be frozen and stored for later us.

The success rate of IVF depends on the woman's age and the reason for the infertility. Multiple pregnancy is possible with this method.

You and your partner should give careful thought to all your options. Sometimes counseling can help you sort out your feelings and help you and your partner decide what option is right for you.

If there is a problem with the male partner's sperm, a procedure known as Intracytoplasmic Sperm Injection (ICSI) is performed. Healthy sperm are removed from the man's semen and your eggs are retrieved. The sperm may be obtained though masturbation or by using a special condom during intercourse. In some cases, sperm are obtained through sperm aspiration or testicular biopsy.

In the lab, one sperm is injected into each egg's center. The eggs are checked later to see if they have fertilized. Fertilized eggs (embryos) are placed in your uterus to grow. Any unused fertilized eggs can be frozen for later use. Pregnancy rates with ICSI are about the same as with IVF.