By Patricia K. McLelland, M.D.
Infertility is a common problem in the United States. One reason why we see more couples having issues with infertility is because women are delaying child bearing. Another factor may be obesity because it causes an imbalance in a woman's hormones which results in irregular periods. Infertility is defined as the inability to get pregnant after trying for 12 months. Approximately 15 percent of couples are infertile.
Most healthy young couples in their 20s have about a 20-25 percent chance of getting pregnant with each menstrual cycle. The chances of getting pregnant start declining in our late twenties and thirties. At age 35 the chance of getting pregnant with each cycle is around 15 percent. Being healthy is very important however it does not offset the natural age related decline in fertility.
The process of getting pregnant is complex and so the cause or causes of infertility may include one or both partners. The male partner contributes to or is the sole cause of infertility in 40 percent of couples. Problems with ovulation (production of the egg) in the woman contribute to infertility 20 percent of the time. Less often, women may have scarring of their tubes or endometriosis (when the lining of the uterus implants in the abdomen and can cause scarring). About 25-30 percent of cases of infertility are unexplained.
Typically, evaluation for infertility is initiated after one year of trying to get pregnant without success. However if the couple is concerned, if the woman is over 35 or there are obvious medical problems that affect fertility, the evaluation should begin immediately.
Evaluation includes a careful medical history and physical exam focusing on problems associated with fertility, for example, previous pregnancies, no periods or irregular periods, history of sexually transmitted diseases such as gonorrhea, Chlamydia and pelvic inflammatory disease (PID). Tests that are often ordered include a semen analysis (SA), the semen analysis evaluates the number and quality of the sperm. The SA is not completely predictive of infertility because men with low sperm counts can still father a child. In the female partner, ovulation is confirmed, if ovulation is not occurring, the most common causes are abnormal thyroid function, high levels of prolactin (hormone that causes the production of breast milk), premature menopause and obesity. If there is concern that the woman's tubes are scarred, a test called a hysterosalpingogram (HSG) will be performed.
Treatment may include medications, surgery or assisted reproductive technology (ART) which includes in vitro fertilization. Fortunately, two-thirds of couples become pregnant with assistance. Often the couple's general health and lifestyle can contribute to infertility. Typical recommendations along with specific treatments include moderate exercise and a healthy, well-balanced diet. Other recommendations include quitting cigarette smoking, street drugs and alcohol, limit medications if possible, avoid extremes of weight (obesity as well as being underweight) and decrease stress. Infertility is not often a problem caused by stress however stress can affect hormone production. Going through infertility is often very difficult for a couple; often they will experience anger, depression, jealousy and strain on their relationship. Fortunately, doctors are more in tune with these stressors and are helping couples deal with them more effectively.
Even though infertility seems to be more common, research is improving our understanding of causes and treatments. Fortunately avoiding known risk factors, having a healthy lifestyle and using appropriate treatments can help many couples to get pregnant.
Patricia McLelland, MD, board certified in obstetrics, and gynecology, is currently a practicing physician at Galen OB/GYN in East Brainerd, TN. She received her medical degree in 1994 from the Vanderbilt University School of Medicine in Nashville, TN. She has been a member of the Chattanooga & Hamilton County Medical Society since 2004. She can be reached at 1651 Gunbarrel Road, Suite 201, (423) 899-9133.