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Fertility Problems

The Biological Clock

The ovaries have a lifetime supply of egg follicles from birth. These ripen into eggs, which can be fertilized to produce pregnancy. By age 30, the eggs have been present for some time. In problems of fertility, the quality of the egg is critical. Therefore, the woman’s age becomes a very important factor.

Age co-factors also include: less frequent ovulation and less regular periods by the late 30s and 40s. The older the woman, the greater the risk of exposure to tubal obstruction. If pregnancy occurs, there is a higher risk of spontaneous abortion. It can be seen that a woman’s reproductive life has a limited time span.

Keep in mind that fertility data are averages only. No woman can consider that she is too old to conceive until her menopause is complete.

The risk of birth defects rises with increasing years. Down’s Syndrome, a chromosome disorder, which affects the mental and physical abilities of the baby, is the most common female age-related defect. It occurs:

  • 1 out of 365 births at age 35
  • 1 out of 109 births at age 40
  • 1 out of 32 births at age 45
  • 1 out of 12 births at age 49

The risk of men age 40 plus passing on birth defects was estimated at 3 per 1,000. Recent findings seem to suggest that it could be higher. Researchers now understand that sperm in men of all ages are more likely to cause birth defects than was previously thought.

The Timing Factor

Timing for the optimum chance of fertilization is critical. Once the egg is in the oviduct, it only remains viable for the next 12 to 24 hours. It must be fertilized during this time. Sperm only remain viable for a maximum of 48 hours. It is essential to know the precise date of ovulation to maximize the optimum chance of fertilization.

Ovulation predictor tests are commercial kits that can be obtained from a local pharmacy. They are inexpensive, simple to use, and accurate. They measure the surge of LH hormones which trigger ovulation. By frequent testing of urine samples and charting the results, the actual time of ovulation can be worked out.

Transvaginal ultrasound is the new high-tech method to detect the time of ovulation. The probe is placed in the vagina, and shows the ovaries with their developing follicles on a monitoring screen. Ultrasound to detect ovulation is costly. Older women may choose this method if the sands of time are running against them. By comparison, charting the vagina temperature, the cervical mucus, and so on, come a poor third. Ovulation is a major factor in female fertility. Know the time of ovulation.

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Fertility Problems

Seeking Donation

  • Sperm Donation: If the man cannot provide sperm, the couple can use a sperm bank. The sperm are put into the vagina via a catheter, and make their way up to the oviducts. The donor, often a medical student, is anonymous. This method is called Artificial Insemination by a Donor (AID).
  • Egg Donation: If the woman cannot provide eggs, the couple can seek an egg donated by a third person. This person may be a close friend of the couple, or a stranger. Her retrieved egg is placed in a culture dish, and there fertilized by the partner’s sperm. The embryo is then put into the woman’s uterus or tubes.
  • Embryo Donation: If neither egg nor sperm can be provided, the couple can seek help from a third woman and man. The woman donates her egg, and the man his sperm. These are retrieved and fertilized in a culture dish, and the embryo is transplanted into the woman.
  • Uterus Donation: A mother “loaned” her uterus to her daughter and became the first grandmother to bear her own children. The daughter had been born without a uterus, but she could provide an egg. This was retrieved and fertilized by sperm from the daughter’s husband in a culture dish. The resultant embryo was implanted in the mother who successfully gave birth to twins.
  • Surrogacy: If a woman has lost her uterus, another woman can provide hers for pregnancy and childbirth. This is somewhat different from the previous example, because the partner usually has intercourse with the other woman in order to impregnate her, and money is involved. The custody of some infants of surrogacy birth has been bitterly fought over in the law courts. Perhaps only in very close and loving families does surrogacy not prove to be a very tricky area of human choice
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Fertility Problems

Self-Help

The following are suggestions which can be helpful during the time of waiting for pregnancy to occur:

  • Know the time of ovulation, and the entire fertile period.
  • Check that love making is sufficiently frequent.
  • Avoid the “female superior” position; it allows the male ejaculate to spill out of the vagina.
  • The missionary position, man on top, is the most appropriate for fertility needs.
  • Avoid moving after ejaculation to allow the semen to pool in the fornix areas around the cervix.
  • Remain on the back for at least half an hour with the knees drawn up and a pillow under the hips.
  • Eschew the douche. The fluid can upset the ecology of the vagina and hence upset the motility of the sperm.
  • If lubrication is required, avoid the use of water-soluble jellies which can be spermicidal.
  • Eat a balanced diet, with fresh vegetables and fruits, low-fat proteins and unrefined grains.
  • Maintain a normal body weight. Avoid all crash diets and slimming programs.
  • Exercise in moderation. Exercise abuse upsets ovulation and causes irregular periods.
  • Avoid alcohol and marijuana. Both reduce sperm production and can affect the female reproductive system.
  • Avoid cigarettes. Couples who smoke have a significantly lower fertility rate than couples who do not.
  • Hot baths and jacuzzis affect sperm production. Avoid tight-fitting pants and jockey-type underwear. Keep the groin cool.
  • Relax. Stress is a factor in fertility problems.
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Fertility Problems

Frequency of love making

Ninety-two percent of couples can expect pregnancy to occur within 18 months of intercourse without contraception. If under age 25, some fertility experts recommend waiting between 18 months and a full two years. It is recommended that couples over age 25 visit a fertility clinic after unprotected intercourse for one full year.

Consider the following data from a study of fertile couples:

  • Of those who make love 3 times a week, 51 percent conceive within 6 months of trying.
  • Of those making love twice a week, 40 percent conceive within the first 6 months.
  • Of those who make love once a week, 32 percent conceive within the first 6 months.
  • Of those who make love less than once a week, only 16 percent conceive within the first 6 months.

Be sure that infrequent love making is not the problem.

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Fertility Problems

Fertility Problems

Problem Areas

Some women get pregnant very easily. Others believe it is a miracle when they finally conceive. Fertility problems are now regarded as “couple problems,” yet the breakdown between the genders is interesting.

Infertility can result from:

  • Male problems: 25 percent of couples
  • Female problems: 35 percent of couples
  • Female and male: 24 percent of couples
  • No known cause:16 percent of couples

Factors to be investigated include:

  • Man: Is the quality of sperm poor or good? (testicles)
  • Woman: Is a viable egg produced at midcycle? (ovaries)
  • Man: Are the sperm tubes unblocked? (epididymis & vas)
  • Woman: Are the egg tubes unblocked? (oviducts)
  • Woman: Is the uterus lining well-prepared? (endometrium)
  • Both: Are the sex hormones produced in proper balance?

However, many fertility problems are not really problems and can be resolved by the couples themselves. The first factors to consider do not involve medical intervention.

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Fertility Problems

Fertility Drugs

There are different kinds of fertility drugs to stimulate the ovaries. Each has advantages and disadvantages in terms of time, negative side effects, cost, and so on. Some are taken orally, others require shots. Still, others are delivered via a pump which is worn at the waist with a drip feed entering a vein in the arm; this allows for small doses to be slowly and steadily absorbed.

Fertility drugs work in various ways, usually on the pituitary and/or hypothalamus. They stimulate the ovaries in the early part of the cycle to produce more and better follicles. They are very effective; 80 to 90 percent of women will ovulate regularly on the 13th or 14th day. Where the only cause of infertility is poor ovulation, there is a very good chance of pregnancy.

In fact, fertility drugs stimulate the ovaries so successfully that more than one egg is produced. This results in the problem of multiple births. There is a 10 to 25 percent chance of twins and triplets; with higher numbers, some of the embryos die, and/or are severely retarded. Though fertility drugs do involve multiple births, further research may soon reduce this risk.

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Fertility Problems

Body Weight

Fat cells absorb and release the female hormone estrogen. In women who are overweight, estrogen is not only produced by the ovaries, but also from the extra fat cells in other parts of the body. This release of extra estrogen from extra fat cells upsets the fine balance of the feedback system between the pituitary hormones and estrogen. If the problem can be detected on the bathroom scales, reduce weight to within the normal range for age.

Overweight in men. Heat damages sperm production. In men who are overweight, an excess of flesh at the buttocks, inner thighs, and lower abdomen not only keeps the groin hot, it raises the temperature in the testicles. This reduces their ability to produce vigorous sperm. The testicles should be a few degrees below body heat; hence their cooler position outside the body. Wear loose cotton shorts, and reduce weight to within the normal range for age.

Underweight in women. Being underweight can also upset the feedback system between the hormones. A certain level of fat cells is necessary for hormone production. If body weight drops too low, ovulation can be suppressed. Some women athletes and long-distance runners have scanty or absent periods. Avoid crash diets. Avoid any slimming or exercise program which promises a sudden weight loss or one which drops the body weight below the minimum normal range. Increase carbohydrate consumption. Aim for an even body weight within the normal range for age.