Trying to Conceive

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Having issues trying to conceive can be a worrisome and confusing problem.  We want our customers to be well informed of the different causes of infertility so they can make appropriate choices.

What is Infertility?
Infertility is defined as a couples inability to conceive after one year of unprotected relationship. In women over 35, the time frame is shortened to six months.

A recent survey reported that 14% of American couples (28 million) have documented infertility. Approximately half of these patients seek fertility treatment and, most importantly, 85% will conceive with the appropriate treatment.

Causes of Infertility
The etiologies of infertility are complex and patients need to be evaluated by a reproductive endocrinologists, who is sub-specialized in evaluation and treatment of infertility. A thorough evaluation of both partners are required. Common causes of infertility include male factor 30%, ovulation and egg quality disorders 35%, pelvic adhesive disorders, endometriosis, fallopian tube disorders and uterine anomalies (25%), combined male and female causes (10%), and in 10% of infertile couples have unexplained infertility.

Causes for Female Infertility
Endocrine Problems
Are hormone imbalances preventing my pregnancy?
Your endocrine system of glands and the special hormonal secretions they produce has a deep effect on your reproductive health. From puberty to menopause, the constant current of biological chemicals controls the ebb and flow of menstruation, the production and release of fertile eggs, and the patterns of pregnancy. From the obvious gender-associated male and female hormones to the less obvious thyroid chemicals and the insulin most often associated with diabetes, fertility is shaped and regulated through endocrines. A failure or mistaken rhythm in your endocrine system can interfere with your ability to become pregnant or maintain a pregnancy to term.

This is true for men and women; however, a woman’s complex reproductive patterns, designed to ensure not only conception but the pregnancy to follow, are most often considered in cases of endocrine-related infertility. There is simply more to go wrong in the female reproductive system because it is asked to perform a wider range of functions. This is not to underrate the importance of male endocrinology. There are many cases in which men, as well as women, need hormonal therapy to reach their peak reproductive potential. However, the variety of endocrine problems facing women is substantial.

PCOS
Among the most common endocrine-related causes of infertility are polycystic ovary syndrome (PCOS), endometriosis, and interference from raised insulin levels in overweight or diabetic patients, fibroids, and failure to maintain a pregnancy. This wide assortment of infertility issues can often be treated with an array of therapies, some addressing underlying health issues, others focused on simple relief of symptoms.
Some of the symptoms of endocrine related infertility include, but are not limited to:

  • Irregular periods or complete lack of periods (amenorrhea).
  • Unusually light or heavy periods.
  • Painful menstruation.
  • Menstrual nausea and headaches.
  • Excess hair on the face or body (hirsutism).
  • Overweight or underweight.
  • Immune disorders.

Underlying problems can include endometrial cells growing outside the confines of the lining of the uterus, scarring and adhesions, polyps, cysts, swelling, and open lesions. Such problems can interfere with the ability of the ovaries to create and release mature eggs, and can block passage of the egg to the womb. Even when implantation occurs, endocrinal imbalances can cause miscarriages as the body fails to maintain the modified patterns of pregnancy. The power of endocrines to control the body’s systems can’t be underestimated.

Perimenopause and menopause are also endocrine-related forms of infertility. The arc of fertility from your teens to your late adulthood rises and then falls again as the production of reproductive hormones is reduced. While your fertility doctor can’t yet abolish the effects of time on your reproductive system and the endocrine system that sustains it, more and more often, actions can be taken to extend your fertile years far beyond the limits you would otherwise face. Even when there are no more eggs available for fertilization either naturally (in vivo) or in the laboratory (in vitro), the possibility of serving as a surrogate mother survives and opens up entire new possibilities for parenthood.

More information about Fertility Diagnosis and Testing.

What is healhty, normal fertility?
The male must produce a sufficient number of normal sperm, which are released from the male organ as an ejaculate. The sperm must be deposited in the female organ at the appropriate time during the menstrual cycle, when they can penetrate the cervical mucus, ascend through the uterus and fallopian tubes, and fertilize the egg. Read more about male fertility under Male Fertility Treatment.

The female must produce a healthy, mature egg which is released from the ovary. After release, the egg must travel down the fallopian tube so that it may be fertilized by the sperm. The fertilized egg then travels into the uterus and implants in the endometrium (the uterine lining) which will nourish its further development.

Disruption in any of these processes can lead to infertility. Egg development and ovulation are under the control of complex hormonal interactions including FSH, LH, Estradiol, Progesterone and others. Diseases of the thyroid, adrenal, pituitary, or hypothalamus glands can lead to ovulatory dysfunction. Additionally, conditions such as polycystic ovarian syndrome (PCOS) cause irregular or absent ovulation.

Blockage of the fallopian tubes can occur as a result of serious infection, congenital abnormalities, scarring from previous surgery, or endometriosis. Patients with significant tubal damage usually have the best chance of achieving pregnancy with IVF.
Endometriosis is a major cause of infertility and may be present with no symptoms. Some studies indicate that endometriosis decreases pregnancy rates even though there may be little visible organ damage.

Repeated Pregnancy Loss, Recurring Miscarriage
There are few more painful things a woman or her family can struggle with than repeated pregnancy loss, which is formally defined as three or more miscarriages. The agonizing roller coaster ride of physical and emotional highs and lows, and the grief of repeated spontaneous abortions and miscarriages, can take an inhuman toll on both body and spirit.

Fortunately, there are often possible treatments for repeated pregnancy loss. When an underlying cause of repeated pregnancy loss can be determined, the odds of carrying a healthy pregnancy to term rise dramatically. Your fertility doctor can help determine the tests and procedures necessary to improve your own chances.

There are several probable areas of difficulty you can expect your fertility doctor to consider along the way to a final diagnosis and choice of therapies. Though not a comprehensive list, these are the most probable:

• Endocrine imbalances
• Anatomical abnormalities
• Autoimmune factors
• Genetic defects

Endocrine imbalances occur when the glands of your body fail to maintain the correct patterns to sustain a pregnancy, for any of a number of reasons. Without the correct biochemical cues, your body can’t make the constant metabolic shifts that occur over the course of a normal pregnancy. While pregnancy is a natural function, it isn’t your body’s normal state, and special hormonal instructions are needed for your body to make the changes necessary to carry a child to term. These are among the most complex medical challenges, but great strides have been made in regulating endocrine problems.

Anatomical abnormalities of the uterus can interfere with the ability of an egg to implant securely, or can prevent the implantation from growing safely. These abnormalities are often corrected surgically with few complications, in many cases as out-patient procedures.

Autoimmune difficulties occur in a wide range of instances, when the body fails to recognize the fetus as a pregnancy rather than an infection or foreign protein. Antibodies attack the fetus causing it to miscarry. Fortunately, in many instances autoimmune problems can be treated with aspirin and heparin in low doses, among other methods.

Genetic defects cause a majority of miscarriages, when couples between them carry any of a number of dangerous genetic traits. When the underlying problems are recognized, however, your doctor can use in vitro fertilization techniques to ensure that only a healthy fetus will be implanted – a fertilized egg pre-diagnosed and free from known genetic damage. This doesn’t ensure a successful outcome, but it increases your chances enormously.

By consulting with your fertility doctor, you have a great chance of discovering the underlying causes of repeated pregnancy loss, and of being treated. Statistics as low as 10% or less of achieving a successful pregnancy and carrying to term can shift to as high as 75% when the cause of miscarriage is determined, and higher still in specific cases where treatment and repair are simple and uncomplicated. The reasons for spontaneous abortions and miscarriages, once completely mysterious, are becoming better and better known – and are more and more successfully treated.