Navigating and Treating Infertility
Encountering various obstacles to pregnancy is a fairly common issue for many couples. According to the U.S. Department of Health and Human Services, between 12 and 13 couples out of 100 experience trouble getting pregnant. And some studies suggest that black women may be nearly twice as likely to experience infertility as white women.
This struggle can be frustrating and often takes an emotional toll on couples trying to conceive. However, understanding and treatment of infertility have advanced greatly in recent years. There is recognition that there are many factors and conditions that can affect the chances of becoming pregnant, and that identifying those most relevant to your circumstances can help increase your chances.
What exactly is infertility?
Infertility is generally defined as the inability to become pregnant after one year of regular sexual intercourse without the use of birth control. Pregnancy depends on:
- Healthy eggs produced by the woman
- Healthy sperm produced by the man
- Fallopian tubes that are unblocked to allow sperm to reach the egg
- The ability of the sperm to fertilize the egg
- Successful implantation of the fertilized egg in the uterus
- The hormonal environment supporting the embryo’s development
Just one problem with any of these dynamics and possibly other factors can result in infertility.
Causes of infertility
These may include:
- Ovulation problems
For women, the most widespread cause of infertility is ovulation disorders, which affects approximately a quarter of all infertility cases. In these situations, the monthly release of the egg from the ovaries is disrupted. This can be due to ovaries that function abnormally, poor egg quality, hormonal imbalances (see PCOS below), and other issues. Blocked fallopian tubes is another common reason for infertility and can be caused by infection, endometriosis, or having had major abdominal surgery. Other risk factors include the presence of fibroids, unusual structures of the uterus, as well as unhealthy habits (smoking and alcohol consumption).
This is a major concern as well, due to the fact that women’s eggs decrease in number over time, especially after the age of 35–40. Delays in trying to attempt pregnancy—one year of trying under age 35 for 12 months and delaying over 6 months after age 35—increase issues with ovarian reserve (the number of eggs that are still present), as well as the concern for improper egg division over age 35 that leads to genetic abnormalities, increased risk of miscarriages, or inability to conceive at all.
Women can get their Anti-Mullerian Hormone (AMH) testing through their GYNs and find out what their relative number of eggs may be. Women with an AMH level of less than 1.0 have few eggs remaining and will probably need in vitro fertilization (IVF) to achieve a pregnancy. It is recommended that women begin tests around age 30 so they can be aware of their relative levels early on.
- Sperm issues
While infertility is often regarded as an issue affecting mainly women, there are many conditions affecting male sperm that also impact pregnancy. Common causes of male infertility include oligospermia (few sperm cells produced) and azoospermia (no sperm cells produced). Poor sperm cell health, low motility (ability of sperm to swim), and erection/ejaculation problems are factors as well.
- Pregnancy loss
Recurrent pregnancy loss is a concern in patients that need assistance in achieving a viable pregnancy. For women who have lost one or two pregnancies, evaluation should be considered, especially if they are over 35, due to the increase in risk of genetic losses that are linked to aging. Uterine abnormalities, fibroids, hormone imbalances, and clotting factors can be easily evaluated and treated if found. When no other findings are noted, IVF with embryo biopsy, to determine which embryo is normal to replace, can be instrumental in helping women achieve a viable pregnancy.
Women can take fertility drugs to help regulate ovulation and/or hormones to restore normal hormone production levels. Compromised fallopian tubes may be treated through surgery if there are adhesions that are interfering with the tubes’ ability to pick up eggs. For men, treatments are available to address low sperm counts mainly through urologists with expertise in male infertility. Surgery can also be performed to take sperm directly from the testicle to use in IVF procedures if the counts are extremely low. Men should not be taking any type of testosterone therapy that can decrease sperm production. Furthermore, both partners should refrain from smoking and excess alcohol consumption when pursuing treatment.
Infertility can also be treated through assisted reproductive technology (ART). This can include:
- IVF: Sperm and egg are collected and brought together in a lab for fertilization. After the egg is fertilized, it is placed back in the uterus as a 5 day-old blastocyst.
- Intrauterine insemination (IUI): Sperm is collected and placed in the uterus while the woman is ovulating.
- Preimplantation genetic testing (PGT): This provides information about the health of embryos to know which ones are the best candidates for transfer back to the uterus.
While these treatments have proven to be effective, it is necessary for both partners to undergo thorough fertility evaluations by their doctors to determine the primary obstacles to conception and the appropriate course of action.
Polycystic ovary syndrome (PCOS)
A fairly common condition among women, PCOS is a reproductive hormone imbalance associated with several health issues such as infrequent or no periods, excess hair growth on the face or chin, acne, as well as infertility. The treatment for PCOS varies, depending on whether or not a patient is trying to become pregnant.
If pregnancy is desired, a full evaluation and workup is necessary before starting medication to assist in ovulation. Letrozole is a medication that is often prescribed initially to assist in ovulation; inseminations can also be used to improve outcomes. If three cycles pass and no pregnancy occurs, a consultation with a reproductive endocrinologist is recommended for further options. On a positive note, women with PCOS have a large number of eggs and will have a sufficient amount to have an excellent chance of conceiving.
Leading a healthy lifestyle and following a nutritious diet can also play a part in increasing your chances for pregnancy. The following are some easy and natural ways to prepare yourself—and your partner—for better fertility.
- Eat more fiber-rich foods—fruits, vegetables, and whole grains
- Eat more antioxidant-rich foods—fruits, nuts, dark chocolate, beans
- Reduce refined-carb foods—sugary foods/drinks, white bread and rice
- Reduce caffeine consumption—coffee, tea, energy drinks
- Increase iron intake—spinach, shellfish, turkey, quinoa
- Reduce alcohol consumption
- Maintain a healthy weight (a body mass index (BMI) of less than 25–30 is essential for both partners
- No smoking
- Regular exercise
Dorothy Mitchell-Leef, M.D.
Specializes in Reproductive Endocrinology and Infertility
Learn more about Dr. Mitchell-Leef.