When you're ready to have a baby and becoming pregnant is difficult, it's natural to feel disappointed or frustrated. You are not alone.
Fertility problems affect about 9 percent of men and 11 percent of women of reproductive age in the United States, according to the National Institutes of Health.
What is Infertility?
Infertility is when a couple has been trying for a pregnancy for 12 months and has not conceived.
Your obstetrician/gynecologist can help identify causes of infertility, discuss treatment options and guide you through the process.
The field is constantly changing, and there's new information and testing coming out all of the time," says board-certified Doylestown Hospital Medical Staff Ob/Gyn Melanie Ware, DO. "Whether you're thinking of starting a family or having difficulty becoming pregnant, we encourage patients to schedule a visit.
Causes of Infertility
When a couple is having difficulty conceiving, the cause may be with the woman or the man and may involve a combination of factors where both have infertility issues, according to Dr. Ware. "Sometimes, the cause is unknown, with couples going through all the testing and nothing is determined."
Causes of male infertility include:
- Slow swimming or irregular sperm (motility issues)
- Low sperm count
- Prior infections
- Prior surgeries
- Genetic issues
- Medical problems such as a cancer which have impacted fertility
Causes of female infertility include:
- Hormonal issues such as polycystic ovarian syndrome (PCOS)
- Undertreated thyroid disease
- Prior surgical procedures
- Age 35 or older
- Lifestyle factors that may contribute including diet, caffeine, smoking and alcohol
"A medical history can give us a lot of information," says Dr. Ware. "For instance, talking to a woman about her menstrual cycle helps us understand more about when she is ovulating." She continues, "we look for conditions that interfere with ovulation such as thyroid disease, hormone imbalance and polycystic ovarian syndrome," noting that a woman with PCOS has an increase in androgens, male-type hormones that stop or reduce ovulation frequency. Other PCOS symptoms include acne and hair growth on the upper lip or abdomen.
"For men, semen analysis provides information about sperm count and motility issues," says Dr. Ware.
Exploring the anatomy
"We look at the anatomy with ultrasound to make sure there are no abnormalities," says Dr. Ware.
"A hysterosalpingogram is an X-ray study using contrast to view the fallopian tubes to examine for any blockage that might interfere with the sperm meeting the eggs. In some cases, we perform a minimally-invasive diagnostic laparoscopy, inserting a miniature camera through tiny incisions to look inside a woman's abdomen."
"Based on the couple's test results, we discuss options and determine what the next best steps are," says Dr. Ware. "Some patients ask us to check for medical causes, but don't want intervention."
"When ovulation is irregular, the objective is to increase the chances of an ovulatory cycle. We have medications that improve ovulation rates," says Dr. Ware. "And, if there is a male infertility issue as well, we may offer intrauterine insemination, placing the male sperm into the uterine cavity during an anticipated ovulatory cycle."
Endometriosis causes scarring which can contribute to tube blockages. "We try less invasive treatments such as oral medications first, but sometimes patients may require invitro fertilization (IVF), where sperm and eggs are combined outside of the body, which is more involved and requires the expertise of a reproductive endocrinologist," says Dr. Ware.
When a Reproductive Endocrinologist is Needed
"We sometimes refer patients to a reproductive endocrinologist, a subspecialist in the Ob/Gyn field who focuses on infertility and can perform IVF and other more specialized procedures," says Dr. Ware.
"Donor sperm can help in cases of male infertility and for couples with two female partners who want to start a family," says Dr. Ware."The sperm is implanted via intrauterine insemination (IUI), placing the sperm into the uterus at a time when the woman is expected to ovulate."
Offering Support Through the Process
"If you're trying to become pregnant and it doesn't happen right away, it's easy to become disheartened. We do our best to reassure our infertility patients that we have a plan and are doing everything in our power to help. We see them at least once a month," says Dr. Ware.
Some patients become involved with support groups.
What Can I Do to Improve the Odds?
Preconception health can boost your chances of conceiving and of having a healthy pregnancy, according to Dr. Ware. Tips for a healthy start include:
- Schedule a preconception visit to discuss your existing conditions and make sure you're not on any medications that would be unsafe for pregnancy.
- Review your family history and consider any risk factors or genetic issues that you need to address before conceiving.
- Start a prenatal vitamin three months before conceiving because prenatal vitamins have folic acid which helps prevent birth defects.
- Manage pre-existing conditions such as obesity which contributes to pregnancy complications, infertility and pregnancy loss.
- Maintain a healthy lifestyle by reducing stress, exercising, eating a healthy diet and abstaining from alcohol and smoking.
"Some patients don't conceive, despite going through all options and seeing a reproductive endocrinologist, and they need to make a choice that's right for them," says Dr. Ware. "Though not part of the general Ob/Gyn practice, there are resources to help including support groups, surrogacy and adoption."
Find an Ob/Gyn
Doylestown Health Obstetrics and Gynecology
Doylestown Health's expert OB/GYN physicians and certified nurse midwives provide skilled and compassionate health care throughout all stages of a woman's life, from adolescence through menopause and adulthood. And for families welcoming new babies, Doylestown Health's VIA Maternity Center offers labor, delivery and postpartum care in a state-of-the-art, family-centered facility — complete with a Level II Neonatal Intensive Care Unit staffed round-the-clock by CHOP neonatologists.