First of all, let’s discuss the diagnosis of infertility. Many couples believe they’re having fertility issues after actively trying to conceive for a few months. Although this could mean that you, your partner, or both of you, are suffering from infertility, it’s far too early to know for sure.
Infertility is only diagnosed after one full year of unprotected intercourse.
The ability to have a child is reduced when a person is infertile, but it doesn’t usually mean the person is sterile, meaning they’re physically unable to ever have a child.
For many couples affected by infertility it can feel as though the walls are caving in on them and there’s nothing they can do. It’s not uncommon to experience an overwhelming feeling of guilt or inadequacy, but going to battle with infertility just means you’ve lost the fight, not the war.
The common misconception that we hear is when people say, “Well, we didn’t try every single month.” So to be clear, infertility is a year of not using any protection.
We explain to couples that when fertile people have sex, they get pregnant. For men with normal sperm counts, the sperm live inside a woman for a minimum of three days. It’s hard to not get pregnant if people are “fertile.”
Another thing we hear is, “Well, maybe our timing is off. We really haven’t tried for this year. Our timing has been off so much.” To reiterate, sperm lives for three days and can live up to seven days. You would really have to be off in terms of the timing.
Consider these fertility statistics:
Normal fertility rates are about 20 to 25% per month (cumulative, not additive).
About 30 to 40% of couples get pregnant after three months of trying.
50 to 60% of couples get pregnant after six months.
85% of couples are pregnant in one year.
Once you go a year and you’re still not pregnant, something is going on. After a year of trying your chances of getting pregnant, per month, goes down to about 1 to 4 percent. The cumulative pregnancy rate in the second year of trying is only about 5 to 10 percent.
The Fertility Evaluation
After a year, something’s going on because we’re not satisfied with a success rate of 1 to 4 percent here. The purpose of our fertility evaluation is not to say, “Oh, everything is great. Keep trying,” because 1 to 4 percent is not acceptable.
Rather the purpose of the evaluation is to rule out any significant issues or to take action to remedy the issue. We want to get you away from a low success rate and up to at least 10, 20, 30 percent per month.
Infertility in women who are 35 and greater should be trying to get pregnant for six months and not one year.
For a woman who is 36, 37, 38 years old, we won’t be telling them, “Oh, try for a year.”
We want patients to be their own advocates, a lot of people go see their OB GYNs who themselves are really busy, and they tell them, “It’s been nine months. Oh, it’s been 12 months. Try for another year.”
For women who are 35 and older, try for six months and give me a call.
Advocates in this situation are very important because we don’t want people to try for a year in situations where:
- They don’t get their period.
- They don’t ovulate regularly.
- The woman has a history of pelvic infection, prior surgery.
- The man is experiencing some kind of dysfunction such as:
- An inability to get an erection,
- He can’t ejaculate (or he has a very small volume),
- He has a history of treatment for an auto immune disease or cancer.
These concerns are things that potentially may be an issue preventing you from getting pregnant.
The vast majority of people in the absence of age related issues we are able to help. If people walk in the door and say, “What are the chances I walk out with a baby under your care?”
We’d put them in pretty high numbers but with an asterisk of saying, “Please understand the only two things I can’t do is, I can’t make sperm appear if there’s no sperm present and I can’t make your eggs any better.”
So if it’s not an egg problem or the man is not what’s called azoospermic (an absence of sperm), we’re confident in our abilities to help most people.
If you’re struggling with infertility you can take shelter under these statistics:
Up to 15% of all couples are infertile.
Only 1% to 2% of couples are unable to conceive.
More than half of couples who seek help can bear a child, either on their own or with medical assistance.
In about 1 in 5 infertile couples, both partners have contributing problems, and in about 15% of couples no cause is found after all testing is completed. This is called “unexplained infertility.”
It’s important to keep in mind that men and women are equally likely to have a fertility problem, so if you’ve been trying to conceive for one full year both of you should be tested. Tip: support one another in your journey.
Let’s look at the causes that contribute to infertility in men and women.
What Causes Fertility Problems in Men?
In men, the most common reasons for infertility are sperm disorders. These include:
- Sperm disorders
- Low sperm count (too few or no spermatozoa in the semen)
- Low sperm motility (sperm don’t move as well as they should)
- Good sperm motility but, they move in circles (poor forward progression)
- Malformation of the sperm (specifically the head, body, and tail)
- Obstructions that block the sperm from getting into the semen
Another common problem is a temporary drop in sperm production, which is rarely permanent. This happens when the testicles have been injured, such as when the testicles have been too hot for too long or the man has been exposed to chemicals or medications that affect sperm production, and males who are taking testosterone supplements.
Spending a long time in a hot tub or wearing underwear that holds the testicles too close to the body can increase the testicular temperatures and impair sperm production.
Sometimes there is a physical reason. In the relatively common condition called varicocele, veins around the vas deferens (the duct that carries sperm from testicle to urethra) becomes dilated — similar to a varicose vein in the leg. The pooling of blood in these veins keeps the temperature inside the scrotum too high.
Lifestyle decisions, such as increased alcohol intake and smoking, can have a negative effect on sperm count as well and men who are 40 or older often have decreased fertility simply due to natural aging.
Lifestyle decisions are quite important. The big one is tobacco more than anything else. And the important thing with tobacco is it that may not affect the counts. The counts could be completely normal. But tobacco could affect the DNA and the head of the sperm.
We strongly encourage people to stop smoking and not rely upon an initial diagnosis, “Oh, my semen analysis is normal.” We know that tobacco has negative effects on the DNA so it will not manifest itself in the semen analysis. And in fact, if you go to the Caribbean and you buy a pack of cigarettes, on the pack it will say that in addition to causing cancer, “smoking can can cause infertility in men.”
What Causes Fertility Problems in Women?
When it comes to fertility problems in women, the majority of cases are unexplained meaning, tests do not exist to figure out what the issue is.
The purpose of the fertility evaluation in females is to try and discern if there is an issue that we can identify such as:
- Ovulation issues
- Anatomic issues involving the uterus or tubal issue
- Hormonal issues
- Cervical issues
Historically, the primary reason for infertility in women was pinned on lack of ovulation or, release of eggs from the ovary. The major cause of not ovulating properly is a condition called polycystic ovary syndrome, better known as PCOS. While this is a frustrating scenario,
Another reason for female infertility is the inability of the fallopian tubes to carry eggs from the ovary to the uterus. This is usually due to scar tissue that may have resulted from prior infection or from a condition called endometriosis.
In rare circumstances, fibroid growths, endometriosis, tumors, cervical problems, or irregular uterine shape can keep the egg from implanting in the uterus. Fertilization may not happen if the cervical mucus damages sperm or impedes their progress.
Cervical factors are more common than people think. There’s no test to see if the cervical mucus is an issue. Women who have had prior surgeries on their cervix such as LEEP or a colon biopsy the cervix, even though their mucus may appear normal, the surgeries themselves could have affected the cervical mucus in such a way that the sperm can’t get through the mucus. So when the sperm doesn’t get through, the egg will die. There’s no way to test for that.
Age is a major factor of female infertility and may be the most important factor. In women, fertility declines with age, and even more so after the age of 35. Conception after age 45 is rare.
Additionally, Being overweight or underweight, lifestyle changes, and tobacco use can also play a role in having trouble getting pregnant. There are studies suggesting that fat cells can secrete substances that inhibit embryo implantation. At Park Avenue Fertility we can help women lose weight if it’s been determined that that is an issue affecting pregnancy.
If you’re suffering from infertility please don’t feel like you need to suffer in silence.
We’d love to help! Visit our patient resources page for more information.