Fertility Matters: What to do if you haven't been able to conceive

Fertility Matters: What to do if you haven't been able to conceive
Family Digest Baby magazine, Summer 2000
Reprinted with permission from Family Digest Baby magazine.

In normal couples the probability of conceiving is 25% during a normal menstrual cycle. Infertility affects approximately 10-15% of couples. In general the fertility rates are declining in the United States. Several reasons have been cited, including women postponing childbearing and/or marriage, changing roles of women, and unfavorable economic conditions. Approximately 25% of women will experience an episode of infertility during their reproductive life. Our fertility is decreased as we age. There is a decline in fertility beginning in our mid to late 30's. A study in the 50's demonstrated that 33% of women were infertile at age 40 and 87% were infertile at age 45.

Chromosomal abnormalities become more common with age. These abnormalities are often incompatible with life and result in an early miscarriage. As we age our risk of miscarriage increases. The majority of early miscarriages after 35 are due to chromosome abnormalities. The risk of miscarriage increases to 18% in the late 30's, to 34% in the early 40's.

Other problems that could impair your fertility are previous unrecognized STD's. Untreated gonorrhea or chlamydia can lead to the blockage of the fallopian tubes. Also other illnesses /conditions, like endometriosis, are more likely to be present as we age, which can also impair our fertility.

Other than avoiding delay in conception, what else can be done regarding your fertility?

Minimize cigarette smoking, marijuana smoking, cocaine use and alcohol consumption. All of these behaviors have been associated with decreased fertility (some also in men).
Use an ovulator predictor kit. These kits can be purchased from the local drug store. They are in the same section as pregnancy tests and involve a simple urine screen. Usually there are 5 tests within a kit. This test can predict when ovulation is going to occur within 24-26 hours. Fertility rates are higher when sperm is waiting in the reproductive tract for the egg, than when if ovulation occurs before the sperm is present.
Maintain a healthy lifestyle and weight. Some women will develop abnormal menstrual patterns when they are obese making consistent ovulation, or fertile periods, harder to predict. If you ovulate irregularly then you have fewer opportunities to conceive.
If you are approaching 35 make an appointment to discuss your fertility issues with your provider in order to see if any changes in behavior/medication would be recommended. He or she may also evaluate the need to test your hormone levels (thyroid function, progesterone, prolactin, or follicle stimulating hormone).
If you are approaching 35, then waiting the standard 1 year for an infertility evaluation may be too long. A semen analysis and an X-ray are additional tests to evaluate your fertility. The x-ray, a hysterosalpingogram, is done when dye is injected into the cervix and observed flowing out of the tube. This study allows us to evaluate whether or not the tubes are blocked. PID (pelvic inflammatory disease), infected miscarriage, ruptured appendix, and a previous tubal pregnancy can all cause tubal blockage. A semen analysis will indicate not only if the sperm count is normal, but also if the sperm are normal in appearence and ability to swim.

The presence of menstrual cycles does not always indicate fertility. This presented information will empower you to become more informed about your fertility.

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