When couples reach the point in their lives when they’re ready to have children, they talk about names, they think about the nursery, they may even imagine their child taking his or her first step. What they often don’t consider is the possibility that conceiving may be harder than expected. As months go by with no pregnancy, a couple can feel frustrated, alone and hopeless.
This should not be the case. Infertility is more common than people think. In fact, more than 15 percent of couples in the United States have difficulty getting pregnant or staying pregnant, according to the Centers for Disease Control and Prevention. In addition, over one-third of women have difficulty trying to get pregnant after the age of 35. Peak fertility in females is about 25 years of age and decreases either slowly or fairly rapidly after that. The key is to be evaluated promptly if you are having problems conceiving. Fortunately, there are many options for couples who are dealing with infertility. The first step is to identify the cause.
Before any major testing takes place, couples should first make sure they are on the right path by having intercourse at least every other day at the “fertile time” during the middle part of the menstrual cycle. An over-the-counter ovulation predictor kit can help determine when you are ovulating. An initial evaluation should include baseline hormones that are drawn on the second or third day of the menstrual cycle. It is very important to do the tests on those two days because of the wide variation of “normal” in other parts of the cycle.
If you are still unable to conceive during predicted ovulation, there are a number of reasons why it may not be working. Here are just a few of the possibilities.
If your periods are very irregular, you could have normal hormone levels but you may not be ovulating. This problem can be evaluated by using basal body temperature charts and/or evaluating a blood level of progesterone approximately a week after your predicted ovulation.
Another test that could be done is a hysterosalpingogram (HSG), which is a dye test to evaluate the fallopian tubes. The dye is used to find tubal blockage or damage by scar tissue which could be caused by previous sexually transmitted diseases such as chlamydia or gonorrhea. Another cause for tubal occlusion could be a previous infection in the area of the female reproductive organs such as a ruptured appendix. Once found, a doctor can consider laparoscopic surgery to see if it is correctable.
If you have been off birth control for over a year, or six months if over 35, and are experiencing increasing discomfort with your periods or increasing pain with intercourse, you may have endometriosis. After reviewing your medical history and conducting a pelvic exam, your doctor can diagnose – and often treat – endometriosis by a laparoscopy.
Another reason for infertility may lie with the husband or partner. Statistically, the cause of infertility is 40 percent female, 40 percent male and 20 percent both partners. If your partner has any medical problems, such as obesity, hypertension, diabetes, or other significant illnesses, he should be evaluated with a sperm count. It is important to realize that excessive use of alcohol, tobacco, marijuana or other drugs can have a negative effect on a couple’s fertility.
Sometimes, all of these evaluations come back completely normal and there is no known cause for infertility. In this case, patients can try empiric therapy with an ovulation enhancing drug called Clomid and performing intrauterine insemination with the partner’s sperm at ovulation. The last step for a couple trying to conceive would be a consult with an in vitro fertilization center.
The most important point is, don’t delay an evaluation if you have trouble conceiving. Triggers for earlier workup are advanced age (over 35), a history of very irregular periods, sexually transmitted disease, abdominal operations or previous endometriosis.
No couple ever expects to have to deal with infertility. What should be a magical time ends up being very stressful. The key to dealing with infertility is to realize you’re not alone, and there are many options available to help. Talk with your doctor, your partner, and your friends. You’ll find you have many people on your side.
Dr. Joseph “Skip” Wilkis is a board-certified obstetrician-gynecologist with a special interest and post-residency training in the evaluation and treatment of infertility at Coastal Women’s Healthcare in Scarborough. He can be reached at 207-885-8400.