Infertility: Causes and Options
By Don Wilson, M.D.
Many couples who want a child face the problem of infertility. They have tried to conceive but have not been able to do so. For healthy young couples, the odds are about 20% that a woman will become pregnant during any one menstrual cycle. This figure starts to decline in a woman’s late 20s and early 30s and decreases even more after age 35. A man’s fertility also declines with age, but not as early.
Couples are considered infertile if they have not been able to conceive after 6 to 12 months of having intercourse without the use of any form of birth control. Approximately 15% of couples in the United States are infertile. Infertility may be caused by a problem with the woman, the man, the couple or their lifestyle. Infertility may be caused by more than one factor. Some causes are easily diagnosed and treated, while others are not. In some cases, no cause can be found in either partner. If you and your husband are infertile and you desire to have a child, you should think and pray about having an infertility evaluation.
Certain events must take place in order for the miracle of conception to occur. These include ovulation, fertilization, and implantation. Ovulation is the release of an egg from one of the woman's ovaries. Fertilization is the uniting of the woman's egg with the man's sperm. Implantation is the attaching of the fertilized egg to the lining of the woman's uterus. Ovulation occurs approximately 14 days before the start of the woman’s next menstrual cycle. Once the egg is released, it remains able to be fertilized for approximately 24 hours. During intercourse, the man's sperm are deposited in the woman's vagina. The sperm can live in the women's reproductive organs for 2 to 3 days, sometimes longer. If the sperm and egg unite, fertilization can occur. The fertilized egg then moves through the fallopian tubes into the uterus and becomes implanted where it will grow and develop into a fetus (baby). If there is a problem anywhere in this miraculous chain of events, infertility can occur.
There are many possible causes of infertility. Often the problem stems from a combination of factors in either or both partners. The husband and wife must be diagnosed as a couple to determine the best treatment options for them. A man may be infertile because he does not have enough sperm; because sperm are not active enough; because the passage is blocked or because of a problem of ejaculation. A number of factors can cause or contribute to male infertility: sexually transmitted diseases, genetic or hormonal problems, medical conditions (diabetes, fevers, surgery of the reproductive tract, and varicose veins in the male reproductive tract, certain medications, and exposure of the reproductive tract to high temperatures, injury to the testicles or the use of tobacco, marijuana, or alcohol. A woman may be infertile because of hormonal imbalance or problems in the reproductive tract. Many factors can cause or add to female infertility, including, but not limited to:
hormone levels that prevent the release of an egg from an ovary or the implantation of a fertilized egg in the lining of the uterus
extra weight (more than 30% over ideal body weight) may cause problems with ovulation • scarring or tumors of the uterus or defects of the uterus from birth • too little or poor quality cervical mucus
endometriosis (a condition in which tissue like that normally lining the uterus is found outside the uterus in the woman's abdomen) • adhesions (bands of scar tissue from previous surgery)
Infections that bind together tissues inside the abdomen
sexually transmitted disease resulting in scarring of the internal pelvic organs • medical conditions such as diabetes or thyroid disease
genetic conditions in which a woman may not be able to ovulate or was born with an abnormality of the reproductive tract
women may produce antibodies that prevent conception. As you can see, the miracle of birth is just that—a miracle.
I often tell my patients it is divinely amazing we arrive on earth in as good condition as we do.
If you and your husband desire a child and have been trying to conceive unsuccessfully for 12 months (possibly sooner depending on age and other factors), you should talk to your doctor about any questions or concerns you may have. Your doctor can explain in detail what may be involved and conduct a thorough examination to determine the workup for your situation. After the workup, he or she can then explain the chances for and treatment options available to you.
Remember, God first created your family for you, for your spouse and most importantly, for Him; children are a result of the above. Infertility can be a frightening, discouraging journey, but with the right attitude, knowledge and care, a couple will become better in their walk through it and, hopefully, parents as well.
Dr. Wilson specializes in Obstetrics and Gynecology with the Jackson Clinic. He is Board Certified by the American Board of Obstetrics and Gynecology. A graduate of Middle Tennessee State University and the University of Tennessee Medical School in Memphis, Dr. Wilson completed his Internship and Residency with the University of Tennessee Medical School affiliated hospitals. He is a member of both the American Fertility Society and the American Association of Gynecological Laparoscopists.