Week 16 - Everything I Needed to Know About Infertility

As many people know, infertility is when an individual is unable to conceive a child. Infertility affects between 10% and 15% of American couples and is identified when a couple is unable to conceive after a year of hard work.

I'll preface this post with fully admitting that my experience in this area is essentially nil. While Nadia has done her best to educate me and my developmental psychology class gave me a good base to start from, I do not consider myself knowledgeable in this area at (hence, the blog post to learn about it).

As I've learned in the past though (not from personal experience), conception is extremely difficult and has a whole variety of factors that could lead to the infertile diagnosis. These factors include:

• Sperm production

• Egg health

• Clear passage in the fallopian tubes

• The sperm's ability to penetrate the egg

• The egg's ability to become implanted in the uterus

• Stable hormonal environment

Who's at Fault?

Question: when you think of someone being infertile, who do you think of?

Right off the bat, I think of a woman. But if you look at the numbers, men account for just as many infertility cases as women, coming in at 33% each. The other 33% is problems with both partners and then a little bit is attributed to just unknown causes

Infertile Men

When it comes to male fertility, your main culprits are low sperm count or malformed sperm. Like my psych professor said, you have pinheads, butt heads, and regular sperm. The pinheads don't have enough energy to make it to the egg and die early. The butt heads are able to make it to the egg, but due to the shape of their (butt) head, they can't penetrate the egg.

Men can also experience infertility due to genetic diseases like cystic fibrosis or a chromosomal abnormality.

Infertile Women

For women, infertility rears its head with ovulation disorders, as it accounts for 25% of all infertility cases.

Other causes include:

• Blocked fallopian tubes (possibly due to endometriosis)

• Congenital anomalies

• Uterine fibroids

• Age (especially after 35)

For those under 35 who have been trying to conceive for more than a year and haven't had any success, it would be a good idea to get tested for infertility. For those over 35, testing should happen after 6 months of not being able to conceive.

But since we're dealing with the human body, who knows if the testing will even help, as some couples might find success thinking that everything is working.

Getting Diagnosed

The doctor you go to see will most likely conduct a physical exam to assess each partner's general health and try to find any obvious physical disorders. The doctor will then also interview each partner, learning about their sexual habits to ensure a proper scenario for conception.

If more tests are needed, women usually go through some analyses of body temperature and ovulation, and/or an x-ray of their fallopian tubes and uterus. The men, on the other hand, just jerk it into a cup (excuse my French) and hand it to the doctor to determine sperm quality.

Getting Treated

A majority (around 90%) of infertility cases are remedied using drug treatments or surgical repairs of the reproductive organs. The remaining couples are assisted with In-Vitro Fertilization (IVF).

IVF essentially works like this:

1. Eggs are surgically removed from the ovaries and placed in petri dishes

2. Sperm is then mixed with the eggs

3. After 40 hours, doctors inspect the (hopefully) newly formed zygotes to ensure proper cell division

4. Healthy embryos are then placed in the woman's uterus and go about normal gestation

5. Other embryos can then be frozen for later use

You can watch this video if you're really curious as to how it works.

The Cost of IVF

Due to the highly specialized skills, equipment, and personnel needed for IVF, it's obviously no cheap procedure. The average IVF procedure in the U.S. can cost around $12k, with the possibility that it will fail the first time. In 2008 at least, your chances of bringing your pregnancy to full term using IVF was around 34%.

Can Infertility Treatments be Covered under Insurance?

If you live in any of the following states, your insurance could cover infertility and tests and treatment:

• Arkansas

• California

• Connecticut

• Hawaii

• Illinois

• Louisiana

• Maryoland

• Massachusetts

• Montana

• New Jersey

• New York

• Ohio

• Rhode Island

• Texas

• West Virginia

Of course, the best idea would be to just talk with your insurance company to verify eligibility and coverage.

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As we've seen, infertility can stem just as easily from men as it can from women, and according to this article, most of the time it's the man's problem.

The Issue with Men

Men's arsenals consist of sperm and semen. In short, sperm (produced in the testicles) is what carries all the genetic information that needs to combine with the egg, and semen (produced in various sex glands and prostate) is the fluid that helps the sperm swim to the egg.

Infertility comes in when men have low sperm count (under 15 million), poor swimmers, or just sperm that isn't shaped well and can't penetrate the shell around the egg.

But even if your sperm is winning all the gold medals, it might be getting screwed by the semen. Bad quality semen can enter the equation from various medical conditions, overheated testicles, ejaculation disorders or just hormonal imbalances.

But wait, there's more! Infertility can also happen because of:

• Genetic issues like Klinefelter's syndrome where the man has two X chromosomes and a Y (you really just want 1 X and 1 Y as a man)

• Mumps that could cause testicular swelling

• Hypospadias - when the opening on the penis is not at the tip (usually corrected in surgery shortly after birth)

• Cystic fibrosis - resulting in sticky mucus that could prevent sperm from reaching the ejaculatory duct (through the vas deferens)

• Radiation

• Sulfasalazine - a drug commonly used for Crohn's disease or rheumatoid arthritis (it lowers sperm count)

• Steroids - reduces sperm count and swimming proficiency

• Marijuana/Cocaine - can cause low sperm count

• Age, specifically after 40

• Alcoholism

• Obesity

• Mental stress

The Issue with Women

Some of the most common factors for infertility when it comes to women are:

• Age, specifically after 32

• Smoking

• Alcohol

• Obesity

• Eating disorders

• Diets (lacking in folic acid, iron, zinc, and B-12)

• Too much or too little exercise

• STI, specifically Chlamydia

• Chemical exposure

• Mental stress

When it comes to medical conditions that affect fertility, we have a whole other range, mostly focusing on ovulation disorders:

• Premature Ovarian failure - when the ovaries give up before age 40

• Polycystic ovary syndrome (PCOS) - when the ovaries don't function correctly and ovulation doesn't occur

• Low quality eggs - due to damage or genetic abnormalities

• Thyroid issues leading to hormonal imbalances

• Blocked fallopian tubes

• Fibroids

• Endometriosis

• Sterilization

Getting Treated

When it comes to sex, the best time to do it (assuming you really want to conceive) is the two days before ovulation and then the day of. I tried to read about how to actually find when that really fertile time is, but got real confused real fast. Also, and this is just based on my extremely limited understanding of conception, but my assumption was that the most fertile time was right after ovulation, since that's when the most "fresh" egg is being sent down the tubes. But again, what the hell do I know about how the female body works.

Besides the treatments I had already covered in the first article, fertility treatments can also show up in the form of:

• Epididymal surgery - where blockage of the epididymis (a coil-like structure that holds sperm) is removed to ensure proper ejaculation

• Varicocele - surgically removing a varicose vein in the scrotum

• Erectile dysfunction medication

• A whole bunch of drugs, primarily affecting hormone production

Over-Fertility

When fertility drugs do their job too well, couples run the chance of getting multiple births in their pregnancies. As more fetuses develop, the woman develops a higher risk of premature birth.

Careful monitoring must be in place during these times of treatment, and can be withheld if deemed necessary.

Other Ways to Conceive

Intrauterine Insemination (IUI): Healthy sperm is selected by doctors and then inserted into the uterus at the time of ovulation. This is usually done when the male partner is experiencing some level of infertility.

In-Vitro Fertilization (IVF): Sperm and eggs are combined in a petri dish and then evaluated for quality. The fertilized eggs are then placed into the uterus or frozen for later use.

Intracytoplasmic sperm injection (ICSI): Similar to IVF, but in this case, the sperm is injected directly into the egg to begin the fertilization process

Donation: healthy men and women, usually with very specific traits, are able to donate their sperm and eggs to fertility centers for other people to use

Ectopic Pregnancy

Women who go to receive fertility treatments have a higher chance of having an ectopic pregnancy. This happens when the fertilized egg implants itself outside the womb, like in the fallopian tubes. If this type of pregnancy is not caught soon, surgery is required and that fallopian tube will be lost.

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Now that I have at least a 10-year-old's understanding of fertility, I am curious to see how it affects marriages. Obviously, infertility introduces a whole slew of stresses on a marriage, and can even lead to divorce. But how common is this, and what studies have been done?

This article is based on a study on 47,500 Danish women who began fertility treatment with their partner and were then checked on again later.

And just because this was bugging me at first, the study did exclude partner-less woman who went to fertility clinics.

This study found that after failed fertility treatment, these couples were three times more likely to end their relationship than those who did conceive successfully and that couples who could not conceive after fertility treatments may experience a reduced length of their relationship.

All these women were had gone to treatment centers between 1990 and 2006, were followed for around 7 years, and averaged 32 years of age at the time of evaluation.

When researchers came back to their test subjects, they found that 26% were living alone or divorced since their last check-in and a third of them hadn't conceived a child.

If you think about this study carefully (or took any introductory stat class), though, you should notice that there are plenty of areas for misinterpretation.

First off, this research didn't take into account the actual quality of the marriage/relationship of the couples that stayed together, since they never used any questionnaires or surveys.

Second, other researchers found that infertility could actually bring couples closer together since it can be seen as a form of joint hardship. This study, though, showed that the feeling of closeness through joint hardship only appeared in the initial stages of treatment.

The problem is the number of losses that couple could continue to experience, like miscarriages, stillborns, and the realization that they just might never be able to have children.

As long as couples understand the risk on their relationship in times of failed treatment, and know how to actually grieve in those situations, the rate of dissolved relationships could decline.

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When it comes to infertility, men experience it just as much as women. While this may not be surprising to most people, as a 20-something male, it was actually eye-opening. When I think of infertility, I always think of a woman, maybe because of the culture I grew up in or the number of infertility ads I hear on the radio that always seem to target women.

Thanks to my developmental psychology class I took sophomore year, I knew that actually getting pregnant is a miracle in and of itself. But at a biological level, I never really knew how much could go wrong or what actually made it so hard in the first place.

Hormones play a vital role in everything conception, and when your body can't provide a stable amount, you become infertile. While we have specific drugs and treatments to counteract this, you then run the risk of complicating your pregnancy through multiple births (among other things).

Besides hormone-balancing drugs, there are also various surgical procedures that help couples conceive, either through In-Vitro Fertilization, Intrauterine Insemination, or even Intracytoplasmic sperm injection.

But what happens when these couples go through one or more of these treatments but still can't conceive. Well, in terms of their relationship, they are three times more likely to dissolve their relationship than couples who could conceive after treatment.

But another study found that treatment could actually bring couples closer together, at least in the initial stages, when it is viewed as a sort of joint hardship.

Either way, infertility is a problem just as much for men as it is women, and while there are numerous ways to help treat it, couples need to know how it could affect their relationship in cases where it fails, and the dream of having their own (biological) children is broken.

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