Infertility: Why It Happens and What You Can Do

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Updated: 11/02/2011 11:19 pm

Anyone who has struggled with infertility will tell you this: It can be quite the roller-coaster ride. "The hardest thing for us was not having answers," says one woman, now 38. She and her 45-year-old husband were derailed for several years while doctors tried to figure out the cause of their infertility.

Unlike this couple, about 80% to 85% of U.S. couples are able to get pregnant after a year of trying. When you get past the year mark, however, it's time to seek help. If you're over age 35, it's best not to wait longer than six months. That's because fertility, especially in women, is profoundly influenced by age, says David L. Keefe, MD, professor and chairman of the department of obstetrics and gynecology at the NYU Langone Medical Center.

Although the aging of your eggs is inevitable, there's great variability in fertility in the mid-30s, says Keefe, whose clinical practice focuses on infertility. Some women are as fertile as they were in their 20s, while others very quickly reach the proverbial point of no return. This is mostly determined by genetics, and a simple blood test can measure hormone levels to determine where you are on this spectrum.

Finding an Infertility Specialist

Age aside, if either you or your partner shows signs of problems that need immediate attention, such as a lack of ovulation or an undescended testicle, which can impair normal sperm production, the first step is to find a doctor you trust.

It's OK to start with your ob-gyn, Keefe says, but many couples benefit from seeing a specialist who is board certified in reproductive endocrinology and infertility. You also want to look for a doctor who is a good fit for you personally, "someone who will let you cry, help you cope, and guide you in making sense of things and finding meaning in the different alternatives," Keefe says. Immediately find the exit, Keefe adds, if a doctor dismisses your questions with something like, "Don't you worry. Just let me tell you how this is done."

The couple got their happy ending: three kids, one through gestational surrogacy using their own fertilized embryo, and twins two months later with the help of donor sperm. They advise couples in similar situations to connect with others and to "keep an open mind. The path that ultimately leads to success may not be the one you start on."

Not Yet Conceiving? Here's What You Can Do

If you're trying but not conceiving, ask your doctor to check the health of your eggs and your partner's sperm, your tubes and uterus, and whether you have hormonal imbalances that can lead to infertility, says David L. Keefe, MD.

Treatments might involve:

  • Surgery in either partner to correct any structural obstacles to pregnancy.
  • Oral or injectable drugs to improve the timing or number of eggs released.
  • Intrauterine insemination (IUI) to give sperm a "free ride" into the uterus. Doctors use a catheter to place sperm into the uterus via the cervix around the time of ovulation.
  • In vitro fertilization (IVF) to unite eggs and sperm in a laboratory dish before one or more eggs is transferred to the uterus. Sometimes a single sperm is injected directly into the egg.
  • Egg or sperm donation if your eggs or his sperm are unable to unite and develop.
  • Gestational surrogacy that involves a woman carrying and delivering a child for another person or couple.


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