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If efforts to have a baby are unsuccessful, the question ultimately arises, "When do we stop trying?" Though it may not be easy, giving up the effort can have a happy ending, as is clear from the stories of two couples who met through a small social group in a distant suburb of Washington, D.C., and learned about their mutual interest during casual conversation.

The first couple had tried almost everything, including IVF, and, after 10 years of getting nowhere, gave up medical interventions. Two cycles later the woman conceived and — after a difficult pregnancy — bore a healthy baby girl. The other couple took a different route that is available to many couples who abandon hope for a child of their own. They adopted a newborn baby and now wish they had done it a lot sooner.

Judith Randal, a freelance writer in Lovettsville, Va., writes a weekly health feature for Newsday and has published widely on health and science subjects in other newspapers and magazines.

Infertility Tests

Some infertility tests are for women only, others are for men only, and still others cannot be done without the cooperation of both partners.

An initial workup for a woman can take as little as six to eight weeks, or as much as three months or longer because some of the tests may have to be repeated for verification at different specific times in her menstrual cycle.

The initial workup of a man usually can be done faster both because men have no monthly cycles — and because there are fewer tests for men. Diagnostic surgical procedures may be suggested for both men and women to look directly at reproductive structures and to obtain small tissue samples for laboratory analysis.

His

A semen analysis is almost always the first test done on men and is usually repeated several times. After abstaining from intercourse for about 48 hours, the man collects a sperm sample in a container.

The sample is microscopically examined to determine the number, activity and shape of individual spermatozoa (sperm cells) and the characteristics of the fluid part of the semen.

A healthy, potent ejaculate typically contains 1.5 to 5 cubic centimeters (5 cc = 1 teaspoon) of semen and each cc will contain an average of 70 million sperm that look to be of normal size, shape and behavior. If the specimen markedly differs on any of these factors, further tests may be done to determine whether infection, hormonal imbalance, or another problem could be the culprit.

Among these tests may be a testicular biopsy, a minor operation — performed with a local or general anesthetic — in which a small amount of tissue from the testes is removed for laboratory studies. Since even men with sperm counts well below 70 million per cubic centimeter sometimes father children, this test is ordinarily done only when the count is zero.

If damage to one or both of the vas deferens, is known or suspected, an x-ray examination may also be ordered. As an iodine-containing solution has to be injected into the tubes to make them visible on x-rays, the patient is first given local or general anesthesia. If the examination discloses damage, surgical repairs are often attempted at the same time the diagnosis is made.

Other special tests may be ordered if none of the tests already mentioned seems to explain the man's infertility. The most common of these tests are the bovine mucus test and the hamster-oocyte penetration test.

In the first, bovine (cow) mucus (from the cervix, or neck of the uterus where it opens into the vagina) is placed in a special glass column. Samples of the man's semen are applied to the column, and measurements are made of how well the sperm are able to enter and swim through the mucus, giving some indication of their ability to swim through human cervical mucus.

In the hamster-oocyte penetration test, some of the man's semen is mixed with hamster egg cells that have had their outer shells (membranes) removed. If the sperm are functioning normally, they will penetrate the hamster eggs, an indication that they are also capable of fertilizing human eggs. However, failure of the sperm to penetrate the hamster eggs does not always mean that they are incapable of fertilizing human eggs.

Hers

Women-only tests, more varied and extensive, generally begin with a determination of if and when the woman is ovulating. One of the most popular techniques for pinpointing ovulation relies on the typically slight rise in resting body temperature midway in the menstrual cycle, signaling that ovulation has recently occurred.

A woman's body temperature fluctuates throughout her menstrual cycle, and she is instructed to record these fluctuations on a chart after taking her temperature each morning before getting out of bed. If the chart — called a basal body temperature or BBT chart — indicates that the woman has been ovulating, it can often be used to predict when ovulation will happen during subsequent menstrual cycles. The couple can then use the information to attempt to time conception. Several urine test kits, approved by the Food and Drug Administration for sale over the counter, can be used by consumers to supplement the temperature chart.

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Newer techniques infertility test 1

Newer still than in vitro fertilization are several other techniques that also require the use of fertility drugs. They are:

Gamete Intrafallopian Transfer (GIFT): Similar to IVF except that sperm and eggs are collected and immediately inserted into one or both fallopian tubes, where conception occurs. Unlike IVF, GIFT requires that the woman have at least one healthy fallopian tube. Success rates are similar to those of IVF.

Tubal Ovum Transfer: The woman's eggs are retrieved and put into the fallopian tube close to where it opens into the uterus. The couple then has intercourse or the woman is artificially inseminated. Since this method allows the eggs to be placed beyond the parts of the tube that may be damaged or blocked, it can often be used when GIFT cannot.

Embryo Lavage: A fertile female donor provides the eggs. At the proper time in her menstrual cycle, she is artificially inseminated with the would-be father's sperm. If the donor conceives, the early embryo is washed out of her reproductive tract and transferred to the uterus or a fallopian tube of the woman who is to bear the child. The recipient, meanwhile, has been hormonally treated with fertility drugs to make her uterus receptive to the embryo. This technique allows women who have no eggs of their own to become pregnant — provided they have a uterus.

Surrogate Motherhood: This is an option for women who do not respond to ovulation induction therapies or who have no ovaries or lack a uterus. It also may be an option for those for whom pregnancy might be life threatening or have good reason to worry that they might transmit a serious genetic disorder to the child.

A healthy, fertile woman agrees to be artificially inseminated and also agrees to let the infertile couple adopt the baby. If the female member of the infertile couple can safely provide eggs of her own, these can be fertilized by the IVF process and then transferred to the surrogate woman who carries the fetus to term. In that case, the surrogate mother takes fertility drugs to prepare her uterus. Surrogate motherhood is controversial and has resulted in court cases about custody and parentage, which is rare with other forms of fertility treatment.

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Stress and infertility 2

In addition to the stresses of the medical regimens, overwhelming feelings of loss of control and increasing isolation as described by Blenner, there are psychosocial pressures on couples to reproduce. Erickson's "stages of development" theory describes the tasks of human development from infancy's need to establish trust, through the adolescence's search for identity to middle adulthood which includes the task of generativity. Generativity is the task of guiding and helping children. It is the next stage of a human's development, (according to Erickson), but infertility blocks the accomplishment of this task. The couple can't understand why this stage is thwarted when all of life's other developmental tasks occurred without conscious thought.

Compounding the couple's despair, is the societal stigma that accompanies infertility. The couple may feel "defective" and the inability to fulfill the role of parenthood may be regarded as a personal failure. And while the couple grapples with these unpleasant feelings the woman's biological clock continues to tick adding time pressure to their list of stressors.

Researchers have verified that infertility does cause stress. Comar (1992) reported that infertile women experience twice the level of depression when compared to their fertile counterparts. And this elevated stress does compromise reproduction. Facchinetti (1997) documented that the higher a woman's vulnerability to stress the lower her pregnancy rates. Sharma and Sharma (1992) documented double the pregnancy rates in women who took anti-anxiety pills.

Domar, a researcher who works at the Mind and Body Institute in Boston which is associated with Harvard Medical School proposes a model that explains the deleterious effects of stress on the reproductive functions. This model was published in The Wellness Book (1992) by Herbert Benson.

Cycle of Despair

No Conception / Menses

which leads to:
tubal spasm / irregular ovulation / decreased sperm production

which leads to:
frustration / anger / isolation / depression

which leads to:
emotional tension / stress

which leads to:
No Conception / Menses

Adapted from: A. Domar in The Wellness Book. by H. Benson, 1992

To break this cycle, the emotional tension must be addressed. One intuitively knows that the mind (psyche or soul) can influence physiological responses. Just think of the emotion of fear. When one feels fear, there are distinct bodily symptoms such as dry mouth, pounding heart sweaty palms, etc. that accompany this emotional feeling. Perhaps, techniques available for stress reduction could reverse the emotional stress of infertility.

Benson (1992) contends that stress and relaxation can not co-exist. Several research studies have documented the positive effect of relaxation in other fields. Stuart (1987) used relaxation to help patients reduce blood pressure without medication. Mandle (1990) documented less pain medication use and a decrease in anxiety by hospital patients who listened to a relaxation tape. Goodale (1990) was able to document decreased premenstrual symptoms in women who practiced relaxation techniques. And lastly Domar (1992) cited double the pregnancy rates for In Vitro Fertilization (IVF) patients who practiced relaxation coping techniques.

The tools for practicing relaxation are so varied, there is something for everyone. The ideas suggested below are activities that enhance relaxation. Enjoying one or more of these activities diminishes the negative effects of infertility induced stress.

Stress and relaxation can not co exist!

Everyone has a different way of reducing stress. The following are some things which can help a great deal. Try some of these techniques during your treatment:

Vacations, Music, Sports, Visualization, Humor, Hobbies, Friends, and Prayer and Meditation

Don't forget the value of a good friend. A friend to lend a sympathetic ear can raise one's spirits and decrease the sense of isolation. Consider friends and relatives as prospective confidantes and share the sadness of infertility's elusive goal. It is natural to resist burdening a friend with personal problems. But try reversing the situation. Wouldn't it be an honor and privilege to have a friend share a problem with you? The opportunity to help ease a friend's burden is gratifying and also an expression of the friend's high esteem for you. Give your friend the same compliment. The stress of infertility can be minimized with conscious effort to honor your emotions and utilization of techniques to counteract the effects of infertility's despair. Use of a variety of relaxation methods will restore a sense of control, decrease the sense of isolation, restore optimism and may help increase the chance of pregnancy.

Stress and infertility 1

For many infertility patients, the achievement of an ongoing pregnancy is maddeningly elusive. The anguish of enduring repeated cycle failures creates overwhelming frustration. As time goes on, the prolonged cumulative effect of this stress can actually cause physiological responses counter productive to reproduction. In the paragraphs below the escalating stages of despair are described and relaxation ideas are suggested to help counteract the deleterious effects of stress. Infertility strikes one couple in six. The older a women the more likely she is to need medical intervention to conceive. In this most intimate area of a couple's life the stress of medical treatments demands escalating amounts of time, emotional investment and money. A woman, undergoing infertility therapy herself, wrote the following quote that eloquently expresses the anguish of an infertility patient.

"My infertility is a blow to my self-esteem, a violation of my privacy, an assault on my sexuality, a final exam on my ability to cope, an affront to my sense of justice, a painful reminder that nothing can be taken for granted. My infertility is a break in the continuity of life. It is above all a wound… To my body, to my psyche, to my soul."
-Jorgensen, l981. On healing. Resolve Newsletter, Dec., 1.

The "wound" to the psyche and soul that Ms. Jorgensen addreesses in her quote is the area where patients can make a difference in their own treatment and is the subject of this article. The physician is providing the very best medical care for the "body" but to treat the "wound to the psyche and soul" will require the mental participation of the patient. This article will empower the infertility client to take charge of the progressive stress levels engendered by infertility treatments by explaining:

1. The progression of infertility's despair
2. The consequences to reproductive function that stress can cause
3. And how to utilize joyful and relaxing activities to diminish stress.

Blenner (1990) describes the predictable progression of infertility's emotional toll. There are eight stages as summarized below. The spiral depicted on the right illustrates the downward drift of emotional health and excalating despair

1. Dawning of awareness: Couples plan the best time of the year to have a baby; realize it seems to be taking longer than expected, still identify with fertile population.
2. Facing a new reality: Diagnosis stimulates couples to face reality of infertility. Blaming, guilt arise. Selective perception of success rates and discounting of side effects and risks of treatment. Begin to isolate themselves.
3. Treatment: Hopeful, excited, high energy.
4. Intensifying treatment: Infertility major focus of life, financial and time sacrifices intensify. Anger or depression occurs. Increasing isolation, avoids activities with children. Loss of control.
5. Spiraling Down: Tearful, overwhelmed, enrages by the injustice of infertility
6. "Letting go": Usually husbands "shut down" first, then wives. Resume social life but activities without children (backpacking). Strong desire to regain control of life, quitting is gradually OK.
7. Quitting and moving out: Initial feelings of relief, followed by grief. Initiation of adoption for some.
8. Shifting focus: For childless couples, peaceful resignation. For adoptive parents, focus on the child.

How is infertility diagonized in a woman?

If a woman has an infertility problem, she will be referred to a doctor who specializes in reproductive endocrinology. Her diagnostic tests may include:

• Blood tests and urine tests to check hormone levels.
• A Pap smear to study the health of the cervix.
• Urine tests to evaluate LH surges.
• A basal body temperature test, which checks whether the woman is releasing eggs from her ovaries. A woman's temperature rises slightly during the days she ovulates. The woman will chart her basal body temperature every day for a few months on a graph. She will take her temperature orally or may take her temperature vaginally with a special ultra-sensitive thermometer available at most drugstores.
• An endometrial biopsy, in which the doctor removes a piece of tissue in the uterine lining. Examining this tissue will tell the physician whether eggs have been released and whether the corpeus luteum is producing enough progesterone. This test is often done if the results from the woman's basal body temperature chart are unclear.
• An ultrasound to look for fibroids and cysts in the uterus and ovaries. This test uses sound waves to picture the uterus and ovaries, causes little discomfort, and is very effective.
• A postcoital test, in which the doctor takes a sample of mucous from the woman's vagina. She must have the test during her fertile days and within 12 hours after she and her partner have sex. The test will tell the doctor if the man's sperm can survive in the woman's cervical mucous.

More complex tests include:

• A laparoscopy: If the doctor suspects ovarian or fallopian tube scarring or endometriosis, a woman may undergo a laparoscopy. The doctor makes two small incisions at the pubic bone and navel, and carbon dioxide gas is injected into the stomach to enlarge it.

  Then the doctor inserts a laparoscope, a long tube with lenses and a fiberoptic light, into one incision and a long probe through the other opening in the skin. With the probe, the doctor can view the ovaries, fallopian tubes and uterus to check for scar tissue. In some cases, he may cut away scar tissue discovered during this operation.

  The woman usually has to undergo general anesthesia for the procedure, but the risks of bleeding, infection and reaction to the anesthesia are slight.

• A hysterosalpingogram: This test checks the condition of the woman's fallopian tubes.

  The doctor clamps the cervix and injects a needle filled with dye into the woman's uterus. An X-ray is taken to determine whether the dye passes through the open ends of the fallopian tubes. If the dye emerges from the end of the tubes, they are not blocked.

  The test may also reveal other fertility problems, such as fibroid tumors, structural abnormalities and endometrial polyps. In some cases, the dye actually clears away blockages in the fallopian tubes, and restores the woman's fertility.

  The dye is harmless and is absorbed by the woman's body after going through her tubes. The test may be uncomfortable, but is rarely painful. Unfortunately, it is noted for both false positive and false negative diagnoses.

How is infertility diagonized in a man?

The tests for male infertility are fairly simple and easy. After a medical history and an examination, the man's sperm are tested. He'll be asked to ejaculate into a cup in a private place in the doctor's office or at home, and this specimen will be evaluated. The man should not ejaculate for several days before he takes the test, because each ejaculation may reduce the sperm count.

Health workers will check the man's semen for several factors:

• sperm count (20 to 100 million sperm is the normal number)
• movement
• maturity and shape of the sperm (which reveal its quality)
• the amount of sperm produced (one teaspoon is sufficient)
• acidity (the semen should be slightly acidic)

The man may be asked to undergo this test twice, because some illnesses such as infections or viruses can affect the sperm. If a man has abnormal sperm, he'll be referred to a fertility specialist, where he'll experience more tests, such as:

• Hormonal blood tests.
• Imaging tests that check for swollen veins or reproductive system blockages.
• A testicular biopsy. This is a procedure done in the office. The doctor takes bits of tissue from the testes, and this tissue is examined to see whether the cells that produce the sperm are working properly.
• Anti-sperm antibody tests, which check whether the woman's mucous rejects the man's sperm. These tests also show whether the man produces antibodies to reject his own sperm.
• A hamster egg test, which studies the sperm's ability to penetrate a hamster egg. The outer covering of the egg is removed to allow the sperm to more easily penetrate. This test cannot result in a living embryo. It's expensive, however, and sometimes unreliable.
• A human zona penetration test, which tests whether the man's sperm can fertilize dead human eggs. Again, this test cannot result in a living embryo, and is thought to be more reliable than the hamster egg test.
• A bovine cervical mucous test, which checks whether the sperm can penetrate cervical mucous taken from a cow.

How is infertility diagonized ?

A complete medical history and a physical exam are the first steps in diagnosing a fertility problem. Both partners need to be evaluated. The couple may also need blood tests, semen specimens from the man, and ultrasound exams or exploratory surgery for the woman.

Need To Know: Your Doctor Will Want to Know During the initial medical exam and history, the doctor will need information about the couple's sexual and medical history. They should prepare for these questions: What medical conditions have you had? What medications do you take? Have you had any past surgeries? How often do you have intercourse? When do you have intercourse? Do you use a lubricant? Is there any discomfort during intercourse? Do you feel anxious or depressed about being unable to conceive? For the woman: When did your periods begin? How regularly do your periods occur, and how long do they last? For the man: Do you experience any erection or other sexual problems during intercourse?

How is Infertility Diagnosed in a Woman?

How is Infertility Diagnosed in a Man?

Why does a man become infertile?

The most common cause for male infertility is a problem with the sperm - either low sperm count or sperm with poor quality. Sperm with poor quality cannot move rapidly enough or in the right direction, or may be abnormally shaped. Some conditions that may contribute to sperm problems include:

• Under-developed testes-usually arising after a mumps infection, a hernia surgery, an injury or birth defect.
• Swollen veins in the scrotum.
• Undescended testes-a problem often present from birth in which the testes remain in the body cavity. Normally they descend into the scrotum before birth.
• Infections, such as gonorrhea or tuberculosis, that block the ducts through which the sperm travel.
• Exposure to metals such as leads, or chemicals such as pesticides.
• Certain medications, such as Tagamet (cimetidine), Dilantin (phenytoin), Folex (methotrexate), Axulfidine (sulfasalazine), corticosteroids and chemotherapy drugs such as Cytoxan and Neosar (cyclophosphamide).
• Injury to the testicles
• Chronic prostate infections

Other common causes of male infertility are:

• Autoimmunity, in which antibodies or cells of the man's immune system attack sperm cells, mistaking them for toxic invaders. The antibodies attach themselves to the sperm and may cause them to stick together, or may stop them from penetrating the cervical mucous or the egg.

  Nice To Know: What causes male autoimmunity? Male autoimmunity often develops after vasectomy. Sperm actually are produced after a vasectomy, but may leak out into the body where immune cells target them as invaders. Even when a vasectomy is reversed through surgery, this autoimmunity may continue. Antibodies to sperm have also been located in men without vasectomies-in about 10 percent of infertile men. In these cases, the reason for the existence of these antibodies is often unknown.

• Retrograde ejaculation. In retrograde ejaculation the muscles of the urethra do not force the sperm out. Instead, the sperm travel backward into the bladder. Causes of retrograde ejaculation include:
• Drugs such as tranquilizers or high blood pressure medicines.
• Diseases such as diabetes or multiple sclerosis.
• Neck, bladder or prostate surgery.
• Spinal cord injury.

In a small percentage of cases, male infertility is caused by:

• Sexual difficulties such as impotence, premature ejaculation, or painful intercourse. These problems can often be easily treated.

• Genetic defects or structural problems. In germ-cell aplasia, for instance, the sperm-producing germ cells do not develop correctly. Defects in the Y chromosome or in certain genes may also play a part in infertility.

Rarely, a hormonal difficulty that decreases or stops the man's production of sperm. Hormonal problems may be present from birth or can develop from brain or pituitary gland tumors or radiation treatment. Sometimes, hormonal difficulties are induced by excessive exercise, malnutrition or other illnesses.

Why does a woman become infertile?

Infertility in a woman may stem from many causes, such as hormonal deficiencies, problems in the reproductive organs, and some illnesses. Complications from surgery and certain medications may also impair fertility.

The most likely causes for female infertility are:

• Pelvic Inflammatory Disease (PID) - PID is the most common cause of infertility worldwide. It's an infection of the pelvis or one or more of the reproductive organs, including the ovaries, the fallopian tubes, the cervix or the uterus. Sometimes PID spreads to the appendix or to the entire pelvic area.

  PID usually stems from the same bacteria that cause sexually transmitted diseases, such as gonorrhea or chlamydia. Chlamydia, in fact, causes 75 percent of fallopian tube infections.

  PID may also develop from bacteria that reach the reproductive organs through abortion, hysterectomy, childbirth, sexual intercourse, use of an intrauterine (IUD) contraceptive device or a ruptured appendix.

  Not only does PID cause infertility, but it may also lead to ectopic pregnancy and blood poisoning, a potentially fatal complication.

• Polycystic ovary syndrome (PCO) - This condition affects 5 million American women and is another major cause of infertility. In PCO, the ovaries produce high amounts of male hormones, especially testosterone. LH levels also remain abnormally high while FSH levels are abnormally low; thus, the follicles do not produce eggs. Instead they form fluid-filled cysts that eventually cover the ovaries.

  Recent research indicates that PCO is caused by the failure of muscle, fat and liver cells to accept glucose (the cellular fuel made from the food that humans eat). As a result, the pancreas begins churning out large amounts of insulin, a hormone that usually ushers glucose from the blood to the body's cells. This extra insulin plays havoc with the ovaries, as well as other parts of a woman's body.

  PCO not only causes infertility, but also increases the risk of diabetes, cancer and even heart disease. The symptoms include:

  • Excessive facial hair
  • Thinning hair
  • Acne
  • Depression
  • Unexplained weight gain
  • Irregular or no periods
  • High insulin or cholesterol readings

• Endometriosis - This disease is another common cause of female infertility.

  Endometriosis refers to a condition in which sections of the uterine lining implant in the vagina, ovaries, fallopian tubes or pelvis. These implants eventually form cysts that grow with each menstrual cycle, and may eventually turn into blisters and scars. The scars can then block the passage of the egg.

• Other sexually transmitted diseases such as genital herpes can decrease fertility.
• Ovary Problems - Decreased production of any one of the five hormones that regulate a woman's reproductive cycle may result in infertility. Problems within the ovaries may inhibit reproduction as well. Instead of releasing an egg, the ovarian follicle remains empty, fails to rupture or traps the egg.
• Hormonal Problems - Adrenal or thyroid deficiencies may cause hormonal and ovarian problems.

  Some women produce excess amounts of prolactin, a hormone that normally stimulates the production of breast milk. Prolactin can also prevent ovulation. High levels of prolactin in a woman who is not nursing may indicate a pituitary tumor. It can also result from the use of oral contraceptives.

• Immune System Problems - Women may develop antibodies or immune cells that attack the man's sperm, mistaking it for a toxic invader. Certain autoimmune diseases, in which the woman's immune cells attack normal cells in her own body, may also contribute to ovarian problems.
• Luteal Phase Defect - In a luteal phase defect, a woman's corpus luteum - the mound of yellow tissue produced from the egg follicle - may fail to produce enough progesterone to thicken the uterine lining. Then the fertilized egg may be unable to implant.
• Fibroids - Fibroids, or benign growths, may form in the uterus near the fallopian tubes or cervix. As a result, the sperm or fertilized egg cannot reach the uterus or implant there. Fibroids in the uterus are very common in women over age 30.
• Other Uterine Problems - Abnormal reproductive organs or endometritis (an abnormal swelling of the uterine lining) may make it difficult for the fertilized egg to implant.
• Surgical Complications - Scar tissue left after abdominal surgery can cause problems in the movement of the ovaries, fallopian tubes, and uterus, resulting in infertility. Frequent abortions may also produce infertility by weakening the cervix or by leaving scar tissue that obstructs the uterus.
• Uterine muscle problems - Some women may produce weak, infrequent or abnormal contractions in the uterus. During ovulation, these contractions usually push the sperm up to the fallopian tubes.
• Poor quality cervical mucous - Sometimes a woman's mucous fails to thin around the time of ovulation, and consequently it prevents the sperm from traveling through it. A cervical infection may also be the cause.
• Illness - Certain diseases, such as diabetes, kidney disease or high blood pressure may cause infertility. Ectopic pregnancy and some urinary tract infections may also elevate the risk of infertility.
• Medications - Many medicines, such as hormones, antibiotics, antidepressants, and pain killers may bring on temporary infertility. Commonly used medications such as aspirin and ibuprofen can also impair fertility if taken mid-cycle. Acetaminophen (Tylenol) pills can reduce the amount of estrogen and luteinizing hormones in the body, impairing fertility.
• Premature Menopause - Some women may experience premature menopause, when their ovaries stop producing eggs. Often the cause is excessive exercise or anorexia.

Other causes: some other contributors to infertility include excessive exercise, stress or anorexia.

What Causes Infertility?

Most infertility results from physical problems in a man or woman's reproductive system.

• About 35 percent of all cases of infertility arise from problems in the man's system.
• About 35 percent arise from abnormalities in the woman's system.
• About 20 percent of the time, the man and woman both have fertility problems.
• In 10 percent of cases, no cause can be found.
• Age often increases the risk of infertility.

Infertility can be caused by poor sexual or lifestyle habits that are easily remedied. For example, the couple may be using a sexual lubricant that interferes with the survival of the man's sperm. Or, they may not be having sex often enough. Other easily treated illnesses or lifestyle habits that may contribute to infertility are:

• Heavy use of alcohol, tobacco or drugs.
• Starvation diets or anorexia in the woman.
• Tight underwear or pants in the man, which raises the crotch temperature and reduces sperm count.
• Stress. In a woman, this may cause her periods to be irregular. In a man, stress may reduce his sperm count.

Most of these problems can be resolved with medical treatment or lifestyle changes, such as wearing boxer shorts, avoiding a sexual lubricant, or trying some simple stress reduction methods such as physical exercise or relaxation techniques.

Changing the timing of sex and the couple's sexual techniques may also increase the chance of pregnancy. Sometimes the semen from the man fails to reach the woman's cervix. Placing a pillow under the woman's hips after intercourse may help prevent spillage of semen.

Nice to Know: Does limiting sex boost the man's sperm count? It may. However, research shows that having sex every day or even several times each day both before and during ovulation is the best way to achieve pregnancy. The sperm count may be lower when sex is this frequent, but the constant release of semen may be more likely to fertilize the egg.

Why Does a Woman Become Infertile?

Why Does a Man Become Infertile?

Infertility: the egg and the sperm

How the egg is fertilized
An egg is usually fertilized by sperm within the fallopian tubes - but only if the woman has sex with a man around the time the egg is released. The sperm must penetrate the egg to fertilize it.

Sperm can survive for six days after entering a woman's vagina and can fertilize the egg at any time during this period. However, research shows that fertilization is most likely to occur two days before or on the day the egg is released. The fertilized egg then moves on to the uterus, where it implants and grows into an embryo, and pregnancy results.

The Unfertilized Egg

If the egg is not penetrated by sperm, it lives for 12 to 24 hours. The egg and the bloody lining of the uterus then slough off, traveling out of the uterus, the cervix and vagina - a process called the woman's menstrual period.

Reproduction In A Man

Men have four primary hormones involved in reproduction. They are:

• gonadotropin-releasing hormone (GnRH).
• follicle stimulating hormone (FSH)
• luteinizing hormone (LH).
• testosterone

Here is how the hormones work:

• In a man, the brain's hypothalmus first releases gonadotropin-releasing hormone (GnRH).
• GnRH stimulates the pituitary gland to produce two hormones - follicle stimulating hormone (FSH) and luteinizing hormone (LH).
• These hormones regulate the production of sperm and the release of the male hormone testosterone, all of which takes place in the male testes, located in the scrotal sac.

The Production of sperm

Sperm begin life in the testes in cells called Sertoli cells.

• At the beginning of a sperm's life cycle, hormones develop its head and tail.
• The sperm then escapes from the Sertoli cell into the epididymis, located behind the testes.
• For three weeks, a sperm travels through the epididymis in an energizing fluid containing fructose. As the sperm swims through this fluid, it matures and acquires the ability to swim and move back and forth.
• A mature sperm has a head that contains the man's DNA - his genetic material - and a tail that rapidly moves from side to side, propelling it forward.

Ejaculation

When a man ejaculates during sex, muscular contractions push the sperm out of the epididymis to channels called the vas deferens. The sperm then move to the ejaculatory ducts and out the urethra (the passage through which urine and semen are passed from the body).

• Just before ejaculation, the sperm in the ejaculatory ducts mix with fluids that come from the prostate gland and from glands called the seminal vesicles, creating semen.
• During orgasm, the seminal vesicles push the semen forcefully out into the urethra.
• A muscle in the bladder also locks shut to prevent the semen from traveling backward into the bladder and mixing with urine.
• The semen moves from the urethra to a holding area at the bottom of the penis, where muscles propel it out of the penis.

How a sperm fertilizes the egg

Of the 100 to 300 million sperm released when a man ejaculates, only about 40 survive the trip through the acidic environment of the vagina and cervix. The woman's thick cervical mucous can also be a barrier. But during ovulation, the woman's mucous thins and allows the sperm to travel more freely.

After it bores through the cervical mucous, the sperm trigger the acrosome (a special membrane located on their heads), and it dissolves and releases special enzymes. These enzymes allow the sperm to penetrate the tough coating surrounding the egg in the fallopian tubes. Only one sperm ultimately fertilizes the woman's egg.

Nice To Know: What should I do if I think I am infertile? If you've had more than a year of regular sex without birth control and you haven't achieved a pregnancy, it may be time to see a doctor. If a year hasn't passed yet, a good strategy is to plan to have sex during the days the woman is ovulating. To find the days when she ovulates, a woman can take her temperature by mouth or in the vagina with special thermometers available in drugstores. Her temperature will rise slightly on the days she ovulates.

Facts About Infertility:

• It's a myth that infertility is always a "woman's problem." Half of all cases of infertility result from problems with the man's reproductive system.
• The best protection against infertility is using a condom while you are not attempting to conceive a child. Condoms protect against sexually transmitted diseases, a major cause of infertility.
• Of couples that seek medical treatment for infertility, 20 percent conceive before the treatment actually begins. One reason may be that anxiety about infertility may have contributed to the fertility problem, and contacting a doctor provides emotional relief.
• Fifty percent of infertile couples conceive within two years of starting treatment.
• A woman's temperature rises about 1 degree Fahrenheit during the days she is ovulating (producing eggs). By taking her temperature every morning with a special thermometer, a woman and her partner can chart the rises and falls in her morning temperature. They can then plan intercourse for the days she is ovulating--her most fertile time.

What is infertility?

Infertility is defined as the failure to conceive after a year or more of regular sexual activity during the time of ovulation. An estimated one in every five couples (men and women equally) in the United States experiences infertility. It is not a disease. Rather, it is a symptom that something is preventing the reproductive processes from working properly, and needs treating.

A highly prevalent feeling of people with infertility is loss of control. Most people assume they can have children when they choose. After twenty or thirty years of assuming you would have your children when wanted, and spending time and energy trying not to get pregnant, you feel frustrated when you decide to have the baby and find that it is not so simple.

We are taught from an early age that the harder we work at something, the more likely we are to get it. Infertility is different. How hard you work at getting pregnant or what kind of person you are is irrelevant. Many get stressed at the job of making babies and this work against them. Stress is one of the major causes of infertility in couples who have no problems otherwise.


Symptoms Of Infertility:
Infertility is a major and growing problem. Over three million visits each year to North American physicians are for infertility. The demand for treatment is increasing and the cost, both financial and emotional, can severely strain relationships.

*Inability to conceive a child after one year of unprotected sex
*A total sperm count lower than 5 Million/ml
*The presence of greater than fifty percent abnormal sperm
*Inability of sperm to impregnate egg, as determined by the postcoital or hamster-egg penetration tests

Reproduction In A Woman

Five important hormones stimulate the reproductive system of a woman:

• gonadotropin-releasing hormone
• luteinizing hormone
• follicle stimulating hormone
• estrogen
• progesterone

Here is how the hormones work:

• The hypothalmus, a region in the brain, first releases a hormone called gonadotropin-releasing hormone (GnRH).
• GnRH causes the pituitary gland to produce two more hormones--luteinizing hormone and follicle stimulating hormone.
• These hormones, in turn, tell the ovaries to release estrogen and progesterone.

How hormones regulate a woman's fertility

A woman's ovaries contain 200,000 to 400,000 egg follicles--small sacs that contain the ingredients needed to form ripened eggs.

• Over a two-week period in a woman's monthly cycle, FSH causes several follicles in the ovaries to ripen and mature.
• FSH also orders the ovaries to produce estrogen, which in turn, launches the manufacture of large amounts of LH hormone.
• LH hormone stimulates the release of an egg from the largest follicle into the fallopian tubes - a process called ovulation.
• LH hormone also stimulates the follicle to produce corpeus luteum - a collection of yellow tissue that manufactures progesterone.
• Progesterone and estrogen work together to thicken and prepare the lining of the uterus for a fertilized egg.
• Together, these hormones swell the lining of the uterus with blood, making it easier for a fertilized egg to implant itself there.