Getting Through the Maze of Infertility

Transcription

1 Getting Through the Maze of Infertility All Rights Reserved.

2 Table of Contents Guide to Infertility Section 1 Understanding Infertility... 3 What is infertility?... 3 There are other health problems... 4 There are tests... 5 The causes of diagnosed infertility issues included... 6 In vitro fertilization (IVF)... 7 Section 2 Basics of Getting Pregnant... 8 The woman must be ovulating... 8 How do you know when you're ovulating?... 8 Section 3 - Infertility: Beyond the Basics If you are not successful with progesterone If Clomid does not work for you Natural medicine doesn't make your physician any money Vitamin C is an advantageous vitamin Vitamin E is an essential part of reproduction and fertility Zinc is helpful Section 4 Advanced Treatments Fertility drugs Artificial insemination If your fallopian tubes are blocked If all of these methods fail Payment for extreme fertility options can be very expensive If your insurance policy does not cover the treatment Section 5 Coping with Infertility Depression is now believed to be a real part of infertility treatments Infertility can test a relationship Page 2

3 Getting Through the Maze of Infertility Section 1 Understanding Infertility What is infertility? And why does it cause such sadness and frustration when a couple is faced with it? Experts often define infertility as having tried for a year to get pregnant, and not being successful. If a woman can get pregnant, but then she experiences miscarriages, she is also considered infertile. It seems that many women get pregnant when they aren't planning on it, but it actually is a chain of events that is quite complex. For a pregnancy to occur, the woman must ovulate, which means releasing the egg from an ovary. The egg must travel through the fallopian tube on its way to the womb, or uterus. The sperm from the male must fertilize that egg along its way to the uterus. Then the fertilized egg has to implant or attach itself to the uterine wall. If something happens to cause any of these steps not to happen correctly, this is considered infertility. In 2002, over seven million women in the United States, between the ages of 15 and 44, had significant difficulties in becoming pregnant, or in carrying a baby to full term. This information is from the Centers for Disease Control and Prevention. Infertility does not always indicate a problem in the woman's case. Only in about thirty-three percent of infertility cases is the problem a female factor. In another thirty-three percent of cases, the infertility is caused by male factors, and in the remaining cases, the reason for the infertility is either a combination of male and female factors, or unknown factors. In men, infertility is usually caused by problems in making sperm, which means the man produces no sperm at all, or too few sperm. Or there may be an issue with motility, which is the sperm's ability to get to the egg and then fertilize it. Usually, an abnormal shape or structure of sperm prevents it from being able to move correctly. In some cases, men are born with issues that will affect their sperm. In other cases, problems may appear later on in life, perhaps due to an injury or illness. As an example, infertility in men is sometimes caused by cystic fibrosis. There are various reasons that may increase a man's chances of being or becoming infertile. His lifestyle and health can affect his number of sperm, or their quality and motility. Some of the things that can possibly reduce the number or quality of sperm may include drugs, alcohol, toxins in the environment, health Page 3

4 issues, smoking cigarettes, medicines, age, and chemotherapy or radiation treatment for cancer. In women, ovulation-related problems make up most cases of infertility. If there is no ovulation, there will be no eggs ready for fertilization. If a woman is not ovulating normally, she may miss menstrual periods or have irregular periods. Some other causes of infertility in women are not as common. These include fallopian tubes that are blocked, whether that occurs as a result of endometriosis, pelvic inflammatory disease or a surgery performed as the result of an ectopic pregnancy. A woman may also be infertile if she has fibroids in her uterus, or physical issues with her uterus. Are You Fertile? Discover How You Can Conceive with Ease + Claim 10 Free Pregnancy Tests ($48 value) There are various things that may add to a woman's risk of being infertile. These include stress, age, athletic training, poor diet, smoking, being underweight or overweight, sexually transmitted diseases, alcohol consumption or health problems that may cause changes in hormones. One of the more common affects on fertility is a woman's age. Many women now pursue careers first and wait to have children until they are in their 30's or 40's. This causes some fertility problems. Roughly thirty-percent of couples where the woman is over the age of 35 have some types of fertility problems. Aging can decrease the chances of a woman to become pregnant in various ways. Her ovaries may have become unable to release eggs that are ready to be fertilized. The health of a woman's eggs also declines as she becomes older. She may also have other health issues that can interfere with her ability to become pregnant. In addition, miscarriage risks increase with age. Many women don't understand how long they should work at trying to become pregnant before they ask their physician for help. Most women who are healthy and under thirty years of age don't need to worry about being infertile, unless they have been trying to become pregnant for more than a year. If that much time has elapsed, the woman may need a fertility evaluation. There are occasions when a woman will need to talk to her doctor sooner than this. If a woman is in her thirties and has been trying to become pregnant for over six months, she should discuss this with her physician. Each year after the age of thirty decreases a woman's chances of having a healthy baby, so you will want to be evaluated sooner rather than later. There are other health problems that may also cause issues of infertility. If you have any of these conditions, speak to your physician as soon as possible. If you Page 4

5 have quite painful periods, no periods or irregular periods, more than a single miscarriage, or pelvic inflammatory disease, check with your physician. Regardless of your age, you can always speak to your doctor before you begin trying to become pregnant. He or she may be able to give you helpful advice so that your baby will be healthier. They also have the answers to some fertility questions, and can give you pertinent tips on conceiving. There are tests that a physician can perform to determine why you are having fertility problems. A fertility evaluation will give your doctor helpful information. This will start out with sexual and health histories being taken, and physical exams given. If you're not having issues that you can change easily, like timing intercourse poorly, there will be more tests needed. For a physician to determine the cause of your infertility, it may take a long, intricate and emotional process. You may need months for your doctor to finish up the tests and exams needed. You don't need to be alarmed if your problem isn't discovered right away. When the physician tests the man for fertility, he will start out by testing his semen. He will check the shape, number and movement of the sperm. He may also test the man's hormone levels. If you're the woman in the relationship, the doctor will need to find out if you are ovulating every month. To do this, he may have you track your own ovulation at home. This can be done by recording your basal morning body temperatures for a few months, recording your cervical mucus texture for several months, and using an ovulation test kit you can do at home. You can purchase these at grocery or drug stores. Your doctor may also be able to determine if you are ovulating by doing blood work, and an ovary ultrasound. If it is determined that you are ovulating in a normal manner, there will be more tests needed. There are tests that doctors will commonly use to determine whether a woman is fertile or not. One is a hysterosalpingography test, where x-rays are used to check for problems in the fallopian tubes or the uterus. A special dye is injected into the uterus, through the vagina, and then it shows up on your x-ray. In this way, the doctor can see how the dye moves through your uterus and fallopian tubes. Then he or she can spot any blockages that can cause infertility. Blockages may prevent eggs from going from fallopian tubes to the uterus, or keep sperm from reaching an egg. Your physician may also use a laparascope to look inside your abdomen. By making a small cut in the lower part of the abdomen and inserting the laparascope, your doctor can check your uterus, fallopian tubes and ovaries for physical issues or disease. If you have any scarring or the condition of endometriosis, your doctor can find that through a laparoscopy Page 5

6 Almost six million pregnancies are recorded yearly in the United States, and over four million of those end in live births. Of the two million that do not, roughly 600,000 are lost to miscarriages, about 1.2 million are terminated, about 64,000 are lost due to ectopic pregnancy, 6,000 to molar pregnancy, and 26,000 are stillborn. Roughly 875,000 women yearly have some complications during their pregnancies. There are 307,000 low birth weight babies born each year, and about 467,000 babies are born premature. 155,000 babies are born yearly with some type of birth defect, and in 2001, nearly four hundred women died because of pregnancy issues during or after childbirth. Some women don't gain enough weight to have what health professionals consider to be an acceptable weight gain for pregnancy. About 67 percent of women who became pregnant in 2005 gained between sixteen and forty pounds, and this is a healthy range, according to the CDC. Thirteen percent of women gained fifteen pounds or less, which is not enough weight gain, and twenty percent gained over forty pounds, which is not healthy, and is considered to be too much weight gain. In the 1990's, women between the ages of 30 and 34 became pregnant at a rate that was an increase of three percent. For women between the ages of 35 and 39, the rate was up nine percent, and between the ages of 40 and 44, the rate was up 21 percent. Couples who are younger usually seek infertility treatments, before the woman is thirty years of age, since her chance to become pregnant will drop from twenty percent to five percent between ages thirty and forty. The causes of diagnosed infertility issues included - 18% female and male factor - 17% male factor - 12% female factor - 12 % diminished ovarian reserve - 9% tubal factor - 6% ovulatory dysfunction - 5% endometriosis - 1 percent uterine factor - 11% unknown factor Researchers in the field of fertility also demonstrate the effectiveness and limitations of various infertility treatments, including Assisted Reproductive Technology (also known as ART) and fertility drugs. Fertility drugs themselves are categorized into several different classes, and each Page 6

7 class has a varied rate of success for infertile couples. Guide to Infertility Injectable Gonadotropins and progesterone can supplement hormones that occur naturally, and if the woman's menstrual cycle can be stabilized, her chances to conceive increase. Drugs that induce ovulation, like Human Menopausal Gonadotropin and Clomid are able to increase the chances of a woman to ovulate by 70 to 90 percent. In vitro fertilization (IVF) and Assisted Reproductive Technology are showing success rates that are rapidly improving. According to reports compiled by the CDC, between the years of 1996 and 2005, live births that were the result of embryo transfers had increased by about 22 percent. When two embryos were transplanted, the success rate almost tripled. Single birth numbers as compared to multiple birth numbers went up by 35 percent. In all the age groups that were studied, there was a 29% increase in live births for women under 35 year old, a 24% increase in women aged 35 to 27, an 18% increase in women aged 38-40, a 30% increase in women 41 to 42 and a 7% increase in women over 42 years old. In additional studies, it was found that women who became pregnant through in vitro fertilization or other fertility treatments may have the same complications during pregnancy as women who became pregnant without any infertility treatments needed. One reported CDC study found that in women who received infertility treatments as well as those who did not, that their miscarriage rate was about the same, at 15%. When women have fertility treatments, they are more likely to carry multiple babies, rather than just one fetus. One CDC study found that in 2005, the rate of women having twins had increased by almost 70% since the 1980's, and part of this was attributed to fertility treatments Page 7

8 Section 2 Basics of Getting Pregnant Guide to Infertility If you want to get pregnant, it seems like a fairly simple task, doesn't it? All you have to do is to discontinue your birth control method, have sex, and you'll eventually get pregnant. Right? Sadly for many people who are trying to become pregnant, it doesn't work that easily for many people, and you may be one of those. Since we live in a world of career-comes-first, we often get too focused on methods of birth control, and we forget that, for conception to occur, many things have to be working just right, together. Firstly, the woman must be ovulating. The sperm must be near the egg during the time in which the egg is ripe. Implantation needs to occur. The list goes on. There are some simple questions that are often asked, and they may provide the basic answers you seek, when you have decided you want to have a baby. If you quit taking birth control pills, say, six months ago, and now you're timing productive intercourse for days when you are supposed to be ovulating, why aren't you pregnant? It takes a certain amount of time for most couples to become pregnant, even if there are no fertility issues. About ninety percent of couples can conceive without any medical help, within a year and a half. How do you know when you're ovulating? Ovulation is generally believed to occur on the fourteenth day after your period, by common knowledge, but the timing is more complicated than simply that, and it is individually dependent on the length of your cycle, and on your body itself. It's actually a bit more accurate to say that you ovulate fourteen days before your cycle begins. If you use this knowledge rather than the original guess for proper timing, there is a four day difference in estimated time of ovulation. Four days is a long time difference, when you're looking to become pregnant. Even the fourteen days before your cycle begins estimate doesn't work for every couple, and there are easy ways you can find out when you yourself ovulate, not when most women do. You can track this by charting your cycles based on your temperature, symptoms of fertility, or both. You may simply be asking when you and your husband or boyfriend should have sex, to give you the best chance of becoming pregnant. And you might wonder if some positions will give you a better chance than others Page 8

9 Part of this answer will depend on when precisely you are ovulating. You will need to time your sessions of intercourse around the actual time of ovulation. If you wonder when to take a pregnancy test, they are usually accurate if you are to the point of having pregnancy symptoms, which would include missing a period. Even though modern pregnancy tests can detect the change earlier, you'll be relatively assured if you take the test as soon as you have missed your period Page 9

10 Section 3 - Infertility: Beyond the Basics Guide to Infertility If it has been over eighteen months since you and your husband decided you wanted to become pregnant, and you've been following your body's symptoms and signs but haven't had any success yet, this is the time you will want to contact your physician, to have him or her check on the issue of fertility. If you haven't already used an ovulation predictor kit (also called an OPK), you may also want to use this to determine your most fertile times. Unlike the temperature charting, these tests anticipate your ovulation, rather than simply confirming that is has occurred. OPK's work by means of detecting luteinizing hormone, also called LH. Right before ovulation, you will experience a dramatic, sudden and brief surge of LH, and ovulation tests can detect this, which is a much more accurate predictor of the time of ovulation. If you get a positive result on an OPK, you will likely be fertile in the next three days or so, with your fertility peak about 36 hours after the surge in LH. If you still have no success after using OPKs, your gynecologist will likely be the first doctor you visit, for answers to your problem. If it is discovered that your progesterone is low, you may be given a prescription for progesterone, which is taken every month, after ovulation. If you are not successful with progesterone, you may learn that your lutheal phase is weak, which can be combated by the use of the drug Clomid. This is a fertility medication that boasts a high success rate. Clomid is one of the lesser expensive of fertility medications available, as well. But like any drug, Clomid doesn't work for everyone. Since each woman's body is different, the way you react to Clomid may be different than the way another woman will react to the same drug and dosage. In addition, some women have side effects with Clomid, but you may not notice any. If Clomid does not work for you, you may visit a specialist, who, through testing, might determine that PCOS, or having small ovarian cysts, is the cause of the non-pregnancy thus far. This is treated with cycles of Clomid, then Puregon and Choragon. The prescribed medications you are given are not the only way to enhance fertility and give you a better chance of conceiving a child. You can also use Page 10

11 integrative medicine, which means combining the conventional medicine that you are accustomed to with alternative medicine. You can utilize the abilities of conventional medicine to identify issues like blocked fallopian tubes or a low sperm count, but alternative medicines can gently improve your ovulation, bring your hormones into balance and bring better health to your whole body. Natural fertility treatments have been used around the world, by women and couples who want a child. Your gynecologist may not bring up many of these ideas, because this is not in their area of schooling, as a rule. Natural medicine doesn't make your physician any money, and there aren't very many (if any) people who visit your gynecologist to promote the natural herbs and vitamins used in natural medicine. There also isn't much funding to use for studies about natural medicine, or to increase the public's awareness of the natural treatments available. Vitamin C is an advantageous vitamin to concentrate on when fertility is an issue. If a man does not get enough vitamin C, his sperm may show a compactness of cells, according to a study at the University of Texas Medical School, Galveston. Agglutination occurs after sperm cells are clumped together, which inhibits maximum movement and progression of the sperm. Vitamin C is also important for smokers who may otherwise have more sperm that is abnormally formed, according to Dr. Earl Dawson, in Galveston. Excess smoke can make its way to a man's sperm and lower their function and counts. Vitamin C can possibly neutralize the toxic smoke effects on sperm. On the other side, women need to avoid large doses of vitamin C, since it can cause dryness of cervical fluid. This can make it more difficult for sperm to reach the egg. Vitamin E is an essential part of reproduction and fertility. Vitamin E deficiency can lead to lack of male fertility and absorption in females, according to studies performed on rats. A low level of vitamin E can also result in a decline in sex hormone formation, and sperm-producing enzymes. A study in Italy, at the University of Padua, found that a diet without sufficient selenium may cause infertility in males. Selenium helps to prevent sperm cell oxidation, which aids in the integrity of sperm cells. Seafood, liver and red meat are good selenium sources. Zinc is helpful within more than 200 enzymes and proteins that are essential for fertility in males. Low zinc levels cause testosterone levels to be lower, shrink the size of testicles and allow the production of less healthy, misshapen sperm. Black cohosh has long been recommended for hot flashes and symptoms of menopause, and it also treats vaginal dryness and mood swings. Black cohosh shows little or no tendency of side effects, and it improves menopausal symptoms Page 11

12 To lower cholesterol and to aid in quality cervical fluid production, Evening Primrose Oil (also known as EPO) is helpful. It is a fatty acid and the body converts it to a substance that is similar to hormones, known as prostaglandin E1. EPO also dilates the blood vessels and thins the blood, and assists your body in producing more cervical fluid of a high fertile quality. This fluid is also known as egg white cervical mucus. EPO allows sperm to swim more easily through the uterus and on to the fallopian tube. In addition to aiding fertility, EPO helps with PMS symptoms, and it can give benefits even to women in menopause. It may take a month or so to build up quality cervical fluid. It's important to discontinue EPO after you ovulate, and begin using flax seed oil, which will stabilize your estrogenprogesterone ratio Page 12

13 Section 4 Advanced Treatments Guide to Infertility If you have gone through natural and usual medical methods to gain a chance at pregnancy, and have not had success, you may turn to a specialist, who will be able to help you with more options that are only used after regular attempts have failed. Fertility drugs for women and men alike can help to get your respective reproductive systems on track, for a better chance at becoming pregnant. These drugs may help even in cases where the exact cause of your infertility is unknown. They can be taken along with more invasive measures, as well, to enhance your chances. Artificial insemination is basically a way to get the sperm to the egg. By placing your partner's sperm, in a concentrated dose, in your uterus, this will improve your chances to become pregnant. If your fallopian tubes are blocked, or you have ovarian cysts, genetic defects, fibroids or endometriosis, you may be a candidate for laparoscopic surgery. This can help your doctor to diagnose your problem, or clear a path by which you can conceive. Some surgeries are more invasive in nature, and may require the surgeon to make an incision in your abdomen. Generally, other treatment options are exhausted before this type of surgery is done. If your problem with infertility is a blocked fallopian tube or a low sperm count, or in cases where other treatments have not worked, high-tech procedures may be attempted. Using in vitro fertilization (also known as IVF), your egg cells can be fertilized by the sperm outside of your womb. This is a major, important treatment when other methods of assisted reproduction have not worked. When IVF is utilized, the eggs are removed from your ovaries, and fertilized in a fluid medium. Then the fertilized egg will be transferred to your uterus to attempt a successful pregnancy. Another form of last-resort fertilization is intracytoplasmic sperm injection, also called ICSI. In this method, an egg is injected with a single sperm. It is more often used in cases of male infertility, but is also used when the sperm cannot penetrate your eggs. In less common cases, gamete intrafallopian transfer, also known as GIFT, is used. In this procedure, eggs will be removed from your ovaries, and, along with the man's sperm, are placed in one of your Fallopian tubes. This will allow fertilization to take place within your own body. This procedure is used less often, since in vitro fertilization rates of success are equal, and don't require laparoscopy. In more rare infertility cases, zygote intrafallopian transfer, also called ZIFT, may Page 13

14 be utilized. In cases where the fallopian tubes are blocked, preventing the normal sperm to egg binding, ZIFT can prove to be successful. Eggs will be removed from your ovaries, and then in vitro fertilized. This zygote will them be placed laparoscopically in your fallopian tube. This has a success rate of about 65%. On average, the ZIFT cycle will take about five weeks. You'll need to take a medication for your own fertility, to stimulate the ovaries' egg production. Your physician will monitor the ovarian follicle growth, and after they are mature, your physician will inject you with hcg, or human chorionic gonadotropins. About 36 hours later, your eggs will be harvested, usually transvaginally. After they are fertilized, in the laboratory, the zygotes will be replaced in your fallopian tubes laparoscopically. If all of these methods fail, you may wish to consider using a gestational carrier or surrogate mother. She will agree to carry your baby to term. This is a legally complicated method of reproduction, but it is an option if you haven't had any success with having children on your own. Payment for extreme fertility options can be very expensive. Even for a single attempt, the average cost may be in excess of $15,000. You can check your health insurance policy to see if fertility therapies are covered. Some policies may cover drugs for fertility but not assisted reproductive technology. If your insurance policy does not cover the treatment you are seeking, you may have to pay out of your pocket for the treatment. If you are treated at a reputable clinic, they will remind you that fertility treatments do not come with any guarantees, but the fees will be there, whether the treatments succeed or not. Select a clinic that will only charge you for the services they actually perform. These facilities' management may refund monies paid for any treatments that are canceled. Roughly one third of all artificial transfers will result in a baby. If you use donor eggs, the rates go up to about fifty percent. If you limit caffeine and alcohol and quit smoking, and lose weight if you are overweight, this can increase your odds of becoming pregnant. These health concerns apply to the male in the relationship as well. Some things can't be changed, however your age is a major factor in fertility. Regardless of the treatments you use, you should be given accurate statistics on every eventuality, whether it is the likelihood of having twins, or the chances of an ectopic pregnancy. The most important rates to learn are the odds that the treatment will result in pregnancy, and the likelihood that your treatments will result in your being able to give birth to a healthy baby. As you learn about the rates of success, keep in mind that most statistics are national, and they don't take into account how many attempts will be made with Page 14

15 each method. Many experts believe that three to six attempts of any one procedure are the maximum amount to use, since further attempts will not normally be successful. Your case is individual though, and six attempts of impregnating through in vitro fertilization are not all that uncommon. In your search for fruitful procedures, don't assume that you must go to a large clinic to be successful. A recent CDC report on fertility clinics found that there is not a difference in the success rates when comparing small and large clinics. Learn as much as you can about the reputation of a clinic, and ask your physician's opinion on any clinics you are thinking about using. Ask the clinic for references, and be sure to call them. This is such an important step in your life that you will want to know for sure if your clinic is reputable. I Thought I Was Infertile But Contrary To My Doctor s Prediction, I Got Pregnant Twice and Naturally Gave Birth To My Beautiful Healthy Children At Age 43, After Years of Trying. You Can Too! Here s How Page 15

16 Section 5 Coping with Infertility Guide to Infertility It shouldn't be surprising that if you are experiencing infertility, that depression may well accompany it. The medical community usually focuses on the more physical aspects of infertility, and they don't always take into account the emotions that you feel during the process. There is actually a correlation between the success of infertility treatments and the positive emotional state of the participants. Studies have shown that over fifty percent of patients who work within a body and mind therapy will get pregnant within about six months, as compared to only twenty percent in the control group of the studies. Women who become depressed because they are infertile will have a lower success rate with treatments for infertility. If the depression is treated, you may stand a greater chance of a successful pregnancy. The type of depression that is associated with infertility is different than what might be called typical depression. Psychologists who counsel couples who are experiencing infertility feel that depression of this sort is caused by various combating emotions, including grief, anger, and jealousy as well as sadness. Jealousy may be the most painful part of infertility depression, since it isn't an emotion that is socially acceptable. You may also feel guilty, for depriving your spouse of the chance to have a child. In addition, you may feel that you have let your parents down, if they are waiting for grandchildren. There is also a measure of obsession in this type of depression. Many women simply cannot stop thinking about their infertility, and they even feel it in their dreams. Depression is now believed to be a real part of infertility treatments. The reason for this could be that every month you will be reminded that you have failed to become pregnant, yet again. You may experience many emotions, from loneliness, to issues with children, and on to occasional faith crises. Faith may help in some ways, but in other ways, it can make it more difficult, too, since you may well feel that God does not wish for you to have a baby. This can be quite a struggle. Even if your husband is supportive of you, you may still feel that he doesn't understand what you are truly going through. Men will not usually react the same way to the anxiety and stress of fertility treatments as women will. They don't deal as much with it on a day-to-day basis like the woman usually does. Your monthly menstrual period may also add to your sense of sadness. Men just want the problem fixed, but women can't put this aside like men can, to concentrate on other things. Infertility can test a relationship, since it may affect many aspects of your life. Once you are undergoing fertility treatments, you are with it every day. There Page 16

17 may be injections to be done, and you can't drink or smoke. This can cause couples to become distant and isolated, and this will make your depression even worse. Seek out a counselor who has experience in fertility depression, so that you can head into or through fertility treatments with a more positive attitude Page 17