The Struggle to Conceive

By Heather Mills

What is infertility?

A woman is considered infertile if she tries unsuccessfully for one year or more to conceive having consistent, unprotected sex. This definition also applies to women who suffer repeated miscarriages/ cannot carry a baby to term. Infertility is a medical problem.
One in eight couples struggle with infertility, which can be very stressful for their relationship.
Secondary infertility refers to when a couple has one successful pregnancy, and then cannot conceive again.

Is infertility a female problem only?

At this early stage, the ultrasound can approximate your conception date and determine the number of fetuses by looking at the placenta. The doctor will also examine your pelvis, and check the fetus for any visible abnormalities.

What can a woman do?

The timing of intercourse is important in the conception process, as women are more fertile at certain times of the month. Doctors will usually help their patients understand this cycle and ask them to implement a new routine before beginning tests for infertility.
An ovulation kit from the drugstore – available over the counter – helps women understand their ovulation cycles. Doctors may also encourage tracking the daily changes in a woman’s morning body temperature.
A daily recording of the texture of cervical mucus will help the doctor designate a course of action. (Cervical mucus affects how the sperm proceeds in the uterus, and tests will determine any anti-sperm antibodies that are present). Blood tests and ultrasounds of the ovaries may also be necessary.

What are the options for couples that cannot conceive naturally?

• Surgery or Fertility Medications
• Assisted Reproductive Therapy (ART)
- Intrauterine Insemination (IUI)
- In Vitro Fertilization (IVF)
- Surrogacy and other techniques

Thousands of babies have been born as a result of Assisted Reproductive Technologies. Success rates vary for each option. The main reason is the fact that different couples struggle with different problems. Some procedures are effective for some, yet not for others. A probable cause of infertility can be determined in 80-90% of couples, and the rate of conception with counselling and treatment is about 50%.

There are also surgeries that can be conducted on men, to retrieve sperm or facilitate sperm travel.

SURGERIES

If a woman has blocked fallopian tubes, surgery can be conducted to open them. This is called ‘tuboplasty’. There are also surgeries that can be conducted on men to retrieve sperm or facilitate sperm travel.

ASSISTED REPRODUCTIVE TECHNOLOGY

These processes are very expensive to undergo, and can cost tens of thousands of dollars. Few insurance companies will cover this. Women have also reported that fertility treatments can be painful, stressful and tedious.
Fertility medications stimulate the production of eggs during ovulation, allowing multiple chances for fertilization. When using these drugs, the chance of multiple births is high. Multiple births can also result with other ARTs.
Some processes involve fertilizing the egg outside the body and then implanting it, while others involve fertilizing the egg directly in the uterus. There are also treatments geared towards increasing the sperm’s success of fertilizing the egg.

There are many different kinds of Assisted Reproductive Technology. The most commonly spoken about are:
• Intra-uterine Fertilization
• In-vitro Fertilization
• Surrogacy

INTRA-UTERINE INSEMINATION

In this process, washed sperm is inserted into the cervix at the most promising and fertile time of the woman’s cycle.
IUI is simpler and often less expensive than IVF, and is the most commonly used method of ART.
Before this process is conducted, the woman sometimes undergoes fertility drug therapy. This ensures there is more than one egg available for insemination and fertilization, and increases the success rate of IUI. However, it also increases the chance of multiple births and ovarian hyperstimulation syndrome.

IN-VITRO FERTILIZATION

IVF is associated with the term “test tube babies”, since the fertilization occurs outside the woman’s body, and inside the laboratory.
The first IVF baby was born in England in 1978.
Thousands of children worldwide have now been born as a result of assisted reproductive technology.

Egg Retrieval

• The first drug administered stops the hormones that regulate egg production.
• Over the next week and a half, second drug stimulates the production of multiple eggs.
• The final drug speeds the maturation of the eggs.
• 36 hours later, the eggs are retrieved from the uterus.
• After the egg has been fertilized, it is returned to the uterus.
• To help build the uterine lining, the hormone progesterone is administered. Typically, a woman must wait for two weeks until she can return to the lab and find out her results.

SURROGACY

Surrogacy is when a woman carries and gives birth to another woman’s baby. Surrogacy is an option for a woman who has physical problems that prevent her from carrying a baby to term.
In an IVF surrogacy, the surrogate mother has the fertilized egg of another woman and a man implanted into her uterus, where it grows to term.
In a natural surrogacy, the sperm of the man in the couple is used to fertilize the egg of the surrogate woman. Therefore, the child is biologically related to the surrogate and not the woman who will raise the child. It is the responsibility of the genetic couple to find the surrogate mother.

NOTE: In 2004, the Canadian government passed a law stating that all ova (egg) donation programs involving payment or sharing of ova in return for services is prohibited by law. In some countries, surrogacy is illegal.
There is permission in this law for altruistic donation, and compensation for “reasonable” expenses. Several fertility clinics are currently lobbying for clarity on these laws.

Factors that contribute to female infertility:

• Extreme stress
• Over- or under-weight
• Extremely high activity levels
• Smoking
• Alcohol consumption
• Uterine damage caused by endometriosis, ectopic miscarriages
and resulting surgeries.
• Age (the amount of healthy eggs released for fertilization decreases with age; women are born with all the eggs they will ever have)
• Sexually Transmitted Diseases (chlamydia, gonorrhea and HPV can contribute to infertility)
• Poor diet
• Fallopian tube blockages (can result from disease or infection)

Factors that contribute to male infertility:

• Environmental toxins
• Age
• Smoking
• Alcohol and drug consumption
• Health problems
• Medicines & prescription drugs
• Radiation treatments for cancers
• Low sperm count, problems with motility (movement) of sperm, irregular shape of sperm.