Making Your Fertility Treatment Plan: Taking Control of Your Fertility

Myth #1: Infertility Is the Woman's Problem
For years physicians and infertile couples believed that fertility problems stemmed primarily from the woman. In fact, suspected barrenness was a man's grounds for divorce as well as a king's justification for beheading his wife. Today, however, we know that fertility problems are equally common in both men and women. Although the statistics vary some from study to study, the consensus is that it's the woman's problem about one-third of the time and the man's problem about one-third of the time. In 5 to 10 percent of the cases, the causes can't be clearly identified. The balance of the cases from deficiencies in both partners. This was most dramatically illustrated by Kathy, who had ovulatory problems, while her husband, Steven, had a varicocoele that interfered with his sperm production.

We now know that performing surgery on a woman married to a man with dramatically low sperm count won't improve the odds for pregnancy. You can achieve pregnancy only when both partners are contributing the proper ingredients at the proper time. In the following chapters you will learn more about how this miracle occurs.

Myth #2: Infertility Can Be Cured by Taking a Vacation
Although stress and tension may interfere with your sexual desires and with your performance in the bedroom, there's no scientific evidence that your emotional state directly causes your fertility problem. While menstrual irregularities may be the result of stress and tension, these irregularities can be medically corrected, so that stress need not affect your fertility. Conversely, there's no reason why your fertility problem should affect your performance in the bedroom. I remember Steve and Kathy saying, Sex for pleasure? What's that?" Later in this book you will discover how they managed to restore pleasure to sex and how you can, too.

Myth #3: If You're Fertile, You Should Get Pregnant in Two Months
In a normal population of couples who are trying to conceive, each couple will have a 20 percent chance of getting pregnant the first month. Odds are funny: the remaining 80 percent who didn't conceive the first month have the same chances the next month—only 20 percent of that 80 percent will get pregnant.

For example, if one hundred couples try to get pregnant in January, approximately twenty will conceive. That leaves eighty to try again in February. In February 20 percent, or sixteen, of them will be successful, leaving sixty-six who will have to try in March. In March, 20 percent of those will become pregnant (approximately fourteen), leaving fifty-two for April. So, in three months, roughly half of our hundred couples have conceived, but another half have not conceived. At this rate, after seven months twenty-two people still will not have conceived, and after two years 10 to 15 percent still will not have conceived.

Unless they have reason to suspect there's a problem, I recommend to my patients under 35 years of age that they not be overly concerned about their fertility until they have been unsuccessful for a full year. For hose 35 years and older, I suggest beginning a fertility workup after attempting pregnancy for six months. In fact, it sometimes happens that a couple conceives during the fertility workup without my otherwise doing anything— I'm a benefactor of the odds, you might say. I enjoy this kind of surprise.

The odds for conceiving are especially disconcerting to fertility patients whose problems have been corrected. For example, Steven and Kathy thought that their first artificial insemination treatment (using Steven's sperm) would do the trick. I had to caution them that it might take as many as four to six cycles for them to achieve a pregnancy.

When I reflect on how complicated human reproduction is, I sometimes wonder how most women get pregnant. Nature did not design the human reproductive system so that a woman could get pregnant at the drop of a hat. Later in this book you will find out why our reproductive systems are so inefficient. You will also learn about the most up-to-date diagnostic procedures and corrective treatments available, including in vitro fertilization, frozen embryo transplants, and surrogate wombs. You have many options for improving your odds for conception.

Myth #4: If You Adopt, You'll Get Pregnant
Statistics show that 5 to 10 percent of adoptive couples conceive. I firmly believe, however, that these people would have conceived anyway, regardless of the adoption. As we already know, many couples with fertility problems eventually conceive without any medical intervention. Richard and Margaret almost opted for adoption until I convinced them that they were responding to an old wives' tale, because their secret hope was that adoption would "cause" a pregnancy.

Some adoptive couples choose to continue with their fertility treatment. their adoptive child satisfies their parenting needs, but doesn't satisfy the couple desire to produce a genetic heir. These couples may also eventually achieve a pregnancy.

Myth #5: Once You're Infertile, You're Always Infertile
I have observed that when many couples receive the diagnosis of infertility they just give up. They don't think that the tests, drugs, surgery, and all of their effort will be worth it.

About 5 to 10 percent of these people will conceive without medical intervention. However, 60 percent or more could benefit from fertility treatment. Making a miracle instead of waiting for a miracle is the answer if you really want a child.

Myth #6: Fertility Is a Sign of Virility
Many men feel that fertility problems threaten their manliness. In fact some husbands go so far as to refuse a simple semen analysis, as Michael T. had in the past. He was concerned about finding out that he "wasn't a man. Once he learned why the test was so important for diagnosing their fertility problem, he agreed to take it.

Since in approximately two-thirds of my cases the man's fertility may be the cause, I insist that the male have a semen analysis.

Fertility and sexual function are not necessarily related. In cases where severe hormone deficiencies, physical damage, physical deformity, medic; illness, or drug usage exist, sexual dysfunction may be the reason why pregnancy hasn't occurred. However, I find that this is relatively rare.

Myth #7: You Caused Your Miscarriage
We know that 10 to 15 percent of confirmed pregnancies will miscarry. When we examine the fetus, we find that 60 percent have one-time-ever genetic abnormalities. Sometimes a placenta develops, but no fetus is present (blighted ovum). This will produce a positive pregnancy test but obviously will not produce a baby. Miscarriage is nature's way of discarding a deformed embryo or fetus so a viable pregnancy can begin. The likelihood that a miscarriage will occur with the next pregnancy is once again 10 to 15 percent.

I find that repeated pregnancy loss may indicate a pathological problem such as an incompetent cervix, fibroid tumors, hormonal problems, abnormalities of the immune system or adhesions (scar tissue) inside the uterus. Late chapters will tell you how I successfully treated Debbie W.'s problem with repeated pregnancy loss.

Myth #8: Long-term Contraceptive Use Causes Infertility
Many of you may be concerned that long-term use of oral contraceptive (birth control pills) or intrauterine devices (IUDs) may have impaired you fertility. I would like to address both of these issues. Since the risks of infection and intrauterine scarring may be increased with the use of an IUD, I no longer insert IUDs in women who have not yet had children or who have multiple partners.

When IUD use results in infertility, as it did in Richard and Margaret B.'s case, we have a number of options for restoring fertility. You will learn how Richard and Margaret's treatment resulted in the birth of a healthy baby boy.

With respect to using oral contraceptives, I advise my patients who have menstrual irregularity prior to using oral contraceptives that they may have an underlying fertility problem. This problem will probably grow no worse, but neither will it improve with the use of oral contraceptives. Studies have shown that after the cessation of birth control pills, up to 3 percent of women will experience ovulatory problems. These women usually respond very well to treatment. Problems conceiving that are often attributed to long-term use of the Pill are, in my opinion, more likely due to the fact that as women grow older, their odds for getting pregnant deteriorate naturally. Because Margaret and Richard waited until their mid-thirties to start their family, they had to face this problem.

Some experts feel that the normal aging of the reproductive organs diminishes fertility. As you grow older the fertility potential of the eggs remaining in the ovaries decreases. Others feel that the longer you wait to conceive, the more you risk reducing fertility through infections, use of IUDs, or surgeries. In addition, with age you have an increased risk of developing endometriosis (a condition in which for unknown reasons pieces of uterine lining adhere to pelvic organs and "bleed" with each monthly cycle). In later chapters you will learn more about how each of these factors can affect your fertility. Table 2-1 shows what your odds are for pregnancy at various ages, assuming that you have no serious fertility problems.

As you can see, regardless of the causes, fertility decreases with age. If you know that you may have a problem (for example, if your periods are irregular or you experience extreme pain during your periods), you shouldn't delay having a fertility evaluation.

Myth #9: Therapeutic Abortions Frequently Cause Infertility
Over 1 million abortions are performed in the United States each year. When abortions were illegal, performed by amateurs, and conducted in septic conditions, sterility and even death were common. However, with sterile conditions and professional medical supervision, the first-trimester abortion presents minimal risk for decreased fertility. Repeated abortions, however, may increase your likelihood for early pregnancy loss, premature birth, and failure to conceive.

Table 2-1

Odds of Getting Pregnant Each Month and During the First

Odds of Getting Pregnant During the First Six Months

Average Time to Conception

Myth #10: A Free-Style Sex Life Leads to Infertility
You may have been told that your "escapades" before getting married led to your undoing. This is not necessarily true. There is no evidence that having sex with multiple partners or having sex prior to marriage causes infertility. In fact, you may be surprised to know that as long ago as 1979, over two-thirds of never-married women had had sexual intercourse by the time were nineteen years old.

However, having unprotected sex with multiple partners does increase your risk of contracting sexually transmitted infections (AIDS, gonorrhea, chlamydia, ureaplasma, condyloma, etc.), which may cause pelvic inflammatory disease (PID). One million women will contract PID this year and a quarter of will require hospitalization due to the severity of the disease. If you contract PID once, you have up to a 20 percent chance of developing a fertility problem. This means that 150,000 to 200,000 women exposed to chlamydia or gonorrhea will become infertile this year.

What makes these diseases so insidious is that you may not have any overt symptoms. So until you fail to get pregnant, you may not even know that your tubes have been severely scarred from infection.

I recommend to my patients that they request a pelvic exam if they have any pain, midcycle bleeding, or other abnormal symptoms. Otherwise, as the American College of Obstetricians and Gynecologists recommends, I suggest that my patients have an annual pelvic exam which screens not only for cancer but also for gonorrhea.

Myth #11: A Rise in Your Basal Temperature Means You're Fertile
Many of my patients report that they have been scheduling sexual intercourse to correspond to their rise in basal body temperature, as Margaret and Richard did. Having intercourse after Margaret's temperature rose, however, almost guaranteed that she would not get pregnant. In effect, they were practicing good rhythm birth control. They were having intercourse twenty hours too late!

You are fertile for about twenty-four hours during each ovulatory cycle. A rise in your basal temperature signifies that your ovary is secreting progesterone—an event that occurs twenty-four hours after ovulation. For conception to take place, the sperm must be present immediately before or at the time of ovulation.

Initially, I ask my patients to keep a temperature chart to help me verify that they actually are ovulating. Later, you will find out more about how you can predict when you are fertile and how we can detect what's really happening with your hormones, ovaries, and eggs. In addition, you'll learn how we can control these factors to optimize your chances for conception.

Your own physician is your best ally in the battle against infertility. To take full advantage of his or her skills, however, you must take an active part in your therapy: inform your physician of your symptoms, ask questions, make suggestions, and explore alternatives. Having done this, it becomes much easier to understand and better accept his or her recommendations. Help your physician understand what you're experiencing.

"I should be happy, but I'm not."
Your plan should address not only your fertility problems; it should also attend to your psychological needs—your depression, your anger, your frustration, your feelings of inadequacy. These feelings are absolutely normal. In fact, I'd think something was wrong with you if you didn't have them. I'll show you how other couples have overcome their disappointments and have learned to go on with their lives.

Your plan should also help you deal with your well-meaning but often insensitive relatives, friends, and co-workers. How many times have you heard, "You should be happy. Look at how fortunate you are. You've go everything else anyone could want." Their attempts to comfort you only heighten your anger and widen the communication gap. I'll share with you how other couples have dealt with these people and how they've learned to live in a world full of babies and pregnant women.

Think about your married life before you knew you were infertile. If you want to return to that happy, optimistic life, keep reading!

For more information on your initial visit to your physician read the
INCIID Routine Fertility Workup or IVF.com Homepage.

Miracle Babies and Other Happy Endings for
Couples with Fertility Problems
Copyright © 1986 Mark Perloe M.D., and Linda Gail Christie.