You have found the person with whom you want to create a family. All your ducks are in a row and you are ready both emotionally and financially to be parents. The trying part is fun, right? Then so it goes, month after month being disappointed that there isn’t going to be a baby. Infertility is diagnosed after 12 months of unsuccessful attempts to conceive in women under 35, after 6 months for women over 35 or inability to sustain a pregnancy to a live birth.
Remember when you were young and working so hard to prevent a pregnancy, how your heart could beat a little fast if you thought you might be late? With infertility, it’s all reversed. When couples are trying to get pregnant, hearts beat faster watching the calendar and counting down to see if a period comes or if there might be cause to take a pregnancy test.
As each month progresses without a positive pregnancy test, sex might start to not be a whole lot of fun anymore. Instead, now there are rules about when and how often and how much time must span in between rounds of intercourse because you want the sperm to build up in between ejaculations. There may not be any ability for any post-coital cuddling because the woman’s legs are probably up in the air to some degree. Not in the mood? Tough, get to work honey because we’ve got a baby to make. You can see where the pleasure can come out of sex real quickly.
Each partner may start to quietly second guess themselves and each other. Is it me? Is it you? Did all my years of microwaving food in plastic containers build up toxins that reduced the viability of my eggs? Did the years of using a hot laptop on my lap or wearing tightie-whities instead of boxers lead to less potent sperm? Did we wait too long to start trying to have kids? What are we going to do if we can’t have kids? Then other people start to ask questions like “When are you going to have kids? What’s the matter, don’t you want kids?” It’s intrusive, embarrassing and can sometimes be the beginning of a dream lost.
Sometimes couples aren’t on the same page around fertility issues. One partner may want to pursue testing and more aggressive measures in necessary where another may feel that maybe it’s a sign it’s not supposed to be. One partner may want to adopt where the other may feel that they only want a biological child. Sometimes it’s SO. DARN. HARD. to talk about how it all feels because both partners are a bit raw and a lot vulnerable. To top it all off, someone might end up feeling like a failure somehow. It’s painful and stressful for the relationship.
Of those couples with infertility, about 44% of women will seek medical treatment. The percentages of “cause” are fairly evenly distributed with 1/3 being related to the female, 1/3 being related to the male and 1/3 being either a combination of the two or unexplained. Given those statistics, it’s kind of surprising that often women are the ones tested first. Testing for men is fairly basic and involves a semen analysis to determine things like motility, form, quantity. Testing for women can get a whole lot more involved with costs in time and physical discomfort.
For women, first there will be a physical exam followed up by blood and urine tests (for various hormone levels) and a check of basal body temperature to determine if ovulation is occurring and possibly an ultrasound. Next levels get even more involved and can include endometrial biopsy, dye tests to see if the fallopian tubes are clear, or maybe there could be surgical procedures like laparoscopy. Often the blood tests will take multiple visits to the doctor or lab over different times in a menstrual cycle and maybe over multiple months. For many women, all this testing is mentally exhausting, time intensive and can set off a whole multitude of feelings both during the tests and waiting for results.
Sometimes the testing shows that small adjustments can be done such as medications to treat polycystic ovarian disease or to improve ovulation. A next higher level treatment may involve intrauterine insemination. This might be where the old joke about the turkey baster comes in. With IUI, semen is collected and essentially “injected” into the uterus. Should that not work, many couples will begin to talk about IVF (in-vitro fertilization) which may or may not involve injecting sperm directly into the harvested egg(s).
IVF can be costly and very labor and time intensive. Medications (both oral and injected) are usually given at various times in a cycle to dramatically increase the number of eggs that will mature for harvesting. These medications can sometimes cause moodiness for the woman and the injections can be somewhat painful. The eggs will then need to be harvested in an outpatient surgical suite of sorts where the woman is given mild sedative and pain killer medications and eggs are “aspirated” into a needle injected into the ovaries.
Generally, the eggs are combined into a petri dish with the semen and allowed to fertilize “naturally”. When that cannot achieve fertilization, the sperm is directly injected into the egg (a process called ICSI). Fertilized eggs are monitored in the lab for between 1-6 days and are then transferred into the uterus. Some physicians will recommend daily injections of progesterone for the first trimester to help make sure the pregnancy “takes”.
About 85-90% of infertility cases are treated either with medication or surgery, only approximately 3% need to have advanced treatments such as IVF. Of the women who seek medical intervention for infertility, 65 % give birth. Although that can seem like a dishearteningly low percentage after so much effort, it’s important to remember that couples (under 35) without fertility problems have a 20-25% chance of a successful conception on any given month of trying.
Infertility can be heartbreaking. It’s definitely stressful for both individuals and for the relationship too. Having good support, both medically and psychologically, is very important.
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