Couples Dealing with Infertility

Most couples at one time or another decide they want to have children, but every year approximately 15 percent of couples in the US find out they cannot conceive because they are infertile. The desire to have children and the disappointment of not being able to conceive can be devastating to a couple, and the quest for help can turn into a financial and time consuming nightmare. Infertility is described as the inability to achieve conception after persistent tries over an extended period of time. Normally couples that are not infertile get pregnant-at least once-within three years of having unprotected sex.

Any number of factors could cause a couple to be infertile. In the male, infertility could be related to sperm count-a count of 10 million sperm or less per ml of ejaculate constitutes a low sperm count. A normal count is 20 million or greater of sperm per ml of ejaculate. Some men have an adequate sperm count, but the shape or motility of the sperm is impaired so that the sperm cannot penetrate the egg. Any number of physical, hormonal or genetic defects could interfere with the male reproductive system.

A physical problem, such as hypospadias is a birth defect in which the urinary meatus (opening) is located on the underside of the penis. Hypospadias prevents the sperm from reaching the female cervix. Men with diabetes and those who have had prostate surgeries sometimes develop an anomaly called retrograde ejaculation, in which the ejaculate is forced into the urinary bladder at orgasm, thereby preventing sperm from being delivered to the woman's cervix. Other factors, such as smoking, stress, obesity, alcohol and drugs can play a major role in male fertility.

Female infertility can be caused by damage or blockage of the fallopian tubes, endometriosis-a condition in which uterine tissue grows outside of the uterus within the pelvis. There could be any number of problems concerning hormone production that interferes with ovulation; causes onset of early menopause; fibroid tumors; or any other medical conditions, such as thyroid problems, or diabetes that could interfere with female reproduction.

If a couple has been trying to conceive for about a year and have not yet managed to get pregnant, the woman should see her gynecologist, and the man should see his family physician or a urologist that specializes in male fertility. The couple may have to submit to individual examinations, hormonal testing and scans. Women may have to undergo ovarian testing, and a special X-ray called hystersalpingography, in which fluid is instilled into the uterus and pictures are taken to visualize the uterus and fallopian tubes. The man and woman may have to undergo genetic testing to determine if there is a chromosomal defect to explain their infertility. It may not be necessary for the couple to go through all the tests available, but they may be asked to have any number of them. Even after testing, there may be no valid findings to explain their infertility.

Treatment varies for the individuals. There are many drugs on the market to increase the probability of ovulation. If the woman does not ovulate, she can be injected with a hormone to stimulate her ovaries. In some women, these hormones put their ovaries into overdrive, which may lead to multiple births.

Assisted reproductive technology (ART) is another way to help couples conceive. The most common form of ART is in vitro fertilization. When possible the eggs are harvested from the mother and fertilized outside of the body and implanted into the mother's womb. In women who cannot produce eggs, donor eggs are available for implantation. This is an expensive process, and there is no guarantee that conception will happen with the first try. There is always a chance of multiple births, because multiple eggs are fertilized and placed within the uterus to help insure that at least one will implant and become a pregnancy-sometimes all the embryos "take" and the couple become parents to multiples. Good news for men with spinal cord injuries is that they can also become fathers. Often, men that have spinal cord injuries are unable to achieve ejaculation, and in some cases he is able to be assisted by technology either through electrical stimulation or through surgically harvesting sperm cells to implant in the woman.

The couple needs to decide early on, just how much time, money and effort they are willing to put into this process of trying to conceive. The couple could be financially and emotionally devastated, or they could be on top of the world. Their journey down this path of trying to get pregnant could end up being a nightmare or the dream of a lifetime.