Dr. Aladjem shares a basic understanding of infertility; what happens when you can’t get pregnant and what to do about it.
Infertility problems are more common than one would suspect. Questions abound, public knowledge is scarce. Not too long time ago the wife of a friend of mine asked me if I could tell her why, in spite of her good health, she apparently is “sterile”.
I don’t like medical questions in a social environment. As a courtesy, however, I asked a few basic questions which let me to believe that in spite of being a college educated lady, she had just about zero knowledge of reproduction. I gave her the name of a fertility specialist to consult.
It occurred to me that other women may find themselves in comparable situation. I decided to offer, in this blog, some basic understanding of what happens when you can’t get pregnant and what to do about it.
First of all, understand that infertility problems are shared equally by men and women, since you need an egg and sperm to get pregnant. It is not automatic that the problem is always with the woman. Actually, the odds are 50:50 that, if a problem exists, the cause may be either in the man or the woman. The fact that a man is able to have normal sexual relations, does not automatically imply that he is fertile. In other words, he may produce defective sperm which may not be suitable to fertilize an egg. Therefore, when looking at an infertile couple, one must look at both the woman and the man. This can create problems from the start, since many men do not want to submit to a medical examination, since “there is nothing wrong with me”. Many specialists are reluctant to start clinical investigation on the woman if her husband/partner refuses to be examined.
Assuming the man’s sperm is of good quality and appears healthy and able to fertilize an egg, then the road to study the woman is open.
Understand that the study is long and sometime arduous. If you are in a hurry, don’t start. First, the specialist must determine if your pelvic organs, i.e. uterus, ovaries, tubes, are normal. Ultrasound and sometime X-rays may be necessary to determine the normalcy of your reproductive organs. Subsequently, if the woman has a normal ovulatory cycle, which happens only once a month, hormonal status of the woman has to be established in various stages of the cycle. If there is not enough estrogen in the first part of the cycle, ovulation may not occur. If the hormone progesterone is not at normal levels in the second part of the cycle, even if fertilization occurs, you will lose the pregnancy and most likely you won’t even know that your egg has been fertilized. It would look like a normal period.
After these preliminary studies and depending on what was found, the specialist will make a care plan that will suit your condition. If everything was normal, simple reassurance and may be modifications of life style, timing of attempts to get pregnant and other minor issues will be discussed. Many times, perfectly normal couples don’t achieve pregnancy for a long time. This can be discouraging for both. The monthly anxiety in expectation of a pregnancy, can alone be a factor for not getting pregnant. There are known cases where after years of unsuccessfully attempting pregnancy, the couple decides to adopt, and following the adoption the woman gets pregnant. I call it an “adoption pregnancy”. This supports the idea that years of month to month of anxiety have now resolved with the adoption and a pregnancy occurs. Many women have been told by their doctors that, for whatever reason, they will never get pregnant, and years later she proves them wrong.
What may follow, after such preliminary studies, is an even longer road. If the man’s sperm count is low, there are ways to concentrate several ejaculations and subsequently, during a normal cycle, proceed with an artificial insemination with the husband’s/partner’s concentrated sperm. If the sperm is defective, the specialist will tell you what is available, including artificial insemination with a donor’s sperm.
If the problem is lack of ovulation in the woman, hormonal environment can be manipulated and have the woman ovulate. There is also the alternative to retrieve an egg from the woman’s ovary, fertilize it in vitro (i.e. in the laboratory) and once the egg is fertilized it is placed in the woman’s uterus. The various treatments, some of which are surgical, are not without risks. Some are painful. The specialist will discuss such risks and/or benefits with you and your husband/partner. Many treatments may raise ethical questions, depending on your views, religious beliefs, or other considerations.
Last, but not least, such treatments which may last months and months, are expensive. Your insurance may not cover any of these procedures. Make sure you know what the economics of such treatments are.
SILVIO ALADJEM MD, an obstetrician/gynecologist and Maternal Fetal Medicine (high risk obstetrics) specialist, is Professor Emeritus in obstetrics and gynecology at Michigan State University, College of Human Medicine, in Lansing, MI. He is the author of “10,000 babies: my life in the delivery room” now available on Amazon, Barnes and Noble and other book stores. Dr. Aladjem published extensively in Scientific Medical Journals and wrote several textbooks in the specialty. Should you wish to contact him, you may do so by email at: dr.aladjem@gmail.com
You can read more of Dr. Aladjem’s posts on Imperfect Women by clicking here.
I got pregnant with my first son right away, but the second time was much harder. We ended up starting to talk about fertility treatments, but right we were about to start, BOOM, I got pregnant.
I never had issues conceiving any of my four children. My first I got pregnant on the pill and my other three got pregnant the first time we decided to “try” to have another one. I have many friends though who have PCOS or just other reasons why they are unable to conceive on their own and need the help. I’m so glad that our technology is able to help families conceive and grow.
I went for fertility treatments for my first baby. I needed to do shots and got pregnant the first round. I ended up with Irish twins and then another 16 months later. The second two completely unplanned, but more than welcomed.
I did IVF for my little boy who was just born. Infertility is hard for sure! Great information!
I was blessed to have four children and can’t imaging the frustration associated with not being able to conceive.
There’s so much that needs to go right to be able to get pregnant and have a healthy baby. The fact it happens at all is truly amazing. This is all great information, especially for those who are struggling with infertility.
Great resource for couples trying to conceive. I did not have any issues with conceiving but I have some family members who have been trying for years. I think couples should try and relax, and pray a lot to be blessed with their own child conceived in a natural way. However, if all else fails, then medical intervention is the next best option to take. Thank you for this article.
no problem with conceiving but then i’m always in c-section which is more dangerous.
My first was a surprise baby but I struggled with secondary infertility with my second so I know how hard this can be for families that desperately wants to have a baby.
Great post!
I am thankful that I didn’t have issues conceiving either one of my children. Infertility is an incredible strain and struggle for so many. Understanding it can help those going thru it or others know what an emotional rollercoaster it can be.
Infertility is so hard and heartbreaking. Thanks for shining light on a challenging subject.
As a surrogate mother I have been in the position to learn a bit about infertility and the long hard and costly path it can have for some. There is hope though, and it isn’t always long and costly. I have seen so so many who gave up hope get pregnant when not even trying. Some get lucky the first month of trying fertility drugs. Please have hope! Wishing everyone wanting a baby full arms soon!
That’s such an interesting post. I haven’t read much about infertility yet as it seems that all my friends that wants babies are successfully getting them. Hope it works as easy for me one day.
Thanks for sharing this post. I have a friend who has been struggling with getting pregnant and they are think about trying fertility treatments.
It was difficult for me for both my pregnancies. Infertility is a struggle so many deal with so thank you for sharing this with us.
We had problems are first time around and I did a series of meds. Then, I got pregnant! We didn’t have any issues the second time around.
It took us 8 years to get our son. He was a true blessing.
My friend is about to start fertility treatments. It is not covered so they have been saving up to do it. I hope it works first try for them.
Some of my closest friends have struggled with infertility. It has been a long and emotional process to find answers and solutions to their infertility.
I did not have any infertility issues but a few of my good friends did. It is such an emotional rollercoaster. Finally they all did have their chance at pregnancy though!
Thanks for the great information. I haven’t experienced any fertility issues, but I also don’t plan to have any children. I’m sure it is a very draining situation, mentally, physically and financially.
There are so many couples who have fertility issues and it makes me sad for them. My husband and I never had issues and I’m so thankful for that!
I never had this issue, but I had a friend that did. I felt horrible for her. Having a baby is a true blessing!!
I didn’t have any issues getting pregnant, but a lot of friends have. It’s so prevalent. Thank you for bringing up such an important topic! For those of us who haven’t experienced infertility it’s good to read about this to empathize with others.
Such a difficult situation when couples go through all of this to conceive.