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: email@example.com
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