What if You Don't Get Pregnant?

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A couple may have a fertility problem if they do not achieve pregnancy after one year of unprotected intercourse. At one time, it was assumed that the woman was at 'fault'. Now we know differently.
The subject of infertility, the inability to get pregnant, would fill many books. However, this will give you a brief overview of the causes and what is involved in an infertility evaluation.
If you don't get pregnant within a year (or six months if you are 35 or older), you need to begin an infertility evaluation. No reason for infertility will be found in ten to fifteen percent of couples unable to conceive.

	A Basic Infertility Evaluation
	Causes of Male Infertility
	Causes of Female Infertility
	Additional Resources that May Help
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A basic infertility work-up should first look at a semen analysis and a basal body temperature chart. The semen analysis will assess the amount, shape and mobility of the sperm. If any abnormality is present, a man may be referred to a urologist for a complete evaluation. The basal body temperature chart will establish if and when ovulation is occurring.

Next, to see if the sperm and cervical mucus are compatible, a post-coital test is done. The couple makes love at home and goes into the doctor's office. Your doctor will do a vaginal speculum examination and extract some of the cervical mucus. The mucus is examined for estrogen content, sperm movement, shape and numbers.

To make sure that the amount of progesterone is correct, an assessment is done of the endometrium (the lining of the uterus). This is done by taking a small amount of the endometrium and looking at it under the microscope. The day of ovulation can be predicted within twenty-four hours. If this is out of sync, an abnormal amount of progesterone is being produced. Your doctor can give you progesterone suppositories to place in the vagina daily to correct this problem or otehr medications to decrease the amount of progesterone.

Laboratory studies measuring estrogen, progesterone, FSH, LH, prolactin, and other hormones can assess if you are making the right amount of each.

Tubal patency (the tube opening) is assessed using an x-ray examination called a hysterosalpingogram. Radio-opaque dye is injected into the uterus through the cervix. This is conveyed through the tubes if they are open. An x-ray is then taken and the dye can be seen spilling from the tubes. This also evaluates, to some extent, the inside shape of the uterus.

Even though the condition is rare, a test is done for anti-sperm antibodies. Blood is drawn from both partners and a sample of sperm is obtained. Antibody titers are then evaluated in a laboratory

Finally, if no other cause is found for the inability to conceive, the last step of the infertility evaluation is a diagnostic laparoscopy. This is a surgical procedure that puts a small telescope-like device (a laparoscope) through the umbilicus (belly-button). The pelvic anatomy can be seen clearly. This allows the doctor to look at the normalcy of the pelvic anatomy, search for the prescence of scar tissue, endometriosis, and other factors that may contribute to infertility. At the end of the procedure, a blue dye is put though the uterus and the tubes are examined to watch for spillage of the dye.

After your infertility evaluation is complete, your doctor will inform you of what steps can be taken to correct the individual problems.

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ABNORMAL SPERM	A decreased number of sperm can contribute to infertility. Approximately twenty million sperm per milliliter is considered normal. When examined microscopically two hours after a sample is obtained, 50% of the sperm should be moving and 60% of the sperm should be of normal shape.
ANATOMIC ABNORMALITIES	Developmental problems, such as failure of the testes to descend at the appropriate age, abnormal formation of the testes, epididymis, vas deferens or urethra, can all contribute to infertility.
TOXINS/DAMAGE/DISEASE	Infections such as tuberculosis, syphilis and gonorrhea can cause damage to structures that convey the sperm. Mumps, surgery and traumatic injuries can cause an inability to produce sperm. Radiation, chemicals and various drugs (both legal and illegal) could also contribute to infertility.
HEAT	Regular use of saunas, hot tubs and jacuzzies can increase the temperature of the testes, thus not allowing an adequate number of sperm to be produced. An abnormality in the size of veins in the scrotum, called a varicocele, can also cause an elevation in temperature. A varicocele is a weakening of the wall of the vein, much like varicose veins seen in the legs.
BIRTH DEFECTS	Defects in formation of any of the sex organs can cause infertility. There has been some evidence that DES sons can have structural defects.
ABNORMAL SEMEN	Semen, the seminal fluid that mixes with the sperm, may be too thick. The normal amount of semen in a single ejaculate is between three and five centimeters. Too little may not allow sperm to separated enough to swim, and too much may dilute the concentration of sperm.
OTHER	Impotence, premature ejaculation (ejaculating before the penis enters the vagina), and retrograde ejaculation (back-up of sperm into the bladder instead of through the urethra) can be factors that would not allow pregnancy to occur.
ANTIBODIES	Antibodies are formed to fight disease in the human body and work by sending messages to the white blood cells. The white blood cells then destroy the bacteria or other substance. Rarely, the body makes antibodies against sperm and the sperm are attacked by the white blood cells.

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NO OVULATION	Because signals from the brain to the hypothalamus to the pituitary must be perfect every month, the possibility exists that there may be an interruption of this process. Without these signals, nothing notifies the ovaries to make estrogen and progesterone and ovulation does not occur. The interruption or error can happen one time, or on a continuing basis. An increased amount of estrogen can keep ovulation from occurring. Progesterone also has to be produced in the correct amount or the lining of the uterus will not be ready for the embryo (the early pregnancy that implants into the endometrium) to implant.
TUBAL PROBLEMS	Sexually transmitted diseases, previous IUD use and scar tissue from previous surgery can all cause tubal disfunction. The tube must be open and able to pick up the egg at ovulation.
UTERINE PROBLEMS	An abnormal shape, previous surgery or scar tissue inside the uterus will not allow the fertilized egg to properly implant. DES daughters can have abnormally shaped uteri.
CERVICAL PROBLEMS	Cervicitis, an inflammation of the cervix, can interfere with sperm crossing the cervix on the way to the uterus. Previous cervical surgery, such as cautery, cone biopsies or cryosurgery, can cause abnormalities in cervical mucus. There is a condition called "hostile" cervical mucus in which white cells or antibodies in the mucus kills the sperm.
ENDOMETRIOSIS	Endometriosis is a problem for ten to fifteen percent of women. The question of how much endometriosis contributes to infertility is still unanswered. What is known is that the effects of endometriosis can causae infertility. These include tubal closure, pelvic scar tissue and inability to ovulate.
OTHER	Using lubricants to facilitate intercourse.can create an unfavorable environment for sperm and they will die. Pain during lovemaking which does not allow complete penetration can interfere with fertility.

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A last mention of timing is in order. You must have the right time of the month for fertilization to occur.

ADDITIONAL RESOURCES THAT MAY HELP:

	Trying to Conceive Naturally		Endometriosis Association
	Environmental Causes of Infertility		Endometriosis.org
	Fertility.net		Web Directory of Resources
	RESOLVE		Semen Analysis Explained
	Male Infertility Factor		YAHOO: Health

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Excerpts from: The Family Pregnancy © 1995: MJ Bovo, The Family Pregnancy, Second Edition, currently in production, and Do You Have Any Questions? © 1995: MJ Bovo, are contained within this page. Reprints are not permitted under any circumstances. Please see Terms of Use for full expanation. Violations of the Copyright Code are taken seriously and appropriate action IS TAKEN AGAINST VIOLATERS.