Trying to conceive can both be an exciting and anxiety-promoting time in life. When it happens quickly, it can almost be overwhelming. When it doesn’t seem to happen at all, you can get that terrible pit-in-your-stomach feeling wondering if you’ll ever be able to have a child. It can seem so unfair when there are so many out there getting pregnant without even trying. It can test your self- esteem, your relationship, and sometimes even your faith.
While not all infertility can be treated, there are many options available for those seeking help. Dr. Kristin Craig, a board-certified OBGYN physician at Cache Valley OBGYN in North Logan, Utah helps provide some insight on the topic of infertility and how to approach some of the more common questions asked by people who are experiencing it:
What is infertility?
Infertility can be defined as a lack of conception after one year of activity trying to conceive. It can be caused by many factors, affecting both partners. There is usually a 50% chance that the root of the infertility is from the man, while the other 50% chance may be from the woman.
How can I find out if I’m infertile?
When you think of conception, you think of three main things: egg, sperm, and meeting place (uterus). The work up for fertility involves looking at each of these entities and seeing if there is anything not working right.
- Looking at male factor is the easiest place to start. In order to do so, a semen sample is analyzed, and if it is found that the sperm count is low, there are often several things that can be considered like recent illness, fever, or injuries, among others, which can decrease male sperm counts temporarily. Other causes of temporary low sperm counts may include wearing tight underwear, and getting too warm in hot tubs. If there are male factor problems, a urologist will can then conduct an exam and evaluate the semen analysis to determine if there is need for lifestyle changes, medications or even surgery to improve sperm counts.
- Next, it is important to document female ovulation. If you the patient is ovulating, she should be having regular monthly periods with signs of ovulation somewhere in the mid cycle. Patients must start counting days of a cycle with the start of each period, even if it is light bleeding; this is day 1. Most women ovulate around day 14. Some will have some ovulatory pain, most women will have a clear, watery ovulatory discharge. Ovulation should be documented with an ovulation predictor kit, which can be found at any pharmacy or dollar-store. Please note that ovulation apps WILL NOT be able to tell patients if they are actually ovulating. Identifying not only if they are ovulating, but when they are ovulating is also very important. On occasion, it is found that patients ovulate on a very different day - like day 8, for example. Once this is known, they focused on having intercourse around day 8, and were able to conceive more quickly.
What happens if the sperm counts are good and ovulation seems to be happening? What’s the next step? This is when it is time to take a look at the “meeting place.” Is the sperm making it to the uterine tubes where fertilization takes place? Is the egg making it there? Is there something about the shape of the uterus that prevents implantation of the embryo? Is there something outside the uterus that interferes with conception (like endometriosis)? While these are all dependent on each person’s situation, the next step will be to evaluate the uterus.
Evaluating the uterus usually starts with an exam, possibly an ultrasound, and possibly a test called an HSG, which helps take a look at the inside the uterus. If there are symptoms of endometriosis (which include painful periods and painful intercourse), or a history of an STD that can cause internal damage, a laparoscopic surgery can be considered to evaluate further. Other times, there may be something wrong with the cervix that kills off sperm. While this cannot be tested, the option to bypass the cervix with a procedure called an intrauterine insemination (IUI) is available.
When should I visit my fertility provider and what should I expect from my visit?
If patients are not having regular periods (every 28-35 days) there is no need to wait for a year of “trying” to pass before deciding to see a provider and get treatment. If patients are seeing periods come every 3 months or so and are really heavy, they are probably not ovulating, and it is best to see a provider that can help work on the issue.
Patients should plan on their physician needing documentation of their cycles and ovulation, a semen analysis, and a thorough history of pelvic pain and infection. With this information, they should be able to direct the patient with the next steps to take to conceive.
What are my solutions/alternatives to infertility?
On occasion, everything seems to be perfect and patients still struggle with conception. While unexplained infertility is one of the most frustrating diagnoses one can get, it is with this diagnosis that we often turn to in-vitro (IVF) treatment or even adoption as alternatives. We understand that this is usually not the patient’s first choice (or even our own), but they can still be great options if patients are looking to expand their family size.
At Cache Valley OBGYN, we recognize that dealing with infertility can be an expensive process, both financially and emotionally, therefore, we understand if or when patients may just need a break from trying. Sometimes, there are things we can do during “a break” that actually can increase your chances when they decide they want to start trying again. We just encourage patients to keep their hopes up, and we will continue to try to help them achieve their goals.