Infertility heartbreak

Heather Little-White, PhD, Contributor

When a couple plans to have children and infertility dashes their hopes, the couple usually experiences severe heartbreak and disappointment. The relationship may initially suffer from anxieties about sexual performance. But the anxieties are surmounted when the couple decides to work closely with their doctor to find alternatives to achieving parenthood.

A couple is medically rendered infertile after engaging in unprotected sexual intercourse at least three times weekly for a year. For those who have never had a child, this is described as primary infertility and those who had already conceived are known to experience secondary infertility.

Biological clock

The first reaction to the cause of infertility among couples is to attribute the failure to conceive to physical problems to the women, for example failure to ovulate or blocked tubes. However, the causes of infertility can be equally found in men and or both partners. Women face the biological clock as their reproductive years diminish with age and as the menstrual cycle ceases. Women who have never conceived will find it more difficult after 35, as compared to women who have a least one child. Generally, college-educated and career-driven women are more likely to postpone childbearing until they complete their studies or establish their careers.

Possible causes

Infections: Other causes of infertility among women who wait long to try to conceive is the long-term effects of genital infections or hormonal imbalance. Infections like pelvic inflammatory disease and sexually transmitted infections may scar tubes (oviducts), blocking them and preventing the sperm from moving to ovulate the egg. In some instances, the scar tissue is removed by surgery and conception could take place. Some types of bacterial infection, sometimes undetected by routine testing, may interfere with fertilisation and implantation.

Endometriosis: In this condition, the uterine tissue is implanted outside the uterus, possibly in the oviducts or ovaries. The tissue blocks the movement of the egg and sperm. During menstruation, the extra tissue also contributes to the menstrual flow increasing the number of period days. Endometriosis may be caused by hormonal imbalance and may be corrected by hormonal treatments or surgically removing the extra tissue or by pregnancy when it occurs.

Low progesterone: Infertility is further compounded if the uterus cannot receive the fertilised egg due to low amounts of the hormone progesterone. This may require an endometrial biopsy to remove fibre from the endometrium, a week after ovulation when progesterone levels peaks. A blood test may also accompany the biopsy to determine whether the uterine lining will be able to nourish a fertilised egg implanted in the uterus.

Allergy: A couple's chemistry may lead to infertility. A woman may be allergic to her partner's semen when her blood creates antibodies that kill sperm before they can fertilise the egg. It means that desensitisation has to be done, as it is with other allergies.

Lifestyle: The couple's lifestyle and sexual interaction could be a factor for infertility. If the couple does not engage in unprotected intercourse often enough, then conception will be difficult. On the contrary, if the couple or the man engages in intercourse too frequently, like several times a day, it is likely that conception will not take place as the man's sperm count would be drastically reduced for conception. The count should not be below the minimum number of sixty million per ejaculate for fertilisation to take place. To improve his sperm count and the ability to conceive, the man should be counselled to ejaculate no more than once every other day during the time his partner is ovulating.

Positions during sex: This is a critical factor as couples try to conceive. The male superior position allows the sperm to go deep into the vagina and travel through the cervix to meet the egg. It works better if the woman remains lying on her back for at least 30 minutes after the man ejaculates.

Drugs and chemicals: Hard drugs, tobacco, marijuana and other substances like caffeine and alcohol can affect sexual functioning and lower fertility rates in women and sperm production in men. Environmental chemicals like fertilisers and industrial agents have negative effects on fertility.

Getting help

Semen analysis: To get help with infertility, a couple should see an andrologist, a specialist in urology and male reproductive disorders. A semen analysis should be done to determine the sperm count in freshly ejaculated seminal fluid, collected in a sterile jar and taken to the lab within two hours. If sperm count is low, conception can be made possible by zona puncturing, where holes are made in the zona pellucida, or through sperm microinjection in which a needle is used to inject a sperm in the egg membrane.

Test after sex: A post-coital test is done on the couple who is instructed to have intercourse near ovulation. As intercourse is finished, the woman must get to her doctor who will take a sample of vaginal fluid to assess if the sperm survived. To facilitate this test, the doctor may encourage the couple to have intercourse at a location of the doctor's office, but some couples find this embarrassing.

A hysterosalpingogram is a little more complex procedure which uses a tube inserted through the vagina and cervix to fill the uterus and oviducts with dye. An X-ray screen shows the flow of dye through the tubes to see if there are any blockages.

Laparoscopy is another procedure used in infertility treatment. This involves surgery under general anesthesia and a small telescope is inserted in the abdominal wall to inspect the woman's reproductive organs and reveal sources of any blockages.

Prescription drugs: If a woman is not ovulating, she may be given fertility prescription drugs to stimulate the pituitary gland in the brain for the secretion of follicle-stimulating hormones.

In vitro fertilisation: A woman with block tubes can resort to in vitro fertilisation to bear a child. This procedure involves fertilisation of the egg in the lab instead of in the tubes. A mature egg is surgically removed from the ovary and placed along with live sperm in a laboratory dish with nutrients in a solution similar to what would be in the oviducts. The egg and sperm are left for three days to see if the sperm will fertilise the egg.

If the egg is fertilised, it will be allowed to subdivide a few more times to form a blastocyst containing about fifty cells. This is placed in the woman's uterus and the pregnancy will then run its normal course. The procedure may be successful at the first attempt or may have to be repeated several times. This procedure raises questions about legal and moral issues, with the Church being one of the main opponents.

Artificial insemination: Where there are problems with sperm production, that is the man's sperm count may be low or he had a vasectomy, or the woman may want motherhood without commitment or marriage, the couple may resort to this procedure using sperm from a donor, injected into the vagina during ovulation. Sperm banks freeze and store sperm from donors who require a fee. The donor may also provide fresh sperm directly to the doctor's office.

Surrogate motherhood: When the man is fertile and the woman is not, a surrogate mother may be chosen to bear a child for the couple. With artificial insemination, sperm is place in the vagina of the surrogate mother at the time of her ovulation. She carries the pregnancy to term, delivers the baby and allows the couple to adopt. Some surrogates change their minds and refuse to give up the baby after giving birth. It is advisable to use an attorney when the surrogate is found and arrangements are being made.

Adoption: Sterile couples who do not want to use technology in solving fertility problems can adopt a healthy young baby and can grown to love the adoption as if he/she was conceived by the couple.

The disappointments associated with infertility may not be as painful if the couple examines all the options. If they chose not to opt for any, or fertility may be impossible, they may find that in the long run they can enjoy each other more and have a deeper relationship.

Send questions/comments to heatherl@cwjamaica.com.