Infertility: Why It Happens and What You Can Do

Rob and Heather Salaga of Ridgefield, CT, feel lucky. They have two healthy daughters: Avery, who's 5 years old, and Noelle, 13 months.

But creating a family took time. Each had conditions that made it hard to get pregnant. Heather had polycystic ovary syndrome (PCOS), and Rob had an issue with the shape of his sperm.

It was an emotional journey, Rob says, but working with a team of fertility specialists turned things around.

What Causes Infertility?

For women, infertility is often caused by trouble with ovulation -- the release of an egg by one of the ovaries. It may be related to problems like:

  • PCOS
  • Primary ovarian insufficiency
  • Blocked fallopian tubes
  • Uterus problems

Age is also important. The number and quality of a woman's eggs start to go down when a woman is in her 30s and 40s.

For men, a variety of conditions may lead to fertility problems, including:

  • Varicocele (swelling of veins in the testicles)
  • Infections that affect the making of sperm
  • Problems with the amount, size, shape, or movement of sperm
  • Hormone disorders

Seeing a Specialist

If you've tried to get pregnant for a year -- or 6 months if you're a woman older than 35 -- see a fertility specialist.

To find one, talk to your doctor or people you know. You can also look for board-certified doctors on the website of the American Society for Reproductive Medicine.

When you show up for your appointment, it's OK to be nervous. You'll probably feel better once you start, says Staci Pollack, associate professor at New York's Albert Einstein College of Medicine.

"Doctors, nurses, and staff are there to help you navigate the process," she says. "They're part of your family-building team."

"We discovered that the right specialist who practices fertility medicine every day was our best resource," Rob Salaga says. He and his wife chose a team with a thorough approach, including genetic reviews, a clear roadmap, and data to pinpoint ideal treatment times.

Your specialist will decide what's best for you. You may need to try a combination of treatments.

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Surgery

Your doctor may suggest surgery if you have problems like:

  • Endometriosis
  • Polyps
  • Fibroids
  • Uterine congenital malformation
  • Blocked or damaged fallopian tubes

Doctors also use surgery to treat male infertility that's caused by varicocele.

Medication

"Most people end up taking some sort of fertility medication to help them make more than one egg and to increase the chances that the egg and sperm will meet and fertilize," Pollack says.

Fertility pills help you make more follicle-stimulating hormone (FSH). "Fertility shots give you FSH directly and are very good at growing multiple eggs," she says.

You may take medication to prepare for treatments. Your doctor may prescribe hormone-regulating medication to help your ovaries release eggs.

Medications include:

  • Bromocriptine (Parlodel)
  • Clomiphene citrate (Clomid)
  • Follicle-stimulating hormone (FSH)
  • Gonadropin-releasing hormone (GnRH) analog
  • Human menopausal gonadotropin, or hMG (Repronex, Menopur)
  • Letrozole (Femara)
  • Metformin (Glucophage)

Intrauterine Insemination (IUI)

Intrauterine insemination, or artificial insemination, helps eggs and sperm get together.

When you're close to ovulation, your doctor injects sperm into your uterus. It may come from your partner or a donor. It may have been collected earlier and frozen.

IUI worked for the Salagas, but not right away. They went through two rounds before pregnancy.

In Vitro Fertilization (IVF)

In IVF, your doctor combines sperm and an egg in a lab. Later, the embryo is moved to the uterus.

First, your doctor gets one or more eggs. They may be from your ovaries, donor eggs, or frozen eggs.

Next, she fertilizes them in a lab. She adds sperm to the eggs or injects a single sperm into each egg.

Then they're checked for fertilization.

A few days later, she places one or more embryos in your uterus. Embryos that aren't transferred can be frozen for later.

You may need multiple cycles of IVF until it works.

Surrogacy

If you have unhealthy or no eggs, you might consider surrogacy. A "surrogate" agrees to get pregnant with her own egg and a man's sperm. After giving birth, she gives the baby to the parents.

If you have a health problem that makes pregnancy difficult, you may want to think about someone who may be able to carry the baby for you. You use your own egg and sperm through IVF. Or you can use a donor egg. A doctor transfers the embryo into the womb of another woman, who has no genetic link to the baby.

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Egg or Sperm Donation

You may use eggs or sperm from a donor while you carry the pregnancy.

"Egg donation has become more common today, with couples seeking pregnancies in the fifth decade of life," says Armando Hernandez-Rey, MD, a specialist at Conceptions Florida Center for Fertility and Genetics in Coral Gables, FL.

Donation is common when age is an issue and with single mothers and same-sex couples, he says.

Lifestyle Changes

Some couples try lifestyle changes. Experts say a healthy weight and diet and not smoking, using drugs, or drinking alcohol helps.

The Salagas believe healthy choices were key. Rob ate well and took vitamin C, zinc, fish oil, CoQ10, vitamin E, and vitamin D. For Heather, it was about emotional health.

"Dr. Hurwitz sat us down, and within the first 5 minutes said, 'You don't have to even think about getting pregnant anymore because that's my job,' " Heather recalls.

"To explain the gorilla that jumped off my back with that simple statement? I let go of the fear, I acknowledged the worry -- but then put it aside."

WebMD Magazine - Feature Reviewed by Traci C. Johnson, MD on January 26, 2019

Sources

SOURCES:

Armando Hernandez-Rey, MD, Conceptions Florida Center for Fertility and Genetics.

Edward Marut, MD, Fertility Centers of Illinois.

Staci Pollack, MD, Montefiore Health System and Albert Einstein College of Medicine.

American College of Obstetricians and Gynecologists: "Treating Infertility."

National Infertility Association: "Surrogacy."

Office on Women's Health, U.S. Department of Health and Human Services: "Infertility."

American Academy of Family Physicians: "Male Infertility."

Mayo Clinic: "Male Infertility."

American Pregnancy Association: "Trying to Conceive After Age 35."

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