What is infertility?
Dr. Jennifer Iacovelli Malone, M.D., M.S., founder of Tree of Life Medical and a member of the Arizona Medical Society, the American College of Obstetrics and Gynecologists, the International Menopause Society and the International Society for the Study of Women’s Sexual Health, says that “infertility is defined as not being able to get pregnant after at least one year of trying. Additionally, women over the age of 35 who having been trying for less than one year and women who are able to get pregnant but then have repeat miscarriages are candidates for infertility evaluation.” Dr. Iacovelli Malone explains that in order to become pregnant, a chain of events must take place, and infertility can occur if there is a problem with any of the steps: 1. A woman must release an egg from one of her ovaries (ovulation). 2. The egg must go through a fallopian tube toward the uterus. 3. A man’s sperm must fertilize the egg along the way. 4. The fertilized egg must implant inside of the uterus.
What causes infertility in women?
Dr. Laura Glenn, naturopath at Scottsdale’s Rejuvena Health & Aesthetics who specializes in women’s health, says that she sees three main factors that cause infertility in women: structural issues, hormonal issues or “unknown cause.” “Examples of structural problems include blockage of the fallopian tubes, malformations of the uterus or endometriosis,” she says. “With hormonal issues, there is often either a lack of signals from the brain to the ovaries, or the ovaries are not responding appropriately (for example, in PCOS [or Polycystic Ovary Syndrome]). ‘Unknown cause’ from a conventional medical perspective is the most frustrating to treat, because everything checks out normally, with both the man and woman, but pregnancy is still not occurring.”
Dr. Iacovelli Malone adds that various other factors can affect a women’s ability to conceive, including age, stress, diet, intense athletic training, being overweight or underweight, smoking, alcohol, sexually transmitted infections and hormone changes.
What steps can young women take to care for their reproductive health or prevent possible infertility later in life?
Though many causes of infertility are unfortunately unpreventable, being diligent about one’s sexual health is one way to potentially avert reproductive issues down the road. “The best opportunity we have for preventing infertility lies in preventing transmission of sexually transmitted infections, like chlamydia and gonorrhea, which are major causes of pelvic inflammatory disease that scar the fallopian tubes and cause tubal factor infertility,” says Dr. Glenn. “It is important for young women to talk to their sexual partners about the need for regular STI screening of all partners, and to use condoms regularly. This can directly reduce the risk of infertility.”
Many steps, though, can be taken to help a couple’s chance of conception. “Reducing or eliminating life stressors, both emotional and physical, is important to increase the likelihood of conception,” says Dr. Iacovelli Malone. “Also, eating healthy can make a difference. Being overweight or underweight can affect fertility potential. Also, for women who enjoy intense athletic training, reducing or altering workouts can make a difference in the body’s ability to produce healthy, viable eggs.” She also recommends incorporating food or supplements rich in antioxidants, monounsaturated oils and omega 3 into one’s diet while eliminating caffeine, cigarettes, alcohol and drugs.
Women can also choose to have a “fertility check.” “If it is determined that her ovarian reserve is affected, she can always choose to freeze her eggs to use later in life, when she is ready to have children,” says Elizabeth Shrader, RN, MSN, WHNP-BC, nurse practitioner for fertility management, obstetrics and gynecology at Arizona Associates for Women’s Health in Mesa. “Once the eggs are frozen, they do not age; therefore, this a wonderful option.”
What infertility treatments are couples turning to?
Dr. Iacovelli Malone says: “Some women will turn to freezing eggs and sperm to increase likelihood of conceiving if planning to conceive later in life or receiving medical treatments that may destroy eggs and sperm. Other infertility treatments include initiating fertility and hormone medications (for both men and women) to correct hormonal imbalances, improve sperm health, enhance the ability to make good quality eggs and ensure ovulation; hysteroscopic or laparoscopic surgical interventions to remove anatomical abnormalities, scar tissue or other blockages that affect females and male reproductive structures; hysteroscopic or laparoscopic surgeries to remove fibroids or polyps or other uterine abnormalities that restrict adequate implantation of fertilized eggs; surgical interventions to reverse vasectomies or tubal occlusions; intrauterine insemination (IUI) to help sperm with decreased motility get to an egg for fertilization; and more complex and technical procedures like in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) where sperm is directly injected into the egg to allow fertilization. Additional options include sperm and egg donation and using gestational carriers/surrogates.”
Have there been medical advancements in recent years that are making waves as far as preventing or treating infertility?
Shrader says: “There have been many advances in the field of reproductive endocrinology. The greatest advantage is the progress we have made in cryopreservation of eggs. Three years ago, this was nearly unheard of, and often unsuccessful. Now, freezing eggs to use in the future is almost as good as using fresh eggs. Therefore, if a woman freezes her eggs in her 20’s or early 30’s, then wants to have children in her late 30’s or in her 40’s, she can use those eggs. This greatly increases her chances of having a chromosomally-normal baby because the eggs she is using are young, and the risks of chromosomal abnormalities is much, much less. Furthermore, we have made great advancement in testing embryos for chromosomal abnormalities. Couples who undergo in-vitro fertilization can have their embryos tested for common chromosomal disease, then choose the chromosomally-normal embryos to transfer to help ensure a healthy pregnancy.”
What hurdles do couples dealing with infertility face?
Studies have shown that dealing with infertility can be as stressful as dealing with cancer, says Dr. Glenn. “Emotional struggles are the biggest challenge that I see,” she says. “The vast majority of the population has no concept of the stress that infertile couples are facing.”
The treatment itself, whether fertility drugs, hormones or injections, can have side effects that range from depression and anxiety to mood swings and sleep disturbances, says Dr. Iacovelli Malone. And because most insurance companies do not cover fertility or egg-freezing treatment, Shrader points out that the financial burden can be enormous.
Know the Pros
Arizona Associates for Women’s Health azwomenshealthcare.com.
Rejuvena Health & Aesthetics werejuvenate.com.
Tree of Life Medical treeoflifemedical.net.
