Paging Dr. Frischer - Fertility

Have you or a loved one had trouble getting pregnant? If so, read on. Today we are exploring the field of infertility.If you and your partner have not been able to get pregnant despite having regular unprotected intercourse for at least one year, then you are considered an infertile couple. You would not be alone; up to 15% of couples in the United States are infertile. The male partner is responsible in roughly 25% of infertile couples, 25% are unexplained, and the remaining 50% have problems that can be traced to the woman. Most pregnancies occur during the first six months of unprotected intercourse, and after 12 months, approximately 85% of couples will become pregnant. Half of the remaining 15% will conceive, with continued effort, within the next three years. Age is a huge factor: when the woman is over 35, the infertility rate more then doubles, yet 20% of women now have their first child after that age. The causes are many because the human reproductive process is so complex. There must be normal ovulation of a healthy egg, safe transit of this egg from the ovary to the uterus, healthy sperm to swim up to meet the egg and fertilize it, and then a healthy uterine environment for the fertilized egg to grow into a viable baby. More than 90% of male infertility cases are due to low sperm counts, poor sperm quality, or both. Men most likely to be fertile have a sperm count of over 48 million, with more then 63% of the sperm moving, and more then 12% having a normal shape and structure. Many factors can affect sperm health, including chronic illness (cancers, heart disease, diabetes, etc.), malnutrition, obesity, genetic defects (mainly Kleinfelter's syndrome), environmental factors, structural defects of the body (undescended testicle and varicocele), and age. Lifestyle choices can also harm sperm development, including the use of anabolic steroids, drugs and alcohol, or exposure to sexually transmitted diseases (chlamydia and gonorrhea). If mumps is contracted after puberty, it can lead to permanent changes in a testicle and forever impair sperm production. Even the use of lubricants may affect the health of sperm. Finally, a host of sexual issues that lead to difficulties with intercourse will increase infertility. These include problems with erections, premature ejaculation, painful intercourse, stress, or other relationship issues. And what about women? Exposure to chlamydia and gonorrhea can lead to fallopian tube damage and blockage. Endometriosis occurs when uterine tissue implants and grows outside of the uterus; this affects the function of the ovaries, uterus and fallopian tubes. Ovulation disorders due to hormone imbalances (including elevated prolactin levels) lead to infertility. In polycystic ovary syndrome (PCOS) the body produces too much androgen (a male hormone), which affects ovulation. Fibroids, a common benign growth of the uterus, can grow in the wall of the uterus and block the fallopian tubes. Some medications may lead to temporary infertility. Thyroid disorders, either too high or too low, can disrupt the menstrual cycle. Cancer and its treatment may have a profound affect on fertility. Age is, of course, a significant factor; it leads to fewer eggs being released from the ovaries, poorer egg health, higher risk of miscarriage, and poorer health in general. Finally, and I add this with fear of retribution from my coffee-loving readers, even excessive caffeine consumption reduces fertility. What is the medical work-up for infertility? Both partners will want to see their family doctor for a general evaluation, including a medical history and a physical exam. The first step for men is much simpler and cheaper than for the woman; a sperm analysis will be run. For the woman, lab tests will likely include checks on diabetes, thyroid function and hormone levels. From there the couple may be referred to a fertility specialist for further tests, including a hysterosalpingogram for the woman to ensure that her fallopian tubes are open and capable of delivering the egg to the uterus. Treatment has advanced remarkably. If the male sperm are of good quality, and the women's reproductive apparatus healthy, treatment will begin with medication aimed at ovarian stimulation, commonly known as fertility drugs. If conservative medical treatment fails, the physician may suggest in-vitro fertilization (IVF). IVF is an assisted reproductive technology (ART) technique, which generally begins with stimulating the ovaries to increase egg production. Eggs are then surgically removed from the ovary and fertilized with sperm in a laboratory, in order to produce one or more embryos. An embryo transfer procedure then reinserts the fertilized egg(s) into the woman's uterus. The current success rates for IVF depend on the center and on the doctor performing the procedure, but overall, the Center for Disease Control reported success rates in 2005 of 43% for women under the age of 35, 36% for women aged 35-37, 25% for women aged 38-40, 15% for women aged 41-42, and 6% for women over 42 years old. Clearly, infertility can be caused by a number of issues outside of our control. However, certain lifestyle choices do maximize the chances of getting pregnant. What can you do, starting today, to improve your chances? Most of these recommendations are helpful for both partners: •Work on reducing stress •Eat a healthful and nutritious diet •Exercise regularly •Control your weight •Do not smoke cigarettes •Do not consume excessive amounts of caffeine •Drink alcohol in moderation and not at all during pregnancy •Do not use recreational drugs •Limit your exposure to multiple sexual partners, and protect yourself when you do •For men, avoid exposure to excessive heat (baths or Jacuzzi-type tubs). Heat is deadly to sperm. •Start your family at a younger age •Diagnose and control any health problems immediately; do not put this off until you start "trying" to conceive. I wish you great health and a wonderful family! Dr. Alan Frischer is former chief of staff and current chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.

********** Published: April 24, 2009 - Volume 8 - Issue 1