Parenting & New Baby Advice Blog

Archive for October, 2007

A woman may be infertile because of a variety of conditions. Age is one factor: recent research has shown that a woman’s fertility decreases significantly between the ages of thirty-one and thirty-five and continues to decline thereafter until menopause when it ceases. An imbalance of the female hormones estrogen and progesterone or of other hormones secreted from the pituitary or thyroid glands can interfere with the reproductive cycle. It may also be that she is not ovulating [releasing an egg each month]; this is true in about twenty-five percent of all infertility cases.

Structural problems are often the cause of infertility. The fallopian tubes [through which the egg travels on its way from the ovary to the uterus] may be obstructed, often as a result of pelvic inflammatory disease which enflames the tubes and causes the formation of scar tissue. Endometriosis [displacement of tissue from the lining of the uterus to outside the uterus] may also cause the formation of scar tissue that blocks the fallopian tubes. A weakness in the cervix [the neck of the uterus] sometimes resulting from a previous abortion or other surgery, may render it unfit to hold the weight of a pregnancy. A “hostile” cervix [one that creates an environment that in some way prevents sperm from surviving] may also be the cause of infertility.

Symptoms

The major “symptom” of infertility is the failure to conceive a child after regular sexual intercourse without birth control for a year. Whether there are other indications depends on the cause of the infertility.

Diagnosis

A couple who are experiencing difficulty in conceiving will most likely be referred to an obstetrician/gynecologist or an urologist who specializes in infertility. Diagnosis of the reason for the infertility problem will usually begin with a physical examination and complete medical and sexual histories of both partners.

A fresh sample of the man’s semen will be examined under a microscope to determine the quantity and quality of the sperm. This will provide a sperm count and will also determine whether the sperm are adequately mobile and have oval heads, both of which characteristics are necessary for conception to occur.

To determine whether ovulation is taking place the woman’s basil body temperature [the body temperature upon awakening, before eating or drinking] will be taken every morning for several months. If the temperature rises by six-tenths of a degree to one degree for a few days in the middle of the menstrual cycle, ovulation is probably taking place. An endometrial biopsy [in which a sample of the lining of the uterus is obtained] can also indicate whether ovulation is occurring.

Obstruction of the fallopian tubes can be diagnosed by injecting a dye into the reproductive tract and then performing an x-ray study. Another test consists of injecting carbon dioxide gas into the fallopian tubes and waiting for the patient to feel discomfort in the upper body, which indicates that the gas is passing through the fallopian tubes and that there are no obstructions.

A weakness in the cervix can be diagnosed through a physical examination and an x-ray study. A hostile cervix can be identified by a microscopic examination of the mucous in the cervix shortly after sexual intercourse to determine the rate of sperm survival. Endometriosis is diagnosed by inserting into the woman’s abdomen a small lighted instrument [a laparoscope], through which the doctor can actually see the uterus, fallopian tubes, ovaries and any displaced endometrial tissue that may be causing the infertility.

Hormonal imbalances in both men and women may be diagnosed with blood tests.

Treatment

Treatment for a low sperm count caused by a testosterone deficiency usually consists of hormonal therapy to increase testosterone levels. If the low sperm count is due to exposure to chemicals, radiation, or excess heat.

The causative situation needs to be corrected or avoided. If the sperm count is low for some unknown reason there may be little than can be done.

If male infertility is caused by varicose veins, surgery may be necessary. If an obstruction exists somewhere in the tubes leading to and through the penis, microsurgery to open the blockage may correct the problem.

In women, failure to ovulate is often treated with a fertility drug called clomiphene which stimulates the production of hormones that regulate ovulation. About sixty percent of women treated with this drug become pregnant, and the chances of multiple births are very low. A stronger drug which is a combination of certain pituitary gland hormones may also be prescribed, but it carries a greater risk of multiple births.

A hostile cervix may be treated with the female hormone estrogen, which stimulates the increased production of mucous necessary to transport the sperm. Sometimes sperm can be placed directly into the uterus, bypassing the cervix completely.

Endometriosis may be treated by the surgical removal of displaced tissue and the scar tissue that has formed around it. Hormonal imbalances may be corrected with hormone therapy.

Obstruction in the fallopian tubes may necessitate microsurgery to open the blockage or a new procedure which the egg is removed and replaced beyond the point of obstruction, where it may be fertilized normally.

Test-tube or in vitro fertilization is a relatively new technique in which an egg is removed from the woman’s ovary and it is then placed in a test-tube or special dish containing the husband’s sperm. Once the egg has been fertilized, it is then placed in the woman’s uterus where it will continue to grow. This technique is used primarily in women whose blocked fallopian tubes cannot be opened by surgery.

Although recent advance in treating in fertility have lead to greater and greater success, about fifteen percent of all female infertility problems and about ten percent of all male infertility problems remain undiagnosed and therefore untreatable.

Ideally you should choose health care for your baby [a pediatrician or other caregiver] before your due date so that you have someone to turn to right after birth, if necessary. During late pregnancy, ask for recommendations from friends, other physicians, or midwives, and childbirth educators, or call local reputable hospitals and find out which doctors and pediatric nurse practitioners have privileges there. After some screening for location [medical care close to home, if possible, is a real advantage.], you can make one or several prenatal appointments to discuss your questions and concerns. In many communities an interview to select a doctor for the baby is free. Find out before making very many appointments.

There are several types of health care providers available for babies and children. Each has its own advantages.

Pediatricians specialize in the care of children only; they have more training in childhood illnesses than any of the other providers. Their staffs and waiting room r are geared for children. They have completed medical school and three years of residency training in pediatrics.

Family physicians can care for the entire family, including the children. Those who have completed family medicine residencies have had several months training in pediatrics, but probably refer any serious illnesses to a physician with more pediatric training.

Pediatric nurse practitioners are registered nurses who have taken additional training in clinical pediatrics. Most work in clinics or groups, with physicians available for consultation and referral. They specialize in well-child care and the treatment of common illnesses. They tend to be very capable in the area of children’s development and emotional needs and parenting concerns, and do a lot of teaching in these areas. They refer serious problems to pediatricians.

Private care tends to be more personalized, more convenient, and more expensive.

Children’s health clinics cost less to those with low incomes and usually offer good care, although there may be more waiting and less continuity of care with the same practitioner. Children’s health clinics are largely staffed by physicians taking their specially training in family medicine or pediatrics.

Well-child clinics such as those sponsored by the public health department provide free or low-cost check-ups and immunization, but usually no care for the sick child. After looking into the types of care, decide which you want to investigate and make appointments to get to know the people involved. Ideally, try to do this at least a few weeks before your baby is born.

In a prenatal appointment [they usually last ten or fifteen minutes], you will not be able to discuss all of your questions. Decide on a few areas that interest you the most and discuss those. Pay as much attention to how your questions are answered as to what is said.

1. Do you feel secure picturing this person as your child’s health care provider?
2. Is his or her style and philosophy compatible with yours?