Understanding Infertility

with Connie Malewicki, RNC/APNP, Advanced Healthcare

Posted: Oct. 1, 2004

For a couple struggling to become pregnant, it can seem that everyone has a baby but them. Infertility takes couples by surprise and can have a devastating effect on a relationship. Unlike other medical problems where symptoms appear on their own, a couple can’t know their fertility is impaired until they start trying to have a baby. As time goes on with no pregnancy, stress builds.

Connie Malewicki, RNC/APNP, an advanced practice nurse practitioner with Advanced Healthcare specializing in infertility, said that infertility affects about 15% of the reproductive age population.

Connie Malewicki, RNC/APNP, an advanced practice nurse practitioner specializing in infertility, Advanced Healthcare "One issue I believe should be brought up at every woman’s yearly gynecological exam, is the issue of her fertility. If a woman is postponing having children, she needs to know that it could be more difficult to conceive later."

“We do not know if there are more infertile couples than there were before, or if people are simply seeking treatment more,” Malewicki said. “We do know, however, that women are waiting longer to have their first child, and fertility begins to decline after age 25.”

Infertility is defined as the inability to conceive or an inability to carry a pregnancy to a live birth after a year or more of regular sexual relations without the use of contraception. Women over 35 are instructed to see a doctor after six months of trying to conceive without success. When the cause of infertility can be determined (and about 20% of the time, doctors cannot determine a cause), a third of the time, it is a problem with the woman’s reproductive system, a third of the time it is with the man’s, and a third of the time, it is a combination.

Malewicki said the first step for a couple who is having trouble conceiving should be to see the woman’s health care provider. Often, she said, couples are unaware that the best time of the month to conceive is right before ovulation. Many women do not know that changes in their cervical mucus and body temperature indicate when they are fertile and when they are not. Their doctor can help them to learn what signs to look for.

“For many people, it can be as simple as timing,” Malewicki said. “For others, there could be an infection that needs to clear, or instruction to stop using lubrication during intercourse.” Couples are often instructed to use an ovulation predictor kit, so that they can be sure that they are trying to conceive at the optimal time.

For couples who do not become pregnant even after issues of timing are addressed, it is time to seek the help of a health care provider who can discuss the process of having the cause of their infertility diagnosed. Most insurance covers diagnostic testing.

The most common category of problem for women is disorders of ovulation, where the woman does not ovulate each cycle. Another problem for some women is blocked fallopian tubes.

A common problem for men is oligospermia, where few sperm are produced; less common is azoospermia, where no sperm cells are produced. Semen analysis will provide doctors with the information they need about the man’s sperm. Women often need an X-ray to see if their fallopian tubes are open.

“We often recommend that couples also seek counseling during this time,” Malewicki said. “They need to look at so many issues— drugs that have side effects, high-tech solutions, the possibility of adoption or a childfree life. The longer a couple tries to become pregnant without success, the more stressful it can become. Family and friends often don’t understand.”

Malewicki stressed however, that the majority of couples who come in with infertility issues do eventually have a child. Most of these couples, in fact, will become pregnant through relatively low-tech methods.

Women who have problems ovulating can be given the oral pill Clomid or an injected medication to increase the number of eggs they produce. Men with a low sperm count may have their sperm washed and deposited in the uterine cavity.

Finally, if no other method works, a couple can consider in-vitro fertilization, where the egg and the sperm are combined in a Petri dish and the resulting embryo is implanted in the mother.

Malewicki noted that treatments for infertility may be covered by insurance, but when they are covered, it is rarely in full. The cost for treatment goes up as the level of technology goes up — from a few thousand dollars a year to upwards of $20,000 for one in-vitro fertilization.

Malewicki said that couples need to decide at what point they will stop fertility treatments. Some couples opt to stop before even trying a drug, while other couples will go on to borrow money or use a life’s savings with several tries at in-vitro.

“One issue I believe should be brought up at every woman’s yearly gynecological exam, is the issue of her fertility,” Malewicki said. “If a woman is postponing having children, she needs to know that it could be more difficult to conceive later. I don’t know that all women understand that.”

We Have Answers Do you have medical questions or need help finding a doctor? The experts at Columbia St. Mary's and Advanced Healthcare can help. Click here.