IUI fertilization

Intrauterine insemination, too, is sometimes used for men with poor sperm quality. By implanting “washed” sperm directly into the woman during her ovulation period, IUI has an average pregnancy success rate of between 6 and 25%. Success rates at or above the higher end of this range occur when the sperm count is between 20 to 30 million per ejaculation and are reduced significantly when the count falls below 5 to 10 million.

IUI is typically not successful in cases of:

• Low sperm count

• Low sperm motility

Clomid

In April 2009, the journal Fertility and Sterility published a study that found that men who took Clomiphene citrate (Clomid) along with vitamin E for six months showed an increase in both sperm count and motility. The men in the study had a 37% success rate of impregnating their partners versus men who took a placebo. Those in the placebo group had a 13% success rate. A study by the World Health Organization several years ago did not show a great increase in fertility in men taking Clomid vs a control group taking a placebo, so it appears that the combination of vitamin E and the Clomid hormone makes the difference.

Natural Fertility Treatments

In many cases, natural fertility treatments can be performed at home such as changes in diet, exercise routines and general health will increase a man’s sperm count and motility.

Decrease temperature of sperm

Sperm do not thrive in constant, overly warm temperatures. Therefore, a man trying to conceive should avoid hot tubs, prolonged warm temperatures and heated blankets. Also, avoid sitting with a laptop on your lap for long periods. (Purchasing a cooling fan that fits under the laptop and runs on power from the PC will protect your sperm count and your computer.)

Many medical professionals say the “boxers or briefs” choice makes little difference, but like many natural treatments, switching to boxers while TTC couldn’t hurt.

Lifestyle changes

In general, any lifestyle changes that positively impact a man’s health can also impact his sperm production. Quitting smoking, limiting alcohol, avoiding illegal drugs, keeping your weight in check, and engaging in moderate exercise can all help increase sperm production and energy levels.

Excessive bicycling – for more than three hours a week – on a narrow bicycle seat can lead to reproductive problems. Avid cyclists need not give up their habit, though, as cycling is a healthy lifestyle choice. Simply invest in a wider, cushioned seat, and stand frequently to shift your weight.

Vitamins
Certain vitamin deficiencies can lead to low sperm count and motility. For improved reproductive health, men should take vitamin supplements and eat a diet rich in the following nutrients:

• Zinc

• Vitamin E

• Vitamin C

• Vitamin B12

• Selenium

• Flaxseed oil

You may find a blend of these vitamins in natural fertility supplements designed for men.

Herbs can increase sperm production

As herbal remedies grow in popularity, more reputable companies are introducing herbal supplements. However, herbs have no FDA regulation, and you can’t always determine the potency or reliability of an herbal supplement. Do your research to insure you’re purchasing from a reputable source and you’re not just wasting your money on what are, essentially, sugar pills.

Additionally, take herbs with caution, following the manufacturer’s recommended dosage. As with any medicine or supplement, do not take more than the recommended dose. Pay close attention to your body and stop taking the supplement if you experience any unusual side effects. Ask your doctor or pharmacist about any interactions between herbs or with any prescription drugs.

Popular herbs to improve fertility in men include:

• Ginseng or Panax Ginseng

• Astralagus

• Saw palmetto

Stress Reduction

Coping with infertility can lead to additional stress on top of life’s everyday stressors. A couple trying to conceive can learn methods to cope with stress together. If you recently experienced a major, life-changing event that causes stress, such as a death in your family, job loss, purchasing a home or moving, you may want to cut back on the TTC efforts for a while. In other words, “stop trying,” have sex regularly and only when you feel like it for fun, and wait until the emotional ordeal passes to renew your efforts.

Author: Dawn Allcot

Before you see a doctor, however, make sure you have done everything in your power to get pregnant.

• Are you tracking your menstrual cycles and using some method to ensure you are having sex at or around your time of ovulation?
• Does an ovulation predictor kit show that you are ovulating normally?

If this is the case, a fertility specialist should be able to help you pin down the reason you have not been able to conceive and discuss methods that will help you conceive or make a pregnancy possible. Statistics show that 85 percent of all infertility cases are curable.

Testing for Him

The doctor first will take down your medical history. Testing typically begins with the male, because his test involves a simple semen analysis. The analysis will look for sperm count, healthy movement of the sperm, and the shape and maturity of the sperm cells to determine the quality. The semen’s consistency and volume will be analyzed – approximately one teaspoon is considered normal. The pH balance will be tested – it should be slightly alkaline to survive in the environment of the cervix.

If the test results show abnormalities, a doctor specializing in male infertility will repeat the exam two times over the next three months. Many different factors – from a fever or illness to sexually transmitted diseases – can affect sperm count. Additionally, intense physical activity – and especially bicycle riding – can reduce sperm count, as can high temperatures, such as those experienced in a hot tub. Even wearing briefs instead of boxers can create a warm environment in the testes that can lower sperm count.

If the next two exams bring abnormal results, your partner will be referred to a urologist, who will perform the following tests:

• A sperm antibody test

• Hormonal blood tests

• Testicular biopies to determine if he is sterile

• Vasography which checks for any obstructions

• Fructose test

• Bovine cervical mucus test which checks the sperm’s ability to penetrate cervical mucus from cows

• Hamster egg test which determines sperm penetration strength. This test is important, because if his sperm can’t penetrate the egg, in vitro fertilization will not be successful.

Testing for Her

If your partner’s semen analysis results are normal, or if all of the tests performed by the urologist show no problems, testing begins for you. A gynecologist specializing in reproductive endocrinology can take you through this stage of fertility testing.

The doctor will first view both of your charts and review your medical history, paying particular attention to past surgeries such as appendicitis, myomectomies or fibroid surgery, and any STDs on record. He will ask about your menstrual cycle – if you’ve ever had irregular periods, etc., and he will ask about your contraceptive history. He will then conduct interviews with both of you, either together or separately.

He will ask you both questions about previous pregnancies and their outcomes, as well as how long you’ve been trying to get pregnant. He will also ask many lifestyle questions including:

• Frequency of sex

• Do you use any recreational drugs?

• Do you smoke?

• How often do you drink alcohol?

• How healthy is your diet?

• Do you exercise regularly? How often and what activities?

• Have you experienced any stressful events recently, such as a death or new job?

It may be tempting to lie when you answer some of these questions but your honest answers will help your doctor discover the cause of your infertility and make changes that will help you get pregnant.

Your exam includes a complete physical, including an internal, when the doctor will examine your ovaries for signs of problems such as PCOS (polycystic ovarian syndrome), endometriosis, and PID. An ultrasound may be performed to check the condition of the fallopian tubes and ovaries.

Additionally, blood work will be done or scheduled to check reproductive and thyroid hormone levels and to test for STDs.

A visit to a fertility specialist can be a stressful experience, but knowing what to expect and being prepared can help alleviate some of your concerns, as well as make your visit go smoothly.

How can you prepare?

• Bring a list of questions you and your partner want to ask

• Be prepared with your families’ medical histories and your own medical histories

• Be prepared with information about your menstrual cycle, including ovulation dates from charting your cycle for at least three months.

Author: Dawn Allcot

The tests for you range from very simple in-office tests no more invasive than a PAP smear or ultrasound to surgical procedures.

Post Coital Test
During the Post Coital Test the doctor takes a sample of your cervical mucus. The doctor will examine the cervical mucus under a microscope to determine if it is hospitable to sperm.

Timing is everything with this test; it must be performed four to 10 hours after sex when just prior to, during, or immediately following ovulation (i.e., your fertile period, or the time of your cycle when you should be able to conceive.) Use an ovulation predictor kit to be certain, although you can certainly use other timing methods, including tracking BBT (Basal Body Temperature) and cervical mucus.

Do not:

• Use lubricant during sex

• Douche after sex

• Bathe or swim after sex (a shower is okay)

The doctor will take a small sample of cervical mucus and examine it for:

• Quantity – There should be more plentiful amounts during your fertile period;

• Consistency and clarity – It should be very thin and clear and also very stretchy, almost rubbery;

• Ferning – Under a microscope, the doctor should see a fern-like pattern in the dried cervical mucus, indicating the presence of estrogen without progesterone hormones;

• Cellularity – Few cells, other than sperm, should be present.

If any of these factors show problems, this could be the reason you are having difficulty conceiving. The doctor may recommend artificial insemination by means of intrauterine insemination in order to bypass the cervix all together.

However, the number one reason this test fails is poor timing; if the test was not done four to 10 hours after intercourse or was not done while you were ovulating, then the cervical fluid may not show a favorable environment for sperm to survive, swim and fertilize an egg. If this is suspected to be the case, a second test should be performed at the time of ovulation.

Other causes for an unfavorable cervical environment include:

• Infection or irritation. If this is the cause, testing will show white blood cells in the mucus.

• Procedures performed on the cervix to treat an abnormal Pap smear, such as freezing or laser treatment.

• Medications. Clomid (generic: clomiphene) a fertility drug used to treat infertility caused by anovulation, can have adverse affects on cervical mucus. If your doctor prescribes the drug or increases your dosage, he should perform a post-coital test to be sure the cervical environment is still hospitable to sperm.

Ultrasound
Most people think of ultrasounds as a non-invasive, painless procedure performed on pregnant women in order to see the unborn baby. True, an ultrasound can determine the gender, size (give or take 2 pounds), and often the general health of a fetus, but it can also give a doctor information about why you haven’t been able to conceive yet.

Your doctor will use an ultrasound to evaluate the condition of your ovaries and fallopian tubes, and check for cysts, tumors and uterine fibroids. He will be looking for Polycystic Ovarian Syndrome, endometriosis, and anything else that may be impairing your ability to get pregnant. An ultrasound can show the doctor if your eggs are developing properly and are being released from the ovaries and if the endometrial lining thickens sufficiently to permit implantation.

An endometrial biopsy is used to detect cancerous cells, precancerous cells, infections or any abnormalities that may be affecting your ability to conceive. The doctor inserts a thin catheter, called a pipelle, into the uterus and uses it to draw out cells for testing.

You may experience mild to intense cramping during and after the test. The doctor may recommend you take ibuprofen, such as Motrin or Advil, before and after the test to minimize cramping, or he may offer a prescription painkiller. You may have minor bleeding following the test.

You should take a pregnancy test prior to an endometrial biopsy since the procedure may terminate a very early pregnancy.

Hysteroscopy
A hysteroscopy is an out-patient procedure performed that will allow your doctor to spot abnormalities in the uterus such as:

• fibroid tumors

• polyps

• scar tissue

A hysteroscope is a very thin telescope with a camera on the end that can enter the cervix with no dilation. The uterus is expanded by means of saline solution or carbon dioxide, permitting the doctor to view the inside on a television monitor in the office. Minor cramping may result from the introduction of saline or carbon dioxide into the uterus, but the procedure is not considered especially painful.

Falloposcopy
Cleared by the U.S. FDA (Food and Drug Administration) in 1997 for use to diagnose fallopian tube blockages in women trying to conceive, falloposcopy is regarded as a relatively new and complicated procedure. However, since nearly 35 percent of all female infertility cases are related to fallopian tube damage, this procedure may be invaluable in determining the cause of infertility. Your doctor will probably order less invasive tests first, however, including an ultrasound.

Because the fallopian tubes are located so deep within the reproductive system, past diagnostic procedures carried a 40 percent rate of false diagnoses. The STARRT Falloposcopy procedure, patented by Conceptus, Inc., shows a much greater accuracy rate.

The procedure takes about 45 minutes and is performed with local anesthesia or intravenous sedation. Another benefit of the test is that tubes can be repaired at the same time, with the same equipment, if the doctor finds any abnormalities. Tubal repair can take as long as two hours and your doctor will use a general anesthesia. If abnormalities are found but the tubes cannot be repaired, your doctor will discuss the possibility of in vitro fertilization with you and your partner.

Similar to a hysteroscopy, a falloposcopy views the inside of the fallopian tubes by means of a camera inserted into the body. It enters through a catheter that travels through the cervix and uterus and finally, into the fallopian tube. A fiber optic endoscope with a camera on the end is then inserted through the catheter, so the doctor can view images on a television monitor in the office.

Risks include infection and bleeding, so your doctor may prescribe an antibiotic as a preventative measure.

Laparoscopy
Laparoscopic surgery is an advance in medical technology which permits diagnostic surgery through a very small incision, into which a thin instrument (laparoscope) is inserted in order to take pictures of the abdomen. Carbon dioxide is used to expand the abdomen, permitting the doctor with a clear view of the uterus, cervix, and ovaries and fallopian tubes on a television monitor in his office or in the operating room.

Doctors in the late 20th century commonly recommended this diagnostic procedure in couples trying to conceive. Today, however, other procedures are recommended first. Although laparoscopy is simpler and safer than traditional surgery with a full-size incision, it is still surgery, and often performed under general anesthesia. Rarely does a laparoscopy turn up any abnormalities not spotted by other fertility screening tests.

Hysterosalpigogram (HSG)
According to the Advanced Fertility Center of Chicago, a hysterosalpigogram is a common infertility diagnostic procedure that is helpful in detecting tubal infertility. Since 25 percent of all infertility is caused by tubal abnormalities, this test may be an important one. Less invasive than a laparoscopy, top fertility clinics makes it part of its basic fertility screens.

The test is performed in the radiology department of the fertility clinic, hospital or medical center between days six and 13 of the patient’s menstrual cycle.

Dye is injected into the uterine cavity, through the vagina and cervix. If the fallopian tubes are normal, the dye should spill out into the abdominal cavity. If there is a tubal blockage, the dye will stop at that point. The X-rays will be available for evaluation that day.

An HSG test also detects:

• uterine anomalies

• polyps

• fibroid tumors

• uterine scar tissue

• tubal defects

• scar tissue around the fallopian tubes

Whatever your choice, remember that if you and your partner want a baby, there is one for you, just waiting to be chosen or conceived, taken home and loved.

This article outlines several common causes for infertility and possible treatments. It explains the concepts without jargon so you can have an educated discussion with your doctor about your challenges in trying to conceive.

* Ovulation Factors

Ovulation – the release of an egg into the fallopian tube – is required for conception. Most women ovulate about once a month or approximately every 28 to 31 days.

Oligoovulation means a woman ovulates irregularly. If you suffer from oligoovulation, it will be hard to predict your ovulation by tracking your menstrual cycle, but measuring basal body temperature along with tracking cervical mucus changes may be more effective, as will over-the-counter ovulation predictor kits.

Anovulation means a woman isn’t ovulating at all – either permanently or temporarily. Drastic changes in diet or eating disorders such as anorexia and bulimia can cause temporary anovulation, as can excessive exercise, stress, and breastfeeding. Amenorrhea, also caused by these factors, refers to a lack of a menstrual cycle. Every so often, a woman can get her period but not release an egg during that cycle. This is called an anovulatory cycle.

Some diseases also cause anovulation. These include:

• Pituitary problems

• Polycystic ovarian syndrome (PCOS)

• Hypothalamic dysfunction

• Luteal phase defects

• Pituitary gland, adrenal gland or ovarian tumors

Hormonal imbalances are the number one cause of anovulatory cycles.

Replacement hormones and drug therapy can often induce ovulation, but in some cases, lifestyle changes – such as stress management, reducing strenuous exercise, or stopping breastfeeding – will bring back a normal menstrual cycle complete with regular ovulation.

* Cervical / Uterine Factors

If a woman is diagnosed with cervical infertility – usually done by means of a cervical exam – it means sperm is unable to pass through the cervix and into the uterus. Cervical infertility may be caused by:

• Cervical mucus too thick to allow sperm to pass through;

• A lack of cervical mucus to transport sperm;

• A narrow cervix, also called “stenosis”;

• A cervix infection, sometimes caused by sexually transmitted diseases;

• A sperm “allergy,” where the woman’s immune system attacks the sperm as a foreign body.

Uterine abnormalities are not a common cause of infertility; they are more closely associated with recurrent miscarriages. However, a number of uterine abnormalities may contribute to infertility. Often, these are not the primary cause of infertility but a factor to consider during in vitro fertilization to avoid pre-term pregnancy or miscarriage.

Abnormalities your doctor may check for include:

• congenital malformations;

• leiomyomas (fibroids);

• intrauterine adhesions (scarring)

• endometrial polyps.

* Tubal & Peritoneal Factors

• Completely blocked fallopian tubes

• One blocked tube

• Tubal scarring

• Tubal damage

• Tubal ligation (performed intentionally as permanent birth control)

A tubal blockage located close to the uterus is called “proximal” tubal blockage, while a blockage locating further away is called distal tubal blockage.

Making up about 25 percent of all infertility cases, tubal damage or blockage is one of the most prevalent causes of infertility. It is often caused by pelvic infections, including pelvic inflammatory disease (PID) or pelvic endometriosis, but can also be caused by scar tissue that forms after pelvic surgery. Some STDs, including gonorrhea and Chlamydia, cause pelvic infections that lead to tubal blockages.

Since tubal damage is such a common cause of infertility, most doctors will test for it using a special X-ray called a hysterosalpingogram (HSG) and/or a diagnostic laparoscopy.

Most blockages can be treated with surgery – even in the case of previous tubal ligation patients – but if surgery doesn’t work, in vitro fertilization remains an option for women with tubal infertility issues.

The peritoneum is a thin membrane that lines the pelvic cavity. Problems with this membrane, sometimes caused by endometriosis, ruptured appendicitis, pelvic inflammatory disease and scar tissue, can contribute to infertility.

*Immunological Factors

Several immunological factors may lead to infertility. They include anti-sperm antibodies present in the male or female partner.

These anti-bodies can:

• immobilize sperm;

• make them clump together;

• limit their ability to pass through the cervical mucus or

• stop them from binding to and penetrating the egg.

In vitro fertilization using ICSI (injecting a sperm directly into an egg) has the highest success rate of any current treatments;

A woman’s body rejects the fetus as foreign tissue.

Clinics report a 70 percent success rate when treating this form of infertility by injecting the partner’s white blood cells into the woman prior to conception. When successful, the woman’s body begins to “recognize” the cells, and therefore, later identifies the fetus as “friendly.”

Antibodies in mother produce blood clots.

The prospective mother-to-be produces antibodies that cause clotting in blood vessels that lead to the fetus. Deprived of nutrients, the fetus dies in utero, triggering a spontaneous abortion or miscarriage.

* Endometriosis

Endometriosis afflicts more than 5.5 million American women and girls, and contributes to 25 to 50 percent of all infertility cases. Thirty to 40 percent of women suffering from endometriosis are infertile, so this is an important factor to look at if you have been trying unsuccessfully to conceive.

The Endometriosis Association lists several symptoms of the disease, but the disease may be asymptomic in mild cases.

• Pain before and during periods

• Pain during sex

• Infertility

• Fatigue

• Painful urination during periods

• Painful bowel movements during periods

• Other Gastrointestinal upsets such as diarrhea, constipation, nausea.

What exactly is endometriosis? The Endo-Association defines it as a chronic disease that occurs “when tissue like that which lines the uterus (endometrium) is found outside the uterus, usually in the abdomen on the ovaries, fallopian tubes, and ligaments that support the uterus; the area between the vagina and rectum; the outer surface of the uterus; and the lining of the pelvic cavity.”

The tissue develops into growths or legions that—like the uterine lining—builds up, breaks down and sheds during a woman’s menstrual cycle. Since this lining has no way to leave the body, it results in internal bleeding, breakdown of the blood and tissue and painful inflammation.

*Treatment of Endometriosis

Although endometriosis has no cure, several different treatment options are available to reduce pain and symptoms, slow or shrink growths and preserve or restore fertility.

Medication: In mild cases, over-the-counter pain relievers such as aspirin and acetaminophen (Tylenol) and prostaglandin inhibitors such as ibuprofen (Advil and Motrin) can relieve pain and slow growth.

Hormone therapy: Stopping ovulation through oral contraceptives or other hormone therapy will also stop the build up and break down of legions. Obviously, this isn’t a desirable treatment option for women trying to conceive and may also cause side effects.

Surgery: Surgery – usually laparoscopy, an outpatient procedure in which surgery occurs through the belly button – can remove or destroy the growths and relieve pain. Pregnancy can often occur after such surgery. A more extensive procedure with a longer recovery time – laparotomy – involves a full incision, but is still considered “conservative” surgery, versus the alternative of a hysterectomy with removal of all growths and the ovaries.

Alternative / Natural Medicine: As with most diseases, alternative and natural treatments also exist. These can be used with traditional Western medicine treatments or alone and may include:

• nutritional changes

• homeopathic treatments

• immune therapy

• allergy management

• traditional Chinese medicine such as acupuncture and acupressure

* Pelvic Inflammatory Disease

Most infertility causes are not preventable, but Pelvic Inflammatory Disease, a bacterial infection in the upper genital tract, can be prevented by preventing STDs, including Chlamydia and Gonorrhea. A PID typically affects the uterus, fallopian tubes and ovaries and can lead to infertility. It is also the most important risk factor for ectopic pregnancies leading to miscarriages.

Since Chlamydia and Gonorrhea are transmitted through unprotected sex, use of a condom in any non-monogamous relationship can prevent the diseases and help prevent PID. If you are in a monogamous relationship, both partners should be tested to make sure they are free of STDs before they begin having unprotected sex.

Symptoms of PID include:

• fever;

• chills;

• lower abdominal and pelvic pain

• vaginal discharge or bleeding.

Symptoms may begin a few days after the start of your period.

When symptoms are present, doctors can diagnose PID through a bacterial culture of cervical discharge and a white blood cell count test. (Elevated levels may indicate the infection.)

PID is sometimes confused with appendicitis or a ruptured ovarian cyst, in which case a laparoscopy can confirm PID. It can be cured with antibiotics.

Only 10 to 25 percent of all single cases of PID (that is, not a recurring infection) result in damage to the fallopian tubes that cause infertility, and prompt treatment increases the odds that there will be no enduring side effects.

* Polycystic Ovarian Syndrome

The single-most common cause of female infertility, according to Women’s Health, the Federal Government Source for Women’s Health Information, is Polycystic Ovarian Syndrome. PCOS afflicts one in 10 women of childbearing age, although it can begin in young girls as early as age 11.

The syndrome occurs due to high levels of androgens (male hormones, although females also produce them in smaller quantities) in the body, leading to missed or irregular periods, baldness, excessive facial and/or body hair, cysts in the ovaries, and often, infertility.

A number of other symptoms and disorders are linked to the disease, including:

• obesity

• pelvic pain

• sleep apnea

PCOS also carries with it an increased risk of:

• Type 2 diabetes

• high cholesterol

• high blood pressure

• heart disease

Why DOES PCOS cause infertility?

The follicles within a woman’s ovaries contain fluid and multiple eggs, which begin to mature each month. Usually only one egg matures fully, and the follicle breaks open to release the egg, which travels down the fallopian tube ready to be fertilized. This process is called ovulation.

PCOS prevents the ovary from making all the hormones it needs for an egg to fully mature. Instead, follicles grow and build up fluid, remaining as cysts. Without ovulation, the woman’s body doesn’t produce progesterone, and the menstrual cycle become irregular or non-existent (called anovulation). Obviously, without ovulation, pregnancy cannot occur by natural methods.

Treatments for PCOS

No cure exists for the syndrome but treatment and lifestyle changes designed to manage the illness can reduce the risk of complications, minimize symptoms and also increase the chances of a successful conception and pregnancy.

Unfortunately, one of the most common forms of PCOS treatment is the use of birth control pills to regulate menstrual cycles and reduce the presence of male hormones. This is not a permanent fix, however, and lasts only as long as the woman is on the Pill, so is not a desired treatment for women trying to conceive.

Diabetes medications: Diabetes medications, including Glucophage (metformin) lowers testosterone production and controls the way the insulin controls blood sugar levels. PCOS is linked to insulin production, making this an effective treatment. Glucophage, according to an article in the New England Journal of Medicine, was recently found safe for pregnant women to treat gestational diabetes, and so may be a good option to discuss with your doctor if you trying to conceive with PCOS.

Fertility medications: Since anovulation causes infertility – and is a common symptom of PCOS – medicines designed to stimulate ovulation may help a woman with PCOS become pregnant. Clomiphene citrate, under the brand names Clomid or Serophene, usually works. Sometimes metformin will be added, which may help a woman ovulate with on a lower dose of both medications. Gonadrotropins – a fertility medicine taken by injection – may also be used, but carries a greater risk of multiple births. Finally, in vitro fertilization remains an option for women trying to conceive with PCOS.

Surgery: When fertility medicines don’t work, “ovarian drilling” – a laparoscopic procedure – may be used as a last effort to stimulate ovulation. The surgeon punctures an ovary with a small needle and uses an electric current to destroy a small portion of the ovary. There is a risk of scar tissue developing on the ovary, but the surgery may lower male hormone levels, stimulating ovulation. Effects may last a few months, creating a small window during which a woman may conceive naturally or through artificial insemination. The treatment typically doesn’t help with cosmetic symptoms of PCOS, such as baldness or body and facial hair growth.

Lifestyle modification: Often, women can manage the symptoms and risks of PCOS with lifestyle changes, including regular exercise and a healthy diet rich in fruits, vegetables and whole-grain products. By following a diet similar to what a diabetic should eat, a woman with PCOS can improve her body’s use of insulin and normalize hormone levels, which may stimulate ovulation and even create regular menstrual cycles, leading to the possibility of a healthy pregnancy.

*Premature Ovarian Failure

According to the International Premature Ovarian Failure Association, approximately one to four percent of the female population suffers from Premature Ovarian Failure, sometimes called premature menopause.

More information about PCOS

Premature Ovarian Failure typically occurs in women under 40; it can happen as early as the teen years. POF may be caused by certain syndromes, diseases, genetic disorders or even radiation treatment or chemotherapy, although in many patients, doctors can’t identify a specific cause at all.

If you are not pregnant, breastfeeding or menopausal and your periods have stopped or become irregular, it could be due to POF. You may also experience other symptoms of menopause, including:

• Hot flashes

• Vaginal dryness

• Lack of sex drive

• Painful sex

• Bladder control problems

• Mood swings

• Energy loss

Unfortunately, only about six to eight percent of women with POF will be able to successfully conceive. No treatments exist to restore fertility in women with POF, but you should still seek treatment for the disorder, because it carries several other health risks including an increased risk of osteoporosis, and heart disease.

A doctor may diagnose POF with two FSH tests done approximately a month apart. If FSH (Follicle Stimulating Hormone) levels are normal, it typically indicates the ovaries are working correctly. Women with POF will show FSH levels in the post-menopausal range.

According to the International POF Association, many doctors misdiagnose POF or blame the symptoms on stress. Insist on diagnostic testing to either rule out or diagnose the disorder so that you can begin treatment promptly. Treatment may include hormone replacement therapy and lifestyle changes to manage symptoms and decrease the health risks of complications associated with POF, such as osteoporosis and heart disease.

More information on Premature Ovarian Failure (POF)

* Fibroid Tumors

Fibroid tumors by themselves are a primary cause of fertility in only three to 12 percent of women who have them. If fibroid tumors block the fallopian tubes, they can cause infertility.

However, treatments for fibroid tumors, including myomectomy – a surgical procedure in which fibroids are removed but the uterus remains intact – and hysterectomy can cause permanent infertility. In many cases, fibroid tumors return after a myomectomy and the surgery must be repeated. This repeated procedure can cause uterine scarring leading to infertility. If conception occurs, however, 85 to 90 percent of all women will have a successful pregnancy without complications.

Female Alternative Surgery, which uses lasers to remove the fibroid tumors without damaging the uterus or ovaries and preserving fertility, should be discussed with your doctor, as well.

What are Fibroid Tumors?

Fibroid tumors are benign masses which grow in the uterus. They can be hard and stony or soft and rubbery. Nearly 25 percent of all women of childbearing age have fibroids. They are typically identified during a gynecological exam when a doctor may feel a mass in the uterus; this diagnosis may be confirmed by an ultrasound.

Some women won’t have any symptoms from fibroid tumors and, chances are, without any symptoms, the fibroids also won’t create problems with conception. However, if you are having fertility issues and have any of the following symptoms, fibroid tumors blocking the fallopian tubes may be a cause.

Symptoms of Fibroid Tumors

• Pelvic Pain

• Increased menstrual cramps

• Increased menstrual flow

• Clots

• Irregular or painful periods

• Increased urinary frequency

• Constipation

• Bloating

* Hyperprolactinemia

A hormonal disordered characterized by unusually high levels of prolactin in the blood in non-pregnant, non-breastfeeding women or in men.

This disorder occurs in approximately 10 percent of the population and can result in infertility in males or females. In women, it can cause irregular or non-existent menstrual periods.

Stress, sex, exercise, sleep, nipple stimulation, certain prescription drugs and even eating certain foods can also increase prolactin levels temporarily. If one blood test shows elevated levels of prolactin, a follow-up test should be ordered to confirm the diagnosis.

If hyperprolactinemia is causing infertility, it can be treated with prescription drugs.
* Luteal Phase Defect

The luteal phase of a woman’s menstrual cycle begins immediately after ovulation and continues for approximately 12 to 14 days. If the luteal phase lasts 10 days or less, it is considered a Luteal Phase Defect. Some doctors believe any luteal phase shorter than 12 days can cause problems. This shortened time period may not allow the uterine lining to develop enough for the embryo to fully implant, and often leads to an early miscarriage or a failure to conceive.

LPD occurs because of inadequate progesterone stimulation; it is a hormonal imbalance. You may discover a Luteal Phase Defect while charting your fertility. A time frame between ovulation and menstruation of less than 12 days may indicate an LPD. A doctor can discover an LPD with a simple blood test that detects progesterone levels in your body seven days after ovulation.

It is often treated with vitamin B6 and progesterone cream, which help lengthen the luteal phase.
If over-the-counter treatments don’t work, a reproductive endocrinologist may prescribe Clomid or progesterone suppositories.

* Other Causes of Infertility

Several other causes of infertility exist. A reproductive endocrinologist may explore some of these possible causes with you.

Anything that effects your menstrual cycle, including stress, rapid weight loss or gain, travel, and intense exercise can cause temporary infertility. These are all factors to consider when you are trying to conceive.

Additionally, some medical conditions can lead to infertility. Some diseases associated with infertility, pregnancy complications or miscarriage include:

• Diabetes

• Lupus

• Thyroid Disease

Author: Dawn Allcot

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