Infertility is Not Just a Woman's Issue


By Anne Rainville, MD, FACOG T


he decision to start a family is scary and exciting and when you decide it is time to become parents you assume that making that decision is all it takes and it will happen natu-


rally right away. For over 80% of fertile couples that is the case; most become pregnant within 6 months of trying. However, for approximately 15% of couples, they can find that they are still not pregnant despite trying for over 12 months. This is the medical def- inition of “infertility”; however some prefer to call it “delayed con- ception” as most of those couples do eventually become pregnant with 50% of them conceiving spontaneously in the next 12 months of trying. Although this is somewhat reassuring, couples who are experiencing delayed conception want to be pregnant now! After 12 months of trying, if a couple has not become pregnant then it is appropriate to do an evaluation to see if there are any treatable causes for this delay.


Infertility is a “couple's” problem; it should not be thought of


as only a woman’s issue. It is extremely important to have a semen analysis done as a first step in the evaluation of delayed concep- tion. As high as 40-50% of sub-fertile couples are found to have abnormal semen analysis results so the semen analysis should be done in a specialized laboratory to obtain crucial and accurate clinical information.


Not surprisingly, evaluations for women is much more compli- cated. It is easiest to break down the evaluation into specific areas. The first step is to make sure that the woman is ovulating regularly. Most women who have regular menstrual periods occurring every 28-30 days do ovulate and using urine ovulation predictor kits will help anticipate when that will happen. A good rule of thumb is to use a 5 day kit and start testing day 11 of your menstrual cycle (day 1 is the first day of menstrual bleeding). When you get a positive result then you will release an egg within 24-48 hours after that.


26 Essential Living Maine ~ March/April 2017


This is the best time frame to have intercourse! If there is no obvi- ous positive result, then that could indicate where the problem lies. Ovulation problems can have many causes and the first step in figuring out what might be going on is to have some basic blood work. Of course if you have not had a complete physical exam within the last 6 months then that should be done as well. Thyroid abnormalities and other glandular abnormalities such as Polycystic Ovarian Syndrome may be present or other medical problems and/ or medications can also be a potential cause.


The next step in the evaluation is to make sure that the pelvic organs are healthy and there are no abnormalities that could be in- terfering with pregnancy. A pelvic ultrasound and a specific radio- logical study called a Hysterosalpingogram (HSG) can be done to evaluate the uterus and fallopian tubes. An office pelvic exam can be done to make sure that the cervix is normal in appearance and healthy. Other procedures can also be done, including a minor outpatient procedure called a laparoscopy, to evaluate the pelvis.


There are some things you can do that have been proven to


help in achieving that desired pregnancy. Some of the most com- mon questions people have relate to what the ideal timing and frequency of intercourse is in order to achieve pregnancy. Forget what your best friend or your mom told you (unless either one is an OB/GYN). The most fertile time in a woman’s menstrual cycle is approximately 6 days long and includes the 5 days prior to ovula- tion and the actual day of ovulation. This is not affected by age. The highest probability of conception occurs in the two days prior to ovulation and the day of ovulation. With a normal menstrual interval (occurring every month) then ovulation occurs approxi- mately 13 days from the first day you started bleeding. Frequency of intercourse should be approximately every 1-2 days during this fertile time and to assure the best quality sperm will be present,


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