Our Bodies, Ourselves (103 page)
Read Our Bodies, Ourselves Online
Authors: Boston Women's Health Book Collective
Another common cause of infertility is blocked fallopian tubes or other structural problems. This can be due to endometriosis, pelvic inflammatory disease (PID), or scarring due to surgery or repeated injury. Some women are born with structural abnormalities affecting their reproductive organs that may also prevent the egg from traveling down the fallopian tube, inhibit the growing embryo from implanting in the uterus, or increase the risk of an ectopic pregnancy. Uterine fibroids, which are noncancerous growths in the uterus, are also associated with obstructions in the uterus and/or fallopian tubes as well as repeated miscarriages.
Other possible causes of infertility include immune system problems, issues with the cervical fluid, and luteal phase defects.
Sometimes a man is born with a condition that causes male infertility and other times problems emerge later in life due to illness or injury. More than 90 percent of male infertility is due to sperm abnormalities affecting sperm count, sperm motility (movement), or sperm morphology (shape). Some causes of male infertility include:
⢠Varicocele, which occurs when the enlarged veins on a man's testicle(s) cause temperature increases that can affect the number or shape of the sperm.
⢠Retrograde ejaculation, which occurs when the muscles of the bladder wall do not function properly and sperm are forced backward into the bladder instead of forward out the urethra. This can be caused by surgery, spinal cord injury, certain medications, or aging.
⢠Structural abnormalities that damage or block testes, the ducts that carry the mature sperm, or other reproductive structures.
⢠Underdeveloped, undescended, or injured testes.
Sometimes, even after extensive testing, physicians are unable to find any medical reason for the infertility. You seem to be ovulating normally, your fallopian tubes are open and healthy, your
partner has a high sperm count with good motility, and neither of you has any other underlying health issues. This type of diagnosis provides hope to someâmaybe, if there is no known problem, pregnancy will happen after allâwhile it leaves others extremely frustratedâif we don't even know what's causing the problem, how can we address it?
Infertility affects us not only physically but also emotionally. When faced with infertility, many of us react with shock, anger, and denial.
I am incredibly pissed, after being fantastically shocked, that the second blood test shows there is no longer a pregnancy. There is anger at my body, at God, at my own intuition. . . . I hang up on my sisters and mom when they call me to console. I am inconsolable. It feels [like] the grief and anger will consume me
.
It's normal to have a wide range of emotions about infertility. You may feel something you or your partner did in the past caused your present inability to conceive or to stay pregnant. One or both of you may feel guilty and responsible for your childless state. Could drug or alcohol use, masturbation, past abortions (even though properly performed), or unusual sex practices be “responsible”? Though these do
not
cause infertility, it's easy to place the blame on anything we can think of, because we want explanations for the unexpected and inexplicable. Try to have compassion for yourself. Infertility is not your fault.
SECONDARY INFERTILITY
Secondary infertility occurs when a woman who has previously been pregnant is unable to conceive again. Many of the same causes mentioned above may be a factor with secondary infertility; however, the most common issues are usually related to age, tubal damage, male factors, or a combination of factors.
MEN AND INFERTILITY
Because of the very nature of infertility, women experience the bulk of the responsibility for treatments, regardless of whether the infertility is caused by male or female factors. Women usually begin the process of seeking out a diagnosis or treatment, while our male partners follow along, sometimes in denial of their need to seek care or be involved. It is easy for men to feel that infertility is a threat to their virility or manhood, and there's very little social support or information geared toward men struggling with infertility.
Yet male infertility can occasionally indicate a underlying medical condition in need of treatment, such as heart disease or cancer. A thorough examination of your partner by a urologist trained in male infertility is an important step in the evaluation of any infertility problem and a good investment in his health.
Many of us find it difficult to spend time with our friends' or relatives' children. Child-centered holidays may become stressful, lonely, and depressing times as we wonder, “Why them
and not me?” It's common to feel envious and jealous of others' fertile state.
MAXIMIZING YOUR FERTILITY
Certain factors can affect fertility in both women and men. Some of these factors can be modified, while others are not under our individual control.
â¢
Alcohol, tobacco, and other drugs.
Drinking, smoking, or using drugs while trying to conceive can delay conception and increase miscarriage. The good news is that these risks begin to reverse immediately upon quitting.
â¢
Weight.
Women at a healthy weight are more likely to be fertile. Being excessively over- or underweight can disrupt ovulation and lead to hormonal imbalances for both women and men. If you are overweight, losing even 5 percent of your body weight is sometimes enough to improve fertility.
â¢
Sleep and relaxation.
Try to get plenty of sleep and do what you can to reduce stress. While there is no scientific evidence that stress
causes
infertility, reducing stress may help you feel better able to cope.
â¢
Your environment.
Exposure to radiation, metals such as lead, chemicals such as pesticides, and other toxins can lead to reduced fertility or infertility. When possible, avoid exposures to known or suspected toxins. (For detailed information, see
Chapter 25
, “Environmental and Occupational Health.”)
â¢
Your overall health.
Illnesses such as diabetes, kidney disease, autoimmune diseases, high blood pressure, and genetic disorders can contribute to infertility. Previous sexually transmitted infections and other infections can impair fertility for both men and women. Before you begin infertility treatment, review any medications you are on with your provider. Over-the-counter and prescription drugs, including antibiotics, painkillers, antidepressants, steroids, and hormonal treatments can all impact fertility.
â¢
Healthy sperm.
Activities and practices that cause the testicles to overheat can damage sperm. Because of this, menâparticularly those with a marginal sperm countâmay want to avoid hot tubs and hot baths, minimize long bike rides or horseback riding, and keep electronics (cell phones, computers, etc.) away from their laps.
Although taking good care of yourself is important, self-care usually cannot address the root cause of infertility. Infertility is often beyond our personal control.
[During that time] two more friends announced their pregnancies, and one friend who had become pregnant five months after we started trying gave birth. I was shocked at how much they affected me. I stayed in bed and cried all day after the second one. I felt like a terrible friend, full of envy
.
In addition to the stress of going for tests and treatments, you may be subject to other pressures at home and at work. Friends and family
may ask you, “Well, has it happened yet?” Perhaps worse is when they don't say anything but look at you and sigh a lot. People you hardly know may provide unwelcome comment.
© Can Stock Photo Inc. / lofoto
I have found it quite hard dealing not only with our infertility problem but also with the reactions of people around me. I'm sick of people telling me to “relax,” “stop thinking it out,” “adopt and you'll get pregnant,” and all the other wonderful clichés, although said to be comforting, ring of insensitivity
.
With the myriad of feelings surrounding infertility, good coping skills are essential. Here are some tips to help manage and lower the stress of infertility.
⢠Acknowledge your feelings.
⢠Don't blame yourself.
⢠Work as a team with your partner.
⢠Communicate openly with your clinic and health care providers.
⢠Seek support through friends, family, and professionals if needed.
⢠Educate yourself about your infertility diagnosis and treatment.
⢠Don't let infertility take over your life.
No one should face infertility alone. Other women and couples who have already been diagnosed or treated can supplement the information you receive from your physician with firsthand knowledge and provide you with additional resources that may help buoy your spirits during treatments.
Our clinic, and other friends going through fertility treatments, advised us to keep the process to ourselves. Seven years later, my wife and I looked at each other and realized that the pain we endured could have been greatly reduced if we had shared our experience with others rather than keeping it bottled up inside of us. Once people learned what we were going through, they threw their arms around, and they all said, âOh, I wish I had known. I would have gone out of my way to support you.'”
Joining a weekly or monthly infertility support group made up of others going through similar experiences may also be helpful to you and, if you have one, your partner. For a list of support groups in your area, visit resolve.org. You might also want to talk to women who decided not to pursue infertility treatments or chose to stop after a certain number of tries, or women or couples who made the decision to adopt or remain childless. Be on the lookout for knowledgeable and compassionate support that will help you make decisions that will serve
you
best in the long run.
You may also want to work with a professional counselor who can provide ongoing support.
There are many well-trained clinical social workers or psychologists with expertise in the unique psychological, emotional, and ethical issues related to infertility. They can also offer strategies for coping and provide guidance as you decide whether and how to continue treatment. Some fertility clinics provide counseling at the clinic; you can also find knowledgeable independent counselors.
Infertility websites offer all kinds of information about the causes, diagnoses, and various treatments for infertility. Online support groups and infertility blogs are tremendously popular and can help you stay connected with others going through similar experiences.
Because anyone can post just about anything on the Internet, it's important to be a critical consumer. Be wary of sites that are strictly commercial, such those sponsored by specific infertility clinics or drug companies, as they may downplay the risks of treatments, exaggerate success rates, or exploit in other ways your deep desire to bear a child. For more information, see
“Health Information Online.”
Finding a physician who specializes in infertility can be challenging. Though there are more than four hundred fertility clinics in the United States, your options will largely depend upon where you live; whether you have health care insurance and, if so, what it covers; and your financial resources.
For most women, seeing a family practitioner or gynecologist is the first step. These primary care physicians can perform the initial testing and perhaps even start you off with some basic treatments.
If these first measures are not successful, ask for a referral to an infertility specialist or a reproductive endocrinologist (RE). REs are ob-gyns who have several years of additional training in treating infertility and are board-certified in reproductive medicine and infertility. The Society for Reproductive Endocrinology and Infertility (SREI) (socrei.org), the Society for Assisted Reproductive Technology (SART) (sart.org), and the American Society for Reproductive Medicine (ASRM) (asrm.org) websites all list members who are infertility specialists.
It's crucial to have a good relationship with your fertility care team from the start. Your providers should describe any tests and procedures, and their risks and costs, clearly and patiently so that you understand what to expect. Choose a doctor with whom you feel comfortable as well as one who will take the time to listen to your hopes and fears, answer your questions, be sensitive to your specific feelings and needs, and respect your decisions. Most important, make sure whoever you decide to work with on your infertility journey has good quality control and strong ethics. For a list of questions to ask your fertility clinic or specialist, go to the American Fertility Association website (theafa.org) and search “Important Questions for Your Doctor.”