Pregnancy Problems: Infertility, Reproductive Assistance Explained

Infertility is a disease of the reproductive system defined as the inability to achieve pregnancy after one year of unprotected intercourse. It’s a myth that if you try hard enough, pregnancy is guaranteed. Infertility is a medical condition. One in seven couples experience infertility.

Though it’s often assumed that infertility is largely a female problem, the reality is quite different. About one-third of infertility cases are due to problems in the male partner, another third of the cases are due to the female partner, and the remaining third of infertility cases are unexplained. Male problems include conditions in which no sperm or too little sperm is produced.

Conditions that affect women include ovulation disorders, blocked fallopian tubes (usually due to inflammation from infection or endometriosis), and anatomical deformities of the pelvic organ. While some people will insist that stress causes infertility, it is certainly true that infertility causes stress.

A diagnosis of infertility is made first by taking a thorough history and doing a physical examination, which are then followed by running a series of tests. For women, these include a laboratory test of hormone levels, ovulation charts, X-rays of the fallopian tubes and uterus, and a laparoscopy, in which a scope looks inside the body and provides a visual of the pelvic organs.

Men usually have a sperm analysis. Eighty percent of the treatments for infertility fall into two categories—either medicinal or surgical. Several medicines are available that can improve ovulation, while surgical techniques can remove a blockage from the tubes and ovaries.

More aggressive treatments include artificial insemination and in vitro fertilization. With artificial insemination, ovulation is regulated with medications, and a health-care provider then artificially deposits semen in the vagina. For some patients, including same-sex partners, this is a very effective technique. In vitro fertilization is recommended for couples who want to conceive but are affected by a total blockage of the fallopian tubes or a very low sperm count. This technique surgically removes eggs from the ovary of the female and mixes an egg with sperm outside the body in a laboratory. Once a new embryo is formed, it is placed back inside the uterus. This technique has proven to be quite successful for couples who would otherwise not have been able to conceive on their own.

Twins and More!

If one is good, is two better? How about three? Or four? Or more? Of course, it’s not exactly a matter of choice. Or is it?

The number of multiple births in the United States has increased dramatically over the past two decades. The number of twin births has increased by nearly 75 percent, making up 95 percent of the multiple births in this country, while the number of births involving three or more babies has gone up fivefold.

Two factors are responsible for this increase in multiple births. More women are waiting until they are over the age of 30 to have children, and these women are more likely to conceive multiples. The other, probably more significant factor, is due to the use of fertility-stimulating drugs and assisted-reproductive techniques (ART), such as in vitro fertilization. In fact, more than half of the infants born through ART were from multiple births.

The more babies a woman carries at once, the greater the risk of complications. The greatest risk with multiples is early labor resulting in premature births. More than half of twins, 90 percent of triples, and virtually all quadruplets or more are born preterm. These babies, like all preterm babies, face numerous health challenges both in the newborn period and later in life in the form of possible lasting disabilities.

Other complications of multiples include high blood pressure and diabetes. An ultrasound exam can detect almost all cases of multiples by the beginning of the second trimester. Because multiple pregnancies are automatically termed “high risk,” it is absolutely essential that mothers-to-be of multiples eat properly, get plenty of rest, and make frequent visits to their doctor.