Dad's Guide to Pregnancy For Dummies. Sharon Perkins

is an issue that affects more than 7 million people in the United States, but not getting pregnant within a month or two doesn’t necessarily mean you’re infertile. Couples under the age of 35 are diagnosed with infertility following 12 months of attempted reproduction without achieving a pregnancy.

      Knowing the facts about infertility

      Imagine 100 average couples under the age of 35 trying to get pregnant. The following outcomes are expected:

       75 couples are pregnant within a year.

       10 couples are pregnant after two years of trying without medical intervention.

       10 couples need treatment from an infertility specialist in order to conceive.

      Causes of infertility can be complex and often hard to diagnose. Some are related to the health and lifestyle issues we cover in the earlier “Evaluating Health to Get Ready for Parenthood” section. Despite treatments and diagnostic practices that primarily focus on women, the statistics paint a different picture:

       One-third of infertility is diagnosed as female-factor.

       One-third of infertility is diagnosed as male-factor.

       Between 10 and 15 percent of infertility cases are diagnosed as a combination of male- and female-factor.

       About 20 percent of infertility cases are unexplained following diagnostic testing.

      For women, the main causes of infertility are

       Ovulatory disorders: No ovulation or ovulation on an irregular schedule.

       Tubal disorders: Fallopian tubes are blocked or have an infection that interferes with ovulation or sperm travel.

       Uterine issues: Fibroids and polyps (growths that can cause blockages) or an abnormally shaped uterus.

      For men, the main causes of infertility are

       Low sperm count: Not enough guys to get the job done.

       Decreased sperm motility: The sperm has trouble moving forward into the fallopian tubes.

       Abnormally shaped sperm: Abnormal shapes usually indicate chromosomal abnormalities.

       No sperm present in the ejaculate: A blockage somewhere in the reproductive tract or hormonal disorders can cause an absence of sperm.

      Checking on potential problems when nothing’s happening

For many couples, the first step toward fixing infertility is admitting that you’re having a problem. It’s not an easy revelation to make because it means that at some basic level, your bodies are failing you. Fertility problems aren’t fair, they’re not fun, and they can be cause for a wide array of emotions, frustrations, and outright anger.

      The good news is that this is an age in which getting pregnant doesn’t have to be a simple matter of the birds and the bees. Throw in a doctor or two, and you may be well on your way to conceiving in no time flat.

      If you’re not getting pregnant after a few months, especially if your partner is older than 35, it’s time to check things out — for both of you. For her, this may involve the following tests:

       Blood tests: These check hormone levels, including follicle stimulating hormone, or FSH. FSH levels are normally below 9 mIU/ml on day two or three of the menstrual cycle; higher levels indicate decreased ovarian reserve and the possible need for medical intervention.

       Hysterosalpingogram (HSG): This test injects dye into the uterus through a catheter placed through the cervix. The dye outlines the shape of the uterus and fallopian tubes. HSG can identify blockages in or dilation of the fallopian tubes that interferes with embryo transport, and it also shows fibroids and polyps in the uterus, which may interfere with implantation.

       Hysteroscopy: This test uses a hysteroscope, a sort of mini-telescope, to evaluate the uterus for fibroids or polyps. Small fibroids and polyps can also be removed at the time of the test.

      For you, it’s a quick trip to the urologist for a full physical, blood work, and a semen analysis. This is the only way you can find out your sperm count and the quality and motility of your sperm.

      Semen collection at a medical center is just as uncomfortable as it sounds, but it must be done. Just keep your expectations to a minimum and forget all those movie scenes showing posh rooms, dirty magazines, and absolute privacy. If you have to produce in the doctor’s office or a hospital lab, you may very well find yourself in a bathroom, unable to escape the distractions of screaming children and the witty banter of the nursing staff outside the door.

Some offices allow specimens to be collected in the privacy of your home and then delivered to the lab within an hour. Ask your doctor about this alternative, as well as any special instructions for collection and transportation.

      Working through it when your partner needs treatment

      Some female fertility issues are easily dealt with by simply taking a pill that induces ovulation. But female infertility can also lead to daily injections of fertility medications, uncomfortable vaginal ultrasounds to assess egg development, painful surgeries to remove fibroids or repair damaged fallopian tubes, and frequent blood tests.

      Fixing female fertility issues can be a drawn-out affair that combines inconvenient and uncomfortable procedures with medications that manipulate hormones, a difficult combination if there ever was one. And if your partner suddenly views childbearing as a woman’s most important prerogative, her seeming inability to accomplish it and subsequent emotions can make fertility treatment a tough time for both of you.

      

Even though you may have your own stresses when dealing with fertility issues, remember that at least you aren’t dealing with a barrage of excess hormones, and keep your cool if conversations get complicated.

      Exploring solutions when your sperm don’t stack up

      A count of less than 20 million is considered a low sperm count. Although that may sound like a large number, due to the number of abnormal sperm in the normal sample and the distance required to reach the egg, it takes a lot of good sperm to achieve conception.

      

Sperm is produced on a cycle, so the semen you produce now actually was created three months ago. If your sperm count is low, start thinking back to what was going on three months prior. An illness, medications, or a hot-tub vacation may be the culprit.

      Learning the components

      What exactly makes a semen specimen normal? The following guidelines from the World Health Organization (WHO) are deemed the ideal for baby making:

       Volume: About 1.5 to 5 milliliters of semen should be present in a single ejaculate, equaling about a teaspoon.

       Concentration: Strength in numbers is key. You need at least 20 million sperm per milliliter of ejaculate to hit the normal range.

       Motility: For every man, an average ejaculate contains dead, slow, and immobile sperm. However, at least 40 percent of your sperm in a single sample should be moving.

       Morphology: Shape is also important to reproduction, and the lab technician examining your sample takes a close look at how