Infertility:

How do I know if I have an infertility problem?

If you're trying to have a baby and it is not happening as quickly as you expected, you probably have many questions. RESOLVE answers some of the more frequently asked questions about infertility.

What is infertility?

Infertility is a disease or condition of the reproductive system often diagnosed after a couple has had one year of unprotected, well-timed intercourse, or if the woman has been unable to carry a pregnancy that results in a live birth.

Is infertility a "women's problem?"

Infertility is a medical problem. Approximately 35% of infertility is due to a female factor and 35% is due to a male factor. In the balance of cases, infertility results from problems in both partners or the cause of the infertility cannot be explained.

How long should we try before we see a doctor?

Most physicians advise you not to be concerned unless you have been trying to conceive for at least one year. However, if you are over 30 years old, have a history of pelvic inflammatory disease, painful periods, miscarriage, irregular cycles, or if your partner has a known low sperm count, you may want to seek help sooner.

Many couples have a hard time admitting that there may be an infertility problem. After each menstrual period, they hope that "maybe it will work this cycle". When these hopes are dashed month after month, a woman often consults her regular ob/gyn or clinic.

How do we find good infertility treatment?

Many ob/gyn's and urologists are specially trained to treat the patient having difficulty getting pregnant.

Doctors who specialize in infertility are board-certified in reproductive endocrinology. Many physicians have also learned by doing and can be considered to have special expertise in infertility.
If your situation warrants an infertility specialist, you can get a referral from your present doctor or local hospital/clinic, from the RESOLVE National Office, or friends or family members. Talk with the doctor or office staff first to learn about fees and insurance coverage, types of tests used, his/her availability to patients, and willingness to talk with you at length and answer questions about your particular situation. Most specialists prefer to see a couple together at the first appointment. Always ask questions to be sure you are getting the best treatment available.

At what time of the month is a woman most fertile?

The day you start your period is "Day 1". Around "Day 14" you may ovulate. This means that your ovary produces an egg. That egg is viable for about 24 hours; this is your most fertile time. However, not all women ovulate on "Day 14". Some ovulate a little earlier and some later. Some don't ovulate at all. Remember, you can get your period even though you are not ovulating. Your ability to ovulate can vary from month to month. Sperm is viable for about 48 hours. It is crucial for sperm to be present during the woman's most fertile time.

How can a woman tell when she ovulates?

The simple, inexpensive way of finding out the approximate time when you ovulate is to take your basal temperature every morning and record it on a chart. You can buy a Basal Body Thermometer at your drug store. Save all your charts so you can review them with your doctor. Three or four months of charting should be adequate.

Are there any other ways to detect ovulation?

Yes. You can buy an ovulation predictor urine test at your drug store. Also, your body may signal when you are about to ovulate; many women feel twinges in their lower abdomen (your ovaries are on the right and left sides of your lower abdomen). Other women notice clear, stretchy vaginal discharge just at their fertile time. Your doctor can also request an ultrasound or appropriate blood tests to determine ovulation.

How often should we have intercouse?

It is a good idea to have intercouse every other day around the time you ovulate. (Day 10, 12, 14, and 16.) Remember, every woman is different, and may not ovulate exactly on "Day 14". And, just because you ovulated on "Day 14" this month, doesn't mean you will next month. It is preferable to have intercourse every other day rather than every day so that sufficient sperm will be available.To increase your chances of the egg becoming fertilized, do not douche or use lubricants immediately before having intercourse.

What tests should our doctor perform?

Blood tests to check all hormone levels in the woman; thyroid, prolactin, and androgen levels.

Complete semen analysis on the male partner
Post-coital test (this should never take the place of a complete semen analysis).

Hysterosalpingogram, an x-ray to evaluate if the woman's fallopian tubes are open.

Endometrial biopsy, to check the quality of the uterine lining.

Laparoscopy, out-patient surgery to check for endometriosis or pelvic scarring in the woman.

If you have not had these tests done, ask your doctor about them. It is useless to proceed with treatment unless you have ruled out all the possibilities.

How is a semen analysis done?

The lab will provide instructions to abstain from sex for a certain period of time before the test, and it will give you a small jar to use for the specimen. After masturbating and ejaculating into the jar, you must take the whole specimen immediately to the lab. You may be asked to produce a specimen at the lab, where they will provide a private room.

What about smoking and drinking alcohol and caffeine?

There is evidence linking reproductive impairment with exposure to alcohol, tobacco, and caffeine. Alcohol and tobacco use have been demonstrated to affect the reproductive capacities of both men and women, and tobacco is an especially potent reproductive toxin. It is wise to be in the best physical shape possible while you attempt to conceive and, of course, to ensure a healthy pregnancy and baby.

Are hot tubs really bad for a man?

Yes. High temperatures can kill sperm. That is why the scrotum is located outside the body -- to act as a kind of "refrigerator" to keep the sperm cool. So, it is a good idea to avoid hot tubs, saunas, and steam rooms. Wear loose pants and underwear.

What else can we do?

Learn as much as you can about infertility. Get and read good, reliable information (not just from popular magazines) from your doctor, library, or trusted friends or family. RESOLVE has over 60 fact sheets on different topics related to infertility, and support groups in many areas.

In conclusion

Don't be afraid to ask your doctor or nurse questions, or to call the RESOLVE HelpLine. The more you know, the more you will be able to ask for information and get the help you need. Educating yourselves can save years of frustration and disappointment.