You may be planning ahead for a future pregnancy or you may be in the midst of intense hormonal treatments. You may have tried IVF without success. Or you may not be seeking medical treatment at all: perhaps you are simply growing increasingly frustrated over the number of months you've been trying to achieve a successful pregnancy. You may believe it's your fault, yet statistics indicate the cause of infertility is almost as likely to rest with your partner as with you.
Approximately 35 percent of fertility problems are caused by the man's issues, another 35 percent are caused by tubal and pelvic problems in the woman, 15 percent from ovulation dysfunction, 5 percent by immunological, anatomic or thyroid problems, and 10 percent are attributed to "unknown" causes.
It is important to keep in mind that while studies indicate that one in ten women between the ages of 15 and 44 years old will experience infertility, more than 95 percent of couples who seek treatment will not need to undergo advanced reproductive techniques such as in vitro fertilization in order to conceive. Of the 10 percent of infertile couples diagnosed with "unexplained fertility," almost half will conceive within three years. As a general rule, of couples trying to conceive:
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57 percent succeed within three months
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72 percent succeed within six months
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80 to 85 percent succeed within one year
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90 percent succeed within two years
How Conception Occurs
Before we explore what can go wrong, let's go through what happens when everything works. The fertilization process takes approximately twenty-four hours, and it begins with ejaculation. Immediately after being deposited in the vagina, semen coagulates -- perhaps as a defense mechanism against the vagina's acidic environment, which allows only about 10 percent of sperm to survive the first 10 minutes inside. After about 20 minutes, the sperm become fluid again and swim up to the cervix, where protein strands in the cervical mucus (present only just before or during ovulation) carry the sperm into the uterus. Since the released egg is viable for 12 to 24 hours and sperm live for 48 to 72 hours, the window of opportunity opens for only about two to three days. Some experts believe that the chance for conception increases if the woman and man experience orgasm simultaneously, because the rhythmic contractions of vagina and uterus during orgasm help propel the sperm closer to the cervix. On the other hand, if the woman experiences orgasm before the man ejaculates, that could lessen chances for conception.
Among the hundreds of sperm that reach the uterus and then the fallopian tubes, some become lost or embedded in the lining of the fallopian tubes. By this point, the heads of the sperm have lost their protective coating, so they can penetrate the egg. (During "sperm washing," a procedure used in artificial or assisted conception, this protective membrane is removed artificially.)
Unlike the female eggs that bow out gracefully in favor of another, sperm rushing out of the testes upon ejaculation compete furiously to beat each other to the finish line: the egg. They refuse to accept defeat after the winning sperm has penetrated the egg and continue their attempts to enter. Once a sperm reaches and penetrates the egg, the egg undergoes biochemical changes to ensure no other sperm can enter it, and the sperm and egg combine their genetic material.
The fertilized egg then takes a four-day journey to the uterus, where it secretes a hormone called human chorionic gonadotropin (HCG) (detectable by home pregnancy kits) and implants itself in the uterine lining. If the egg doesn’t make it to the uterus, it can grow in the fallopian tube, forming what is known as an ectopic, or tubal, pregnancy that must be removed surgically. This is more common in women with scarring from endometriosis, sexually transmitted diseases, or previous pelvic surgery.
Structural problems that can cause ectopic pregnancy or infertility also include fibroids and other malformations. All reproductive specialists -- conventional, alternative, and TCM (traditional Chinese medicine) -- agree on at least a single point: that "mechanical" or structural reproductive obstacles to fertility must be treated before any other problems are addressed and a successful pregnancy can occur.
© 2007 , Raymond Chang, M.D. with Elena Oumano, Ph.D.
from What Your Doctor May Not Tell You About Getting Pregnant: Boost Your Fertility with the Best of Traditional and Alternative Therapies, Warner Wellness, an imprint of Warner Books, Inc., 2007