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President
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As seen on the Sally Show 4/17/2000

 

 

 
How Common is Infertility?

According to the National Center for Health Statistics (NCHS) approximately 4.5 million couples experience infertility each year. Less than 2 million of the infertility couples actually seek help from the medical community. While infertility is not an epidemic, it is a common health problem in men and women. 

Fortunately, 90% of all cases have a specific cause for the infertility that can be uncovered with proper diagnosis by physicians who specialize in reproductive medicine.

Almost every citizen can recall at least one family member, co-worker, or friend who has trouble conceiving. Individuals who were previously conceived may find infertility problems with subsequent attempts. Infertility is a very personal and private health problem. Embarrassment and anxiety (concerning what the cause may be, lack of knowledge about when and where to seek medical help, and worry about what will happen in treatment) prevents many infertile couples from seeking medical services.

When the word "infertility" is mentioned to the general public, the most frequently associated medical treatment is the word "IVF" or in vitro fertilization. Approximately 3% of all infertile couples who enter treatment, actually are provided IVF. 

Many other effective forms of treatment are available for men and women. For some women who do not ovulate regularly, brief treatment with an ovulation inducing mediation may be all the treatment that is needed.

Semen analysis may detect an infection or antibody problem that can be treated with a few physician office visits and the proper mediation. Other couples may require one of the various forms of artificial insemination in order to achieve conception.

Milk and Infertitity -
1994 Science News

Women who would like but have failed to conceive a child may want to review how big a role dairy products play in their diet, a new study suggest. A team of researchers in the United States and Finland now reports that where per capita milk consumption is highest, women tend to experience the sharpest age-related falloff in fertility.

With the exception of certain northern European populations and their descendants, most adults lose the ability to easily digest lactose, a sugar in milk. Because lactose intolerance discourages high consumption of milk and other dairy goods rich in galactose -- a sugar apparently toxic to human eggs -- this trait may be beneficial, observe gynecologist Daniel W. Cramer of Harvard Medical School and his coworkers.

Five years ago, Cramer linked galactose consumption with increased risk of ovarian cancer. To look for hints that this sugar might also affect fecundity, his team compared published data from 36 countries on on rates of fertility, per capita milk consumption, and hypolactasia -- the adult inability to digest lactose. In the Feb. 1st American Journal of Epidemiology, they now report a correlation between high rates of milk consumption and waning fertility, beginning in women just 20 to 24 years old.

The strength of that association -- and the rate of fertility decline -- grew with each successively older age group studied. In Thailand, for instance -- where 98 percent of adults are hypolactasic -- average fertility in Women 35 to 39 is only 26% lower than peak rates [at age 25 to 29]. By contrast, in Australia and the United Kingdoms where hypolactasia affects only about 5% of adults, average fertility by 35 to 39 is fully 89% below peak rates.

Many factors -- including marriage customs, divorce rates, contraception use, and individual wealth -affect fertility, the authors concede. However, notes Cramer, the new analysis does offer "demographic confirmation of what we have observed both experimentally, when you feed a mouse high galactose, and clinically, in women with galactosemia [an inability to metabolize galactose]." Women with this disorder who have high concentrations of the sugar in tissue are infertile, he observes.

Before Infertility Evaluation, Take Azithromycin -
Before you consult an infertility doctor to help you become pregnant, ask your doctor if you should be given antibiotics to treat a group of germs called mycoplasma.
A recent report from Germany (1) confirms many other studies (2,3,4) showing that the most common cause of infertility is a uterine infection. Of women being evaluated for infertility, 40% between the ages of 26 and 35 were infected with chlamydia or other mycoplasma, as were 36% of those with a previous history of uterine infection and 50% of those with tubal blockage. In another study more than 60% had evidence of a past infection. (5) These infections cause both male and female infertility. The uterus is shaped like a bull's head with two horns. The ovaries are located outside of the uterus at the tip of each horn. An egg travels from the uterus down into the horn and then into the body of the uterus itself. Small hairs called cilia sweep the egg down the tubes into the body of the uterus. A past infection with mycoplasma can damage the cilia (4) so the egg remains in the horn or an infection can block the tubes so the egg can't even reach the body of the uterus. Mycoplasma can cause male infertility by damaging sperm so they are unable to swim toward the egg and fertilize it. Men and women can be infected with mycoplasma. even though all available tests can't find it (5,6) and they may have no symptoms at all. They may have burning on urination, discomfort when the bladder is full or an urgency to void. Women may have only spotting between periods. (7) Treatment with the newer erythromycins, clarithromycin and azithromycin, can cure mycoplasma infections and help many women to become pregnant before they spend thousands of dollars on infertility evaluations.

INFERTILITY TESTS

As soon as you first suspect that you may be infertile, you should keep a daily diary of your "basal" body temperature (BBT). Take your temperature as soon as you wake, before you get out of bed. This diary should also contain a daily description of changes in vaginal and cervical tissue and mucus (position, color and texture) checked when you first urinate. This diary (if kept faithfully) will be as valuable to diagnosing your infertility than the most expensive test, but it costs nothing but a thermometer. We recommend a digital thermometer that remembers your last reading until the next day, since you are practically asleep when you first take your temperature. You might also note lovemaking in this diary. Your standard "annual" gynecological examination will detect the most elementary problems. But if that's all you're getting, someone is wasting your time.
Blood tests are valuable to see what is going on with hormone levels, and screening for infections (you should specifically ask that both aspects be checked). Infections can be detected with a single blood sample, but hormone levels must be tracked through a series of tests throughout your cycle.
Men:Get your sperm tested before hundreds are spent on her. Your test is a fraction of the cost of her cheapest test. Also: Don't waste your time, money and embarrassment...on some lab that is going to have some joker with a microscope go "1,2,3,4...300,000 , yup you've got lots of sperm." That doesn't tell you hardly anything. Take your sample to the office of a fertility specialist who will put the sample through the paces as if it were going to be used to fertilize an egg under a microscope. I think they call it in-vitro fertilization (IVF) preparation. They will get to know your sperm so well they can practically tell you it's personality: motility, density, shape, endurance, sense of direction, everything. If you have a problem with collection ask your lab if they can provide a condom designed specifically for sperm collection.
Women: After your man has submitted to the embarrassment of a sperm test, you need to have a sperm test of your own. A post-coital (after-sex) exam: A sperm sample will be collected from your body a certain amount of time after you have made love. You need to know whether your body chemistry is killing his sperm. This test may be the most embarrassing of all tests for you, but it's cheap, easy and necessary. Abdominal fluid should be screened for infection.
Genetic screening will rule out (relatively rare) genetic causes of infertility.
One of the best values in diagnosis, for us, was a $100 vaginal ultrasound. This procedure can detect most of the possible physical problems in your abdominal reproductive system. It took us three years to find a doctor who even suggested this exam, it should have been done before anyone gave us a prescription for fertility drugs.
Laproscopic examinations (non-surgical) of uterus and entrance to the tubes can tell a lot. (Maybe $200) no surgery required.
Get your plumbing checked with x-rays of dyes released into your uterus. The doctor will watch the flow of pressurized dye to see if all reproductive organs are open and positioned where they should be. This "Hysterosalpingogram" at low pressure will detect a blocked tube, and at higher pressure might open a blocked tube or cause trauma. Communicate to your doctor about her approach, your expectations and pain management. This test might cost $500 and could take you out of commission for a few days from the abdominal inflammation and pain, but it is extremely informative.
Abdominal laproscopic examination (surgical) is the most expensive "test" I list. You should be able to complete every other test for under $1000 dollars total. This surgery might cost $3000 but will tell a great deal about the condition of your ovaries and tubes. And it can be more than an examination. If the doctor finds a correctable problem during this examination, he should be prepared with lasers, knifes and needles, prepared for anything. This surgery is, for example, a major form of treatment for endometriosis and PCO.

Vitamin E And Male Infertility -
Research conducted in the U.K. is suggesting that vitamin E may cure a significant amount of male infertility cases. As published in the October issue of Fertility and Sterility, the research showed that consuming 600mg per day of vitamin E dramatically improved the function of human sperm. Because spermatozoal disfunction is the most common cause of infertility among men, the authors of the study believe that vitamin E could be an easy and inexpensive means to treat this condition.
The Sheffield study was prompted by information provided by a U.S. prospective study of 139 couples in which it was found that men generating high levels of reactive oxygen species had seven times less of a chance of conceiving, versus men with low levels of reactive oxygen species. The U.K. study is the first double-blind, randomized, placebo-controlled trial administering vitamin E in vivo to treat men with reactive oxygen species-related infertility. Approximately 20% of all male infertility cases are associated with reactive oxygen species.

Low plasma zinc concentration
In order to increase the possibility of clearly visible results, the study was conducted among women with a relatively low plasma zinc level. The 580 participants all had a zinc concentration below the level that in another study had been established as the median value.
From the gestational age of an average of 19 weeks onwards until delivery, 294 expectant mothers daily received a multi-preparation (folic acid, iron and other non- specified minerals) plus 25 mg zinc, and 286 women a multi-preparation plus a placebo.
The birth weight of the children born from the mothers in the zinc-supplementation group was a mean 126 gram higher and the head circumference 0.4 cm greater, both differences being statistically significant. The favorable influence of zinc was greatest in women with a BMI (body mass index) of less than 26 kg/m2. In this sub-group the children born from the mothers who had received extra zinc had a mean 248 gram higher birth weight and a 0.7 cm greater head circumference than the children of the women who had been treated with a placebo.
(The effect of zinc supplementation on pregnancy outcome; Goldenberg RL et al. (Department of Obstetrics and Gynecology, University of Alabama at Birmingham, USA); JAMA, 274(6):463-468, 1995 Aug. 9)

Low magnesium level in erythrocytes
The study concerned 12 women with a history of unexplained infertility or early miscarriage, and in whom a too low magnesium level in the erythrocytes was found.
Oral supplementation of this mineral did lead in 6 of the women to the normalization of the red blood-cell magnesium level, but it did not in the other 6 women, in spite of the daily dosage of 600 mg magnesium during 4 months.

Glutathione peroxidase
Further study revealed that in the six women, who failed to normalize their erythrocyte magnesium level, the concentration of the selenium containing enzyme glutathione peroxidase was significantly lower than in the other group. After these women had received, next to magnesium, also selenium (200 mcg selenomethionine per day), the magnesium level as well as the glutathione peroxidase level in the red blood cells was restored.
All twelve women became pregnant within eight months after the magnesium level in the erythrocytes had been restored, and were delivered of a healthy baby. (Red cell magnesium and glutathione peroxidase in infertile women -- effects of oral supplementation with magnesium and selenium; Howard JM et al. (Biolab Medical Unit, Londen, Engeland); Magnesium Research, 7(1):49-57, 1994 March)

Infertility and your emotions -
According to The Couple's Guide to Fertility, most infertile couples believe that if they understand the causes of their fertility problems, dedicate themselves to treating it and persevere in their pursuit of pregnancy, they will eventually have a baby. Unfortunately, this isn't always true. Frequently their are factors beyond you or your fertility doctor's control that determine the outcome of fertility treatments. When things don't work out, your frustrations and fears of not having a child can become intensified. You will have to cope with the emotional impact of infertility before, during and after your treatment. If you are fortunate enough to have a baby, dealing with the emotional crisis of infertility may be easier than if you have made heroic efforts, but failed to produce a child. If fertility treatments do not succeed, you have to be able to work through your feelings and either choose to end infertility treatment and accept life without a child or pursue other options, such as, adoption. At some point, you must be able to resolve the emotional issues involved so that your unfulfilled struggle to have a baby will not remain your life's main focus.
The emotional challenges of infertility change during the different phases of recognition, evaluation, treatment and resolution of your problem. Many factors may influence your emotional responses including the causes of your infertility, the types of treatment you have been receiving, how long you have been dealing with infertility and how well you and your spouse cope with the usual stresses of life. you may feel anxious before and during your initial interview with a fertility specialist and whenever the specialist makes a specific diagnosis of your fertility problem. This is especially true for the partner who may feel guilty or angry about being identified as the source of the problem. If both you and your mate contribute to the fertility problem as is often the case, then one won't be as quick to take blame for causing the infertility.
Don't be surprised if you feel emotionally unsettled at the beginning of your fertility evaluation. The work-up is foreign and intrusive and may be uncomfortable both physically and emotionally. During your treatment you will likely become more accustomed to the rigors of therapy, but if the treatment drags on, you may find that your stress level increases as you become increasingly aware of the possibility that your treatment may not be successful. One of the most important emotional issues of fertility treatment is loss of control. You may often feel as though you have lost control over your bodies and your lives. You may never have been confronted with a problem that not only challenges your concept of your own health and integrity, but also makes you dependent on your doctor and the medical care system. You may sleep, drink and think infertility all day long from the minute the wife wakes up to take her basal body temperature until the husband and wife go to bed knowing that tonight is the night to make love. The constant intrusion into tour lives of fertility drugs that require repeated ultrasound scans, blood tests and examinations also puts daily pressure on your relationship. In addition, infertility can strike at the very core of your identity.
Children were supposed to be a part of life's plan. Marriage and family are a universal dream, but the dream may seem more like a nightmare to the infertile couple who hasn't been able to conceive.
One way y on can gain control is to understand your particular fertility problem. You need detailed information about the infertility work-up, reasonable treatment options and your chances of success. Only then can you male well-informed decisions regarding the course of your treatment. Both partners should thinly about and discuss the extent to which they want to pursue fertility treatment. How far are you willing to go in achieving a pregnancy knowing that no treatment is guaranteed to be successful? Would you consider adoption? If so, how quickly? How do you feel about the prospect of living without your own biologic child or anv child at all? Once the evaluation begins, the fertility team should provide you with as much information as you need to make these decisions. If you fail to achieve a pregnancy or carry a pregnancy, the doctor and his Staff should also help you understand and accept what has happened. This means spending adequate time with you to talk about what you have gone through and its impact and making himself available to answer any questions that you may have. Each time a treatment fails you may experience a period of mourning which includes sadness accompanied by grief, anger and jealousy. After many failed treatment cycles, you may experience numbness and disbelief often replaced by a period of questioning as you look for more answers and more treatments.
Because of recent significant advances in infertility treatment, most infertile couples believe that fertility specialists can work wonders, but medical science doesn't have the solution to every fertility problem. Of all couples who experience infertility, about 50% will eventually have their own biological child.

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