f you are having trouble conceiving and you are considering treatment, there are numerous resources to help you with your decision making process. Of course, the wide range of fertility treatments available today can be overwhelming. Infertility affects millions of couples each year and the drugs and treatments for it represent a $3 billion business.
The following is a general overview to help you navigate the different steps you can take, as well as the available options.
How are things supposed to work?
When I was in high school, our sex-ed instructor was so determined to scare away teen pregnancy that she made it sound like spontaneous combustion. You would have thought a boy could get a girl pregnant just by staring at her long enough. Of course it didn’t work that way back then and it certainly doesn’t work like that when a couple decides they actually want to get pregnant. In fact, the process is so complicated it’s a miracle anyone gets pregnant at all.
When things happen the way they’re supposed to, it goes something like this:
1. Each month the pituitary gland in a woman’s brain sends a signal to her ovaries to get an egg ready for ovulation. One single egg. A woman will have over a million eggs (or follicles) in her ovaries when she’s born, most of which will be eliminated through a process called atresia, leaving her with approximately 400,000 by the time she reaches puberty. If only one egg is promoted to ovum once a month between the ages of thirteen and sixty, only 564 eggs are needed. So generally speaking, there are plenty of eggs to go around.
2. The pituitary hormones FSH (follicle stimulating hormone) and LH (luteinizing hormone) stimulate the ovaries to release an egg. Another word for all this is ovulation and it is “primetime” in the getting pregnant schedule (usually around day 14 of the menstrual cycle).
3. The egg travels through the fallopian tube and can be fertilized for up to 24 hours after release. Sperm can live for 5 days, but the egg is only alive for 1 day - so timing is everything. Conception is most likely when whoopee takes place 1-2 days before ovulation.
4. To go to the big dance, a sperm must connect with the egg in the fallopian tube during this time. Sperm are mighty. They can live for up to 5 days, but they have to be inside the fallopian tube at the same time as the egg for conception to occur. And as mighty as they are, sperm must be the right shape and moving in the right direction (they can’t steer) for all of this to work out. It just takes one, but there needs to be plenty to choose from since most of them will try valiantly, but fail to get the job done. For this reason, they work as a “team” in order to break down the egg’s defenses and send one lucky candidate across the finish line. The vaginal and uterine environment needs to be healthy in order to give these guys a fighting chance, too.
5. If fertilized, the egg moves into the uterus where it cozies up to the uterine lining and begins a nine month process known as Wow!-we’re-actually-having-a-baby.
INFERTILITY Infertility is when a problem occurs during any of the above mentioned steps. Millions of couples are affected by it each year - so if you are having trouble conceiving, you are not alone and there are ways to treat it.
How long do you do things on your own before considering there may be a problem?
Generally speaking, couples are advised to seek medical help if they've been unable to conceive after having “regular, unprotected intercourse” for at least one year. “Unprotected” shouldn’t need an explanation, but what does “regular” mean? Twice a week? Twice a day? The important thing here is that whoopee occurs with enough regularity so that sperm are available during that 2-day window before ovulation. For most couples, 2 or more times a week gets the job done (though many husbands seem to feel that a higher frequency is more desirable).
Women’s Health Nurse Practitioner, Barbara Dehn, has been working with couples for over 20 years and says the age of the couple is one of the most salient factors. If you are between 35 and 40, she recommends trying for 6 months before seeing a specialist. Couples over 40 should seek help if they don’t get pregnant after 3 months of trying.
In addition, if a woman is over 30 and has a history of pelvic inflammatory disease, painful periods, miscarriage, or irregular menstrual cycles, or if a man is known to have a low sperm count, it's advisable to seek help before trying for a year.
How do you find a fertility specialist?
Many OB-GYNS and urologists are specially trained to treat patients who are having trouble with conception; but if yours isn’t, ask for a recommendation. Doctors who specialize in infertility are board certified in reproductive endocrinology and you should have many to choose from if you live in a big city. If you live in a more rural area, you may have to travel for treatment. When evaluating clinics, keep the patient pool in mind as you look at statistics. A clinic with a high success rate in an area with less complicated cases may not have as much expertise as one with lower stats involving tougher cases.
What are the different types of fertility treatments? This all depends on which part of the getting-pregnant process is being affected. Your doctor will first try to determine why you haven’t been able to conceive. If the trouble is with ovulation, your doctor may recommend you try one of several medications. If you have blocked or damaged fallopian tubes, surgery may be the way to correct the problem. Sometimes the exact complication remains unexplained and your doctor may offer you a number of steps you can take to get around whatever the problem may be.
MEDICATIONS Hormone stimulating meds include: Bravelle, Clomid, Follistim, Lupron, Ovidrel, Pergonal, Pregnyl, Repreonex, and Serophene. Some of these drugs are taken orally, some are injected, but they all aim to increase hormone levels that support ovulation. Side effects vary and every woman’s experience is different, so it is important to explore all the options. Clomid and Serophene pills, for example, have more side effects than hormonal shots, such as Pregnyl, but the pills are less expensive and carry a lower risk of ovarian hyperstimulation syndrome. Use of Clomid and Serophene is also less likely to result in a multiple child pregnancy. Keeping all of this in mind, it is best to discuss specifics with your fertility specialist.
SURGERIES Blocked or damaged tubes can prevent the egg from being fertilized by the sperm. Fortunately, this problem can often be repaired with tubal surgery - 20%-60% of women have successful pregnancies after these types of procedures.
Sometimes tissue similar to the lining of the uterus grows around the ovaries, fallopian tubes, or other pelvic regions and interferes with conception. This condition, known as endometriosis, can often be corrected with laparoscopic surgery.
Hysteroscopic surgery is an incision-free procedure used to remove uterine polyps, fibroids, scar tissue, and uterine septum.
Depending on the situation, your doctor may recommend other surgical procedures, as well.
f you are having trouble conceiving and you are considering treatment, there are numerous resources to help you with your decision making process. Of course, the wide range of fertility treatments available today can be overwhelming. Infertility affects millions of couples each year and the drugs and treatments for it represent a $3 billion business. 
