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Coping with fertility issues

March 15, 2012
By STACEY KUKKONEN - DMG writer ( , The Daily Mining Gazette

Editor's note: This is the second in a series of three articles regarding pregnancy.

LAURIUM - While it may seem like some women only need to think about getting pregnant and then do, for others, the process may be more difficult.

But before jumping to unnecessary conclusions, it's important to understand the underlying reasons why some women may find it harder to conceive. Doctors at Aspirus Keweenaw see it all the time - couples come in to learn why they have been trying to conceive for a set amount of time to no avail, without knowing many of the causes.

"For older doctors like me, we were taught that 12 months of unprotected intercourse not resulting in a pregnancy would be the reason to start an infertility evaluation," said James Feeley, M.D., OB/GYN. "It takes healthy couples a few months of trying to actually conceive."

Assuming there are no infertility issues at play, the odds are 85 to 90 percent that a couple will conceive within the course of a year without contraception, Feeley said. Those who have been trying longer with no pregnancy are welcome to explore their options with their health care provider and learn about some of the causes.

"The question is how early to intervene," Feeley said. "When considering infertility, it's important to consider (the) male factor, tubal patency and ovulation. There are plenty of other issues that can play a role."

Steven Woodworth, M.D., endocrinologist at Aspirus Keweenaw, said when he sees fertility patients, he turns to the male factor first.

"Abnormal sperm is present 60 percent of the time and is the No. 1 thing that needs to be looked at first," Woodworth said.

A man's cycle is 74 days, he said, meaning a man's sperm is only as good as his last 74 days. A number of factors can affect that supply, including exposure to carbon monoxide, spending a few minutes in a hot tub or supporting a hot laptop on the lap for matter of time. Checking the male is as simple as producing a sample in the comfort of his own home to be analyzed at the hospital.

"We will test him once to exclude him as a factor and screen him," Woodworth said. "Then we move on to the next issue."

In females, fertility issues could be a matter of timing. The window to fertilize an egg is only 12 to 24 hours long, even though sperm can live in the cervical mucus for days before ovulation, Woodworth said. Ovulation kits can be purchased over the counter and are used daily, displaying a surge when the egg is about ready to ovulate. The test kits are ideal for couples who work opposite schedules, have a hard time identifying the ovulation window or for women who have irregular menstrual cycles.

"If the man and woman have opposite work schedules and don't get together at the right time, that's a problem," Feeley said.

Another possibility to consider is depression and emotions in women who are trying to conceive. Those who are depressed may be less sexually active, Feeley said. And emotions certainly play into a female's monthly cycle, said Sharon Stoll, M.D., OB/family medicine at Aspirus Keweenaw.

"You hear of women not getting periods when they're under stress and it's just nature working," she said. "Your body thinks it's a time of war or famine, or something terrible is happening. Why would it want to reproduce then?"

Stoll has a special interest in women with polycystic ovarian syndrome, and often, women with the condition have issues with fertility, as well.

"Aspirus offers a comprehensive workup with women," she said. "We can look for underlying causes why a woman may not ovulate."

Although PCOS isn't easily diagnosed, common signs that point to someone having PCOS includes having cysts on the ovaries, being overweight, having excess unwanted hair on the upper lip, chin, chest and belly, irregular cycles and a high risk of pre-diabetes and insulin resistance.

"Women who are thin can also suffer from this condition," Stoll said.

While most, but not all, women ovulate every month (and even normal women don't ovulate every month), women with PCOS sometimes ovulate only a few times per year, Stoll said. Symptoms can be alleviated by getting within the ideal body weight and following a low-carb diet and gentle exercise routine, she said.

"I think it may get over-diagnosed because women who are overweight can struggle from infertility simply from being overweight and not have PCOS-like traits," she said.

It wouldn't hurt for trying-to-conceive women to cut back on caffeine and make sure they get a lot of iron in their diets, as well.

"A cup of coffee a day reduces your chances of conceiving by 10 percent," Woodworth said.

Another factor in fertility issues is age. Bonnie Hafeman, M.D., family medicine specialist with Aspirus Keweenaw, said many professionals are waiting longer to have children these days, banking on the idea of taking fertility medication later.

"When it gets too late, the desire to have more children may diminish," she said.

Stoll said couples who opt to wait may be in for a surprise later, as the risks for babies born with Down Syndrome and fertility issues are greater.

"It doesn't always work out that way," she said. "If you're in a satisfied relationship and you want children someday, it's a good idea to start thinking about family."

Feeley, Stoll, Woodworth and Hafeman all agree and stress the importance of being in a healthy relationship before having children.

"You should conceive when you're in a stable, supportive relationship that would be good for parenting," Woodworth said.

Feeley stressed the importance of the woman getting her body prepared for a pregnancy by weaning off or switching medication and seeing a doctor early on in the process.

"While it is true that there are significant concerns regarding the possible effects of these medications on the developing fetus, there are some individuals who simply cannot or will not be able to go through a pregnancy without some medication for conditions such as depression or schizophrenia," he said. "I do advocate a preconception evaluation with the patient and her care providers regarding possible weaning off medications if possible or perhaps switching to drugs thought to be the safest ones for use during pregnancy."



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