Archive for November, 2009

Fertility After Forty

Women are generally fertile from the ages of twelve through the age of about 51.  The actual time in which we can get pregnant, however, is much less than that.  A woman’s fertility starts to spiral down after the age of 35 and becomes precipitously less at the age of 40.

It’s not impossible to become pregnant after forty but one may need more focus in order to conceive a child.  For example, a couple may need to use a fertility kit that determines the exact dates of conception in the cycle.  There are other things a couple might do that will be discussed later.

Trying to get pregnant after age forty isn’t a time for waiting expectantly for that pregnancy to occur.  It’s time to see a fertility specialist to determine the cause of why you’re not getting pregnant. Remember that thirty percent of infertility cases are attributed to the man, thirty percent are attributed to the woman and thirty percent are attributed to both the man and the woman.  The rest are of unknown origin.  It pays to know the cause of the fertility issues and correct what one can correct.

Sometimes it’s a matter of the woman not ovulating.  Medications like Clomid® (clomiphine citrate) are easily taken and can stimulate a woman to ovulate.  It’s taken on days five through nine of the cycle and increases the chance of fertility in a woman.  If the man has a low sperm count, an andrology clinic can take several sperm donations and concentrate them, injecting the sperm into the uterus on the day of ovulation.  These are simple ways to improve fertility in women and men of all ages.

In some cases, more is necessary to ensure a pregnancy.  These include in vitro fertilization in which a sperm and egg are united in a Petri dish and incubated until an egg becomes fertilized.  The egg is then transferred through the cervix in order to be implanted and create a pregnancy.

Other choices include zygote intrafallopian transfer, in which the fertilized egg is transferred into the fallopian tube and is allowed to travel down into the uterus for better chances of implantation. In gamete intrafallopian tube transfer, the sperm and the egg are transferred into the fallopian tube for fertilization.

Finally, in subzonal sperm injection or intracytoplasmic sperm injection, the sperm is injected into the egg or the outer layers of the egg to ensure fertilization and to then transfer the fertilized egg into the uterus.  Over the age of forty, there is a higher risk that she’s had an STD sometime in her lifetime in which the infection has caused a Fallopian tube blockage.

Chlamydia is well known to cause this. Endometriosis can also block the fallopian tubes.  This means that even if a woman over forty is ovulating nicely, the egg cannot get into the Fallopian tube to become fertilized.  Some form of in vitro fertilization is required in such cases in order to achieve a pregnancy.  This is the cause of infertility in some fifty percent of infertile women.

It is possible for many women over the age of forty to become pregnant.  It just takes a bit of sleuthing to determine if there are any issues affecting fertility and correcting those issues to create a pregnancy.

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Unexplained Infertility

There are times when all of the fertility tests have been done and the doctors have no answers.  You are diagnosed with the dreaded “unexplained infertility” or fertility of unknown origin.

This can hamper the conception process because the doctors do not know what to fix.  Unexplained fertility is, unfortunately, the cause of ten percent of couples who are infertile.

Doctors check for various causes of infertility and determine the cause of the infertility.  If the following are found, then the diagnosis of unexplained fertility is determined.

•    The Fallopian tubes are not closed and appear healthy
•    You are having normal ovulations
•    You have no adhesions in your pelvis
•    Your postcoital test is negative
•    You have no endometriosis
•    Your sexual partner has a normal sperm motility test

There are several causes of unexplained fertility.  One of them is that you have abnormal fallopian tubes which do not properly sweep the egg and sperm together for fertilization.  This does not often show up on hysterosalpingogram. An abnormality of one’s eggs can cause poor fertility.  If the eggs are of poor quality, they won’t be fertilized well.

There is a syndrome called Luteinizing Unruptured Follicle Syndrome or LUF in which the egg is trapped inside the sac it has matured in due to a decrease in the Luteinizing Hormone level which contributes to the release of the egg from the sac so that ovulation technically does not occur.   You can have an abnormal luteal phase, which is the period of time after ovulation but before you get your period.  Your hormone levels can fall before the egg is properly implanted, leading to an aborted pregnancy.

Another cause of unexplained fertility is your immune system.  Women can be “allergic” to sperm or treat sperm as a foreign invader or can see their own eggs as being foreign, killing them off before they can be fertilized.  All of this can have a serious effect on fertility. 

Infection in the body can affect fertility as well.  One such infection is called T-strain Mycoplasma and may not show up on routine tests for pelvic infections.   Poor sperm can result in unexplained fertility issues.  The sperm can appear normal but cannot break through to the outer shell of the egg.

One cannot discount the issues of stress and psychological distress on both male and female fertility.  The stress of not getting pregnant or the stress of a job can cause problems with fertility that are not identifiable on testing.

The treatment of unexplained infertility can be tricky.  The chances of becoming pregnant with treatment of unexplained fertility issues are about thirty percent.  Choices of fertility treatments include using fertility drugs to enhance ovulation and allow the development of more eggs.  If this treatment doesn’t work,  you can try intrauterine insemination which releases sperm into the uterine environment, increasing the chances of a pregnancy. 

Finally, IVF or in vitro fertilization can be used, which brings sperm and egg together in a Petri dish and implants the resultant embryo or embryos into the uterus.

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Herbs for Infertility

Herbs have been used since about 200 AD for the treatment of infertility in ancient China. While the scientific evidence on the efficacy of herbal medicine in the treatment of infertility is lacking in many cases, most of the herbs used for fertility are safe and can be tried by any woman who would like to use herbal medicine to aid in fertility.

Using herbs for infertility still mean you have to know the cause of the infertility. If the tubes are blocked, for example, no amount of medication or herbs will unblock them.  On the other hand, if the infertility is due to a hormonal imbalance, herbs have a place in helping the infertility—sometimes to the advantage over medical means of controlling infertility.

There are about 150 herbs available for use in promoting fertility, although most doctors use the top 8 to 20 herbs that can be given as pills, tablets, tinctures, teas or granules.  The most commonly used herbs for infertility include:

•    Chastetree Berry. This causes the release of luteinizing hormone from the pituitary gland that promotes ovulation and may normalize the periods in women who do not ovulate.
•    Red Clover Blossoms. This herb is rich in estrogen-like compounds that build up the uterine lining making it better for implantation and promotes egg maturation.
•    Dong quai. This herb tones the uterus by maximizing the metabolism within the uterus, regulating the menstrual hormones and improving menstrual cycles.
•    Licorice. This helps women who have elevated testosterone levels and reduced estrogen levels, common in polycystic ovarian syndrome.
•   Black cohosh. Acts like Chastetree berry and releases luteinizing hormone but it also binds to estrogen receptors in the body, mimicking estrogen which helps in egg maturation and in the uterine lining development.
•   Wild Yam. This increases the production of cortisol in the body and progesterone and may help prevent early miscarriage due to progesterone deficiency.
•   False Unicorn Root. May help prevent miscarriage due to weakness of the uterus and helps women who suffer from pelvic congestion.
•    Tribulus. Helps treat sexual dysfunction as well as infertility.  Balances the hormones in the body.
•    Saw Palmetto. This herb overall strengthens and tones the reproductive system.  It increases libido which can help with conception.

One has to remember that, just because an herb is considered to be natural, it is not always safe and may mix with regular pharmacological medications in dangerous ways.  Herbs, too, can have serious and notable side effects so that it helps to be in contact with your doctor when taking these herbs.

Better yet, see a naturopath or herbalist, who often have extensive knowledge in the use of herbs and their effects, in order to get the type of herb that is best for you.  You need to be completely forthcoming with both your doctor and an herbalist or naturalist as to which medications you are taking so that the two types of treatments do not interfere with one another.

Get your hormone levels checked before trying any of these herbs for infertility so as to know which herbs will work best for you.

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Signs and Symptoms of Pregnancy

Pregnancy can be a wonderful time of anticipation and wonder.  There are some symptoms to look forward to in order to know that you are pregnant. Some are pleasant and others are less than pleasant.

Early in the pregnancy, there can be some spotting as the placenta digs into the uterine wall.  It can begin around the time of the anticipated period and can last up to the twelfth week of pregnancy.  Too much bleeding can mean a threatened miscarriage but a bit of spotting or heavy discharge is normal.  The estrogen content in the body is high at this time so the discharge can be heavier than normal.

A woman can begin to feel a sensitivity to smells or nausea around certain foods.  She can find that foods she tolerated perfectly well when she wasn’t pregnant will be too overwhelming to eat. Specific foods that can cause this are peppers, onions and meats, but any food might be more than a pregnant woman can handle.  Fortunately, this passes generally after the twelfth week of pregnancy.

Women tend to gain weight as soon as they find they are pregnant and long before the uterus or the fetus actually weighs anything.  A woman’s blood volume increases in anticipation of the advancing pregnancy and there is water weight gain that causes her to gain up to a pound a week, even in the early stages of pregnancy.

In the beginning stages of pregnancy, a woman can become more irritable or emotional—almost as if she has premenstrual syndrome.  She might find herself more tearful and crying for the least little thing.  She might also find herself more angry and irritable than before she got pregnant.  All of this is due to hormonal changes occurring rapidly in the early stages of pregnancy that affect both the mind and the body.

Women find that they are thicker around the middle or in the pelvic region, even before the baby has grown enough to enlarge the uterus.  This is extra water weight that makes her look a bit pregnant even before she is very far along in the pregnancy. 

Swelling of the ankles can occur, especially as the pregnancy advances.  Women can get varicose veins or spider veins as the pregnancy advances due to the pressure of the enlarging uterus on the veins exiting the legs.  Some women can get swelling of the vulva due to varicose veins in the vulvar area.

As the pregnancy advances, a woman tends to be less irritable and will actually feel radiant and happy most of the time.  She may still be more emotional, on the other hand, due to the hormones of pregnancy.  She may also develop back pain due to the fact that she must tip her back backwards a bit to accommodate the advancing pregnancy.  This causes what’s known as a “lumbar lordosis” and results in lower back pain and pains in the legs.

Everyone has her own set of symptoms and signs of pregnancy, and not every pregnancy is the same.  What’s true is that, if you carefully pay attention, you can tell you are pregnant within a few weeks of becoming pregnant.

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