The first thing God asks of humans is: “Be fruitful and multiply.” That same God, as recounted in the Bible, doesn’t make it easy for some of the matriarchs to conceive.
As a doctor who specializes in infertility treatment, I offer the following reflections and suggestions. First, a couple should seek help after one year of attempting to conceive. If the woman is over age 35, wait only six months, and seek help immediately if there is reason to believe infertility will be an issue. The problem can be overwhelming and it is important to approach infertility in a logical and methodical manner. To simplify, I refer to “SEMS,” as acronym that stands for sperm and egg, can they meet and can they stick?
Sperm: Semen is evaluated for its concentration of sperm, motility (movement), and morphology (form). Any prior illness, surgery, or extreme exercise can damage sperm.
Eggs: Irregular or absent ovulation is the most common cause of infertility. If an egg does not leave the ovary and enter the Fallopian tube, conception cannot occur. Obesity, prediabetes, and thyroid disease are some causes for irregularities in ovulation.
Does the woman have a good egg supply? Age is the most important factor, but certain illnesses can affect the ovaries. By age 30, 10 percent of women will meet the criteria of “diminished ovarian reserve.” Proof that a woman’s egg supply is waning influences how aggressive she needs to be.
Sperm and egg — can they meet? Several conditions — prior infections, fibroids, tumors, endometriosis, and polyps, among others — may cause the Fallopian tubes to be blocked, thus interfering with the meeting of sperm and egg.
Sperm and egg — can they stick? Seventy percent of all pregnancies fail. In some instances, a woman may never even know she was pregnant. It is important to evaluate miscarriage risks in every couple being evaluated.
Infertility health care has made enormous advances, and many of the issues noted above can be treated. It is important to evaluate the situation, discuss all options, and make informed decisions. A doctor should provide a number of choices so that the individual or couple can make decisions autonomously while adhering to the principle of beneficence — choosing from among the treatment options that can actually help.email print