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Chapter One: lnfertile or Subfertile? An Oveview
It's ironic: When couples don't want to have a baby, they assume that they are fertile and put a lot of energy into preventing pregnancy. Then, when they decide it's time to start a family, they suddenly appreciate how difficult it actually is to conceive a child.
Getting pregnant requires exquisite timing, a balanced hormonal system, good general health and a measure of good fortune. A woman's endocrine system must release precise levels of hormones at specific times during her menstrual cycle. Her ovaries must produce and release at least one mature and healthy egg follicle, and that egg must be able to make its way through the Fallopian tubes toward a welcoming uterus. A man's reproductive system must produce semen containing an abundant supply of healthy sperm ready to swim eagerly toward the intended target. The woman's cervix must produce enough mucus to protect the sperm and hurry them into the uterus and Fallopian tubes. once the egg and sperm have been united, the thickened uterine lining must be responsive and ready to nourish the fertilized egg after it has implanted.
A single missed cue or minor glitch, and the system doesn't work. Considering the complexities, it's no wonder that a healthy and fertile couple stands only a 20 percent chance of conceiving a child in any given month. It also explains why more than 5 million Americans of childbearing age are considered technically infertile, meaning they have tried to conceive a child for one year or more withoutsuccess.
But there is hope. As many as half of all infertile couples do go on to get pregnant and have healthy babies. Thesecouples could more accurately be defined as subfertile. They may not suffer from a physical problem that prevents conception, but it may take them longer than one year to become pregnant. For these couples, the stork may arrive sooner if Mother Nature is offered a little extra help.Understanding Infertility
Most couples who want to have children are successful some sooner, some later. Typically, half of the couples who decide to stop using contraception will conceive within three to five months, and about 85 percent of the couples will conceive within a year. However, that leaves 15 percent or roughly one out of every six couples who will experience fertility problems.
Impaired fertility has many causes. For about 35 to 40 percent of couples, the problem lies within the woman; for another 35 to 40 percent, the problem lies within the man; and in the rest, both partners have a problem or the cause is unknown.
Among women, hormonal imbalance is the most common cause of infertility. Other possible causes include scarring or obstruction of the Fallopian tubes, an allergic reaction to sperm, endometriosis, hostile cervical mucus, chromosomal abnormalities, a prolapsed uterus, fibroids, or physical injury to reproductive organs, among other causes. And, of course, age plays a significant role: A woman's fertility peaks in her mid-twenties; her fertility declines gradually until age thirty, and then begins to fall off more rapidly. Many women remain fertile into their forties, but conception becomes more difficult with each passing year.
Among men, abnormal sperm either low sperm count or inferior sperm quality is to blame for most fertility problems. It may take only one sperm to fertilize an egg, but the average ejaculation contains between 40 million and 150 million sperm. Most of these sperm don't stand a fighting chance of getting within striking distance of the awaiting egg; some 80 to 90 percent of them are killed off by vaginal fluids. Due to this intense screening process, men who ejaculate fewer than 60 million sperm may have difficulty impregnating their partners. In medical terminology, oligospermia means low sperm count and azoospermia means the absence of living sperm in the semen.
Not surprisingly, the number of sperm in an ejaculate and the degree of fertility are strongly correlated. But even men with low sperm counts can impregnate their partners. In fact, studies at fertility clinics have found that 52 percent of men whose sperm counts were below 10 million per milliliter of ejaculate achieved pregnancy, as did 40 percent of those with sperm counts as low as 5 million per milliliter of ejaculate.
Numbers count, but when it comes to fertility, sperm quality is even more important than quantity. A man can have a high number of sperm, but if a majority of them are abnormally shaped or poor swimmers, he can have a harder time becoming a father than a man with fewer sperm of a higher quality. Sperm quality is based on several factors, including motility (how fast and straight the sperm swims) and morphology (sperm size and shape). At least 60 percent of the sperm should be normal in appearance and motility. The quality of the seminal fluid its volume and viscosity or stickiness also plays an important role. Problems with sperm can stem from a number of causes, including a varicocele (a vari cose vein in the scrotum), prostate infections, ductal obstructions, ejaculatory dysfunction, mumps, alcohol use, nicotine, illness, or excessive fatigue.
Many couples experience periods of infertility that come and go for no apparent reason. Approximately 25 percent of women have reported episodes of infertility at some point during their reproductive lives. In many cases, a couple may not know they are experiencing impaired fertility because they are not trying to get pregnant at that time. This ongoing fluctuation between periods of fertility and infertility may help to explain why each month approximately 3 percent of couples with unexplained infertility suddenly conceive on their own.
Subfertile couples may benefit from experimenting with the fertility-enhancing natural remedies and practices suggested in this book. Of course, fertility drugs and assisted reproductive technologies can offer hope to couples with serious reproductive problems, but most subfertile couples would do well to begin with simple, natural methods of enhancing their fertility. In many cases, these low-tech treatments will work and a couple can avoid turning to expensive, invasive, and stressful high-tech fertility treatments.