American Medical Association Family Medical Guide - American Medical Association [265]
• Weight problems Overweight women produce excessive amounts of estrogen and underweight women produce too little estrogen, both of which can disrupt ovulation. Obese women have an increased risk of miscarriage, which can result from a hormonal imbalance. Obese men can become infertile when layers of fat increase the temperature around the testicles, producing a low sperm count.
• Alcohol consumption Having even one alcoholic drink per week can lower a woman’s chances of conceiving by about 7 percent. Excessive drinking (consuming more than two drinks a day) lowers a man’s sperm count. The more you drink, the lower your chances of conceiving.
• Sexually transmitted diseases STDs such as chlamydia can cause scarring of the fallopian tubes, blocking them and preventing eggs from traveling to the uterus.
• Caffeine Consuming more than two caffeine-containing beverages per day may decrease fertility.
Age and success rates for assisted reproductive technologies
A woman’s age has the biggest influence on the success of an assisted reproductive technology using the woman’s own eggs. The success rates are defined by pregnancies and live births. The success rates are highest for women in their 20s and start to decline after about age 30, reflecting the normal gradual decline in a woman’s fertility with age. The chart above is based on 1999 figures from the US Centers for Disease Control and Prevention (CDC).
Diagnosing Infertility
During the time you are trying to conceive, keep track of the length of your menstrual cycles for a few months and use a home ovulation-predictor kit to predict when you ovulate. Recording this information in a log will help you determine the best time to have intercourse, and the information can help your doctor later if you seek help trying to conceive. In the past, many doctors told their patients to try to conceive for 12 months before seeking medical help, but because many women are waiting until they are older to have a baby, this may be too long.
If you have not conceived after 6 months of trying, you and your partner should see your doctor, especially if you are over age 30, have a history of pelvic inflammatory disease (PID; see page 871), or have irregular periods. Your doctor will take a complete medical history from both you and your partner, including asking questions about the frequency and timing of your sexual intercourse. He or she may order some initial infertility tests. Depending on the findings of these tests, your doctor may then refer you to a reproductive endocrinologist (a doctor who specializes in diagnosing and treating fertility problems).
Infertility Testing in Women
Infertility testing is usually much more extensive for women than for men. The initial tests will determine if you are ovulating and can evaluate the quality of your eggs. At your first appointment with the infertility specialist, he or she can test your baseline levels of follicle-stimulating hormone (FSH) and estrogen. FSH stimulates the growth of follicles (fluid-filled sacs that contain the developing eggs) in the ovaries. If you have an ovulation problem, measuring the level of luteinizing hormone (LH) also can be helpful. LH stimulates the follicles to release an egg and causes the lining of the uterus to thicken in preparation for a pregnancy. The doctor can compare these initial hormone levels with levels found at other times in your cycle.
MY STORY Secondary Infertility
My husband and I had our first child, Shelby, when I was 34. I had no trouble getting pregnant, and the pregnancy went very smoothly. When Shelby was 3, we decided it was time to have another child.
We tried to conceive for about a year. My husband, Ray, wanted to start infertility treatment after a few months,