Infertility

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For many couples, infertility is a crisis, often accompanied by feelings of guilt or inadequacy. But a diagnosis of infertility is not a verdict of sterility. While about 15 percent of all couples are infertile (that is, they are Unable, to conceive after a year of trying), only 1 or 2 per-cent are sterile (meaning that conception is physically ruled out). Of couples who seek help, about half can eventually bear a child, either on their own or with medical assistance.

In cases of infertility, about 40 percent are caused by a problem in the man, and another 40 percent by a problem in the woman. Both the man and the woman are contributors in the remaining 20 percent of cases.

Causes

In men, the most common reasons for infertility are sperm disorders, such as a low count (the number of sperm in (lie ejaculate), low motility (impaired swimming ability of sperm), malformation of the sperm, or blocked sperm ducts.

Sperm output can also be temporarily reduced by high temperature in the sperm-manufacturing teslicles -a result of spending long periods in a hot tub, for example, or wearing tight underwear. A temperature problem may also have an organic origin: If a vein around a testicle gets twisted-a fairly common condition called a varicocele-cooling of the testicle by blood is diminished.

In women, iniertility can often be traced to a lack of ovulation or an impeded journey of the egg from the ovary to the uterus via the fallopian tubes.

A failure to ovulate may be caused by hormonal imbalances or by cysts in the ovary. Interruption of an egg's progress through the fallopian tube from ovary to uterus may result from endometriosis, tumors, adhesions, infection, or prior surgery.

In the uterus, implantation of the egg may be prevented by fibroid growths, endometriosis, tumors, cervical problems, or irregular uterine shape. Fertilization may not take place if the cervical mucus damages sperm or impedes their progress.

Age is a Factor :

In women, fertility declines after 35, and conception after 45 is rare. Being overweight, or underweight, can also play a role. In both men and women, fertility can be diminished by psychological factors, such as anxiety and depression, and by environmental agents, such as radiation, pesticides, and other chemicals.

Diagnostic and Test Procedures

In tracing the cause of infertility, a physician generally begins by interviewing the partners about their health histories, use of medications, and sexual histories and practices.

The man under-goes a physical examination first, since male in-fertility is usually related to sperm health or function, which can be readily tested.

For the woman, testing generally begins with a full physical exam and cervical smear. A physician will then determine whether the ovaries are producing and releasing eggs normally. Blood tests can measure hormone levels.

The ovaries and uterus may be examined by ultrasound, and a specific test can check for tubal blockage or abnormality in the uterus. A post-coital test, done two to five hours after inter-course, can determine whether the man's sperm and woman's cervical mucus are compatible.

Treatment

Many couples once pronounced barren can now produce their own child. Some may be helped by common-sense steps that raise the chances of conception.

Couples are often advised to have inter-course just before ovulation, which occurs 13 to 15 days before menstruation and may be indicated by a slight rise in body temperature or by chemical changes detectable with an over-the-counter urine-testing kit. A new device is able to detect ovulation from a single drop of saliva.

A more aggressive strategy is to induce ovulation with hormones or fertility drugs. Such drugs have a good record of success, but they also increase the chance of multiple births.

In men, disorders of the prostate gland, seminal vesicles, testicles, or urethra can often be treated. A varicoceie can be tied off, allowing testicle temperature to return to normal.

The small percentage of couples whose infertility cannot be corrected can try artificial fertilization. In the procedure known as IVF (in vitro fertilization), the egg is fertilized outside the woman's body, then placed in the womb or fallopian tube. In another procedure, called GIFT (gamete intrafallopian transfer), egg and sperm are brought together in a fallopian tube. Both methods are difficult and seldom succeed on the first attempt; they are also costly.

Alternative Choices

A variety of alternative treatments may enhance fertility. Among professionals you may want to consult are acupuncturists and homeopaths.

Mind/Body Medicine

Relaxation techniques can reduce psychological stress, which sometimes contributes to infertility. Behavior therapy may help, as can massage, yoga, or meditation.

Nutrition and Diet

Zinc is important for fertility in both sexes; a supplement of 15 mg a day may help (take 2 mg of copper if taking zinc). Vitamin C has been shown to aid men whose sperm clump together, and it may improve sperm count. The amino acids arginine and carnitine may be of benefit to men whose sperm count or sperm motility is low.

At Home Remedies

For Women:

Don't douche; it makes the vagina less hospitable to sperm.
After intercourse, remain supine for a few minutes; this holds your organs in the best position for sperm to enter the cervix.

For Men: