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Maybe you’ve just gotten married and have vague plans to start your family in a couple of years. Maybe you have one child and think you’ll have a second with the same ease. Or maybe you’re just beginning to wonder why—after three months of trying (or six or eight)—you’re not yet pregnant. Whatever your situation, know this: If you want a baby, you can’t assume it will just happen. As you’re reading this, some six million women and their husbands are facing infertility. They’re wondering what they need to do next to become pregnant, frustrated that they didn’t realize sooner just how big an impact age or medical problems were going to have on their lives.
No matter how much the word “infertility” is in the air, it is still a shock to realize that you are one of the ones who can’t just get pregnant when you want. First you may joke, “Guess I didn’t have to be quite so careful about birth control.” But gradually, you have to give up your fantasies—”we’ll have our child in June, so I can take the summer off”—and confront the fact that, for you to have a baby, it is going to take significant effort. As you undergo medical tests and treatments, a new techno-vocabulary dominates your life and a new self-image- patient -emerges. You have joined the 10 percent of U.S. couples who will experience infertility at some point in their reproductive lives.
The good news (if there’s anything good to be said about infertility) is that there is more real help available than ever before. But there is also a lot of incompetent treatment out there, not to mention hype. “Infertility care is a highly competitive, for- profit business,” points out Brian Kearney, Ph.D., a molecular geneticist and author of High-Tech Conception: A Comprehensive Handbook for Consumers. “You need to sort through what you hear and learn to ask the right questions.” Then, you can get the care that has the best chance of working for you.
Given the exquisitely intricate orchestration of hormones and engineering it requires, it seems astonishing anyone ever has a baby. Your egg, triggered by release of just the right hormones, needs to mature in the ovary, be released into the fallopian tube, then be fertilized by a sperm, travel down the tube, and implant in the uterus, there to grow to a seven-pound baby. That stunning complexity shows how easy it is for a glitch in any part of the system to throw the process off. Some of these malfunctions may have been with you since birth; others are the legacy of infection, lifestyle, age, or, frustratingly, factors no one can explain. While there are dozens of causes of infertility (and, often, multiple reasons a couple can’t conceive), basically, these break down into a handful of categories:
The lining may not be thick enough for the egg to implant. Or you may have endometriosis, where, for unknown reasons, the lining of the uterus grows outside the uterus (in the fallopian tubes or abdominal cavity), possibly impairing the movement of the egg through the fallopian tube or causing hormonal or other disruptions.
These include a low sperm count, sperm of poor quality (perhaps abnormally shaped), low motility (sperm are too slow-moving), blocked or missing transport tubes (which prevents sperm from reaching the ejaculate), or absence of sperm altogether. There may also be a problem with the quality of a man’s semen, or there may be an infection.
It took the most advanced techniques of reproductive medicine—and a small coincidence—for Lori and Ken Kreher to become the parents of Blake Edward, born last January. In 1995, Ken, who has been a paraplegic since a 1989 construction accident, was working with a personal trainer, in hopes of making the U.S. Paralympics team. Learning that the Krehers desperately wanted a second child (daughter Kelli was 7 months old at the time of her father’s accident and, says Lori, “the only thing that kept Ken going then”) and that the method they were trying wasn’t getting them anywhere, the trainer suggested they contact another client of his,Sherman J. Silber, M.D., a prominent fertility specialist and director of the Infertility Center of St. Louis. In a remarkable technique, doctors were able to extract sperm directly from Ken’s testicle and fertilize Lori’s eggs through ICSI. The first attempt failed, but three months later, when doctors tried ZIFT (inserting five fertilized eggs into Lori’s fallopian tube), she became pregnant. “We just went wild,” says Lori. “It was such a good thing to finally happen.”
These problems can also kick in after you’ve had a child. Or a mild abnormality might become more severe, making it difficult~r impossible-to conceive again. Such “secondary infertility” can elicit the same feelings of disappointment and frustration, tinged perhaps by guilt that you’re not satisfied with having one child.
Standard texts define infertility as the inability to become pregnant after one year of regularly timed, unprotected intercourse. But you don’t have to wait for it to be “official.” In fact, many fertility experts believe that at six months, you might start exploring whether something’s wrong.
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