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Infertility Awareness

May 08, 2022 11:00AM ● By Dr. Ngozi Onuoha

April 24 to 30, 2022 was National Infertility Awareness Week. This week raised awareness about removing stigma and barriers for people who want to raise a family. Infertility is not anyone’s fault. There are many factors that lead to difficulty with conception. Infertility affects 7.3 million Americans.

We can show support by being non-judgemental towards people trying to conceive, and by educating ourselves.

Persons trying to conceive should educate themselves about infertility, join support groups, understand the basics about the female and male reproductive systems, understand what ovulation is, how to optimize fertile periods, and how to reduce the stress of infertility.

Infertility is the lack of conception after one year of trying to conceive in a couple if the woman is younger than 35 years of age, or after 6 months if the woman is older than 35 years of age.

There are 2 main contributors to infertility

  1. Male factor

  2. Female factor

The male factor: The man is the first to be screened for infertility when a couple presents for evaluation. Semen is submitted for seminal fluid analysis to determine factors that affect sperm effectiveness in fertilizing the egg. Other tests include blood tests and testicular ultrasound. The specialist for this field is a urologist or reproductive endocrinologist.

The female factor: After the man has been assessed, and there is no concern for male factor causing infertility, the woman undergoes a series of tests. The specialist for female infertility is a gynecologist or reproductive endocrinologist. These tests will be listed below:

1. Assessment of ovulation: This is the first step for accessing female infertility. Tests to determine eggs release are as follows:
  • Urine test kit to measure Luteinizing hormone (LH) levels- This is a readily available over-the-counter urine kit to measure urine LH level. A rise in LH levels indicates that ovulation (release of egg) will occur within 12 to 36 hours. Typically women with a 28 day cycle will ovulate on days 13 to 15. Urine testing for LH surge should start 2 days before expected ovulation.
  • Blood test for progesterone - A raised progesterone is seen with ovulation. Typically done one week before the anticipated onset of the next menstrual period.

  • Basal body temperature - Progesterone production starts at ovulation and increases body temperature by 0.5 degrees Fahrenheit.

2. Assessment of Ovarian reserve: Ovarian reserve is the number and quality of eggs in a woman's ovaries. As women age, the ovarian reserve diminishes. Tests for ovarian reserve include the following tests:

  • Follicle-stimulating hormone (FSH) - This is a blood test. The feedback of estrogen produced by the eggs affects the FSH level. When estrogen is high, FSH is low. When estrogen is high, FSH is low. High levels of FSH indicate a reduced ovarian reserve.

  • Anti-Mullerian Hormone (AMH) - This is a blood test. This hormone is produced by the follicles in the ovaries. If the level of AMH is low, it means that the eggs are in short supply and there is reduced ovarian reserve.

  • Antral Follicle Count (AFC) - This test is obtained by transvaginal ultrasound. The total number of follicles is measured in the first few days of the menstrual cycle. Fewer than 10 antral follicles may indicate a reduced ovarian reserve.

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3. Assessment of Tubal patency: Blocked fallopian tubes can stop the sperm from fertilizing the egg.

  • Hysterosalpingogram - The test to check for any tubal blockage is called HSG (hysterosalpingogram). This is an x-ray procedure by a radiologist, gynecologist, or interventional radiologist. Contrast dye is injected through a small tube inserted through the cervical os, and x-rays are taken to see if this dye spills out from the fallopian tubes. This test is uncomfortable and can cause cramping.

  • Saline hysterosalpingogram - This is similar to the HSG mentioned above, however, for this saline is used and an ultrasound is performed to assess the uterine lining and tubal patency.

4. Assessment of Uterine cavity: Some abnormalities of the uterine lining can create distortion of the uterine lining and affect the implantation of a fertilized egg.

  • Hysteroscopy - This is a minimally invasive test where a small catheter is inserted via the cervical os to look at the lining of the uterus for any adhesion, fibroids, or polyps. Like the HSG above this can also cause mild to moderate discomfort. This procedure is by a gynecologist or reproductive endocrinologist.

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There are many options for infertile couples, including the use of fertility medications, intrauterine insemination (IUI) or artificial insemination (AI), or in vitro fertilization (IVF). Couples may also consider surrogacy or adoption as a way to bring a child into their lives.

Surrogacy means a woman carries a pregnancy for a person who is not able to have children. Surrogacy requires the use of a surrogacy agency, legal documents, and payment.

Adoption is to formally and legally accept a child as one’s own. Adoption is facilitated through an adoption agency and requires legal documents.

And there are those who opt to live without raising children, who live a life full of wonderful experiences by sharing the joys of parenting through family and friends. There are many opportunities to serve children in need through mentoring, volunteering, and fostering programs.

This article originally appeared on Health4Naija.


Disclaimer: This content of this post is for health education and for the purpose of improving health literacy and does not constitute any type of medical advice.

 Dr. Onuoha is a board-certified Internist and Geriatrician. She is the founder of Health4Naija for Health awareness. Follow her on Instagram @health4naija and Facebook.

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