What are some common causes of miscarriage?

Although pregnancy loss is common, there are a number of different factors that may lead to or contribute to pregnancy loss. Some of the more common reasons for miscarriage are described below.

Chromosomal abnormalities

Genetic factors cause a wide array of chromosomal abnormalities, which in turn can cause miscarriage. It’s hard to prevent these situations, but informing your healthcare provider of your full family history and performing specific blood work to test for these conditions can sometimes help women determine if genetic factors will be a risk factor.

Uterine abnormalities

Uterine abnormalities can prevent pregnancy from occurring, or increase the risk of miscarriage if conception does occur. A woman’s uterus can be shaped in such a way that makes conception difficult, divided by a misplaced muscle, or not fully formed. These problems are often congenital, or present from birth, but have gone unnoticed until a woman is trying to conceive. Fibroids, scarring, and a retroverted or tipped uterus are also conditions that can cause miscarriage.

Cervical insufficiency

This occurs when the cervix begins to dilate and thin too early in pregnancy. This can lead to miscarriage, especially after the first trimester. It can be hard to diagnose an insufficient cervix before symptoms start to occur, but once diagnosed, providers may be able to treat the problem early and will carefully monitor the woman throughout the rest of her pregnancy. However, if treatment is unsuccessful and the cervix continues to dilate, early induction and delivery might be unavoidable.

Untreated illnesses and bacterial infections

Minor infections such as yeast infections or the common cold should not impact the health of your fetus. Rather, women need to be aware of some of the more serious illnesses that could impact their pregnancy and ensure they are treated before pregnancy, or as soon as possible after learning they are pregnant. Some of these include syphilis, bacterial vaginosis, malaria, toxoplasmosis, influenza, a prolonged fever, epilepsy, or thyroid disease. Healthcare providers test women for some of these diseases during the initial obstetric appointment – this includes chlamydia, gonorrhea, HIV, and Hepatitis B, but if you know you are at an increased risk for any disease, you should inform your provider.

Polycystic Ovary Syndrome (PCOS)

Women with PCOS are nearly three times more likely to experience miscarriage than women who don’t have the condition. Treatment is especially important in these cases, because certain medications such as metformin might reduce this risk of miscarriage.

Lifestyle factors

Certain lifestyle factors, such as the use of alcohol, drugs, or tobacco, high levels of stress, obesity, and excessive amounts of caffeine can contribute to the likelihood of pregnancy loss.

Immunologic disorders

Immunologic disorders are disorders in which the body’s immune cells attack healthy cells within your body. A large number of these disorders exist and vary greatly in cause, and certain types can impact the health of your pregnancy. One example is antiphospholipid syndrome (APS), an autoimmune disorder that affects blood clotting and raises the risk of miscarriage. Lupus and type 1 diabetes are other examples of illnesses that can cause miscarriage. Blood tests can help diagnose an autoimmune disorder, and from there, treatment and intervention vary by the individual, and her healthcare provider.

Sources

• “Common Causes of Miscarriage.” RESOLVE. RESOLVE: The National Infertility Association, 2016. Web.
• “Uterine and ovarian abnormalities.” MarchofDimes. March of Dimes Foundation, Aug 2015. Web.
• Lucia Halmen. “Does Incompetent Cervix Cause Miscarriage During The First Trimester?” PregnancyTips. Conceive Media Network, Jul 22 2015. Web.
• “Repeated Miscarriages FAQ.” ACOG. American College of Obstetricians and Gynecologists, May 2016. Web.
• “Does PCOS affect pregnancy?” NIH. US Department of Health and Human Services, May 23 2013. Web.
• Sevi Giakoumelou, Nick Wheelhouse, Kate Cuschieri, Gary Entrican, Sarah E.M. Howie, and Andrew W. Horne. “The role of infection in miscarriage.” OxfordJournals. Human Reproduction Update from the European Society of Human Reproduction and Embryology, Sep 19 2015. Web.

Although the terms “infertile” and “sterile” often get thrown about like they’re the same thing, there’s actually a big difference between the two. So what is that difference exactly?

Infertility and sterility differences to consider

A person is considered clinically infertile if they have been unable to conceive with unprotected, well-timed sex for 12 months or more (6 months for those 35 and older). Infertility is extremely common, and once the reason for the infertility is diagnosed and treated, most formerly infertile couples do in fact conceive successfully. Men and women alike can be the source of infertility with a variety of different causes. Some common ones include:

Sterility is totally different. A person who is clinically sterile is unable to conceive, whether through medical or surgical intervention, or through assisted reproductive technologies. Sterility is most commonly a result of a medical condition or surgical procedure, like a vasectomy, hysterectomy, or ectopic pregnancy that results in the removal of a fallopian tube. Chromosomal disorders like Klinefelter’s syndrome could also result in sterility.

The bottom line

Here are the TTC acronyms you should know about

AF:

Aunt Flow. Your period.

Thanks for the invite, but my Aunt Flow’s in town. I’m gonna go home and treat her to some wine and reruns.

BBT:

Basal Body Temperature. BBT may spike right before ovulation, so many women track it to help them pinpoint their ovulation.

The very first thing I did this morning was grab my thermometer and take my BBT.

BCP:

Birth Control Pills.

In almost no time after I stopped taking BCP, I was pregnant.

BD:

Baby Dance. Sexual intercourse, usually done on the most fertile days of your cycle. (Can also mean baby dust, which is a phrase you use to wish someone good luck.)

My ovulation test is positive, which makes me want to dance – the BD, that is!

BFN/BFP:

Big Fat Negative/Big Fat Positive (on your pregnancy test).

Every time I buy a pregnancy test, I think about how it could be the one to show the BFP.

BOB:

Baby on the Brain!

I’m having a hard time shopping with BOB. All I can think about is tiny socks and pacifiers, which makes it impossible to keep track of my grocery list.

CD:

Cycle Day. A specific day in your menstrual cycle (or fertility treatment cycle). To track it, start by counting from the first day of your last menstrual cycle.

It varies each cycle, but normally I ovulate on CD 13, or 13 days after the first day of my period.

CM or CF:

Cervical Mucus or Cervical Fluid. Changes in cervical fluid indicate that a woman is at different stages of her cycle.

At the most fertile point of each cycle, my CM is clear and super stretchy.

CP:

Chemical pregnancy. A very early miscarriage.

My doctor recommended that I put off trying again until one cycle after my last CP.

DD:

Darling daughter. A daughter you already have.

DH, DD, and I go on vacation next week.

DH:

Dear husband.

I’m 42 and DH is 43.

DPO:

Days Past Ovulation, or Cycle Date Post Ovulation.

By 7DPO of the TWW, I’m already wondering if every little cramp is a sign of pregnancy.

DS:

Darling son.

It’s a challenge to care for DD and DS while also TTC.

ENDO:

Endometriosis. A chronic disease in which tissue that is supposed to grow in the uterus grows outside of it. Millions of women experience this condition and it can affect fertility.

After getting diagnosed with ENDO, I was able to find a huge and supportive online community of other women who had the same condition.

EWCM:

Egg White Cervical Mucus. When your cervical mucus looks like egg whites, it may mean that you’re at your most fertile point.

Nothing is as exciting as seeing EWCM when TTC!

FMU:

First Morning Urine. Most pregnancy tests require that women take them the very first time they pee in the morning. In the morning, urine typically has the highest concentration of Human Chorionic Gonadotropin, or hCG, an early pregnancy hormone.

I tested with FMU and got a faint BFP.

FP:

Follicular Phase. The phase of the menstrual cycle when follicles mature in the ovary. This phase begins on day 1 of your period, and ends with ovulation.

I’m so excited to try and get pregnant, I just want my FP to be over!

hCG:

Human Chorionic Gonadotropin. A hormone produced during early pregnancy that helps the baby grow.

I had a positive test, which means there was enough hCG in my urine to detect a pregnancy.

HPT:

Home Pregnancy Test. A pregnancy test that you can take at home. This morning my HPT showed a BFP – but I’m going to my doctor’s to take a blood test to confirm.

IUI:

Intrauterine Insemination. A specific kind of fertility treatment where sperm is placed directly into a woman’s uterus during ovulation.

After 2 years of TTC, we’ve decided to try IUI.

IVF:

In Vitro Fertilization. A procedure in which an egg is fertilized in a lab and then implanted.

We went through several rounds of IVF before getting a BFP.

LMP:

Last Menstrual Period. The first day of your last period.

I started my LMP on June 6th.

LPD:

Luteal Phase Defect. If the corpus luteum didn’t form properly, a luteal phase defect may occur, causing a short luteal phase. This can make it hard for a woman to get pregnant.

I’ve been really accurate with my charting, because I suspect I might have LPD and I want to have a lot of information to show my provider.

LSC:

Low Sperm Count. Commonly the cause of male infertility.

A semen analysis showed that my partner has an LSC.

M/C:

Miscarriage.

I got my first BFP a year ago, which ended in a really upsetting MC.

MF:

Male Factor Infertility.

To help with the MF issues, we found an infertility counselor who was covered by our insurance.

NTNP:

Not trying for pregnancy, not preventing pregnancy.

I just stopped taking BCP, so I guess that we’re NTNP.

O or OV:

Ovulation.

I O’ed on CD15 and BD on days 13 and 15.

OPK or OPT:

Ovulation Predictor Kit or Ovulation Predictor Test. These tests tell you when your body has a surge of luteinizing hormone (LH), which indicates the onset of ovulation.

I just got a positive OPK, which means BD as soon as possible!

PCO, PCOS, or PCOD:

Polycystic Ovaries, Polycystic Ovary Syndrome, or Polycystic Ovary Syndrome Disease. A condition in which a woman’s levels of estrogen and progesterone are unbalanced. Women with PCOS develop cysts on their ovaries, and the condition can cause infertility.

My doctor thinks I have PCOS, so I’m waiting to hear back about my blood work.

POAS:

Pee On Stick. Taking a pregnancy test (peeing on a stick), usually at home.

I’m 7DPO and it’s so hard to wait to POAS!

RE:

Reproductive Endocrinologist. A type of fertility specialist.

I’m meeting with an RE tomorrow to go over my fertility test results.

SA:

Semen Analysis. This is a test that providers can use to determine the quality and quantity of a man’s sperm.

The results of his SA show he has low sperm count, low motility, and poor morphology.

SO:

 Significant other.

My SO and I have decided that next month we’ll start TTC.

TWW or 2WW: Two Week Wait. The time period between when you ovulate and can take a pregnancy test.

 just started my TWW and I need to find some ways to distract myself!

TTC:

Trying to Conceive.

I haven’t decided who I want to tell that we’re TTC.

U/S:

Ultrasound.

Our first U/S is scheduled for the end of the month.

There are some health conditions that are strongly associated with living in a bigger body. This is not a cause and effect relationship, but a correlative one. Nonetheless, knowing about challenges you might face can help you identify specific symptoms to bring up to your provider so you can work together to optimize your health and fertility.

Hormonal imbalance

The menstrual cycle is dependent upon several hormones “communicating” with one another in the body. When one is off, it can have a ripple effect, disrupting the whole menstrual cycle. This means if you’re experiencing irregular menstrual cycles, it’s possible you aren’t producing the right levels of hormone to cause you to ovulate monthly, this can make TTC very difficult to impossible.  

Hormonal imbalance can also cause insulin resistance, something more common for those in larger bodies. Insulin resistance is when the body’s cells don’t respond effectively to insulin hormone. This causes elevated blood sugars and increased fat stores. This shift affects the hormones involved in the menstrual cycle and can cause skipped periods and cycle irregularity among other health issues. If you’re concerned you may be experiencing something like this, you should definitely speak with your provider about it. They can do testing to diagnose insulin resistance and you can work together to treat it!

PCOS

Along similar lines, Polycystic Ovary Syndrome (PCOS) is the most common endocrine disturbance in women of reproductive-age in the world. It is also the most common cause of infertility and causes changes in the hormones involved in the menstrual cycle and metabolism. PCOS commonly causes cycle irregularities, anovulation (not releasing an egg during your cycle), or even amenorrhea (lack of a period/cycles for several months) along with other physical symptoms like having many benign (non-cancerous) cysts on the ovaries, extra hair growth on the face and hair loss on the top of the head. It’s important to note that not everyone with PCOS will have all of these symptoms.

You should know that in addition to infertility, the hormonal shifts caused by PCOS can lead to other significant health issues like diabetes and heart disease. So if you suspect you may have PCOS, it is very important from an overall health standpoint to talk to your provider. If you are diagnosed with PCOS, it may also be necessary to work closely with your provider when TTC. While PCOS causes infertility, in many cases, conception is possible with the right treatment.

Weight stigmas and what you can do

Beyond these common health concerns, you may get advice that is solely based upon the size of your body and not your health status. For example, the most common “health” advice given to those in larger bodies is to “lose weight.” But it is important to note, the science of weight and body size consistently shows that dieting for weight loss is ineffective and damaging to our health. This type of messaging in healthcare and from social sources as well can really take a toll on your mental and physical health. One of the ways that is commonly manifested is in disordered eating. This is an all too common issue amongst people of all sizes and can be very dangerous. 

When people are told the first step to getting pregnant is to lose weight, they limit calories, cut out entire food groups, and stop honoring their internal hunger and fullness signals. This can lead to nutrient deficiencies, binge eating, and fear or obsessive thinking around food. And, it doesn’t end in weight loss in the long run! In fact, many people who diet end up at a weight higher than they were when they started.

This all might leave you wondering what you can be doing to improve your chances of conceiving in a bigger body. We’re here to help with some evidence-based information, free of fatphobic bias.

First, throw away your scale. This might sound unconventional, but the number on the scale is irrelevant to your health and can be very triggering. In fact, research has shown that simply changing one’s body weight alone is not a direct indicator of health improvement. Health promoting behaviors are what improve our health outcomes (independent of weight). Setting goals based on how you feel, how your body functions, and what you personally need to be living in a healthier body is more reliably associated with overall improvement in one’s health. 

So what is a health-promoting behavior? 

• Managing stress
• Getting adequate sleep
• Engaging in physical activity
• Nourishing your body with food and water

Now that you know what a health promoting behavior is, how can you put them into practice in your life? It can be very effective to set a SMART goal. S  for Specific, M for Measurable, A for Attainable, R for Relevant, and T for Time-sensitive. To make a SMART goal for yourself, you’ll have to do some critical thinking to make it possible to follow through on. Here’s an example of that process:

Initial thought: “I want to exercise more often.”

Things to consider: “What type of exercise do I enjoy, what time am I going to use to do this, what equipment do I need, how will I make it sustainable, when will I reassess and change the goal as needed?”

SMART goal: I will walk around my neighborhood for 30 minutes three evenings a week after dinner for the next two weeks.

You can apply SMART goals to all sorts of challenges. When it comes to nutrition, try to eat a variety of nutritious foods and avoid any diets or “lifestyle changes” that are meant to change your body size or suggest cutting out entire food groups. You could set the goal for yourself to check in with your body 15 minutes before one meal a week and see what you’re really craving and hungry for and commit to following your body’s lead for that meal. (Note: If you have to cut out a specific type of food for medical reasons like allergies or celiac disease, of course, that’s important and appropriate advice to follow)

This quote from Jen McLellan sums up the way nutrition fits into the picture: “Food choices that aim at regulating blood sugar and insulin (low glycemic foods and missing minerals/vitamins) are the best option to help turn the hormone train back around. It isn’t about weight, it is about how a woman’s body is using the tools and food being put in.”

If you’re struggling with disordered eating, please know this is not your fault and recovery is possible with support. Here are some resources that can help:

• National Eating Disorders Association (NEDA)
• Families Empowered and Supporting Treatment of Eating Disorders (F.E.A.S.T.)

Beyond health promotion: Finding the right care team

Another major obstacle to TTC in a larger body is finding the right healthcare team for you and your family. Unfortunately, size discrimination is very common in the fertility world. And you may have to spend more time and emotional energy than you’d like on finding a provider who respects you and practices weight-inclusive care. You may also choose to involve a more diverse team of experts in your healthcare than your primary fertility/obstetric provider. For example, working with a weight-inclusive dietician can help you immensely in learning which foods nourish your body and help you meet your goals. 

It is your right to play an active role in your own healthcare. That means being a part of the treatment decision making, which medications you take, and which interventions you choose for yourself. In some cases, you may need to ask what other options are available. In situations where you feel you are being discriminated against because of your size, it can be helpful to have some idea of what you want to say in response. Here is an example of a card you can carry with you with some suggested wording you can use. 

Remember, even though these obstacles can be difficult to confront, you don’t have to do it alone. You can always talk to a doctor. Support groups, care teams, and loved ones are also excellent resources. The effort is worth it for you as an individual and for your growing family.

Reviewed by the Ovia Health Clinical Team

Read more

• Fertility hormones: multi-tasking, heavy lifting, pretty incredible chemicals
• Polycystic Ovary Syndrome (PCOS)

Sources 

• Jen McLellan. “Infertility for Plus Size Women: When Weight Loss isn’t the Only Answer.” Plus size birth. https://plussizebirth.com/infertility-for-plus-size-women/. 
• “Fat Positive Fertility Resources.” Nicola Salmon, https://nicolasalmon.co.uk/resources/.

Getting pregnant after an infertility diagnosis

Unfortunately, getting pregnant after being diagnosed with infertility is oftentimes far easier said than done. Many peoples’ dreams of pregnancy are delayed by conditions of infertility, but eventually, the vast majority of people (even those previously diagnosed as infertile) are able to successfully conceive – it just might take a little time and a little help.

What does “infertility” really mean?

Contrary to popular belief, just because somebody is diagnosed as “infertile,” it doesn’t mean they are entirely unable to get pregnant. Resolve, the National Infertility Association, defines infertility as “a disease or condition of the reproductive system often diagnosed after a couple has had one year of unprotected, well-timed intercourse or if the woman has suffered from multiple miscarriages and the woman is under 35 years of age. If the woman is over 35 years old, it is diagnosed after six months of unprotected, well-timed intercourse.” Conditions of infertility can affect all people and tend to do so with an equal likelihood.

Most people diagnosed as infertile do have some underlying condition that is preventing them from getting pregnant, but more often than not, the condition can be successfully treated or circumvented by a fertility specialist.

What is the difference between “infertility” and “subfertility”?

There is a lot of overlap between the terms “infertility” and “subfertility,” but despite the similarities, there are some serious differences as well. Most people diagnosed as “infertile” require medical assistance to conceive, whether IVF, artificial insemination, Clomid, or something else.

A person who is subfertile is still able to conceive without medical intervention, but it may take a bit longer than for most. Polycystic ovarian syndrome (PCOS) is an example of a condition that many consider to be one of subfertility, as a woman with PCOS may still ovulate and be able to conceive on her own. It’s important to understand the difference between infertility/subfertility, and sterility, as even couples who have been diagnosed as infertile or subfertile can conceive, while those who are sterile cannot.

What are the most common causes of infertility?

Infertility can, and does, affect men and women and at about an equal rate – in fact, studies show that about ⅓ of cases of infertility are attributed to male-factors, ⅓ to female-factors, and ⅓ have unknown causes. Some of the most common causes of infertility in females include:

• PCOS

PCOS is a condition caused by a hormonal imbalance that can result in cysts on the ovaries, and a disrupted menstrual cycle. Women with PCOS tend to have irregular ovulations and periods, if they occur at all, which can make getting pregnant a challenge. Clomid and Metformin are some of the more popular medications that fertility specialists can prescribe to help you fight PCOS.

• Endometriosis

Endometriosis is a disorder in which endometrial cells (cells from the inner wall of the uterus) grow in places outside of the uterus, which can result in serious pain, and problems getting pregnant in the future. Endometriosis can affect hormone balances, and also impair a woman’s ability to ovulate, or inhibit a fertilized egg from implanting in the uterine wall.

• Fibroids

Uterine fibroids are a less common cause of infertility than PCOS or endometriosis, but can prove disruptive all the same. Fibroids can seriously interfere with the ability of a fertilized egg to implant, and can also cause miscarriage if one does successfully conceive. Women of African descent are more likely to develop fibroids, as are women who are overweight.

Some common male causes of infertility include:

• Poor sperm quality

Whether due to age, lifestyle factors, or bad luck, some men’s sperm have trouble making their way to, or fertilizing, an egg waiting in the fallopian tube. Some men may have a low sperm count, while others could have poor sperm motility. Couples can still get pregnant if a man has poor sperm quality, but the likelihood is reduced. A fertility specialist may be able to recommend a course of action for the best chance of conception.

• Varicocele

Varicoceles are enlarged veins in the scrotum that raise the temperature of the testes, hindering sperm production. Because varicoceles can reduce sperm count or harm the quality of sperm produced, they make conception difficult. If the varicocele is severe enough, a fertility specialist might recommend surgery to cut the veins contributing to the varicocele. Surgery is relatively minor, and men recover fully within about a week.

• Blockages

Some men may have blockages in the vas deferens or epididymis, which can prevent healthy sperm from reaching and fertilizing the egg. A fertility specialist might recommend a surgical procedure to remove the obstruction. Men with blockages also generally have otherwise healthy sperm, meaning in vitro fertilization with one’s own sperm is entirely possible.

How can a fertility specialist help?

Fertility specialists are doctors who are trained in the diagnosis and treatment of conditions of infertility. Whether through medical or surgical options, fertility specialists can help manage just about any condition of infertility.

Read more

• Endometriosis
• Could I have PCOS?

Sources

• “Trouble Conceiving and Infertility.” Fertility Authority. Fertility Authority, n.d. Web.
• American College of Obstetricians and Gynecologists. “Evaluating Infertility: FAQ136.” ACOG. American College of Obstetricians and Gynecologists, 6/12/2015. Web.
• “Endometriosis and Infertility: A Committee Opinion.” ASRM. American Society for Reproductive Medicine, 9/12/2015. Web.
• “Polycystic Ovarian Syndrome (PCOS).” American Diabetes Association. American Diabetes Association, 7/2/2014. Web.
• Mayo Clinic Staff. “Infertility – Definition.” Mayo Clinic. Mayo Clinic, 7/2/2014. Web.
• Jeffs B, Meeks JJ, Ito M, Martinson FA, Matzuk MM, Jameson JL, Russell LD. “Blockage of the rete testis and efferent ductules by ectopic Sertoli and Leydig cells causes infertility in Dax1-deficient male mice.” Endocrinology. 142(10):4486-95. Web. 10/1/2015.

Potential causes of infertility

There are many different possible causes of infertility in both men and women, so it’s recommended that couples who are struggling to conceive visit a fertility specialist to identify and treat the particular condition of infertility. Many fertility problems can be fixed, and couples go on to have healthy, successful pregnancies.

Women

Women can suffer from a range of different infertility conditions with various causes, including hormonal and anatomical issues.

• Polycystic Ovarian Syndrome (PCOS) – PCOS develops from a hormonal imbalance that usually results in the growth of small, benign cysts on the outer edge of the ovaries. Women with PCOS tend to have irregular and absent periods and ovulations, making getting pregnant more difficult. The disorder can have wide-ranging effects, from weight gain, acne, and increased risk of diabetes, to thinned hair on the head and excess hair growth on the face and body. People with PCOS can benefit from tracking their cycles to best predict their ovulation, but if this is ineffective by itself, a fertility specialist may recommend an ovulation-inducing medication like Clomid, possibly in conjunction with Metformin. Surgical options like ovarian drilling, which induces ovulation by making tiny holes in the ovaries, also have significant success rates and minor recoveries. There is no test to diagnose PCOS, so doctors will often only diagnose PCOS if all other explanations have been ruled out.
• Endometriosis – Caused by a buildup of uterine tissue in the pelvic area outside of the uterus, endometriosis can result in fallopian tube blockages, scarring, cysts, and other damage. These blockages bar eggs that the ovaries release from making their way through the tubes, preventing fertilization. Endometriosis can also be quite painful, especially during your period. Women who have endometriosis may want to consult a fertility specialist about surgical options, both to better understand the extent of the extent of the possible tissue damage and to remove it. Laparoscopic surgery can remove the obstructive tissue and help clear the way for eggs to move through the fallopian tube. In vitro fertilization (IVF), in which the egg is fertilized in a laboratory before being transferred to the womb, is another option for women battling endometriosis.
• Hormonal problems – Oftentimes, women who have irregular cycles will have trouble getting pregnant, due to irregular, infrequent, or absent ovulations. Short luteal phases may also contribute to the problem, in which menstruation begins before a fertilized egg would have time to implant in the uterine lining. Hormone supplements are a good option for women with hormonal disorders, in order to regulate the condition and induce ovulation.

Men

• Poor sperm quality: Whether due to age, lifestyle factors, or bad luck, some men’s sperm have trouble making their way to, or fertilizing, an egg waiting in the fallopian tube. Some men may have a low sperm count, while others could have poor sperm motility. Couples can still get pregnant if a man has poor sperm quality, but the likelihood is reduced. A fertility specialist may be able to recommend a course of action for the best chance of conception.
• Varicocele: Varicoceles are enlarged veins in the scrotum that raise the temperature of the testes, hindering sperm production. Because varicoceles can reduce sperm count or harm the quality of sperm produced, they make conception difficult. If the varicocele is severe enough, a fertility specialist might recommend surgery to cut the veins contributing to the varicocele. Surgery is relatively minor, and men recovery fully within about a week.
• Blockages: Some men may have blockages in the vas deferens or epididymis, which can prevent healthy sperm from reaching and fertilizing the egg. A fertility specialist might recommend a surgical procedure to remove the obstruction. Men with blockages also generally have otherwise healthy sperm, meaning in vitro fertilization with one’s own sperm is entirely possible.

Read more

• Infertility treatments
• Other options

Sources

• Mayo Clinic Staff. “Infertility Causes.” Mayo Clinic. Mayo Clinic, 7/2/2014. Web.
• “What Causes Female Infertility?” Stanford University. Stanford University, n.d. Web.

Causes of infertility a fertility specialist can help with

All people can be affected by conditions of infertility, due to a wide variety of factors. Fertility specialists can address with the following conditions:

Female Factors

• Polycystic Ovarian Syndrome (PCOS): Developing due to a hormonal imbalance where a person’s body creates excess androgens, PCOS usually causes small, otherwise benign cysts to grow on the edge of each ovary. PCOS often results in irregular periods and ovulations, if ovulation occurs at all, making conception difficult. It has a wide range of other symptoms that not all people experience, including extra hair growth, acne, and darkened areas of skin. A fertility specialist might treat PCOS with Clomid, a drug that induces ovulation, or through a procedure called ovarian drilling, in which ovarian follicles are bored with small holes to encourage ovulation. Some research suggests that a healthy diet is very effective in reducing PCOS symptoms and complications.
• Endometriosis: Caused by a buildup of uterine tissue outside of the uterus, endometriosis can result in blockage that prevents the passage of the egg through the fallopian tube. Endometriosis can sometimes be treated with hormonal supplements, but your fertility specialist may also recommend laparoscopic surgery to remove the obstructive endometrial tissue. Endometriosis can cause pain, cyst development, bleeding, and scarring in the pelvic region and make it more difficult to get pregnant. Symptoms are typically most severe during your menstrual phase.
• Hormonal problems: Often, people who have irregular cycles will have trouble getting pregnant due to irregular, infrequent, or absent ovulations, as well as short luteal phases. A fertility specialist might try to treat these conditions with a medication like Clomid, or other hormone regulators. In vitro fertilization (IVF) is another option for people who experience infertility due to ovulation problems.

Male Factors

• Poor sperm quality: Whether due to age, lifestyle factors, or bad luck, some people’s sperm have trouble making their way to or fertilizing an egg waiting in the fallopian tube. This may be because of the sperm’s shape (called morphology), ability to swim (called motility), or genetic makeup (including damaged DNA), among other possibilities. Various tests can reveal if low sperm quality is an issue for your partner. If this is the case, a fertility specialist may recommend lifestyle changes, certain medications, IVF, or other forms of Assisted Reproductive Technology.
• Low sperm count: Sperm quality isn’t the only thing that affects fertility: the number of sperm contained in ejaculate also matters. Also called oligospermia, a low sperm count means fewer than 15 million sperm per milliliter of seminal fluid. There may be no outward symptoms of low sperm count, but some people with this issue also experience hormone imbalances, testicular or groin pain or swelling, erectile dysfunction, or low libido. There are a wide variety of lifestyle and medical factors that can cause low sperm count, including smoking, being overweight, exposure to x-rays or chemicals, heavy bicycle riding, taking certain medications, and excessive heat. A doctor will perform a physical exam and semen analysis to determine whether sperm count is within normal range, then may prescribe a variety of medications and treatments depending on the cause.
• Varicocele: Varicoceles are enlarged veins in the scrotum, which raise the temperature of the testes and hinder sperm production. They sometimes feel like a heaviness or an ache, and the veins may be visibly enlarged. A fertility specialist may recommend surgery to repair the varicocele, or IVF.
• Blockages: Some people may have blockages in the vas deferens or epididymis, which can prevent healthy sperm from reaching and fertilizing the egg. These obstructions are common, affecting about one in every five infertile people. A fertility specialist may treat blockages with surgery or recommend IVF.

Have you been trying to get pregnant for over a year?

If you and your partner have been trying to get pregnant for over a year (or six months for women who are over 35), it’s probably time to seek help. This doesn’t mean that you won’t ever conceive naturally, but you may benefit from a professional evaluation.

Figuring out the cause

If you and your partner have been trying to conceive for over a year without success, you’ll want to figure out whether there’s a cause. If there’s an underlying issue, you and your doctor will have a better idea about how to fix or work around it. Many fertility complications have safe and effective treatments. Fertility issues affect about 10-15% of couples and can occur in both men and women. Some of the most common ones include:

• Polycystic Ovarian Syndrome (PCOS): A condition of infertility caused by a combination of hormone imbalances (specifically an excess of androgens) that can cause irregular or absent ovulation. About 10% of women have PCOS, making it one of the most prevalent causes of infertilty.
• Endometriosis: A disorder in which uterine tissue grows outside of your uterus, which can cause pain, cyst development, bleeding, and scarring in the pelvic region and make it more difficult to get pregnant. Symptoms are typically most severe during your period.
• Sexually transmitted diseases or infections: Some STDs, especially if they go untreated for a while, can damage your reproductive organs and decrease your chances of conception. Untreated gonorrhea and chlamydia can lead to Pelvic Inflammatory Disease (PID), fallopian tube infections, and other problems. Luckily, they’re easily treated.
• Sperm issues: Whether the quantity of sperm in semen (sperm count) is too low, their movement is restricted, or there is a problem with their shape, problems with your partner’s sperm may often account for the difficulties you’re having.
• Subfertility: Even if there is no diagnosable condition, some people may simply be less fertile than others. Behavioral, genetic, and bodily differences can all affect fertility. Lifestyle choices like drinking alcohol, smoking marijuana, and being overweight can also contribute to difficulty getting pregnant, even if everything is anatomically normal.

The above conditions may cause subfertility or infertility, which can make getting pregnant more difficult. Unless they cause sterility (permanent inability to conceive), though, most couples will be able to conceive one way or another.

Read more

• Your initial conversation with a patient coordinator
• types of fertility treatement

Sources

• “ASRM Patient Resources: Trouble Getting Pregnant?” ASRM. American Society for Reproductive Medicine, n.d. Web.
• Mayo Clinic Staff. “Infertility – Definition.” Mayo Clinic. Mayo Clinic, 7/2/2014. Web.
• Li TC, Saravelos H, Chow MS, Chisabingo R, Cooke ID. “Factors affecting the outcome of laparoscopic ovarian drilling for polycystic ovarian syndrome in women with anovulatory infertility.” British Journal of Obstetrics. 105:3. pg 338-44. Web. Mar-98.

Treatment options for infertility

Read on to find out more about how doctors can treat infertility.

Fertility Medications

Only your doctor can decide whether a fertility medication might be right for you, but both men and women may definitely make use of them to treat certain cases of infertility.

Women who have Polycystic Ovarian Syndrome (PCOS), or other conditions of infertility that can disrupt ovulation, can make use of fertility-stimulating drugs like Clomid or Bravelle, which help to ensure that you release a healthy, fertilizable egg each ovulation cycle. These drugs include hormones that stimulate the egg and its follicle to grow.

Men with erectile dysfunction may be able to take drugs like Viagra or Cialis to help him have successful intercourse. Problems with sperm count may also be treated by hormone supplementation in some instances.

Fertility Surgeries

Your doctor will probably try other methods of getting you ready to conceive, and will hold off on surgery unless it is a must. However, many problems of infertility can only be corrected with surgical techniques, so it’s important to know all of the options.

Women whose infertility is attributable to a blocked fallopian tube may need laparoscopic procedures to be able to successfully conceive. Ovarian drilling is also a possibility to help ensure that a woman with PCOS ovulates each cycle. Other surgeries may be possible depending on your particular circumstance.

Men may require surgery to fix in an inner mechanical problem as well, like varioceles, which drain the testicles and make getting pregnant difficult. Other problems could include tumors, scar tissue, or other growths that need removal.

More Help

If medication and surgery is still unsuccessful, many couples are able to conceive using assisted reproductive technology, like in-vitro fertilization (IVF). IVF takes your egg and fertilizes it using your partner’s sperm in a laboratory, bypassing the need for ovulation, and fertilization in a fallopian tube. The fertilized embryo will be implanted in your womb a few days afterwards. Lots of couples who cannot conceive naturally are able to get pregnant through the use of IVF technology.

Read more

• Everything you need to know about intrauterine insemination

Sources

• Li TC, Saravelos H, Chow MS, Chisabingo R, Cooke ID. “Factors affecting the outcome of laparoscopic ovarian drilling for polycystic ovarian syndrome in women with anovulatory infertility.” British Journal of Obstetrics. 105:3. pg 338-44. Web. Mar-98.
• Mayo Clinic Staff. “Infertility: Treatments and drugs.” Mayo Clinic. Mayo Clinic, 7/2/2014. Web.
• Dr. Roger Lobo, ASRM. “Infertility Treatments. Video.” ASRM. American Society for Reproductive Medicine, n.d. Web.

How to help your fertility

Although the connection may not seem readily apparent, individuals who maintain a healthy lifestyle are far more likely to conceive quickly, and have healthy pregnancies, than those in a relatively worse state of health. And those who are TTC have the best chances of doing so quickly if they maintain a well-balanced diet chock full of vegetables and folate (which not only helps your fertility, but makes for a healthier pregnancy), stay active, get a sufficient amount of sleep each night (the body’s time to recover), and manage to avoid feeling too stressed out. General health problems do not have to turn into diagnosable diseases like PCOS or endometriosis to affect your fertility, so it’s important to stay as healthy as you can to increase your chances of conceiving quickly, and having a healthy pregnancy.

Preventing Infertility

Lots of general health problems can lead to conditions of infertility, so it’s very important to stay healthy to avoid these issues. Obese and diabetic individuals run a much greater risk of developing Polycystic Ovarian Syndrome (PCOS), which can inhibit the ability to ovulate. Obesity, stress, and malnutrition may also lead to missed periods or ovulation cycles, both of which can drastically decrease your chances of conceiving.

What You Can Do

Ovia can help you track your general health data so you’ll know when you might need to make a change. The following metrics can have huge effects on your fertility, and Ovia can help you follow your guidelines.

• Activity: If you’re trying to conceive, you should aim to get at least 30 minutes of exercise a day to stay as healthy as you can. It should be noted, however, that individuals whose workouts are too intense may be at risk of decreased fertility and missed or irregular cycles, so it’s important not to overdo it.
• Sleep: Getting the recommended 8 hours of sleep each night can do wonders for your body’s recovery, and your fertility health.
• Blood Pressure: Too high, or too low blood pressure may signify a health problem that could affect fertility, so it’s important to monitor. Abnormal blood pressure during pregnancy may also prove dangerous, so it’s definitely good to keep an eye out for your BP.
• Nutrition: If you’re trying to conceive, you should get plenty of calcium, folate, and Vitamin D, among other nutrients that may increase your chances of getting pregnant and encourage a healthy nine months once you’re successful. It’s also important for your general health to get a sufficient amount of water, usually recommended as 8 glasses per day.

General health problems can certainly cause issues of infertility and make conceiving a bit more difficult, but keeping your general health strong is one of the best ways to promote your fertility health as well, and ensure a speedy road to pregnancy!

Read more

• Exercise and fertility
• 9 best foods to boost your fertility

Sources

• “Polycystic Ovarian Syndrome (PCOS).” American Diabetes Association. American Diabetes Association, 7/2/2014. Web.
• Wise LA, Rothman KJ, Mikkelsen EM, Sørensen HT, Riis AH, Hatch EE. “A prospective cohort study of physical activity and time to pregnancy.” Fertility & Sterility. 97(5):1136-42.e1-4. Web. 5/12/2015.
• Dr. Walter Willett. “Nurses’ Health Study II.” National Institutes of Health. United States, 1989-. Web.
• “Nutrition During Pregnancy: FAQ001.” ACOG. American College of Obstetricians and Gynecologists, 4/15/2015. Web.