The good news today for couples trying to conceive is that you can do a lot to avoid, treat, or prevent potential problems before you get pregnant. This blog discusses what you can do if you have the following concerns while trying to conceive: irregular periods, polycystic ovarian syndrome (PCOS), tubal disease, sperm problems, uterine fibroids, or genetic issues.
Polycystic Ovarian Syndrome. If you have irregular cycles or you don’t release an egg (ovulate) every month, you can get testing to identify and treat the cause. There are numerous causes of irregular periods including, but not limited to stress, heavy exercise, hormonal imbalance, certain medications, and pregnancy.
Some women with irregular cycles are diagnosed with Polycystic Ovarian Syndrome (PCOS). Since PCOS is caused by hormonal imbalances, patients with PCOS may experience a combination of irregular cycles, elevated levels of the male hormone androgen, and multiple small fluid filled cysts on their ovaries that do not grow during the menstrual cycle like normal follicles. Women with PCOS may also have abnormal insulin metabolism which can over time lead to metabolic syndrome and obesity.
Women with PCOS may have a disruption of normal cyclic changes of hormones -- levels of luteinizing hormone (LH) and follicle stimulating hormone (FSH) -- essential to ovarian follicular growth and ovulation. Consequently, their follicles may not mature and release eggs regularly with each cycle, or there is a lack of cyclic changes all together, thus resulting in infertility. With this hormonal disruption, more estrogen may actually be produced, which thickens endometrial tissue causing irregular periods, and having more of the male androgens, testosterone, and DHEAS over time can cause acne and excessive hair on your face.
There are many ways to treat PCOS symptoms and treatment will depend on your specific needs. To normalize cycle length and avoid irregular flow, your doctor may prescribe birth control pills. If you are trying to get pregnant, your doctor will likely prescribe medication to stimulate ovulation. Ovarian stimulation medications, like clomiphene, can help by inhibiting the effects of high estrogen levels and regulating the balance of LH and FSH. Your doctor may also provide gonadotropins (FSH) to stimulate your ovaries directly to produce an egg (or several). In this case, your doctor will closely monitor the effects to avoid overstimulation of the ovaries. Your doctor may also recommend in vitro fertilization (IVF).
Uterine Fibroids. Uterine fibroids are benign (non-cancerous) growths in the uterus. They can be located in the top layers of the uterus or deep in the uterine muscles. They can be tiny or large. Depending on multiple factors, uterine fibroids can cause a problem with either fertility or pregnancy. Reviewing your gynecological history during preconception counseling may suggest that uterine fibroids could be an issue and follow-up imaging tests can confirm the size and location of uterine fibroids. If necessary, you can undergo surgery to remove your fibroids.
Tubal Disease. If your fallopian tubes are blocked, your doctor may suggest to try passing fluid through them or perform surgery to open them up. Sometimes, tests that force fluid into the fallopian tubes to check if they are open have this happy side effect. However, many situations may not be easily fixed by surgery, or you may be advised to conceive by IVF instead of surgery.
Or, if the fallopian tubes can’t be opened, you can still try to conceive by using in vitro fertilization (IVF). IVF is a medical procedure in which eggs and sperm are fertilized in the laboratory, bypassing the fallopian tubes where fertilization and early embryo growth normally occur. Fertilized eggs grow a few days in the lab until the embryos are ready to implant. Then, your doctor places one (or two) embryos in the uterus with the hope that the embryos will implant in the uterus and start a pregnancy.
Sperm problems. If your partner has a poor semen analysis result, fertilization through intercourse may be unlikely. But other options, such as intrauterine insemination (IUI), in vitro fertilization (IVF) are possible.
If you have mild to moderate sperm problems, consider intrauterine insemination (IUI). With IUI, lab technicians can wash and concentrate your partner’s sperm sample to maximize the quality of the available sperm. What’s more, your doctor can time insemination at ovulation. In some cases, you can take medications to encourage the growth and release of your eggs at the right time. Finally, sperm are delivered directly to the uterus, helping sperm that don’t swim well-- all increasing your chances for fertilization and pregnancy.
If you have moderate to severe sperm problems, your doctor may suggest IVF with intracytoplasmic sperm injection (ICSI). In this case, a lab technical can select the best sperm from the processed semen ejaculate. Eggs, recovered from the woman after ovarian stimulation using medications, are then injected with a single sperm (if ICSI is used). The fertilized eggs grow for a few more days in the lab until they are ready to implant. Your doctor will transfer the embryos into your uterus where they have a chance to implant and start a pregnancy.
Genetic issues. Knowing your genes can help you and your partner make informed decisions about how to proceed with your family building. If both you and your partner carry genes that can cause debilitating or even lethal genetic diseases, you lower the risk of passing on a disease gene by using IVF and genetic screening of the embryos before transfer. Pre-implantation genetic testing (PGT) screens embryos for genetic disease genes before embryos are transferred to the uterus to produce a pregnancy. Your doctor reviews the genetic test results on each embryo with you, discussing the relative risk of each. Couples can then decide which embryos to transfer. Knowing your genetic history also helps prepare you for family health risks and possible challenges.
Today, fertility patients have more options than ever to help them overcome multiple obstacles to their family building dreams. Seeking pre-conception counseling can do a lot to help you meet your fertility goals.
Visit Fertility Concerns for more fertility health information and interactive tools to personalize your fertility path.