Understanding infertility

More than 250,000 Canadian couples struggle with infertility. Although you can't do much to turn back the biological clock, technological innovations are now making it possible for many more people to ultimately bring a child into the world.

Getting pregnant and carrying a baby to term may seem like the most natural thing in the world — until the requisite healthy machinery, exquisite timing and luck aren't on your side. If pregnancy remains elusive after 12 or more months of regular, unprotected sex, infertility is diagnosed. Having repeated miscarriages is also a form of infertility. The situation can leave you angry and heartbroken.

In one in five cases no cause can be found, even after a full medical workup. Sometimes a problem with the male partner can be spotted and treated. Often — in a third of cases — there’s an issue with both partners. For women, age is always a factor. You're born with a finite number of eggs that start to run out in a fairly predictable way after age 30.

In most cases, however, doctors eventually identify and treat the problem. Nearly 30 percent of women with infertility, for instance, have fallopian tubes that are blocked, preventing the egg from travelling through the tubes into the uterus. Pelvic inflammatory disease, a prior pregnancy in one of the tubes (called an ectopic pregnancy), endometriosis or pelvic surgery can cause this kind of blockage.

Another 20 percent of infertile women have an ovulation disorder, often infrequent ovulation because of hormonal imbalances, weight problems, heavy athletic training or even stress. Disorders of hormone-producing glands such as the thyroid and pituitary can also interfere with ovulation.

And in 20 percent of cases, fibroids or another disorder of the uterus disrupt embryo implantation or cause miscarriages.

• Lifestyle measures, such as tracking ovulation cycles and keeping your weight within normal ranges.
• Treatment of underlying medical causes of infertility, such as fibroids, endometriosis and menstrual problems.
• Drugs to boost ovulation.
• In more complicated cases, artificial insemination or assisted reproductive technologies with or without super-ovulation drugs.

• Keep time on your side. Over age 30? If infertility is an issue, don't wait a whole year before seeing a doctor. And go after six months if you're over 35. Always go if you aren't menstruating, have had three or more miscarriages, or have a reproductive organ infection.
• Don't let money be the issue. Before seeking treatment, check out your medical insurance coverage. Companies vary widely in how much testing or treatment they'll pay for.
• Express your feelings. Infertility hurts your sense of womanhood, self-worth and identity. You may feel sorrowful, angry or withdrawn. Relationships can fray from the pressure. Don't stuff these feelings away; talk to your doctor about counselling or finding a support group.
• Be wary of dietary supplements. Traditional treatments may (or may not) work; there’s no guarantee that products contain what they claim. High doses of the anti­depressant St. John’s wort, the cold-fighter echinacea and the memory-enhancer ginkgo may damage eggs, sperm and the fertilization process. Bottom line: supplements are unproven, so never delay getting conventional medical help while you wait to see if an herb will work.