Fertility Options Coach

For more than 17 years, Mother’s Day was one of the worst days of the year for me. It is an in-your-face reminder that I can’t seem to manage something that 15 year olds do in the back of cars every day. This article was written before my daughter was born. I have included it without major edits since it reflects what it feels like to be in the darkness of infertility without any way of knowing when the light will come.

Two weeks ago I was staring at what must be my hundredth pregnancy test, willing the second line to appear. “Please God, this time, let me be pregnant. I can’t take another failure.” I had been muttering these words for the last two weeks. When that one lonely line appeared on the test, I told myself it was ok. I’d make it through this, again.

My husband and I were on our way back from a conference on polycystic ovarian syndrome (PCOS). PCOS is one of the reasons I am in this infertility boat. I started driving north out of Arizona. About 20 miles of highway flew under our wheels before I was forced to pull over when the road started floating in my tears. My husband drove for the next three hours as I cried myself to sleep, woke and cried some more. My brain said we could, and would, try again. My heart felt as exposed and desolate as the wind-sculpted red cliffs around us. The twisted sagebrush desperately sought moisture from the desert soil. I wondered if my womb was as desolate as the sun baked clay. Did a fertilized egg seek that frantically to find sustenance within my body—and fail?

By nightfall the sight of red blood silenced any fantasies that the test might be wrong. It was more than just menstrual hormones that kept me in tears over the next week. Just days before the insemination we learned that we would never have a baby without help—and expensive donor sperm. I know that our financial and emotional stamina is limited, so each attempt feels like my only chance—even though I know it isn’t. I know that even if we run out of fertility options that we will someday have enough saved for an adoption and we’ll probably even find an agency that will give us a baby despite my husband’s health. Knowing this doesn’t help much. My heart still feels like an empty piñata. I wonder if the next swing will bust it wide open.

I’d already taken an emotional beating long before I started the infertility treatments. Nearly five years ago, while I was still single and living in Virginia, a social worker at a Washington, DC, foster adoption agency told me she was looking for permanent homes for four babies. She promised me that if my file was complete in the next 30 days one of those babies would be placed with me. I needed one signature from one person to complete that file. When that person finally followed through and signed that paper after five months, it was too late.

Red tape started to fly between the various agencies and the state border was closed to children from DC. I begged the state of Virginia to place a child with me. I offered to take older children, sibling groups, children of any race, pored over web sites asking about child after child. After 18 months I sold my house. The handpainted clouds still floated over the wild animal border in an unused nursery. I’m not ready to go the public adoption road again and we don’t have the money for a private infant adoption right now.

I’m an active griever. Since I closed the door to that unused nursery I have lived in 5 states, changed careers, written two books, and found a million reasons to smile. No matter how busy I keep myself, my arms stay empty.

I believe we will be parents someday, but each day I struggle to maintain that hope and faith as I see and hear of children who are neglected or abused. When I hear of murdered children or hear a parent explain why they left three small children alone in a car while they ran into a store, I think of the hundreds of infertile women I have talked to over the years I have worked with women who suffer with PCOS. Each time, I pray that these women will each find the peace and healing they need and, if possible, someone to call them “Mommy” next year.

Mother’s day is a tough time for being infertile. Few days are as apt to bring the desire to remain in bed all day with a box of tissues and the remote control. From the time I was diagnosed at 19 through when I was finally pregnant at 36, I sat through more than my share of difficult Mother’s days. Here are some ideas to help you cope if Mother’s day is hard for you.

* Consider skipping family events and doing something else that day. For some, attending a family event with seemingly endlessly fertile family members can be really hard. If these events ae really hard for you, consider letting your mom (or mom-in-law) know that even though you love them, it is just too painful for you to participate so you will see them at another time.

* If you do decide to do your own thing on Mother’s day, consider whether a good walk, a movie, or some other simple event will give you a chance to put your mind on other things. If you are experiencing severe grief or depression, you may not feel like doing much of anything, but you will feel better if you go somewhere and do something. I often spent hard days at a coffee shop or bookstore with my journal. If this is too personal for you to experience in public, consider doing some journal time at home with a treat such as a favorite movie.

* If you must participate in a family event, try to spend some time alone before hand so you can regroup and work through your feelings. If the family always had brunch on Sunday with mom, plan a quiet journal session the night before so you can work through your feelings before you are facing a lot of people.

* Holidays can also be a good time to paint the bathroom or clear the weeds out of the garden. Activities can help lift your spirit and give you a constructive outlet for our stress.

Whatever you choose, keep in mind that while your arms may be empty today, there is always hope for tomorrow. This year will be my first Mother’s day with a child of my own. However, the year before I got pregnant was one of the worst Mother’s days I have had as I was just about to divorce and wondering if I would ever have a baby. Life is unpredictable and this may be your last Mother’s day without a baby.

Having a sperm analysis done can be emotionally difficult, but interpreting the results can be even more unnerving. It is important to have a sperm analysis done early in an infertility workup. There are no symptoms for a low sperm count or poor sperm motility. Finding out early that there is a problem with the sperm can save months of anxiety and can save a woman from having unnecessary tests. Often there are simple treatments such as antibiotics that can improve fertility.

It is important to have at least 2 – 3 semen tests done. You need at least two tests done to determine whether your results are “normal.” If your doctor accepts only one result and does not request a second test, change doctors. The results on any one day can be very different from other days and can lead to believe there is a problem when there isn’t one – or can lead to a false assurance that everything is fine.

A man’s testes produce sperm continuously. The number and health of the sperm can be affected by nutrition, stress, and other health factors. It takes about 74 days for sperm to mature, so if you do find that there are problems you will need to improve your nutrition and overall health for at least 2-3 months to see if that improves sperm count and sperm health. A man’s sperm count may vary so it is a good idea to have more than one sperm analysis done to make sure that the results are accurate.

Mature sperm look a bit like microscopic tadpoles. The enzyme-coated head contains the genetic material for fertilizing the egg. The tail moves back and forth to propel the sperm forward and through the woman’s reproductive system. An average ejaculate contains 40-150 million sperm. Only a tiny percentage of these – a few hundred – will get close to the egg.

The analysis will be looking for several different things:

Sperm Count. Not everyone agrees on the right number for healthy sperm. Generally over 20 million sperm per milliliter is said to be fertile. Some labs consider over 40 million to be necessary for fertility. Again, more than one test is necessary as your count can change with temperature, medications, infections, colds or viruses and other factors. Numbers below 20 million are usually considered low, although they may still result in pregnancy.

Motility. More than 50 percent of your sperm need to be motile (able to move quickly) for normal fertility. At least 65 percent of them must be alive. Their ability to move well is very important in their ability to reach the egg and fertilize it. Being sick or exposure to drugs and tobacco can reduce motility.

Morphology. They will be looking for high numbers of malformed sperm. Those with misshapen heads, broken or poorly shaped tails, and other unusual shapes can not swim well or penetrate the egg. At least 50 percent of your sperm must be properly shaped to ensure fertility.

White and red blood cell count. Infections can cause high levels of white or red blood cells in the semen. This is usually treated with antibiotics.

Clumping. Sperm that clump together may be a sign of antisperm antibodies caused by your body mistaking sperm for an invader. This can also be the result of an infection.

If any or all of these factors are below the norm you may be considered “subfertile.” This simply means that your results are lower than normal. It is not the same thing as being completely infertile. As long as you have some healthy sperm there is a possibility of a healthy pregnancy. It may simply take longer or it may require some medical intervention.

See the vitamins for fertility page for tips on vitamins and supplements that may increase sperm count, morphology and motility. Clearing up any underlying infections with antibiotics can improve sperm counts as well.

If all else fails there are a number of medical procedures that can help even those with very low sperm count or poor motility to conceive.

The first question asked by many women just diagnosed with polycystic ovarian syndrome is “Will I ever get pregnant?” One source said that women with PCOS have an 80-90 percent chance of having a baby, but I was unable to find any research studies to back this up. While some women with polycystic ovarian syndrome will not be able to get pregnant, I believe that the majority can and do eventually have healthy babies.

First, 5-10% of women of childbearing age have PCOS. If their symptoms are mild they are often undiagnosed. If they have even one child, many physicians will say they can not have PCOS. This is ridiculous if you look at the diagnostic criteria. The most common criteria for diagnosis include a failure to ovulate regularly. However, for many women this means they have long cycles (35 days or longer in many cases) but they DO ovulate.

Some women with PCOS have unhealthy eggs because their periods are too far apart, in many cases this is correctable with herbs, diet or drugs. Many women with PCOS also have a thyroid condition. Frequently, if this is treated they begin to ovulate. Many women with PCOS have frequent miscarriages, but they eventually have a healthy baby—often with the help of progesterone cream or suppositories. Some women find that losing weight, taking vitex or other herbs, or reducing stress cause them to begin ovulating (for me it was all three!). Some learn to detect ovulation through cervical mucus and basal body temperatures (BBT or temperature charting). Again, these women often have healthy babies without medical intervention.

It is hard to know how many women with PCOS become pregnant without help since many women are first diagnosed with PCOS because they are having trouble getting pregnant. Often metformin or other insulin-sensitizing drugs work wonders and they are able to get pregnant and carry a baby to term.

The fact is, only a small percentage of women with PCOS ever make it to the stage of trying fertility drugs. Clomid (clomiphene citrate) is often the first drug of choice since it is cheap and easy to take. I did find studies indicating that Clomid alone works for 70% of women with PCOS. Other women find that they need Clomid and metformin or stronger fertility drugs. The success rate tends to drop a bit as time passes and stronger methods are tried, but the bottom line is that most women who have PCOS and want children have them.

Even for those who are told they will never succeed at getting and staying pregnant, there is much reason to hope. Several close friends of mine have surprised themselves and their doctors by getting pregnant after years of infertility. “Lisa” adopted three children and then found herself pregnant in her late 30’s. It seems that for many women their PCOS symptoms mellow out as they get older. “Anne” went to the doctor to find out why she was infertile after several years of marriage—she was 3 already months pregnant and boy number two followed just 15 months later. “Susan” had three miscarriages and was told she would never carry a baby to term. Four months later she was pregnant with her daughter and her son is two years younger. “Barb” got pregnant when she was not even thinking of fertility and now counts herself extremely blessed to have two healthy boys.

I know many women who have done everything possible to get pregnant, even IVF, and have not succeeded. But the majority of women with PCOS DO get pregnant. There is even more reason to hope for the young women who are just now learning they have PCOS. First, they are more likely to be diagnosed at all. This means many women will be diagnosed who would have been overlooked ten or fifteen years ago when my generation was first beginning the march from doctor to doctor looking for answers. We know so much more than we did then. Treatments, both natural and medical, are much, much better than ever. In addition, being diagnosed now means they have the chance to prevent much of the physical and emotional trauma older women have experienced because our doctors just didn’t know how to help us.

My advice to any particular woman is to do all you can to increase your fertility (see my other articles and my books for more information about this). Then do your best to relax and let your body work. The odds are with you in the long run.

Men may be particularly sensitive about infertility. Male identity is frequently closely tied to sexual performance and virility. Often there are no symptoms of male infertility other than the inability to conceive so infertility is often considered to be a woman’s problem. The truth is that about 40% of infertility is due to male factors. Men may not talk much about their fertility but it is a common problem.

Male fertility starts with large quantities of healthy, well-formed sperm. About 90% of male infertility is caused by low sperm counts. Low sperm count can be caused by pollution, diet, genetics and many other factors. Other causes of male infertility can include sperm that die too quickly or are not formed properly, and physical problems such as enlarged scrotal veins (varicocele) or fluid accumulation in the scrotum (hydrocele). Correcting circulation to the testes with exercise or surgery may restore fertility.

Under current guidelines from the World Health Organization a sperm sample is considered to be normal if there are at least 20 million sperm per milliliter and at least 50% of those sperm are moving. If there are less than 20 million sperm or fewer of them are mobile, then it is considered to be abnormal. However, the National Cooperative Reproductive Medicine Network proposed new guidelines in 2001 that suggest a sperm count of greater than 48 million per milliliter and more than 63% mobility is normal. Anything between 13.5 million and 48 million would be considered to be in a “grey area” according to the proposed guidelines. Those with fewer than 13.5 million sperm and fewer than 32% mobility would be considered infertile.

There are many simple things you can do to improve sperm quality and sperm count. Nutrition is one of the most important steps to better sperm, although there are also a number of herbs proven to improve your odds of fertility. It is important to note that men also need proper levels of luteinizing hormone (LH), follicle stimulating hormone (FSH) and testosterone. There are a number of herbs that will help to make sure your hormones are properly balanced.

Start with a thorough health workup and sperm analysis. Talk to your doctor about any concerns that arise. Thyroid problems or diabetes can also interfere with proper hormone levels so it is important to discuss these issues with your doctor.

Between 28% and 71% of men with low sperm count are in fact suffering from an infection in the reproductive organs. Infections of the prostate and epididymis (a tubular structure secretion collectors on top of each testis) can interfere with sperm production or block the path of sperm. Infections can lead to anti-sperm antibodies. Some infections, such as Chlamydia, are sexually transmitted. Many infections have no outward symptoms, they just silently cause inflammation that can block the flow of sperm. They may also cause sperm anti-bodies to form, causing the immune system to kill sperm. Treating the infection with antibiotics can often restore fertility.

Some infections, such as an inflammation of the testicles following the mumps can result in permanent infertility. Chromosomal abnormalities such as Klinefelter’s syndrome may be associated with permanent infertility.

There are natural treatments for many causes of male infertility. Many natural remedies have astoundingly high success rates in scientific studies.