Another hormonal condition that is a common cause of infertility is when a woman has a luteal phase defect (LPD). A luteal phase is the time in the menstrual cycle between ovulation and the start of the next menstrual period. LPD is a failure of the uterine lining to be fully prepared for a fertilized egg to implant there. This happens either because a woman's body is not producing enough progesterone, or the uterine lining isn't responding to progesterone levels at some point in the menstrual cycle. Since pregnancy depends on a fertilized egg implanting in the uterine lining, LPD can interfere with a woman getting pregnant and with carrying a pregnancy successfully.

Certain lifestyle choices also can have a negative effect on a woman's fertility, such as smoking, alcohol use, weighing much more or much less than an ideal body weight, a lot of strenuous exercise, and having an eating disorder.

Unlike women, some men remain fertile into their 60s and 70s. But as men age, they might begin to have problems with the shape and movement of their sperm, and have a slightly higher risk of sperm gene defects. They also might produce no sperm, or too few sperm.

Lifestyle choices also can affect the number and quality of a man's 36 Trying to Conceive sperm. Alcohol and drugs can temporarily reduce sperm quality. And researchers are looking at whether environmental toxins, such as pesticides and lead, also may be to blame for some cases of infertility.

Men also can have health problems that affect their s.e.xual and reproductive function. These can include s.e.xually transmitted diseases (STDs), diabetes, surgery on the prostate gland, or a severe t.e.s.t.i.c.l.e injury or problem.

If you or your partner has a problem with s.e.xual function or li-bido, don't delay seeing your doctor for help.

Treating Infertility You should talk to your doctor about your fertility if you: * are under age 35 and, after a year of frequent s.e.x without birth control, you are having problems getting pregnant; or * are age 35 or over and, after six months of frequent s.e.x without birth control, you are having problems getting pregnant; or * believe you or your partner might have fertility problems in the future (even before you begin trying to get pregnant).

Your doctor can refer you to a fertility specialist, a doctor who focuses in treating infertility. This doctor can recommend treatments such as drugs, surgery, or a.s.sisted reproductive technology. Don't delay seeing your doctor because age also affects the success rates of these treatments.

There are many ways to treat infertility.

Tests The first step to treat infertility is to see a doctor for a fertility evaluation. He or she will test both the woman and the man to find out where the problem is. Testing on the man focuses on the number and health of his sperm. The lab will look at a sample of his sperm under a microscope to check sperm number, shape, and movement.

Blood tests also can be done to check hormone levels. More tests might be needed to look for infection or problems with hormones. These tests can include: * an x-ray (to look at his reproductive organs); * a mucus penetrance test (to see if sperm can swim through mucus); or 37.Pregnancy and Birth Sourcebook, Third Edition * a hamster-egg penetrance a.s.say (to see if sperm can go through hamster egg cells, somewhat showing their power to fertilize human eggs).

Testing for the woman first looks at whether she is ovulating each month. This can be done by having her chart changes in her morning body temperature, by using an FDA [U.S. Food and Drug Administration]-approved home ovulation test kit (which she can buy at a drug store), or by looking at her cervical mucus, which changes throughout her menstrual cycle. Ovulation also can be checked in her doctor's office with an ultrasound test of the ovaries, or simple blood tests that check hormone levels, like the follicle-stimulating hormone (FSH) test.

FSH is produced by the pituitary gland. In women, it helps control the menstrual cycle and the production of eggs by the ovaries. The amount of FSH varies throughout the menstrual cycle and is highest just before an egg is released. The amounts of FSH and other hormones (luteinizing hormone, estrogen, and progesterone) are measured in both a man and a woman to determine why the couple cannot achieve pregnancy. If the woman is ovulating, more testing will need to be done. These tests can include: * a hysterosalpingogram (an x-ray to check if the fallopian tubes are open and to show the shape of the uterus); * a laparoscopy (an exam of the tubes and other female organs for disease); and * an endometrial biopsy (an exam of a small shred of the uterine lining to see if monthly changes in it are normal).

Other tests can be done to show whether the sperm and mucus are interacting in the right way, or if the man or woman is forming antibodies that are attacking the sperm and stopping them from getting to the egg.

Drugs and Surgery Different treatments for infertility are recommended depending on what the problem is. About 90 percent of cases are treated with drugs or surgery. Various fertility drugs may be used for women with ovulation problems. It is important to talk with your doctor about the drug to be used. You should understand the drug's benefits and side effects.

Depending on the type of fertility drug and the dosage of the drug used, multiple births (such as twins) can occur in some women. If 38 Trying to Conceive needed, surgery can be done to repair damage to a woman's ovaries, fallopian tubes, or uterus. Sometimes a man has an infertility problem that can be corrected by surgery.

a.s.sisted Reproductive Technology (ART) a.s.sisted reproductive technology (ART) uses special methods to help infertile couples, and involves handling both the woman's eggs and the man's sperm. Success rates vary and depend on many factors. But ART has made it possible for many couples to have children that otherwise would not have been conceived. ART can be expensive and time-consuming. Many health insurance companies do not provide coverage for infertility or provide only limited coverage. Check your health insurance contract carefully to learn about what is covered. Also, some states have laws for infertility insurance coverage.

Some of these include Arkansas, California, Connecticut, Hawaii, Illinois, Maryland, Ma.s.sachusetts, Rhode Island, Texas, and West Vir-ginia.

In vitro fertilization (IVF) is a type of ART that is often used when a woman's fallopian tubes are blocked or when a man has low sperm counts. A drug is used to stimulate the ovaries to produce multiple eggs. Once mature, the eggs are removed and placed in a culture dish with the man's sperm for fertilization. After about 40 hours, the eggs are examined to see if they have become fertilized by the sperm and are dividing into cells. These fertilized eggs (embryos) are then placed in the woman's uterus, thus bypa.s.sing the fallopian tubes. Gamete intrafallopian transfer (GIFT) is similar to IVF, but used when the woman has at least one normal fallopian tube. Three to five eggs are placed in the fallopian tube, along with the man's sperm, for fertilization inside the woman's body. Zygote intrafallopian transfer (ZIFT), also called tubal embryo transfer, combines IVF and GIFT. The eggs retrieved from the woman's ovaries are fertilized in the lab and placed in the fallopian tubes rather than the uterus.

ART sometimes involves the use of donor eggs (eggs from another woman) or previously frozen embryos. Donor eggs may be used if a woman has impaired ovaries or has a genetic disease that could be pa.s.sed on to her baby. And if a woman does not have any eggs, or her eggs are not of a good enough quality to produce a pregnancy, she and her partner might want to consider surrogacy. A surrogate is a woman who agrees to become pregnant using the man's sperm and her own egg. The child will be genetically related to the surrogate and the male partner, but the surrogate will give the baby to the couple at birth.

39.Pregnancy and Birth Sourcebook, Third Edition A gestational carrier might be an option for women who do not have a uterus, from having had a hysterectomy, but still have their ovaries, or for women who shouldn't become pregnant because of a serious health problem. In this case, the woman's eggs are fertilized by the man's sperm and the embryo is placed inside the carrier's uterus. In this case, the carrier will not be related to the baby, and will give the baby to the parents at birth.

Counseling and Support Groups If you've been having problems getting pregnant, you know how frustrating it can feel. Not being able to get pregnant can be one of the most stressful experiences a couple has. Both counseling and support groups can help you and your partner talk about your feelings, and to help you meet other couples like you in the same situation. You will learn that anger, grief, blame, guilt, and depression are all normal. Couples do survive infertility, and can become closer and stronger in the process. Ask your doctor for the names of counselors or therapists with an interest in fertility.

40.Trying to Conceive Section 5.2 Do s.e.xual Positions Affect Conception?

"s.e.xual Positions for Baby-Making"

2007 BabyCenter LLC (www.babycenter.com).

All rights reserved. Reprinted with permission.

Are some s.e.xual positions better than others for conceiving?

There's no evidence that any particular s.e.xual position is more likely to lead to conception. You may have heard that positions that deposit the sperm closest to the cervix-such as the missionary position (man on top)-are more promising than other positions. But there are no studies to back this up.

Proper timing, on the other hand, is a crucial factor. To make conception more likely, have s.e.x a day or two before you expect to ovulate and then again on the day of ovulation.

Will having an o.r.g.a.s.m help my chances of conceiving?

Some people believe that a woman who climaxes after her partner e.j.a.c.u.l.a.t.es is more likely to get pregnant, but there's no evidence to support this notion either.

The female o.r.g.a.s.m isn't a necessary component of conception, but it is possible that uterine contractions help sperm move toward the fallopian tubes. (Such painless contractions happen involuntarily even when you're not having s.e.x, particularly around the time of ovulation.) Should I stay lying down afterward?

There's no evidence that it makes a difference, but it can't hurt.

Remaining horizontal for 15 minutes or so after intercourse allows more s.e.m.e.n to remain in your v.a.g.i.n.a. Of course, with millions of sperm in every e.j.a.c.u.l.a.t.i.o.n, there should be plenty of sperm in your v.a.g.i.n.a even if you get up right away.

Note: If you've been trying to conceive for a year or more without success (or three to six months if you're 35 or older), or your periods are irregular, your best bet is to see a fertility specialist.

41.Pregnancy and Birth Sourcebook, Third Edition Section 5.3 Using Ovulation Predictor Kits From "Home-Use Tests: Ovulation (Urine Test)," from the Center for Devices and Radiological Health (www.fda.gov/cdrh), part of the U.S. Food and Drug Administration, February 1, 2003. Reviewed by David A. Cooke, MD, FACP, March 31, 2009.

What does this test do?

This is a home-use test kit to measure luteinizing hormone (LH) in your urine. This helps detect the LH surge that happens in the middle of your menstrual cycle, about 1 to 1 days before ovulation. Some tests also measure another hormone-estrone-3-glucuronide (E3G).

What is LH?

Luteinizing hormone (LH) is a hormone produced by your pituitary gland. Your body always makes a small amount of LH, but just before you ovulate, you make much more LH. This test can detect this LH surge, which usually happens 1 to 1 days before you ovulate.

What is E3G?

E3G is produced when estrogen breaks down in your body. It acc.u.mulates in your urine around the time of ovulation and causes your cervical mucus to become thin and slippery. Sperm may swim more easily in your thin and slippery cervical mucus, increasing your chances of getting pregnant.

What type of test is this?

This is a qualitative test-you find out whether or not you have elevated LH or E3G levels, not if you will definitely become pregnant.

Why should you do this test?

You should do this test if you want to know when you expect to ovulate and be in the most fertile part of your menstrual cycle. This 42 Trying to Conceive test can be used to help you plan to become pregnant. You should not use this test to help prevent pregnancy, because it is not reliable for that purpose.

How accurate is this test?

How well this test will predict your fertile period depends on how well you follow the instructions. These tests can detect LH and E3G reliably about nine times out of 10, but you must do the test carefully.

How do you do this test?

You add a few drops of your urine to the test, hold the tip of the test in your urine stream, or dip the test in a cup of your urine. You either read the test by looking for colored lines on the test or you put the test device into a monitor. You can get results in about 5 minutes.

The details of what the color looks like, or how to use the monitor varies among the different brands.

Most kits come with multiple tests to allow you to take measurements over several days. This can help you find your most fertile period, the time during your cycle when you can expect to ovulate based on your hormone levels. Follow the instructions carefully to get good results. You will need to start your testing at the proper time during your cycle, otherwise the test will be unreliable, and you will not find your hormonal surges or your fertile period.

Is this test similar to the one my doctor uses?

The fertility tests your doctor uses are automated, and they may give more consistent results. Your doctor may use other tests that are not yet available for home use (i.e., blood and urine laboratory tests) and information about your history to get a better view of your fertility status.

43.

Chapter 6.

Frequently Asked Questions about Infertility What is infertility?

Most experts define infertility as not being able to get pregnant after at least one year of trying. Women who are able to get pregnant but then have repeat miscarriages are also said to be infertile.

Pregnancy is the result of a complex chain of events. In order to get pregnant: * a woman must release an egg from one of her ovaries (ovulation); * the egg must go through a fallopian tube toward the uterus (womb); * a man's sperm must join with (fertilize) the egg along the way; * the fertilized egg must attach to the inside of the uterus (implantation).

Infertility can result from problems that interfere with any of these steps.

Excerpted from "Infertility: Frequently Asked Questions," Office of Women's Health (www.womenshealth.gov), part of the U.S. Department of Health and Human Services, May 1, 2006.

45.Pregnancy and Birth Sourcebook, Third Edition Is infertility a common problem?

About 12 percent of women (7.3 million) in the United States aged 15 to 44 had difficulty getting pregnant or carrying a baby to term in 2002, according to the National Center for Health Statistics of the Centers for Disease Control and Prevention.

Is infertility just a woman's problem?

No, infertility is not always a woman's problem. In only about one-third of cases is infertility due to the woman (female factors). In another one third of cases, infertility is due to the man (male factors).

The remaining cases are caused by a mixture of male and female factors or by unknown factors.

What causes infertility in men?

Infertility in men is most often caused by: * problems making sperm-producing too few sperm or none at all; or * problems with the sperm's ability to reach the egg and fertilize it-abnormal sperm shape or structure prevent it from moving correctly.

Sometimes a man is born with the problems that affect his sperm.

Other times problems start later in life due to illness or injury. For example, cystic fibrosis often causes infertility in men.

What increases a man's risk of infertility?

The number and quality of a man's sperm can be affected by his overall health and lifestyle. Some things that may reduce sperm number and/or quality include: * alcohol; * drugs; * environmental toxins, including pesticides and lead; * smoking cigarettes; * health problems; * medicines; 46.Frequently Asked Questions about Infertility * radiation treatment and chemotherapy for cancer; and * age.

What causes infertility in women?

Problems with ovulation account for most cases of infertility in women. Without ovulation, there are no eggs to be fertilized. Some signs that a woman is not ovulating normally include irregular or absent menstrual periods.

Less common causes of fertility problems in women include: * blocked fallopian tubes due to pelvic inflammatory disease, endometriosis, or surgery for an ectopic pregnancy; * physical problems with the uterus; and * uterine fibroids.

What things increase a woman's risk of infertility?

Many things can affect a woman's ability to have a baby. These include: * age; * stress; * poor diet; * athletic training; * being overweight or underweight; * tobacco smoking; * alcohol; * s.e.xually transmitted diseases (STDs); and * health problems that cause hormonal changes.

How long should women try to get pregnant before calling their doctors?

Most healthy women under the age of 30 shouldn't worry about infertility unless they've been trying to get pregnant for at least a year.

At this point, women should talk to their doctors about a fertility evaluation. Men should also talk to their doctors if this much time has pa.s.sed.

47.Pregnancy and Birth Sourcebook, Third Edition In some cases, women should talk to their doctors sooner. Women in their 30s who've been trying to get pregnant for 6 months should speak to their doctors as soon as possible. A woman's chances of having a baby decrease rapidly every year after the age of 30. So getting a complete and timely fertility evaluation is especially important.

Some health issues also increase the risk of fertility problems. So women with the following issues should speak to their doctors as soon as possible: * irregular periods or no menstrual periods; * very painful periods; * endometriosis; * pelvic inflammatory disease; and * more than one miscarriage.

No matter how old you are, it's always a good idea to talk to a doctor before you start trying to get pregnant. Doctors can help you prepare your body for a healthy baby. They can also answer questions on fertility and give tips on conceiving.

48.

Chapter 7.

Preventing Unintended Pregnancies Chapter Contents.Section 7.1-Contraception (Birth Control) ................................ 50 Section 7.2-Mifepristone (The Morning-After Pill) .................. 58 Section 7.3-Facts about Abortion in the United States ........... 60 49.Pregnancy and Birth Sourcebook, Third Edition Section 7.1 Contraception (Birth Control) Excerpted from "Birth Control Methods: Frequently Asked Questions,"

by the Office of Women's Health, March 19, 2009.

What Is the Best Method of Birth Control (or Contracep- tion)?

There is no best method of birth control. Each method has its pros and cons.

All women and men can have control over when, and if, they become parents. Making choices about birth control, or contraception, isn't easy. There are many things to think about. To get started, learn about birth control methods you or your partner can use to prevent pregnancy. You can also talk with your doctor about the choices.

Before choosing a birth control method, think about: * your overall health; * how often you have s.e.x; * the number of s.e.x partners you have; * if you want to have children someday; * how well each method works to prevent pregnancy; * possible side effects; and * your comfort level with using the method.

Keep in mind, even the most effective birth control methods can fail. But your chances of getting pregnant are lowest if the method you choose always is used correctly and every time you have s.e.x.

What Are the Different Types of Birth Control?

You can choose from many methods of birth control. Talk with your doctor if you have questions about any of the choices.