Female Infertility
Overcoming Challenges

Transcript from September 24, 2002 Today's Show guest,
Dr. Pat McShane

Over 6 million couples in the United States are infertile, and those who want to have children may face daunting medical, financial and emotional considerations. In the first part of a week-long series on “Today,” Dr. Pat McShane, a reproductive endocrinologist, discusses the basic facts about infertility.

For many women, infertility is one of the biggest crises. Infertility is almost always a surprise and it is really hard for them to deal with it. If you don’t get pregnant in one year of unprotected sex, you probably are infertile. If you are over 35, you are probably infertile if you haven’t gotten pregnant in six months of unprotected sex. Forty percent of the time, infertility is caused by the woman, and 40 percent by the male, while the remaining 20 percent is unexplained.

The general causes are low sperm count, poor ovulation, obstructed or blocked tubes or age. Usually there are two factors involved — one cause is the woman, and one cause is the male... or there are two problems with the woman, like an obstructed tube or difficulty ovulating.

At What Age Is Age Really a Factor?

You’re in pretty good shape until you are 35. After 40, things can be very critical and you need to see a specialist. After 40, your chance of getting pregnant is less than 5 percent a month. A woman under 30 has a 30 percent chance to get pregnant. Women who are 35 or older should go right to a fertility specialist. Others should try one year of unprotected sex before seeing a gynecologist. The gynecologist can give you a basic fertility test.

The Infertility Evaluation

For women, this involves a hormonal blood test and an X-ray test with dye. For men, it involves a sperm count.

For women
There are three basic blood tests:

Hormonal screening tests
This test will give you information on three aspects of your fertility. These three tests are taken with one blood draw.
This blood test should be taken on the third day of your period.

The TSH (thyroid stimulating hormone)
This test checks to see if you have an overactive or under-active thyroid. The thyroid is the thermostat of the body, and problems would indicate that your body or your general health are not doing too well.

Prolactin blood test
This test is to see if there is an abnormality in the pituitary hormone which may cause abnormal menstrual cycles.
Women age 35 or older should also have the FSH or Follicle Stimulating Hormone blood test. This is a hormonal test of ovulation and determines ovarian reserve and tells you about the health of your eggs and ovaries.

More Tests

A dye study should be taken on the fifth day of your period — this is called an HSG test. You get an X-ray done and dye is injected into the uterus in order to outline the uterus and the fallopian tubes. It is usually done to show the condition of the uterus and fallopian tubes and to see if there are any blockages or problems.

For men
Sperm count is done independently by the male partner. A good sperm count is 20 million per cubic centimeter. Good motility — which is the ability of the sperm to move spontaneously — is over 50 percent.

Preventing Infertility

You shouldn’t smoke or drink alcohol and you should seek medical care if you are ill. You should also not wait too long to have children.

Are There Ways to Optimize Infertility?

You should try for a normal weight and have a good diet. You should exercise some, but not too much. If you find out that you are infertile, there is hope and help. So don’t shy away from the issue.

Is Stress a Factor?

There are studies that show those who have support through support groups, or a counselor, are more likely to have a long-term pregnancy. People who report less stress indicate less of a chance for miscarriages and more of a chance to get pregnant.