Unfortunately, we know that difficulty conceiving among couples isn’t uncommon, affecting as many as 1 in 6 couples.  What we don’t often mention is that men can contribute to infertility, too.  As many as 30% of infertility cases are at least in part attributable to male factors, and in fact, about 20% of all infertility cases are due to male factors alone.
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So, why is this happening?  The contribution required from men for conception to occur involves an adequate number of sperm that look and move normally, but over the last 40 years, the sperm count in developed countries (yep, that’s us) has declined by roughly 50%.  From 1973 to 2011, sperm counts for men in North America, Australia, Europe and New Zealand declined by 59.3% and sperm concentration declined by 52.4%  Fortunately for Asian, African and South American men, they seem relatively unaffected so far.

How does your partner know if he’s affected?  A semen analysis can answer the question of whether he’s producing adequate sperm and whether or not they have a normal appearance and motility (they’ve got to be able to get where they’re going – it’s a long trip!).  A normal sperm count is at least 15 million sperm per milliliter of semen, and a minimum of several milliliters produced during each ejaculation.

If his semen analysis isn’t normal, what are our options?  Depending on how abnormal the analysis is, lifestyle changes may be the easiest first step.  Known risk factors for a low sperm count are obesity, smoking and excessive drinking, exposure to certain chemicals or radiation, frequent hot tub/sauna use, steroid use, and too tight underwear (yes, seriously-this can increase temperature in the scrotum and damage sperm, no matter how good he looks in them!).  If your partner meets any of these criteria, then lifestyle changes may be a simple place to start for improving sperm count and quality.  Medical history aspects can also play a role, for instance an undescended testicle or varicocele (dilated blood vessel) or lump may require surgical management by a urologist prior to conceiving.  Lastly, a testicular infections should be treated immediately, whether sexually transmitted such as gonorrhea, or simply increase white blood cells noted in the semen analysis.  Vaccination against mumps (MMR) can prevent orchitis, another infection that can affect the testes and may result in male infertility by affecting sperm production or transport.

We’ve tried all of the things listed above, and still no luck.  What now?  For those whose sperm counts are only mildly low, IUI (intrauterine insemination) may be a reasonable option.  Essentially, your ob/gyn takes the sample produced by your partner and places it directly inside the uterus closer to the egg rather than having the sperm make the trek from the vagina.  Kind of a head start on the race for fertilization.  If there’s either severely diminished counts or absence of sperm altogether, meeting a reproductive endocrinologist to discuss IVF may be your best bet.  Sometimes this can involve sperm directly extracted from your partner’s testes (yep, just like it sounds), or sometimes donor sperm may be required.

Infertility struggles can often be a sensitive issue and may even be tough to discuss with your partner.  In many cases, though, involving him not only in the discussion of infertility but also having him participate in the evaluation can help shed some light on why conceiving is hard in nearly 1 in 3 cases.  Involving him now in these difficult conversations will be good practice for involving him in difficult conversations  later (for instance, when it comes time to divide up those late night diaper-changing duties 😉 )

Dr. Nick

What is ovulation and why is it important?  Let’s go over this conception issue: Egg meets sperm- simple enough, right?  Not exactly.  The sperm has to meet the egg at the right time.  The average menstrual cycle is 28 days and the first day of your period is considered day 1.  Your body has to prepare the uterus and the egg before the egg can be released (this is ovulation).  This takes about two weeks.  So about 14 days after your period starts is when the egg is released (aka ovulation occurs).  The egg is making its way down the fallopian tube to the uterus and if it meets the sperm along the way, then fertilization occurs.  Once the fertilized egg reaches the uterus, this is when implantation of the pregnancy can occur.  If implantation does not occur, then your period will start and the cycle will repeat itself.  The tricky part here is that the sperm has to be waiting and ready to meet the egg after ovulation happens.  Remember, it takes the sperm a while to get there too.  The best time to have intercourse is really the day before or the day of ovulation.  If you have intercourse the day after ovulation has occurred, this will likely be too late (the egg only lives about 12-24 hours).

How do I know when ovulation occurs?  Some people may have some pelvic pain at the time of ovulation.  However, most of us don’t get any special signals as to the time or day that it is occurring.  It is a bit of a guessing game.

What is the best way to approximate ovulation?  The best way to do this is to use an app (this is the cheapest way as well).  There are so many apps online that you can use:  Fertility Friend, Glow, Kindara, Clue, Period Tracker, and Ovia, just to name a few.  Many of these are free.  Just download it and input the first day of your last menstrual period and it will give you a fertility window.  The window is trying to capture the day before and the day of ovulation but it gives you a couple days before and a couple days after.  

Remember to have sex every day during your fertility window.  Many places will encourage you to have sex every other day to save up the sperm- don’t do this.  There is no truth to this- just have sex every day during your fertility window and if you happen to have sex the day of or the day before ovulation your chance of becoming pregnant can be as high as 30%.

A more expensive way to predict this is an over the counter ovulation kit.  What is this test for?  This test works by detecting a rise in Luteinizing Hormone (LH) in your urine, which usually occurs 24 to 36 hours prior to ovulation.  Several reasons my patients don’t tend to like this: Many people never get a rise in LH even if they are ovulating and it is also an added expense.

What not to do: Don’t check your basal body temperature!!!  Many places online will have you measure your temperature and record it.  This is useless, because your temperature does not go up until after ovulation has occurred and now you have missed your fertility window.

Am I ovulating?  If you have a period every month, you are probably ovulating.  If you have very irregular periods (such as every 3 to 4 months), you are not likely ovulating.  If this is the case, you should talk to your provider right away.  I hope this helps you determine when you are ovulating and taking that first step towards creating your family.  Still have questions?  Give us a call at 208-523-2060 and make an appointment to discuss your fertility issues.  Good luck, and happy conceiving :)

Dr. Pam

Dealing with infertility can be one of the hardest challenges couples face.  In addition to the frustration that comes from difficulty having a child, the emotional burden can affect not only each individual in the relationship but also have a negative affect on the dynamics of the relationship itself.  One of the most important things to know as you face infertility is that you aren’t alone, and in fact, impaired fecundity (the inability to have a child) affects as many as 6.7 million women in the U.S., or roughly 11% of reproductive-age women.

However, women aren’t alone as the cause of infertility, and in approximately 40% of infertile couples, men are either the sole cause of infertility, or at least a contributing factor.  In fact, in about 25% of all infertile couples, there are more than one element that contribute to the infertility.  So, with all of the possible causes, how do we know when and where to start in order to help you?

Infertility workups are undertaken when between 6-12 months of unprotected intercourse doesn’t result in successful pregnancy.  We generally begin our workup looking at the 3 basic parts of infertility.  First, let’s get the men’s part out of the way since it’s easy (insert your joke about guys always being easy here).  Essentially, a semen analysis can let us know if there are adequate sperm numbers and whether they look and move normally.  It’s simple, noninvasive and relatively cheap.

Like the women we test, the female evaluation is a little more complex than the male’s and involves two separate components.  First, we want to know if the woman is ovulating as well as the quality of eggs that she has.  This functional aspect is often checked using a Day 21 progesterone and an AMH (anti-Mullerian hormone) level.  There is also a structural component to check, and this can be done using various imaging studies depending on provider preference and clinical suspicion. 

After the evaluation is done, there is good news for most couples.  Between 85-90% of couples are able to conceive with either medication (ie clomid, letrazole, etc) or minimally-invasive surgical intervention (ie myomectomy, tubal ligation reversal, etc).  Even for those couples who require IVF, we are now able to refer to infertility specialists who come to Idaho Falls monthly, so a trip to Salt Lake is no longer required.

Whether you’re just beginning the evaluation, or if you need medical assistance with ovulation or the latest in robot-assisted surgical intervention, make an appointment with Teton Women’s Healthcare to learn about all of your infertility options.​  You can also check out resolve.org for more information.

Nick