What are the Most Common Medical Challenges to Conception?

What seems like should be a natural course of “Mother Nature” can often times turn into a maze of obstacles. The challenges in trying to conceive can seem insurmountable. The official diagnosis of “infertility” comes after a couple has been unsuccessfully trying to conceive for a year or longer (six months if 35 years or older), or impregnates but results in miscarriage.

It is at this point that the consideration of a medical evaluation is wise. Both partners should begin with basic evaluations in order to garner a clearer picture of what might be specific challenges to conception.

In addition to common infertility issues, there are some medical challenges to conception that may prevent pregnancy, and it is good to know what to expect.

Medical Challenges

A thorough history of the following for both should be discussed:

  • Previous surgeries (hernia, appendectomy etc.)
  • Past and present use of pharmaceuticals (birth control, depo provera, anti-depressants etc.)
  • Occupations hazards and exposure to chemicals or recreational drug use
  • Previous pregnancies
  • Sexual history including STDs
  • Significant health changes in the last 6-12 months (weight gain, bowel changes, etc.)
  • Menstrual cycle history (PMS, cramping, pelvic pain, clotting, blood loss, infections)

FOR A WOMAN: Begin with your regular OB/GYN with a pap smear, pelvic exam, urine analysis, and blood tests including hormone levels (FSH, Estrogen (estradiol), progesterone and testosterone). An ultrasound of your pelvic area may also be indicated.

FOR A MAN: Begin with a GP for an overall physical exam and a semen analysis.

Based on the results of your basic evaluation, the detection of your fertility problems and treatment might become clear. If not, you should get a referral to a Fertility Specialist. The requirements for successful conception are:

  1. Ovulation
  2. Sperm production and effective transport to the egg
  3. Oocyte (egg) and sperm fertilization
  4. Successful implantation in uterus for natural growth

Fertility Problems

Any number of obstacles may occur in this process. The woman may be anovulatory (ovulation does not occur). There may be a fibroid, endometriosis or blockage in a fallopian tube(s) that impedes the normal pathway to conception. A woman might have Polycystic Ovarian Syndrome (multiple cysts or follicles within the ovaries). PCOS could include insulin resistance and something called impaired hypothalamic-pituitary-ovarian axis function. Egg quality in general may be poor due to age or prolonged stress. Your doctor might discuss a laparoscopy or a hysterosalpingogram (HSG). Both of these are basic surgical procedures to “see” inside the reproductive area, as a means to diagnose further.

A man might have low sperm count, motility and/or morphology which renders the overall production, function, quality and quantity unable to fertilize.

Hormonal Problems

The definition of hormone is:

  1. A substance, usually a peptide or steroid, produced by one tissue & conveyed by the bloodstream to another to effect physiological activity, such as growth or metabolism.
  2. A synthetic compound that acts like a hormone in the body.
  3. Any of various similar substances found in plants and insects that regulate development.

A hormone is a chemical substance produced in by any of the glands comprising the endocrine system. These chemical substances carry specific messages through the bloodstream to regulate the functioning of specific locations or systems. How the endocrine system functions are adjusted through feedback loops that go through the “Hypothalamus-Pituitary Axis” located in the brain. The endocrine system, along with the nervous system, affects every aspect of our physiological function.

An Endocrinologist is a doctor who specializes in endocrinology. For example, if a woman is diagnosed with Polycystic Ovarian Syndrome (PCOS), she may be referred to an endocrinologist because this is a condition that is related to hormonal imbalance. On the other hand, you may never need to see an endocrinologist.

If you are having difficulty trying to conceive and you haven’t had a hormone panel, you’ll want to have a baseline for the following hormones:

  • Estrogens and Progesterone Levels: A minimum amount of estrogen is needed to support healthy ovulation and sufficient progesterone required to retain fetal growth.
  • Follicle Stimulating Hormone (FSH): Day 2 or 3 levels of FSH hormone via blood test is one way of checking ovarian reserve. If your FSH levels are borderline or high (depending on the lab assays), that is indicative of lower ovarian reserve, which means it will be more difficult for you to conceive.
  • Luteinizing Hormone (LH): Stimulates ovulation and the development of the Corpus Luteum, which must develop in order for fertilization to occur.
  • Thyroid Hormones: Thyroid Stimulating Hormone (TSH); T3 and T4 levels might need to be checked via a blood test. If your day 2 through day 6 basal body temperature averages below 97.4, consider having your thyroid tested.
  • Adrenal Hormones: Our adrenal glands secrete cortisol, dehydroepiandrosterone (DHEA), epinephrine, norepinephrine and aldosterone. Even though Adrenal health is extremely important in fertility, it is not routinely tested, so be assertive if you suspect you need this test (see the Stress and Fertility page for more information about this).

Your Primary Care physician or OB/GYN should make recommendations based on your overall physical health, family history, age and fertility workup. It’s important to get a hormonal baseline so that you and your health care provider know which options are the best choices for you regarding fertility treatment.

Hormones are a crucial element of your fertility success.

The good news is that, even if either of you turns out to be at a disadvantage in any of these ways, there is a way to maximize your success in trying to conceive.

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8 thoughts on “What are the Most Common Medical Challenges to Conception?

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