MEDICAL SELF-CARE

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NEW HOPE FOR INFERTILE COUPLES

This issue's column was guest-written for Dr. Tom Ferguson—by a contributor to Medical Self-Care magazine.

An estimated three and a half million married couples in the United States—one-sixth of all married couples in this country—are currently infertile. The figure represents an increase of almost 50% during the past 20 years.

However, thanks in large part to recent medical advances, the situation is anything but hopeless for the millions of Americans now being treated for infertility. The success rate for solving the problem has risen from 50% in the 1960's to about 70% today. And when having children is simply impossible for a couple, there are support groups that can help them deal with the emotional complexities that accompany the situation.

In addition, physicians as a group are becoming more enlightened about the subject than they were in the past. Traditionally, infertility was viewed as a woman's malady . . . but doctors now estimate that 40% of all couples' organic fertility problems rest with men. The woman is judged infertile in half the cases, and in 10% the cause is either shared or unknown.

But why has infertility become so prevalent in recent years? Several factors account for the increase.

Maternal age. The social changes and economic pressures of the last decade have caused a large number of couples to delay parenthood. This trend may be beneficial as a move toward parenting from a more secure emotional and financial base . . . but for many women it also diminishes their chances of conceiving. Women reach peak fertility in their early 20's. From the mid-30's on, their reproductive potential gradually diminishes.

Infections. Reproductive-system infections in both men and women take a considerable toll on fertility. They can inflame delicate tissue and leave obstructive scarring. A woman's fallopian tubes, for instance, are especially susceptible to such injury. Sexually transmitted diseases (STD's)— particularly untreated gonorrhea in women are the most damaging of all. This is disturbing, since STD's now strike more than 15 million North Americans—including 3 million teenagers—every year. The widespread incidence of these infections among adolescents suggests that we may see an even further increase in infertility among young couples in the years to come.

One major cause of infertility in women is pelvic inflammatory disease (PID), which is brought on by bacteria that enter the reproductive tract . . . often as a result of untreated gonorrhea or in association with an intrauterine device. PID can be a "silent" infection, wreaking its damage on the fallopian tubes before any symptoms appear.

Environmental and occupational factors. Drugs, radiation, pollutants, and other toxic chemicals can impair fertility. The testicles are particularly sensitive to toxic chemicals, including such infamous compounds as Kepone, DBCP (dibromochloropropane), and dioxin (the well-known contaminant in Agent Orange, the herbicide used widely in Vietnam during the war). These and other spermatotoxic substances are suspected contributors to a dramatic decline in the average sperm counts of American men during the past 50 years. [EDITOR'S NOTE: For a detailed discussion of the male infertility problem, read the article titled "The Sperm Crisis" on page 176 of MOTHER NO. 83.]

Stress also can impair reproductive ability. Studies have shown that anxiety can interfere with sperm production and with the female reproductive cycle. Ironically, then, the severe stress of dealing with infertility may actually add to the problem.

Contraceptives. Birth control pills were intended to prevent conception only when taken as prescribed, but some women experience "post-pill amenorrhea", an inability to resume a normal ovulatory cycle after quitting the pill. At highest risk are women who had irregular cycles before they started taking oral contraceptives.

Endometriosis. This disease, long associated with infertility in women, involves overgrowth of the uterine lining, the endometrium. When this happens, endometrial cells appear elsewhere in the body . . . for example, on the ovaries or in the fallopian tubes, which may become blocked. Up to 20% of infertile women—most typically, individuals in their 30's and 40's who have never had children—have endometriosis. Severe menstrual pain is commonly the major symptom, but one-third of those with the condition experience no significant discomfort. Laparoscopy, a relatively simple surgical procedure that uses a small instrument to examine the abdominal cavity, is necessary to obtain a definitive diagnosis. Treatments include analgesics, sex hormones, and/or surgery, but all have significant failure rates. Frustratingly enough, pregnancy—if it can be achieved—seems to cure the disease.

Varicocele. This common cause of infertility in men involves a structural abnormality of the blood vessels in the scrotum. Blood collects in the affected area and its heat impairs sperm production and morphology (slaape). Fortunately, varicoceles can often be corrected surgically: About 50% of those who have the operation are able to father children.