Infertility can be attributed to a number of physiological problems: blocked fallopian tubes, endometriosis or pelvic scarring in women, a low sperm count or abnormal sperm in men. At least one-quarter to one-third of all infertility cases fall into a gray area that doctors simply call "unexplained."
Interestingly, one of the most significant factors in infertility is not a physical abnormality at all. It's simply the relentless thief of time. Many women want to delay childbearing in order to pursue a career. But what is good for the resume isn't necessarily good for fertility.
Dr. Francis Polansky, founder of the Palo Alto-based Nova In Vitro Fertilization clinic, draws a graph that illustrates that a woman is at her fertility peak near the age of 20. After age 35, the line charting her fertility level plummets. In fact, if a woman is 38 years or older and she and her partner have been trying unsuccessfully for six months to get pregnant, Polansky advises not waiting the traditional extra six months before seeking the advice of a specialist. "At this point, this couple needs to move forward very quickly," he says.
"By age 40, it becomes very, very difficult to get pregnant," says Polansky, who will not accept a patient over the age of 43. "Even then, I am very straightforward. There is only a tiny chance that she will conceive. The egg quality is too much reduced. Also, there is about a 50 percent chance of losing the pregnancy to miscarriage after age 40."
Other frequently cited causes for infertility include the increase in pelvic infections caused by undiagnosed sexually transmitted diseases, and the use of intrauterine contraceptive devices that might cause infections or scarring. Exposure to toxins, perhaps even everyday pollution, might play a role in a portion of unexplained female fertility problems and low sperm count in males.
Pelvic surgery that leaves scar tissue or egg damage resulting from chemotherapy could also be contributing factors, says Dr. David Adamson, director of the Palo Alto-based Fertility and Reproductive Health Institute of Northern California. "It is very difficult to show, however, that the actual rate of infertility is increasing," he says. "By the very nature of the age of people who have been having children over the last 15 years (baby boomers), there are more people experiencing problems with infertility, but I would say that the rate itself has not gone up."
Polansky and Dr. Linda Juidice at the Stanford University Medical Center agree.
"Infertility rates have actually remained pretty constant at about 10 to 15 percent," Juidice says.
Adamson and Polansky also note that as people begin to feel more open about discussing infertility, the impression is created that it is a growing phenomenon. "A lot of people are simply coming out of the closet," Adamson says.
For more information about infertility, call Resolve of Northern California at 459-2997.
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