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FERTILITY

Understanding Fertility

Dealing with fertility problems can be discouraging, emotional and often unexpected. Working with your provider to understand the components of fertility and possible treatment options is a great place to start on your journey. Getting pregnant requires three components: the sperm, the egg and the passageway where the sperm and egg meet (fallopian tube).

If there are problems with one or more of these components, it can be difficult to get pregnant. Let’s take a closer look at fertility and conception.

Sperm Development

Sperm are male reproductive cells produced in the testicles. Men produce millions of sperm each day. Sperm developing inside the testicles take roughly 90 days to fully mature. Sperm are held within a coiled tube of the testicle called the epididymis until they are ejaculated. Sperm mixes with fluids from other glands to form semen before it is ejaculated. The semen helps nourish the sperm.

Egg Development

Eggs are female reproductive cells stored in the ovaries. Women are born with their entire supply of eggs; over time the quality and quantity of eggs decline with increasing age. Starting in puberty, one egg matures and is released into the fallopian tube each month. This process is called ovulation. Every egg is enclosed in a tiny sac called a follicle. Many follicles begin to develop every cycle but only one egg will fully mature and ovulate in a given month. About two weeks after menstruation, a signal is sent to the mature follicle to open and release the egg. What is left over from that follicle (called a corpus luteum) produces progesterone. This hormone prepares the uterus for implantation of a fertilized egg. If a pregnancy does not occur, hormone levels fall and the next menstrual period begins.

How Sperm and Egg Meet

A sperm needs to fertilize an egg within 12-24 hours after ovulation for a pregnancy to occur. The sperm must travel up the cervix through the uterus and into the fallopian tube to meet the egg. Millions of sperm are ejaculated and only a few hundred manage to reach the egg. Fertilization occurs inside the fallopian tube after a sperm penetrates the protective covering of the egg.

The fertilized egg, now called an embryo, moves from the tube into the uterus. About 7-10 days after fertilization, the embryo implants into the lining of the uterus.

Obstacles to Pregnancy

Age
Women are born witha fixed number of eggs in their ovaries. As a woman gets older, the quantity and quality of her eggs decline. This process starts around age 35 and rapidly increases after age 40. For a woman in her 20s to early 30s, there is a 25-30% chance of getting pregnant in one menstrual cycle. By the time a woman is 40, that chance drops to less than 10% per cycle. A man makes sperm throughout his life, although there are problems that can affect sperm production and quality regardless of age.

Problems with Sperm
Suboptimal sperm counts can be attributed to various health or lifestyle factors. Even if the sperm count is normal, the sperm may not function properly or may not be fastidious enough to make it through a woman’s reproductive tract to fertilize the egg. There can also be problems with the blood vessels within the testicles or the tubes that carry sperm from the testicles.

Problems with Ovulation
About 25% of infertile women have problems with ovulation. Ovulatory dysfunction is often due to hormonal imbalances causing the inability to produce a fully matured egg or failure to ovulate or release an egg from the ovary.

Problems with Fertilization
A blockage in the reproductive tract of the man or woman may prevent fertilization.

Problems with Implantation
An embryo may not be able to implant in the uterus because of problems with the uterine lining or shape of the uterus.

Lifestyle Factors
• Smoking, alcohol and drugs can decrease the quality and quantity of eggs and sperm.
• Weight problems can affect hormone levels thereby impairing ovulation.
• Medications, supplements and herbal remedies can affect fertility. Be sure to inform your health care provider of any medications or other supplements you take.
• Chemical exposures can affect hormone levels.
• Sexually transmitted diseases can cause scarring of the reproductive tract.
• Excessive exercise can cause irregular menstrual cycles and a poor ovulatory pattern.
• Testicular heat can cause decreased sperm production.

RESOURCES

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