Infertility

http://www.medicalnewstoday.com/articles/165748#diagnosis

Definitions and physiology of illness 

Infertility is when someone is unable to get pregnant after a year of having unprotected sex. Women that are over the age of 35, and have been trying to conceive but have been unsuccessful for 6 months are also considered infertile. A woman that may be able to get pregnant, but unable to carry to term may also be infertile (Women’s health, 2019). https://www.womenshealth.gov/a-z-topics/infertility 

For a woman to become pregnant there are many steps that must be successful. First an egg must be released from an ovary. Next the egg must travel through a fallopian tube to the uterus. Then a males sperm must fertilize the egg. Lastly the fertilized egg needs to attach to the uterus. A problem with any of these steps can cause infertility. In women the most common cause of infertility is problems with ovulation. If a woman does not ovulate, there will be no eggs. Some other less common causes of infertility in women can be blocked fallopian tubes due to pelvic inflammatory disease, endometriosis or surgery for an ectopic pregnancy. It may also be caused by physical problems with the uterus or uterine fibroids. Uterine fibroids are clumps of non- cancerous tissue and muscle on the uterine walls. In men, infertility can either be a problem that they are born with, or it may become a problem further down the line caused by illness or injury. The most common cause of infertility in men is varicocele. This is when the veins on a man’s testicles are too large, which heats the testicles and may affect the number or shape of sperm. Other possible causes are that a man may not make enough sperm or any at all (CDC, 2019). https://www.cdc.gov/reproductivehealth/infertility/index.htm 

Impact of illness on Sexuality

Sexual dysfunction in couples experiencing infertility is a very complex issue. There have been many links to infertility and sexual dysfunction, in both men and women. Infertility may give rise to negative effects on relationships and sexual function, along with an increased risk for psychological problems, such as depression (Shahraki, 2018).  https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-018-0584-2 

Infertility can affect sexual dysfunction physically and emotionally. Physically, there can be problems involving the phases of sexual response, such as desire and arousal. There may also be pain disorders that include a decreased libido, erectile dysfunction, premature ejaculation, and/or vaginismus. Most of the time, sexual desire and performance is affected by the pressure of having planned sex, pressure to perform on demand, extensive and painful tests, and anxiety. The longer one comes to the conclusion of being infertile, there are many feelings of depression and sexual inadequacy (ASRM, 2020). Couples often lose sexual desire during non-fertile times, due to the pressure of trying for a baby. Infertility and sexual dysfunction can increase the disappointment of not being able to have children and the distress of medical treatment. In fact, medical treatment used to treat infertility has also been shown to increase the risk of sexual dysfunction. Sexual dysfunction is more likely to occur in women than men, due to the increased risk of stress that infertility brings on (Starc, 2019). This can often lead to couples to avoiding or not even caring about sex, along with them losing affection as a whole. 

https://hrcak.srce.hr/index.php?show=clanak&id_clanak_jezik=334746

https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/sexual-dysfunction-and-infertility/ 

http://www.verywellfamily.com/symptoms-of-infertility-1960282

Interventions and Patient/Family Planning

Infertility can be a very frustrating problem for a couple to deal with. However, know that you are not alone in this journey. UCLA Health estimates that there are around 6.1 million people dealing with infertility in the United States, with 10% of those trying to conceive (UCLA Health, n.d.). There are plenty of options to consider if you find that you or your partner is dealing with infertility. Women with infertility can make an appointment with a reproductive endocrinologist, a doctor who manages infertility, to help find more information about their options (CDC, 2019). https://www.cdc.gov/reproductivehealth/infertility/index.htm https://www.uclahealth.org/obgyn/ivf-patient-education

Due to the commonality of infertility, there are multiple resources available to help an individual or couples get through this process. It is recommended to receive medical interventions and see medical professionals after one year of trying to get pregnant, if under 35, with no success and 6 months of trying if over the age of 35 (CDC, 2019). First, it is important for females to track their menstrual cycle and know when they are the most fertile, which is when the Luteinizing Hormone (LH) is at its peak. This can be done by the “calendar method”, which involves tracking your period for half a year and then being the most sexually active on day 12-15 if trying to conceive (Planned Parenthood, 2020). There are also over- the- counter ovulation tests that can help track when the LH is highest (Mayo Clinic, 2020). Knowing when you are most fertile and have the highest chance to release an egg can be the most important part. There is also a variety of other tests that can be done through one’s OB-GYN, such as x rays of the uterus, looking at the females eggs available for ovulation, imaging of the fallopian tubes, ovaries and uterus and genetic testing (mayo clinic). However, infertility may not only be due to the female’s body. There are reports of about 35% of couples going through infertility due to both the male and female, and 8% of couples having fertility issues has been linked solely to the male (CDC, 2019). Males are able to get an analysis done by the lab on their semen, biopsies done on their testes and imaging of their brain, vas deferens and transrectal/ scrotal area (Mayo Clinic, 2020). 

https://www.cdc.gov/reproductivehealth/infertility/index.htm https://www.plannedparenthood.org/learn/birth-control/fertility-awareness/whats-calendar-method-fams https://www.mayoclinic.org/diseases-conditions/infertility/diagnosis-treatment/drc-20354322 

To help with infertility and less complications with sperm meeting eggs, doctors have found a treatment that can help some couples get pregnant through new science and technology. These methods include artificial insemination, in vitro fertilization, and intracytoplasmic sperm injection (Johns Hopkins Medicine, 2020). Some solutions that have been found to help with infertility and can be fixed with no drug or medical interference includes changing lifestyle habits, diet, and changing medication regimens (Mayo Clinic, 2020). https://www.hopkinsmedicine.org/health/conditions-and-diseases/male-infertility https://www.mayoclinic.org/diseases-conditions/infertility/diagnosis-treatment/drc-20354322 

Watch the video below for more information about why infertility is caused and more ways to help deal with infertility. 

It’s important to educate yourself about not only all the options that you can take, but also being prepared for your doctor appointments. Your doctor may ask you questions about your sex life, menstruation cycles, genital pains, and sexual dysfunction which are topics can be very personal and embarrassing to talk about. However, your doctor asks these questions in order to get a better scope of your health history, which is why it’s important to be prepared for questions like this so your doctor can suggest the best options that fit you and your partner. Questions can differ between men, women, and for couples.

Questions that your doctor may ask couples can include: https://www.mayoclinic.org/diseases-conditions/infertility/diagnosis-treatment/drc-20354322 

• How long have you been actively trying to get pregnant?
• How often do you have intercourse?
• Do you use any lubricants during sex?
• Do either of you smoke?
• Do either of you use alcohol or recreational drugs? How often?
• Are either of you currently taking any medications, dietary supplements or anabolic steroids?
• Have either of you been treated for any other medical conditions, including sexually transmitted infections?

For men:

• Do you have any difficulties putting on muscle or do you take any substances to increase muscle mass?
• Do you ever notice a fullness in the scrotum, particularly after standing for extended periods of time?
• Do you experience any testicular pain or pain after ejaculation?
• Have you had any sexual problems, such as difficulty maintaining an erection, ejaculating too soon, not being able to ejaculate or reduced sexual desire?
• Have you conceived a child with any previous partners?
• Do you regularly take hot baths or steam baths?

For women:

• At what age did you start menstruating?
• What are your cycles typically like? How regular, long and heavy are they?
• Have you ever been pregnant before?
• Have you been charting your cycles or testing for ovulation? If so, for how many cycles?
• What is your typical daily diet?
• Do you exercise regularly? How much?

You also need to prepare yourself to ask your doctor questions and advocate for you and your family. You know your body the best and can explain to your doctor your situation, so they can better understand how to help. Also, don’t be afraid to speak up and ask clarifying questions when you don’t understand something that your doctor talks about. Health literacy is a big problem in the U.S. due to many people not understanding the terminology or scope of the services (CDC, 2019).

Here is a link that lists ways you can talk to your doctor and also how to advocate for yourself in patient and doctor interactions. 

https://blog.uvahealth.com/2019/12/09/how-to-talk-to-your-doctor-other-ways-patients-can-advocate-for-themselves/

 In addition to getting help from general physicians, OBGYN’s, geneticists and various other experts, it may also be beneficial for the couple to visit with marriage counselors to help cope with the stress and emotions that come with infertility (American Association for Marriage and Family Therapy, 2020). This can help the couple deal with the stress they may be feeling, expressing emotions to one another about their thoughts, and overall improve and make their relationship better in hopes of bringing a child into the world. (https://www.aamft.org/Consumer_Updates/Infertility.aspx) 

Where to find Support 

Finding the support needed for illness along with the health concerns that are related to that illness can be very important for the individual and their relationships. When discussing infertility it is important to mention that getting support is different for both men and women. Both sexes can have this illness along with health concerns, but support is individualized. Online peer support has been increasingly supported for infertility. Four out of every five patients, regarding fertility, showed an interest in online peer support (Grunberg, Dennis, Costa, & Zelkowitz, 2018). The offer of online peer support allows for the individual to stay anonymous, along with having access to the support when needed and cost-effective for individuals. A supportive app that provides contact with people in similar circumstances allows for the men and women to discuss possible commonalities within their diagnosis along with getting treatment recommendations. Convenience, communication, and anonymity were key when discussing support wanted for fertility patients, which were all achieved by online peer support (Grunberg, et al., 2018). 

https://www.rbmsociety.com/article/S2405-6618(18)30038-8/fulltext
https://www.sciencedirect.com/science/article/pii/S2405661818300388 

The last thing to discuss is sexual health in regards to infertility. About 37% of men and 25% of women felt that their sex life was lacking quality. Along with this, more than half of the couples studied felt that the pressure was overwhelming during sex because they felt it was more difficult (Luk & Loke, 2019). This study examined and found that infertile couples suffer from several infertility, sexual, and relationship concerns (Luk & Loke, 2019). For couples that have relationship concerns involving infertility, emotionally focused couples therapy (EFT-C) could be very effective. It was found to enhance satisfaction and marital adjustment in couples that are infertile (Soleimani, Najafi, Ahmadi, Javidi, Kamkar, & Mahboubi, 2015). 

https://www.tandfonline.com/doi/full/10.1080/02646838.2018.1529407

http://www.ijfs.ir/article_45329.html 

With all that being said, there should be more research regarding infertility and sexual health along with support and treatment options. Many individuals are unaware that these options exist and feel uncomfortable discussing these difficulties with their provider. Reducing the stigma while advocating for better care is of utmost importance.