Facing infertility: after trying unsuccessfully to conceive, Heather and Anthony Pansera turned to intrauterine insemination

FDA Consumer, Nov-Dec, 2004 by Michelle Meadows

Heather Pansera and her husband, Anthony, started trying to have a baby as soon as they got married in 2000. In 2001, they settled into a new house in Canton, Ohio, with plenty of room to raise a family. One year passed, and Heather, 32, didn't think much about it. Another year passed and she panicked.

"We were a couple for five years by the time we got married, so we decided to let nature take its course," she says. "It never crossed our minds that getting pregnant would be so difficult."

It seemed like everyone else was having babies, says Anthony, 39. "I have three brothers and three sisters, and they all had kids. You're happy for other people, but you want to experience it too."

An evaluation by a fertility specialist revealed no clear-cut reason for their inability to conceive naturally. What ultimately worked was a combination of a drug to induce ovulation and intrauterine insemination, a procedure in which a catheter was used to deliver Anthony's sperm directly into Heather's uterus around the time of ovulation.

The first five attempts with intrauterine insemination failed, and Heather and Anthony felt crushed each time. They finally got good news after the sixth try.

In February 2004, they found out that Heather was pregnant and due to have a baby in October. Looking back on it, Heather wishes that they had sought medical help sooner and had known more about infertility. "At the time, I felt like I was the only one with the problem," she says. But the Panseras' experience is not uncommon. According to the American Society for Reproductive Medicine (ASRM), 6 million Americans, roughly 10 percent of the population of reproductive age, face infertility.

Here are answers to frequently asked questions about infertility.

Q. What is infertility?

A. Infertility is a disease or condition of the reproductive system that interferes with the ability to conceive. It's typically defined as not being able to get pregnant after having regular unprotected sex for one year. "Regular" is considered every few days when a woman is ovulating--the time of the month when one or more eggs are released from the ovaries. Couples may want to seek medical treatment sooner than the one-year mark if the woman is over 35 or if there is a history of irregular menstrual cycles or diseases of the reproductive system.

Infertility also includes the inability to carry a pregnancy to term, as in the case of someone who's had multiple miscarriages, says Diane Clapp, director of medical information at RESOLVE, a nonprofit advocacy organization for men and women facing infertility. "Some people think that infertility is all in the head and can be fixed with relaxation or a vacation," says Clapp, who is a registered nurse. "But infertility is a medical disease that most people can be treated for." About two-thirds of people who are treated for infertility will become pregnant, according to RESOLVE.

Q. How is conception achieved?

A. Many people don't give much thought to the details of conception. But conceiving a baby is the result of a chain of events. One missed step any where along the way can throw every thing off. First, an egg must be released during ovulation. A man's sperm must be able to reach the egg and fertilize it. The fertilized egg then must travel through the woman's fallopian tube to the uterus and be successfully implanted there. For the embryo to develop, the woman must be producing an adequate amount of hormones. For example, human chorionic gonadotropin (HCG) is a hormone that helps maintain a pregnancy. After a fertilized egg is implanted in the uterus, HCG is produced by the developing placenta, the structure that supplies nutrients to the baby.

Sometimes a couple will succeed in conceiving after identifying when the woman ovulates and having sexual intercourse around that time. Using ovulation test kits and basal thermometers can help determine more precisely when ovulation occurs. Basal thermometers can indicate a rise in body temperature, which occurs when a woman ovulates. But infertility is more than just bad timing. It can involve disorders that prevent conception or implantation from taking place.

Q. What are the primary causes of infertility?

A. For men, the primary cause of infertility is a sperm disorder. A man may have no sperm or low sperm, or there could be a problem with how the sperm is moving.

For women, the primary cause of infertility is an ovulation disorder. Normally, a woman ovulates every month, usually around the middle of the menstrual cycle, which averages 28 days. Experts say that women with an ovulation disorder may not ovulate at all or they may ovulate irregularly.

Other common causes of infertility in women are a blockage of the fallopian tubes, which prevents an egg from traveling to the uterus, and hormonal defects that make the uterine lining unprepared for egg implantation or that keep a pregnancy from being maintained.

Q. What are the main risk factors for infertility?

A. A woman's fertility starts to decrease in her early 30s and takes a big drop alter age 35. According to the ASRM, a healthy 30-year-old woman has about a 20 percent chance each month of getting pregnant. By age 40, that chance is only about 5 percent.