Getting Pregnant For Dummies book cover

Getting Pregnant For Dummies

Authors:
Lisa A. Rinehart ,
John S. Rinehart ,
Sharon Perkins ,
Jackie Meyers-Thompson
Published: March 4, 2020

Overview

The hands-on guide that addresses the common barriers to achieving pregnancy and offers tips to maximize your potential for fertility

For millions of people, starting a family is a lifelong dream. However, many face challenges in welcoming children into the world. According to the Centers for Disease Control and Prevention (CDC), approximately 12% of women in the US from ages 15 to 44 have difficulty getting pregnant or staying pregnant. A variety of factors exist that can contribute to infertility, such as ovulation disorders, uterine abnormalities, congenital defects, and a host of environmental and lifestyle considerations. But infertility is not just a female problem. For approximately 35% of couples with infertility, a male factor is identified along with a female factor, while in 8% of couples, a male factor is the only identifiable cause. Fortunately, there are many treatment options that offer hope.

Getting Pregnant For Dummies discusses the difficulties related to infertility and offers up-to-date advice on the current methods and treatments to assist in conception. This easy-to-read guide will help you understand why infertility occurs, its contributing risk factors, and the steps to take to increase the chances of giving birth. From in vitro fertilization (IVF) to third party reproduction (donor sperm or eggs and gestational surrogacy) to lifestyle changes to understanding genetic information to insurance, legal and medication considerations, this bookcovers all the information you need to navigate your way to the best possible results. Packed with the latest information and new developments in medical technology, this book:

  • Helps readers find real-life solutions to getting pregnant
  • Covers the latest information on treatments for infertility for both women and men
  • Offers advice on choosing the option best suited for an individual’s unique situation
  • Explains the different types and possible causes of infertility issues
  • Provides insight to genetic testing information
  • Provides suggestions for lifestyle changes that help prepare for conception

Getting Pregnant For Dummies is an indispensable guide for every woman trying to conceive and for men experiencing infertility issues.

The hands-on guide that addresses the common barriers to achieving pregnancy and offers tips to maximize your potential for fertility

For millions of people, starting a family is a lifelong dream. However, many face challenges in welcoming children into the world. According to the Centers for Disease Control and Prevention (CDC), approximately 12% of women in the US from ages 15 to 44 have difficulty getting pregnant or staying pregnant. A variety of factors exist that can contribute to infertility, such as ovulation disorders, uterine abnormalities, congenital defects, and a host of environmental and lifestyle considerations. But infertility is not just a female problem. For approximately 35% of couples with infertility, a male factor is identified along with a female factor, while in 8% of couples, a male factor is the only identifiable cause. Fortunately, there are many treatment options that offer hope.

Getting Pregnant For Dummies discusses the difficulties related to infertility and offers up-to-date advice on the current methods and treatments to assist in conception. This easy-to-read guide will help you understand

why infertility occurs, its contributing risk factors, and the steps to take to increase the chances of giving birth. From in vitro fertilization (IVF) to third party reproduction (donor sperm or eggs and gestational surrogacy) to lifestyle changes to understanding genetic information to insurance, legal and medication considerations, this bookcovers all the information you need to navigate your way to the best possible results. Packed with the latest information and new developments in medical technology, this book:

  • Helps readers find real-life solutions to getting pregnant
  • Covers the latest information on treatments for infertility for both women and men
  • Offers advice on choosing the option best suited for an individual’s unique situation
  • Explains the different types and possible causes of infertility issues
  • Provides insight to genetic testing information
  • Provides suggestions for lifestyle changes that help prepare for conception

Getting Pregnant For Dummies is an indispensable guide for every woman trying to conceive and for men experiencing infertility issues.

Getting Pregnant For Dummies Cheat Sheet

Getting pregnant can be a complex and lengthy process for those diagnosed with infertility. Getting through the fertility treatment may seem difficult. Following are a few of our cheat lists to not only help you decipher fertility testing but also help you understand fertility treatment a little better. [caption id="attachment_268905" align="alignnone" width="556"] © Natalia Deriabina[/caption]

Articles From The Book

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General Pregnancy Articles

Infertility Awareness Month Spotlights a Common Problem

Infertility has long been a silent struggle for some people trying to start a family. But this June, Infertility Awareness Month seeks to help those suffering learn more about conception and become more vocal about their journey.

The prevalence of infertility

Infertility is usually defined as not being able to get pregnant after one year of trying. It also refers to women who are able to become pregnant, but struggle to carry their pregnancy to term. Six million women are
diagnosed with fertility troubles each year in the U.S., which equates to roughly 10 percent of women ages 15 to 44. Moreover, around 1 in 8 couples deal with infertility on their way to becoming a family. It’s a common problem, but it’s often kept quiet, as many couples feel shame, fear, or judgment around the issue. Overall, Western culture is becoming more open to discussing infertility. Maybe you’ve seen it addressed on TV shows like This is Us, Parenthood, or Friends. Maybe you’ve heard about the infertility journeys of celebrities like Kim Kardashian, Emma Thompson, and Gabrielle Union. Or, maybe you saw a friend post “I am 1 in 8” on social media. Though it’s not as taboo as it once was, it still can be difficult to know how to discuss such a personal issue. Infertility Awareness Month is meant to help others see the wide reach of this disease and to give those struggling with it a way to start conversations with friends, family, and other loved ones.

Not just a woman's issue

Though people tend to think of infertility as a woman’s struggle, its causes are split equally between women and men. A third of infertility cases are caused by female reproductive issues, another third by male reproductive issues, and the remaining third by a combination of male and female or unknown issues. Male infertility issues tend to be a bit more straightforward; they’re usually caused by low sperm production, slow sperm movement, or variant sperm shape. Female infertility problems, on the other hand, can be very complex. Because many different organs and systems need to work together to produce a viable pregnancy, just one irregularity may prevent fertility.

Checking out the organs

Doctors will often check a woman’s uterus and fallopian tubes first to see if any tumors, polyps, or scars are present. The fallopian tubes can also be damaged in some way. The roles they play in fertilization are vital: Think of them not only as the intersection where the sperm and egg have their “meet-cute,” but also the romantic bistro where the relationship incubates and, finally, the minivan that carries the fertilized egg to its new home: 1000 Uterus Place. Unfortunately, fallopian tubes can swell, dilate, or even burst. If there’s anything wrong with them, it’s likely the woman will need to look into in-vitro fertilization (IVF) to get pregnant.

Parsing PCOS

Another common cause of infertility in females is polycystic ovary syndrome (PCOS). It’s unknown what causes this mysterious syndrome, but it’s quite prevalent, affecting 1 in 10 women of childbearing age. PCOS can manifest in myriad ways. Women with PCOS may experience irregular periods, excessive hair growth on their face, chest, or thighs, or male-pattern baldness on their head. Often, women with PCOS will develop multiple cysts on their ovaries (sometimes referred to as a pearl necklace — because of the appearance of the “chain” of circular cysts on ultrasounds). However, the presence of cysts isn’t necessary for a PCOS diagnosis. Doctors may also measure hormone levels, such as insulin, androgens, and progesterone. Since PCOS interferes with ovulation (that interference is what can cause irregular periods), women with PCOS may have trouble growing the follicles that produce an egg to full maturity, and thus, have issues becoming pregnant. Thankfully, there are fertility medications that can aid ovulation, such as Clomid and Letrozole. If all else fails, IVF is another option for women with PCOS.

'Outside' fertilization (aka in vitro)

You’ve probably heard of in vitro fertilization (IVF) before, but what does it actually mean? In vitro is a Latin term that literally translates to "in glass." This refers to a glass test tube or petri dish where a doctor or scientist observes or performs an experiment. In contrast, in vivo is a Latin term that translates to "in the living." So, when something happens in vitro, it happens outside of a living organism. But to get to that “outside” fertilization, a lot of stuff needs to happen inside first. An IVF treatment cycle involves different courses of drugs and hormones meant to stimulate egg production and egg maturation. If the drugs work as planned, an egg collection and sperm collection are scheduled, and an embryologist will put the egg together with the sperm (this is the in vitro part). If this is successful, the egg fertilizes, and an embryo begins to form. A few days later, this embryo is placed in the uterus, and a pregnancy test is performed after a few weeks to see if the implantation worked.

Sadly, it often takes many cycles of treatment for IVF to be successful, and each procedure can be very expensive, time-consuming, and stressful. However, there are things people wanting to start a family can do to help. Explore this IVF cheat sheet to discover ways to improve chances at IVF success, learn common abbreviations and procedure names, and view ways to keep high spirits on this journey.

Infertility support

Whether those struggling with infertility are in and out of doctors’ offices, calculating an ovulation window, or trying to discreetly inject themselves with hormones in public, it’s easy to feel alone when undergoing infertility treatments. But there are organizations that exist to help women and families on this journey:
  • RESOLVE: The National Infertility Association exists to help all people on a family-building journey find knowledge, community, advocacy, and eventually, resolution. In addition to providing important facts about infertility, RESOLVE also helps connect people with medical professionals and support groups.
  • Fertility Out Loud helps people struggling with infertility to understand cryptic insurance policies, learn how to reply to insensitive comments (like “Your clock is ticking! Better hurry up!”), and connect and share stories on social media platforms.
  • Rescripted is an online community for those trying to conceive (TTC) founded by two women who underwent their own IVF journeys. Aside from articles and support stories, this site also has videos on how to perform common hormonal injections and a digital pharmacy where users can search for inexpensive fertility medications.
For general information about how to assess fertility and nurture pregnancy, check out Getting Pregnant for Dummies.

General Pregnancy Articles

Female Structural Problems That Impact Fertility

Women’s infertility issues can be very complex because so many different systems can be at fault. Is the problem uterine, tubal, hormonal, age-related, or ovarian? Any one of these problems can cause enough trouble to prevent you from becoming and staying pregnant.

A healthy uterus

Maybe you had an HSG to evaluate your fallopian tubes and uterus, or maybe you had a hysteroscopic surgery for an even closer look into the uterus. Looking at the uterus is an integral part of any fertility workup because the uterus nourishes and holds a baby for nine months.

Finding fibroids in the uterus

Fibroids, or benign tumors, are commonly found inside or on the outside of the uterus. They’re extremely common, with 40 percent of women between the ages of 35 and 55 having at least one. Fibroids are even more common in African-American women, with 50 percent having at least one. Fibroids can cause bowel or bladder problems, very heavy bleeding, or pain. Fibroids can be either inside or outside the uterine cavity; their location determines whether they cause a problem with your ability to get or stay pregnant. Fibroids completely outside the uterus, such as pedunculated fibroids, which are attached to the uterus by a stem, don’t usually cause a problem with fertility. Submucosal fibroids grow through the lining of uterine wall and can cause a miscarriage. Fibroids can be surgically removed through a process called a myomectomy. A small fibroid inside the uterus can usually be removed by hysteroscopy, a procedure in which a thin telescope is inserted into the uterus through the vagina. This is outpatient surgery and is relatively atraumatic. In contrast, large intramural fibroids require an abdominal incision and a hospital stay. You generally need to deliver by cesarean section after an abdominal myomectomy.

Removing polyps in uterus

Polyps are small fleshy benign growths found on the surface of the endometrium. Very small polyps usually cause no problem with getting pregnant, but larger polyps or multiple polyps can interfere with conception. Polyps can cause irregular bleeding; they can be diagnosed via sonohysterogram or hysteroscopy and can be scraped off the endometrium. Polyp removal is called polypectomy.

Clearing out the fallopian tubes

Most women have two fallopian tubes, one on each side of the uterus, next to the ovaries. Because these tubes are the transport path from the ovary to the uterus, a problem with one or both tubes can have a big impact on your baby-making ability.

How fallopian tubes should work and what can go wrong

Fallopian tubes are not just tubes. If they were, then repair would be much simpler and far more successful. Tubes actually have jobs to do: specifically, to transport and culture. The tube is where the sperm and eggs meet, and fertilization takes place. So, the tube must allow sperm to migrate through the uterus and into the tube. The tube also must pick the oocyte from the surface of the ovary when it is ovulated and move it nearer the uterus. Finally, once the fertilized egg, now called an embryo, has developed for two to three days, the tube must move the embryo into the uterus. The inside of the tube is lined with cells that have hair-like projections that move in a wave-like fashion to transport the embryo. (Think beach ball at a football game moving around the crowd.) Infections can damage these hair-like projections and decrease or destroy the tube’s ability to perform the transport function. This is a microscopic function and therefore cannot be diagnosed. Also, the tube acts as an incubator for the early development of the embryo. The environment in the tube, designed specifically for the embryo, is unlike anywhere else in the body. This function also cannot be seen or diagnosed.

Sometimes a tube is surgically removed after an ectopic pregnancy, a pregnancy that starts to grow in the tube rather than in the uterus. If this pregnancy is found early enough, it may be possible to dissolve the pregnancy with a chemotherapy agent called methotrexate. However, if the fetus grows large enough undetected in the tube, the tube can burst, causing life-threatening bleeding. The only way to stop the bleeding is to remove the tube.

You can get pregnant with only one tube but having one ectopic pregnancy leaves you at a higher risk to have another. Frequently, when a tube is removed, the surgeon will look at the other tube and find that it looks okay. For a person with an ectopic and one remaining tube, the pregnancy rate is estimated to be about 70 percent, of which 10 percent are another ectopic. So why don’t the other 30 percent conceive? Probably because the tube may appear normal and be open, but damage on the interior of the tube has caused it to malfunction and not be able to perform the job it needs to do. When women become pregnant after an ectopic has been removed, they usually do so within the first year. Beyond that pregnancies can occur but they are rare, and the couple may want to pursue IVF.

Damaged tubes

Women who have only the left ovary and the right fallopian tube can get pregnant because the egg can “float” to the remaining tube. Of course, this also applies to women who have the left tube and the right ovary. (One study estimated that the egg gets picked up by the opposite tube about 30 percent of the time.) Sometimes fallopian tubes are seen to be enlarged on ultrasound or during an HSG. If the tubes are very swollen and dye doesn’t flow through them, you may have a hydrosalpinx, the medical term for a tube filled with fluid. If both tubes are dilated, the condition is known as hydrosalpinges. A hydrosalpinx interferes with pregnancy in two ways:
  • The egg cannot be picked up by the dilated tube, whose fimbriae (the end) is blocked by scarring.
  • The tube has an environment that damages the development of the embryo.
The treatment for a hydrosalpinx is surgical. In mild cases, the end of the tube can be opened and the ends peeled back like a flower. Surgical repair of damaged tubes has a low chance of success primarily because surgical repair does not address the damage on the interior of the tube. However, in severe cases, the tube will not work even if it is opened. In these cases, the tube or tubes must be removed, and you need to have IVF. This diagnosis is a hard thing for many women to accept because it definitely ends any chance that they’ll be able to get pregnant on their own. However, well-done studies have demonstrated that pregnancy rates are lower for women with bilateral hydrosalpinges. Having one hydrosalpinx and one open tube still reduces the chance for a successful IVF cycle. The reason why the hydrosalpinx reduces the pregnancy rate is unknown, but theories propose that the fluid in the tube can leak into the uterus prevent implantation. In very rare cases, women can be born without any fallopian tubes; often the tubes are missing as part of a syndrome in which the external sex organs look normal, but the vagina, uterus, and fallopian tubes are missing. Of course, if you’ve had two ectopic pregnancies, you may have had both tubes surgically removed also. Sometimes fallopian tubes look fine on an X-ray but may be surrounded by adhesions (scarring) that prevent them from picking up the egg. Endometriosis, tissue growths found anywhere in the pelvis, can grow in or around the fallopian tubes and is a common cause of adhesions around tubes. Normal tubes can’t be visualized by ultrasound.

Because the fallopian tubes play such a large role in getting pregnant, you’ll probably need intervention, such as IVF, to get pregnant if a problem is discovered with them. Removal or absence of the tubes, or a blockage that can’t be removed, makes IVF inevitable if you’re trying to get pregnant.

Addressing scar tissue

For doctors who perform surgeries in this area, it's typical to see scar tissue, or adhesions (as shown), in your reproductive system. Many women having a second or third cesarean section delivery or other surgery had scar tissue throughout the pelvis that needed to be cut away before the delivery team could get to the uterus. Adhesions form when blood and plasma from trauma, such as surgery (like an appendectomy, tubal removal of an ectopic pregnancy or fibroid), form fibrin deposits, which are threadlike strands that can bind one organ to another. They can be removed, but surgery to correct adhesions may result in — you guessed it — more adhesions. The amount of scarring depends upon the surgical procedure done but can occasionally be extensive. Adhesions can cause pelvic pain; cesarean sections can cause adhesions, but they tend to be anterior (or in front of) the uterus, and thus may cause difficulty during a subsequent C-section. However, C-sections don’t usually cause problems with tubes (which tend to be behind the uterus), and thus don’t usually cause infertility.

Your chances of getting pregnant after adhesion removal are highest in the first six months after surgery, before extensive adhesions form again. Some adhesions can’t be removed without damaging the tubes or ovaries, and you may need IVF to get pregnant. Since the advent of IVF, surgical repair for pelvic adhesions is uncommon.

If you have adhesions in the uterus itself, you may be diagnosed with Asherman’s syndrome, also called uterine synechiae. Asherman’s can follow a dilation and curettage (D&C), an abortion, or a uterine infection. It can be diagnosed during an HSG but is best diagnosed with a hysteroscopy, where the inside of the uterus can be visualized. Asherman’s is also suspected if you have scant or no menstrual flow or recurrent miscarriages following uterine trauma. There are varying amounts of scarring in Asherman’s syndrome. Some people have very few adhesions, and these are filmy and easy to remove. That person has a very good chance to conceive. If the mild to moderate adhesions are removed surgically, you have a good chance, probably 75 percent or better, of becoming pregnant and carrying to term. Severe adhesions may destroy nearly all the normal uterine lining, and pregnancy may not be possible. Less frequently, a person will have extensive intrauterine scarring and that person will have a very poor chance for achieving a pregnancy. A gestational surrogate may be needed in these cases.

General Pregnancy Articles

Basic Causes of Male Infertility

If a couple tries to conceive but can’t seem to do it, one of the first things that doctors look for is a problem with the man’s sperm. Sperm compose about 5 to 10 percent of semen, and are the only part of the semen that can cause pregnancy. If a man is infertile, there is a problem with his sperm — often a low sperm count or low motility. Sometimes, male infertility can be treated. Just because testicles look normal doesn’t mean that they are fully functioning. The most common problems of male infertility are:

  • Low sperm count, which means that the man isn’t producing enough sperm

  • Low motility, where the sperm he is producing lack sufficient ability to swim to the egg

The basis for the problems may be abnormal sperm production, which can be difficult to treat, or that the testicles are too warm. Heat is known to decrease sperm count, so the solution could be as simple as changing the style of underwear from tighty-whities (briefs) to boxers. Another cause can be a blockage somewhere along the line, which may be corrected through surgery.

Interestingly enough, most semen analysis is done by gynecologists, specialists in the female reproductive system. A gynecologist is usually the first person a woman consults when she has problems getting pregnant. Commonly, the gynecologist asks that the man’s sperm be analyzed. If the tests reveal a problem with the sperm, the man is sent to a urologist for further evaluation.