Most women will have the desire to have their own children one day. It is therefore important to understand what normal fertility means. 85% of couples will be able to conceive within 12 months after they start trying while an additional 7% will be able to conceive in the second year. This means 92% are able to conceive within 2 years of trying. Infertility is a term that is used to describe the condition where a couple trying to conceive has been unable to achieve pregnancy after having regular and unprotected intercourse after one year in women under 35 years old or six months for women over 35 years old. It can be also used to describe women who are able to conceive but unable to carry the pregnancy as it leads to miscarriage, recurrent loss, stillbirth, or other issues. While the general recommendation is for couples to seek help only after 12 months, there are several causes of infertility where couples should seek help earlier:
- Irregular menstruation
Women who have regular menstrual periods also have regular menstrual cycles that usually occurs every 21 to 25 days. This also means that ovulation occurs regularly. Ovulation usually occurs once every 2 weeks before the next menstruation starts. However, in women who have cycles more than 35 days, they may not be ovulating regularly. Ovulation is essential for conception. For women who are trying to conceive and have irregular menstrual cycles, it is best they undergo an evaluation before trying to conceive.
- Women over the age of 35 years old
Couples that have a partner over 35 years old (women who will be carrying the pregnancy using their own egg should seek help earlier as egg numbers decrease rapidly as the woman ages. As aging progresses, the quality of the egg decreases. This means the chances of the egg being genetically normal are lower. Therefore, in women over the age of 35 years old, a fertility evaluation for the couple is much more urgent especially if they have tried conceiving for 6 months or more.
- Medical history
In women with a medical history of pelvic infections and / or sexually transmitted infections such as gonorrhea or chlamydia, these conditions can cause inflammation and permanent scarring in the fallopian tubes. An open passage is essential in the process of conception as sperm must be able to travel through the tubes to reach and fertilize the mature egg released through via the process of ovulation. If you have a history of the above conditions, it is best if urgent evaluation is performed to establish that the tubes are patent. A hysterosalpingogram can be used as part of the fertility evaluation to see if the fallopian tubes are patent.
- Endometrial polyps or uterine fibroids
The abnormalities in the uterus such as endometrial polyps or uterine fibroids an affect the endometrial cavity. This affects how the embryo interacts to implant on the uterus. These abnormalities can also cause abnormal bleeding between menstrual cycles. After six months of attempting conception, evaluation should be recommended to women who have a history of bleeding between their menstruation or history of abnormalities. For the treatment and management of the above conditions, a surgery can be performed by placing a narrow scope that has a camera into the uterine cavity. Small instruments can be introduced through the hysteroscope to remove or correct the abnormalities.
- Semen abnormalities
If a couple has a male partner that has a history of semen abnormalities, it is best that fertility evaluation is performed earlier, best done within six months of attempting how to conceive.
Evaluation of Fertility
The process in the evaluation of fertility would include:
History and physical examination
Your fertility doctor will be asking questions about your medical and family history. Some of the questions may include:
- How long have you been trying to conceive?
- How regular are you having intercourse?
- Are you experiencing any pain during menstruation or intercourse?
- Have you conceived before?
- How are your previous pregnancies?
- Has there been any history of sexually transmitted diseases?
- Have you had abnormal pap smears?
- Is your menstrual cycle regular?
- Was there any medical conditions or previous surgeries?
- Is there family history of medical issues?
These questions will help your doctor diagnose and treat you. Physical examination may also be required.
Ultrasound can help to evaluate the structure of ovaries, fallopian tubes, and uterus. It can also detect abnormalities such as polyps, fibroids, distal tube occlusion, and ovarian cysts. It also can help your doctor to evaluate how many eggs you have left (approximate number). This is known as the antral follicle count and can be used to assess fertility potential.
Depending on the results from the procedures above, your doctor may order a blood test to measure hormone levels such as estradiol and follicle stimulating hormone (FSH) which relates to the functions of ovaries and number of eggs. Thyroid stimulating hormone levels is used to assess thyroid function. Prolactin hormone levels are also measured as it may affect menstrual function if it is too high.
This is a test that is essential to establish the patency of the fallopian tubes, uterine abnormalities such as fibroids or polyps, and if there is any scarring in the uterine cavity. There are many abnormalities that can be corrected surgically.
This test is used to evaluate the male partner. In this test, there are four parameters that are being analyzed: semen volume, sperm concentration, sperm motility, and morphology of the sperm. Abnormality in any of these variables would indicate that the sperm is functioning abnormally thus compromising the sperm’s ability to fertilize the egg.
Vaginal Dryness and Infertility
Some women experience issues with lubrication and may have vaginal dryness. This can be an issue if it leads up to the days before and during ovulation as cervical mucus helps the sperm to move towards the egg for fertilization. Some of the best ways to help you is to exercise and relax as it helps reduce stress. Start by exercising three times a week and take a few hours for yourself for relaxation purposes. Read a book, talk to a friend, or get a massage! Another important factor is staying hydrated. The recommended intake is a minimum of eight glasses of water every day.
Lubricants and Infertility
Lubricants are easily available at most storesX and is used during intercourse to control vaginal wetness. In the United States, 62% of women were found to have used lubricants while as many as 25.3% have used it as early as the previous month. Often, couples trying to conceive have a higher rate of vaginal dryness and 26% were found to be using lubricants. Most vaginal lubricants were found to negatively affect sperm motility. Lubricants such as Astroglide, KY Jelly, and Replens were found in multiple studies to affect sperm motility. Another study showed that the sperm became immotile for 15 minutes after being exposed to these lubricants. For these reasons, couples who are trying to conceive are advised not to use common vaginal lubricants. However, there are also some studies that have not been able to find a negative effect of lubricant use on fertility.
To be safe, why not try other options such as the more sperm friendly lubricants? Some examples are the Pre Seed Lubricant and Conceive Plus Lubricant.
Alternatives to Lubricants
While some of these can be used as an alternative to lubricants, you should first make sure that both you and your partner are not allergic to the product you will be using. Also, avoid products that has sugars or glycerin as it can increase the production of yeast in your vagina leading to yeast infections. To be sure, always check with your doctor to make sure that it is safe for both you and your partner.
- Aloe vera gel
Make sure that the aloe vera gel is 100% pure and contains no artificial ingredients or sugar.
- Egg whites
This may sound gross but many women who believe in homeopathic medicine thinks that it works. The medical community is not comfortable in recommending it!
- Natural oils
You can try unrefined virgin coconut oil that has no added sugars. It also has anti-fungal properties that can be helpful if you are trying to avoid yeast infections.
To read more in detail about the alternatives to lubricants, check these sites out:
- 3 natural alternatives to lube
- Out of lube? Try these 6 alternatives
- 7 products you can use down there if you don’t have lube
At least six million couples in the US have medically defined infertility (about 15%), meaning they have had unprotected intercourse for over one year without a successful pregnancy. Even before the one year date for unsuccessful pregnancy, many couples become concerned if they are failing to conceive, with 9 million US women per year going to her doctor for fertility problems. In at least half of these cases, the male partner is partially or fully the reason for not conceiving.
A common complication for these trying-to-conceive couples (“TTC”) is vaginal dryness in the female partner, with 75% of these couples reporting increased incidence of vaginal dryness due to: the stress of being infertile; having to have timed intercourse; and/ or fertility medications they are taking. Enjoying intercourse can become difficult during daily sexual activity when vaginal dryness and pain become an issue. In fact, over 25% of TTC couples “always” use lubricants while having intercourse(e.g. an estimated 2.25 million Americans).
Vaginal dryness is routinely treated with vaginal lubricant products, of which there are several hundred products marketed in the US. However, three decades of peer reviewed, published research has shown that all existing vaginal lubricants studied to date harm sperm, resulting in rapid losses in their viability (% live) and motility (% swimming). Specifically, there have been at least 11 studies on this topic conducted in Medical school settings, reviewing the effect of 16 different lubricants on sperm, including all of the top selling brands, such as KY, Astroglide and Replens. In each study, sperm motility and viability were dramatically reduced after exposure to even small concentrations (<10%) of these products.
Specific data from these studies show:
- A spermicidal or sperm killing activity of the leading three brands of lubricants as being equivalent to contraceptive jellies such as Gynol. In these studies, sperm had ZERO motility after 30 minutes of contact with the top three selling lubricant products.
- These effects are concentration dependent and were seen even with low concentrations (1-6%) depending on the lubricant product.
- Critically, the negative effect of lubricants on sperm includes decreasing sperm penetration into the cervix in vivo, as determined by the post-coital test (PCT).
In order for conception to occur, motile sperm must be able to penetrate into cervical mucus and proceed to the Fallopian tubes in adequate numbers. Existing lubricant products rapidly decrease sperm motility, thus possibly decreasing the numbers of sperm penetrating the cervix and being able to participate in fertilization. The following quotes from these lubricant studies highlight the investigators’ deep concerns with the use of vaginal lubricants by TTC couples (see a complete list of these references at www.helpconceive.com).
Dept of ObGyn; University of Texas Southwestern Medical Center. “For couples with infertility, the use of vaginal lubricants during intercourse is not recommended.”
Dept of ObGyn; University of Connecticut. “We conclude that all traditional vaginal lubricants should be avoided in patients desiring conception.”
Dept of ObGyn; University of Minnesota. “The spermicidal effect of the lubricants was statistically significant. The lubricants had a similar effect on both normal and abnormal semen specimens.”
Dept of ObGyn; Uniformed Service University, Bethesda, MD. “In vivo (in people) data demonstrated severe impairment to sperm penetration of mid-cycle human cervical mucus by the lubricant.”
Why do lubricants harm sperm? The best pH value for sperm migration and survival in cervical mucus has been established by the World Health Organization at between 7.0 and 8.5. This coincides with the normal rise in pH of cervical mucus found in women at the time of ovulation. In contrast, vaginal lubricants tend to have pH values below 7, and often as much as half of this value. These pH values can cause sperm death. Sperm are also sensitive to both high and low osmolality (concentration of osmotically active particles in solution) because these can cause the cells to either shrink or swell too much. A physiologic osmolality around 320 mOsm/kg (that of semen) is best for sperm function. Sperm motility decreases with exposure to increasing osmolality, with all motion stopping at 600 mOsm or greater. Lubricants have osmolality levels 3-10 times that of semen that causes irreversible damage to sperm motility at contact
In spite of the numerous publications cited above, there remains a great deal of confusion amongst physicians and lay people alike as to the safety of vaginal lubricant use while trying to become pregnant. In fact, many doctors are inadvertently recommending lubricants that harm sperm to their patients based on inaccurate information. In many cases there is a fundamental disconnect between the published data of the effects of lubricants on sperm function and the physician’s knowledge. This confusion exists in part, because the leading brands state in their marketing material that they “will not kill sperm.” or that they have “no effect on sperm motility” in spite of published literature to the contrary.
Additionally, a common misconception is that if a lubricant does not contain a spermicide or if it is water soluble, it will not impair sperm function. Unfortunately, this is completely inaccurate. Water based lubricants often have glycerin (which has been shown to be toxic to sperm) and propylene glycol both of which are highly hyperosmotic. This results in irreversible damage to sperm and a loss in motility after exposure to commercial lubricants. Damage to sperm and subsequent inability of the sperm to penetrate into the cervix following contact with lubricants may prevent conception in some couples, resulting in consequences such as undesired childlessness, or the advancement to more invasive advanced reproduction technologies (all of which carry added economic costs and medical risks). If there is any evidence that a vaginal lubricant can interfere or limit a couple’s fertility, it should carry a warning label to avoid its use while trying to conceive, and testing needs to be established by the FDA for any products that claim to not harm sperm. You can read a full report on this topic written by the author to the FDA at http://ingfertility.com/newreports.html.
In contrast, Pre~Seed “sperm-friendly” Intimate Moisturizer was developed in response to the need for a product to replenish vaginal moisture without harming sperm while couples were trying to conceive. Each lot is tested to not harm sperm before it is sold. So if you are trying to conceive, know the facts about vaginal lubricants. They damage sperm and should be avoided. If you need help with dryness, as many couples do, Pre~Seed was developed by a Sperm Physiologist and has several studies presented at National Reproductive Meetings suggesting its “sperm-friendly” nature.