is a weekly newspaper newspaper in the Pacific Palisades [Los Angeles, CA], and I do the monthly

"Healthy Column"

and uh... I'm nothing healthy right now, but [Sue Laughs]

anytime one of our readers has an issue about fertility, about

miscarriages, about anything to do with reproductive, I go to speak to one of the

top fertility specialists in the United States, Dr. Ingrid Rodi, to help me

clarify, so that I am able to explain to our readers what's going on.

and today

I'm wondering -

'What do you do if you're infertile? What - How do you know if you're infertile?'

and

I thought maybe Dr. Rodi could help us.

well um -

the first thing that

that couples need to know is that when they're considering

getting pregnant

they should consult their

family doctor or gynecologist

for preconception counseling. That means going in before they actually get

pregnant

to determine if there are any changes in the medications that they need, or if they have

any medical problems that might

complicate their pregnancy

and if there are any genetic

mutations that they're at risk for

and

the gynecologist will go over all those things and

give them the go-ahead -

Start her on

vitamins and on

folic acid -

SP: Oh so you should be taking vitamins even before you conceive?

IR: Yes, at least about

three months before.

There's also- SP: But it used to be so easy! Couldn't you just go and get pregnant

and that was it? Why do I have to go see my doctor before i even try?

IR: Well, you know, you want to optimize,

you know the

the chance that

the pregnancy is going to be

as easy as possible and that the baby's going to be as healthy as possible.

and once -

you know - the couples have been given the go-ahead

IF the woman is under thirty,

they're usually -

it's usually suggested that they try for a year.

SP: Okay, now by 'trying for a year' -

What does that mean?

IR: That means either - SP: I mean how many times am I having sex a week? What are we

talking here? IR: Right. That means either

just having sex regularly, meaning

three to four times a week

or using an ovulation prediction kit

which tells her

when she's going to ovulate.

So- SP: Okay, so

we've all seen it on TV - 'Honey! Honey! I'm ovulating! Come home quick!' Is that

really accurate?

IR: Well it's very helpful.

Especially if couples

are frequently out of town

and they're really trying to maximize

the timing,

then the kit is very helpful.

SP: Okay, so then

I'm under thirty and I'm having sex regularly or I'm using an ovulation kit - now

there is an old wives tale too, that after you have sex, if you're a woman you should put

your feet up -

does that actually have any truth to-

IR: No SP: Oh, okay so - IR: As long as everything is where it is supposed to be

you don't have to do anything. SP: You don't have to lay down for another hour, okay.

[Sue snaps her finger] Drat. Okay so now I'm under thirty and having sex regularly for a year

and i haven't gotten pregnant.

IR: Okay, so then, the couple comes back.

Or - if the woman is trying to get pregnant on her own - she comes back

and we look for for those areas which are considered deal breakers so

you need to be ovulating

SP: Why wouldn't I be ovulating? Doesn't every woman ovulate?

IR: Not every woman ovulates, and not every woman ovulates regularly.

SP: Oh, really? IR: So- SP: So if I'm one of those people that doesn't have a period

every month, would I be one of those 'irregular ovulators?' IR: Yes.

SP: Is that normal?

No, it's normal to have a period every month.

And if a woman is having a period

where the interval is more than five weeks

then she may ovulate but she doesn't ovulate regularly.

or at least not

or at least not every four weeks.

can you as a doctor

change that then? So that she can ovulate more regularly?

IR: Yes, there are medications we can give her to ovulate more regularly,

- in most cases.

okay so one of the things is then, if I come in, having that problem, you

check for regular ovulation.

IR: Right, the next thing we need to know is

if the man has sperm

and whether he has an adequate number of sperm.

And we do a semen analysis for that.

SP: Okay,

so,

what would be adequate number?

IR: Well- SP: I thought it only took one?

IR: Yeah, it only takes one, BUT uh... they have a long way to swim all the way from the cervix all the way up

to where fertilization occurs.

so you need actually more than one.

IR: You need about- SP: Or you need a SUPER super sperm to get the job done. spurted

IR: Right so you need - the normal semen analysis would have

twenty million

per CC.

and the usual volume is about-

at least two CCs per ejaculate.

SP: Okay, now so when you say 'CC' - how are we talking - a teaspoon full? Or

are we talking a pin head? What are we talking?

IR: Several drops certainly

SP: Several drops, okay.

IR: So that's measured in the lab

so they measure that.

SP: Okay so my partner who might not be thrilled about this will go to a lab

and produce a little

petrie dish full of semen to be looked at. IR: Exactly.

and then we also need them to be swimming

in the forward direction.

SP: No backstrokers?! IR: No backstrokers, well as long as they go forward [both laugh]

so we look at

both the count,

the motility, and how many of them look normal.

So one of the things that we're looking at is

whether the,

whether the sperm

have normal heads

SP: [pointing at diagram] One's a two header.

Some of the sperm have two heads?

IR: some of them have two heads and -

SP: Will that give you twins, if you have two heads?

IR: they typically don't do much of anything.

and some of these have two tails.

so you really want- SP: This one looks like a pointy head

he's not a good swimmer then either.

IR: No, all of these -

this is the normal one [points] and all of these are not so good.

SP: So could one of them make it up there or probably not? IR: Probably not.

This is the

best way to get up there.

okay, so if you go in then and you find out that

the problem is the sperm

then what do you do? IR: Then there are specialists

who evaluate the male and see

if there's anything they can do to improve the situation

if not then we sometimes have to

treat the

woman to compensate for the problems in the man. One of those treatments is

insemination

'Artificial insemination' or 'in Vitro Fertilization.'

SP: Okay so now

so I'm sorry to sort of goad this, but I haven't heard much about

what - how can a man

improve? I mean what -

just not be as stressed as much? Would that

make better sperm? IR: Well, one of the

things the male

fertility specialist will look at is whether he's on any medications that

have a bad effect on the sperm.

Men who

smoke marijuana

often have sperm that are pretty slow swimmers so- [Sue Laughs]

SP: And they get munchies on the way up, I'm sure.

IR: Yeah - it's not enough for contraception

so I don't mean to suggest that marijuana is contraception, but it may slow them down.

so they have an

evaluation of their hormones

and a physical exam

and if all of that turns out to be normal, we can

inject the sperm into the egg

during in vitro fertilization.

SP: Okay, so now we've gone through:

a possible ovulation problem, a possible sperm problem,

what else might you evaluate me for? You find out that I am ovulating fine, the sperm

seems to be fine, and we are still not getting pregnant.

IR: So you really need the

fallopian tubes to be open.

SP: Oh, can you ovulate even if the fallopian tubes are not open? IR: Yes.

So the fallopian tubes need to be open because the eggs come from

the ovary,

fertilization occurs in the fallopian tube, and then the embryo

goes down

to the uterus.

And if the fallopian tubes are blocked,

you can ovulate, but you can't fertilize the egg.

SP: Where does the egg go then, if they are blocked? IR: It just disintegrates.

SP: and then that means sperm can never get to the egg. IR: Right.

SP: What causes blocked fallopian tubes?

IR: There are a number of causes - a woman could have a ruptured appendix,

and that infection can cause

a blockage of her

fallopian tubes. She could have a

sexually transmitted disease,

such as, chlamydia or gonorrhea

and that could block a tube.

She could have endometriosis, and have a blockage as a result of that.

So it is very important to find out whether the fallopian tubes are open

because otherwise

you can't get pregnant on your own.

SP: What if you find that they are blocked? Then what do you do?

IR: In some cases you can open them, but in the majority

of the cases you undergo in Vitro Fertilization

which can bypass the fallopian tube so we

remove the eggs,

fertilize them in a dish, and then we put them into the uterus. So, we bypass

the fallopian tubes.

SP: Okay, so what else could be a problem then?

IR: Those are the major ones, those are the ones that

we call 'Deal Breakers' because

you know, if you don't have sperm, if you don't ovulate,

and if you have blocked fallopian tubes - those are

serious problems.

SP: How about - Say, I am 45 now.

I have been ovulating, I am 45, I look very youthful, I have kept myself in

great shape,

I've got a younger partner, so his sperm is fine,

we know the fallopian tubes [are fine] -

Why would not be getting pregnant then?

IR: Well because we know that

it takes

more eggs

or more cycles, or more trying

to actually get to the one egg that's going to be normal

because with age the percentage of eggs

that are affected by

all kinds of abnormalities goes up.

SP: But I am so youthful!

i mean I can do a triathlon, I can do - I mean why would my eggs i didn't even any why would why eighties

not be as youthful as I appear to be, even though I am thirty-five?

IR: We're not sure but we think it was an

evolutionary advantage

not to have babies in our forties and fifties. So-

SP: Are you saying that even if I can keep my biceps relatively good, there is

no exercise to keep these eggs young?

IR: No,

the only thing you can do is not smoke cigarettes

and not get radiation or chemotherapy to your ovaries. Those things ACCELERATE the loss of

fertility

but otherwise, your ovaries are on their own time clock.