Taking Charge of Your Fertility

by Toni Weschler

  MALE REPRODUCTIVE ANATOMY

  Jamie leads a charmed life out in the country with her husband and three-year-old. The adorable little boy loves to run around naked in the warm sun. One beautiful spring day, as my friend Mikaela was sitting out on Jamie’s patio sipping iced tea and chatting with her, little Theo ran over, pointed down, and innocently asked, “Mom, this little guy at the end of my penis—is it my brain?” As Mikaela tells it, the reaction on his mother’s face seemed to say “No, honey, but when you get older, it might as well be.”

  Have you ever noticed that bald men usually have hairy chests? Long before I became a fertility educator, I knew there must be some association. Well, it has to do with testosterone, the hormone responsible for the development of male sex traits. Although the exact mechanism is not fully understood, there is a paradoxical correlation between a higher amount of testosterone and being hairy-chested and bald.

  Of course, testosterone is also related to fertility, since it’s responsible for sperm production. But so often when we think of fertility, the tendency is to think only of women. After all, they are the ones who have menstrual cycles and ultimately bear children. Yet if it weren’t for the minor detail of men’s sperm, women would obviously never get pregnant. In addition, whenever there is a fertility problem with a couple, it’s as likely to be due to the man as to the woman.

  As you have seen from the last few pages, there are significant differences between men’s and women’s fertility and sexuality. Interestingly, there are also distinct similarities between male and female reproductive anatomy. Just as women develop eggs in their ovaries, men produce the male counterpart, sperm, in their testes. And just as the woman’s egg is drawn into the fallopian tube, a man’s sperm travels through a tube called the vas deferens. Finally, the woman’s uterus and the man’s prostate, both in approximately the same location, produce nutrients for the egg and sperm, respectively.

  It is no coincidence that men’s testes are situated outside their bodies, since the sperm require conditions 3 to 4 degrees below normal body temperature to develop. Apparently, that design works quite well, because most men produce 100 to 300 million sperm a day! To ensure that the testicles remain cool, the scrotum that surrounds the testes thickens and thins in response to the external temperature. For example, if a man jumps into a cold lake, the scrotum contracts, becoming very thick and pulling the testes against his body. But if he takes a hot shower, the scrotum thins out, allowing the testes to drop down. In this way, the body maintains a steady testicular temperature in various thermal conditions.

  Even though sperm are produced on a daily basis, the production of an individual sperm can take about 72 days to complete. They begin their reproductive journey inside the long, thin seminiferous tubules in the testes before going into “cold storage” in the epididymis, a series of 20-foot-long tightly coiled tubes that act as a school for sperm to perfect their swimming technique. It takes them anywhere from about 2 to 12 days to pass through the epididymis.

  Before ejaculation, the Cowper’s gland releases a slippery, clear fluid designed to facilitate sperm survival and neutralize the acidity of the urethra. People often confuse these few drops of “leaking” with a man’s inability to control his ejaculation. In reality, it is an absolutely healthy and necessary sexual function. But the pre-ejaculate may contain live sperm, which is why “withdrawal” is not recommended for birth control (though, in fact, it is far more effective than risking completely unprotected intercourse!). At ejaculation itself, the prostate and seminal vesicles supply the nutrient-rich fluid in which sperm travel. One of the reasons it takes a while for men to be able to ejaculate again is that the seminal vesicle and prostate need time to manufacture more seminal fluid.

  While we are on the subject of what men emit during ejaculation, you can rest assured that one of the things they do not emit is urine! One of the reasons it’s difficult for a man to urinate when he is sexually aroused is that a muscular sphincter closes the opening of the bladder, preventing him from urinating and ejaculating simultaneously. So, women around the world can breathe a collective sigh of relief.

  What does happen at ejaculation is that the sperm travel from the epididymis through the vas deferens and out the urethra. On the way, the fluid from the seminal vesicles also enters the vas deferens and mixes with the sperm. The seminal vesicles are two saclike structures that produce part of the seminal fluid in which the sperm travels. The other source of fluid for semen comes from the prostate gland.*

  When a man ejaculates inside a woman, the length of time the sperm can survive is directly related to where the woman is in her cycle. If a woman is nowhere near ovulation, and is therefore not fertile, the sperm won’t survive more than several hours. However, if she is approaching ovulation, and has wet-quality cervical fluid, sperm can live up to five days. This is discussed in greater detail later.

  The initial gelatin-like consistency of the semen acts to prevent early leakage out of the vagina, while sugar within the gel provides instant energy for sperm motility. But once it has served this purpose, the gel tends to melt and leak out in the ensuing hours, much to the chagrin of countless women, no doubt.

  Sperm comprise a surprisingly small fraction of the semen itself. The composition of semen is approximately as follows:

  Fluid from the seminal vesicles: 65%

  Fluid from the prostate gland: 30%

  Sperm and testicular fluid: 5%

  Portions of the following list should shed light on why it is that many women who are trying to avoid pregnancy have good reason to be cautious:

  Number of sperm produced per day: 100–300 million

  Typical number of sperm per ejaculate (2–6 ml): 100–500 million

  Typical number of sperm per milliliter: 20–200 million

  Number of days sperm can live in fertile cervical fluid: 5 days

  The good news is that with a method like FAM, women wanting to avoid pregnancy need not concern themselves with whether men produce one or ten million sperm per hour. The point is that once women determine when in their cycle they are not fertile themselves, it doesn’t matter how many sperm the man produces. If there is no egg about to be released, there is no physiological way a pregnancy can occur.

  CHAPTER 4

  Finally Making Sense of Your Menstrual Cycle

  Cindy and Brent are classic examples of educated people being misinformed about normal cycle lengths. They weren’t clients of mine, but Brent told me his theory about the effect of stress on women’s cycles when he heard that I was writing a book on Fertility Awareness. He said his wife was so paranoid about getting pregnant that she would consistently worry herself into having delayed periods. Cindy’s anxiety would lead her to continually buy pregnancy tests, which always turned out negative, followed by menstruation within a day or two of getting those results. Based on this pattern, Brent deduced that anxiety itself was causing the delay, and that the reassuring news of a negative pregnancy test allowed her to finally relax enough for her period to start.

  Seems logical, right? Wrong. As you will learn, starting to worry about an unplanned pregnancy just a few days before your period is due will not delay it, since the time from ovulation to menstruation (the luteal phase) is a finite length that is not affected by external factors such as stress. In reality, what was undoubtedly happening was that Cindy had longer than average cycles, perhaps 32 days or so. But since she was under the commonly held illusion that cycles were 28 days, she would start to panic when Day 30 or 31 arrived. Finally, by Day 32, she would take a pregnancy test, it would come out negative, and lo and behold, she would get her period the next day. But it wasn’t the negative test results that were allowing her menstruation to begin. It was that her cycles were almost certainly about 32 days anyway!

  Copyright © Los Angeles Times Syndicate.

  THE GREAT RACE

  There’s a time when you have to explain to your children why they were born, and it’s a marvelous th
ing if you know the reason by then.

  —HAZEL SCOTT

  Oh, yawn, here we go again . . . the menstrual cycle. Now, before you start whining about how boring this section is going to be, trust me—it’s really one of the most remarkable things that happen within your body. The menstrual cycle is like a fine-tuned symphony, a fascinating interplay of hormones and physiological responses. By the end of this chapter, I think you’ll agree.

  The bottom line is that your body prepares for a potential pregnancy every cycle, whether or not you want to conceive. In essence, your hormones do not always confer with your heart. They just do their thing regardless of your intentions.*

  Every cycle, under the influence of Follicle Stimulating Hormone (FSH), around 15 to 20 eggs start to mature in each ovary. Each egg is encased in its own follicle. The follicles produce estrogen, the hormone necessary for ovulation to eventually occur. A race progresses for one follicle to become the largest. Eventually ovulation occurs when one ovary releases an egg from the most dominant follicle. (The other eggs that began to ripen disintegrate in a process called atresia.) It’s fairly arbitrary which ovary ultimately releases the egg. Ovulation doesn’t necessarily alternate between ovaries, as is often thought.

  Although it averages about 2 weeks, this race to release an egg can take anywhere from about 8 to 21 days or longer to complete. The primary factor that determines how long it will take before you ovulate is how soon your body reaches an estrogen threshold. The high levels of estrogen will trigger an abrupt surge of luteinizing hormone (LH). This LH surge causes the egg to literally pass through the ovarian wall, usually within a day or so of its onset. After ovulation, the egg tumbles out into the pelvic cavity, where it is quickly swept up by the fingerlike projections of the fallopian tubes, called fimbria. Occasionally, the fimbria do not retrieve the egg, and therefore pregnancy would not be possible that cycle.

  At this point you may be thinking, what is she talking about? How many hormones are we dealing with here? Actually, a tidy little way for you to remember the general order of the hormones is through the expression FELOP, which stands for

  So, the next time you’re at a party and someone asks, you’ll have a quick reply ready. Of course, things could get ugly if someone asks you for an even more detailed explanation of the menstrual cycle. For that you should read the more comprehensive version of the cycle elaborated in Appendix C.

  Following the release of the egg from the ovary, the follicle that held the egg collapses on itself, becoming the corpus luteum (or literally, “yellow body”). The corpus luteum remains behind on the interior ovarian wall and starts releasing progesterone. It has a finite life span of about 12 to 16 days, with an average length of about 13 to 14 days. Rarely does it vary more than a couple of days for each individual woman, because being ensconced on the ovarian wall, it’s unaffected by the stresses of everyday life.

  Thus, for example, if Erica’s luteal phase (the phase following ovulation) is normally 13 days, it may occasionally be 12 days, occasionally 14. Sometimes, luteal phases may be 11 or even 10 days. These are considered within a normal range, but phases less than 10 days are problematic, especially if a couple is trying to get pregnant. (I discuss short luteal phases in greater detail in Chapters 6 and 9.)

  Progesterone, the hormone released by the corpus luteum, is incredibly important for a woman’s fertility because it does three things:

  1.Prevents the release of all other eggs for the rest of the cycle.

  2.Causes the uterine lining (endometrium) to thicken and sustain itself until the corpus luteum disintegrates about two weeks later.

  3.Causes the three primary fertility signs to change. These signs are cervical fluid, waking temperatures, and cervical position.

  In a small percentage of cycles, two or more eggs are released during ovulation, but always within a 24-hour period. This phenomenon, called multiple ovulation, is responsible for fraternal twins. The reason more eggs cannot be released later that cycle is due to the powerful effects of progesterone mentioned above. Progesterone quickly stops the release of all other eggs until the next cycle. So a woman could not release an egg one day, get pregnant, and then release an egg again weeks or months later. Her body protects that potential pregnancy by preventing the release of more eggs following ovulation.*

  OVULATION: THE DIVIDING LINE

  The first part of the cycle, from Day 1 of menses to ovulation, is the follicular (or estrogenic) phase. Its duration can vary considerably from woman to woman and for an individual woman over her lifetime. The second phase of the cycle, from ovulation to the last day before the new period begins, is the luteal (or progestational) phase. It usually has a finite life span of 12 to 16 days. What this ultimately means is that the day of ovulation determines the length of your cycle.

  For example, a woman could have an extremely delayed ovulation due to stress or other factors, not ovulating until Day 30 or so. This would result in about a 44-day cycle (30 plus 14). Thus, just because a woman is on Day 44 and hasn’t gotten her period yet doesn’t necessarily mean she’s pregnant.

  My brother Raymond was editing the manuscript for the first edition of this book when he got a call from his good friend Marcella, who lives in Los Angeles. She seemed mildly panicked about possibly being pregnant and was calling him for advice. (Ray was accustomed to his friends’ inquiries, since he possessed a certain expertise on fertility that few men do.)

  She explained that she was worried because she was on Day 42 and had never had a cycle longer than 32 days. Clearly enjoying his role as supportive friend and menstrual detective, Ray proceeded to record all the relevant information. Sex with her boyfriend on Day 5. Check. “Sloppy withdrawal.” Check. No cycles ever less than 25 days. Check.

  The data convinced Ray that pregnancy was extremely unlikely. He then went on to explain to Marcella that if she had been sick, or traveled, or had experienced a lot of stress before she ovulated, it was possible ovulation could have been delayed days or even weeks, thus causing the extended cycle. She was not terribly reassured. “You must have been stressed out about something,” he said. Marcella insisted that all was basically uneventful in her life, and that the only unusual anxiety she was experiencing had crept in just a few days earlier, about a week after her last period was “due.”

  Beyond being a menstrual detective, Ray was also an amateur historian. He loved dates. He took out his calendar and stared at it. “Marcella,” he said coyly, “let me just verify. Your last period started on January 6, so you normally would’ve ovulated around January 20, give or take a few days.”

  “Yeah, I guess,” she mumbled nervously.

  “So, I’m just curious, on January 17, did you just sleep through the earthquake, or what?”

  There was a distinct pause.

  “Oh God, I forgot about that! That was one of the scariest things I’ve ever been through, 6.7 on the Richter scale! It was awful.” Ray laughed and told her to relax, that she almost certainly wasn’t pregnant. Three days later Marcella called back, delighted to inform him that she had just gotten her period. Ray suggested that the next time a massive quake strikes, the mayor should go on citywide TV. That way he could assure the women of L.A. that if their periods are late, it’s quite possible there’s nothing to worry about. It could just be your garden-variety, seismically delayed ovulation.

  It should also be noted that a woman may occasionally not release an egg at all. This is referred to as an “anovulatory cycle.” These types of cycles may range from very short to exceedingly long, and are discussed further in Chapter 7.

  THE DRAMA OF CONCEPTION

  When the egg passes through the ovarian wall, it’s usually picked up by the fallopian tube. Once it’s released, it can take less than a minute for the fimbria to draw the egg into the tube with gentle sweeping motions. Assuming fertilization does not occur, the egg remains alive for a maximum of 24 hours, after which it simply disintegrates and gets reabsorbed by the body. The egg is
about the size of the period at the end of this sentence, hardly large enough to be seen reclining on the sanitary napkin, even if it were to come out during your period.*

  If fertilization does occur, it will take place in the outer third of the fallopian tube within a few hours of ovulation. (It does not take place in the uterus, as is commonly believed.) The lucky sperm may have journeyed up to several hours for this momentous rendezvous. The fertilized egg will then continue to be pulled toward the uterus by vibrating cilia, hairlike projections that line the fallopian tubes. After a week or so, it reaches its ultimate destination of the uterine lining and begins the burrowing-in process. (See The Beauty of Reproductive Biology section of the color insert.)

  © OpenStax College, Human Pregnancy and Birth

  In order for conception to occur, though, there must be three factors working together: the egg, the sperm, and a medium in which the sperm can travel to reach the fallopian tubes. The medium is fertile-quality cervical fluid, which acts as a living conduit to direct the sperm through the cervix. Women produce cervical fluid under the influence of increasing levels of estrogen in the first part of the cycle. Because the sperm can live up to five days in fertile-quality cervical fluid, it’s possible to have intercourse on Monday and get pregnant from that act on Friday. So, without wanting to burst anyone’s bubble, you could enjoy a deliciously romantic, snowy evening making love in front of the fire, but not actually conceive until five days later, while you’re jogging and your sweetheart is on a plane to attend a meeting in Kalamazoo.