Infertility is defined as the inability for a couple to become pregnant after a year of regular, unprotected intercourse. The male partner, the female partner, or both, may have a fertility problem. In women over 35 years old, an evaluation and possible treatment is needed after 6 months of unprotected intercourse.
A person who is infertile has a reduced ability to have a child. It usually doesn't mean a person is sterile — that is, physically unable ever to have a child. Up to 15% of all couples are infertile, but only 1% to 2% are sterile. Half of couples who seek help can eventually bear a child, either on their own or with medical assistance.
Men and women are equally likely to have a fertility problem. In about one in five infertile couples, both partners contribute to fertility problems, and in about 15% of couples, no cause is found after all tests have been done. This is called "unexplained infertility."
For many couples, infertility is a crisis. Fertility problems often come with feelings of guilt or inadequacy. But a diagnosis of infertility is not necessarily a verdict of sterility.
One-third of cases are due to infertility involving only the male and one-third of cases of infertility are involving only the female. The remaining cases of infertility involve both the mail and female or the cause is unknown.
- Ovulation disorders
- Polycystic ovary syndrome (PCOS)
- Excessive exercise
- Eating disorders
- Uterine or cervical abnormalities
- Uterine or cervical abnormalities
- Problem with opening of the cervix
- Abnormalities in shape or cavity of the uterus
- Benign tumors in the uterine wall (Uterine fibroids)
- Fallopian tube damage or blockage
- Pelvic inflammatory disease
- Sexually transmitted infection
- Primary ovarian insufficiency
- Early menopause (<40 years of age)
- Pelvic adhesions
- Scar tissue
- Thyroid problems
- Cancer and its treatment
- Certain medications
- Abnormal sperm production or function
- Undescended testicles
- Genetic defects
- Enlarged veins in the testes (varicocele)
- Problems with the delivery of sperm
- Premature ejaculation
- Cystic fibrosis
- Testicular blockage
- Organ injury
- Overexposure to certain environmental factors
- Anabolic steroids
- Cystic fibrosis
- Frequent heat exposure (saunas or hot tubs)
- Damage from cancer or cancer treatment
Most couples achieve pregnancy within the first six months of trying. Overall, after 12 months of unprotected intercourse, approximately 90 percent of couples will become pregnant. The majority of the remaining couples will eventually conceive, with or without treatment.
The main sign of infertility is the inability for a couple to get pregnant. There may be no other obvious symptoms.
In some cases, an infertile woman may have abnormal menstrual periods. An infertile man may have some signs of hormonal problems, such as changes in hair growth or sexual function.
When to see a doctor
In general, don't be too concerned about infertility unless you and your partner have been trying regularly to conceive for at least one year.
Talk with your doctor earlier, however, if you're a woman and:
- You're age 34 or older and have been trying to conceive for six months or longer
- You menstruate irregularly or not at all
- Your periods are very painful
- You have been diagnosed with endometriosis or pelvic inflammatory disease (PID)
- You've had more than one miscarriage
If you're a man, talk with your doctor if you have:
- Low sperm count
- A history of testicular, prostate or sexual problems
Both partners will undergo physical examination to determine if there are any physical disorders contributing infertility.
Gender specific testing
For a man to be fertile, the testicles must produce enough healthy sperm, and the sperm must be ejaculated effectively into the woman's vagina and be able to travel to the egg. Specific tests for male infertility attempt to determine whether any of these processes are impaired:
- Semen analysis
- Hormone testing
- Transrectal and scrotal ultrasound
- Genetic testing
For a woman to be fertile, her ovaries must release healthy eggs. Her reproductive tract must allow an egg to pass into her fallopian tubes and allow the sperm to join the egg for fertilization. The fertilized egg must travel on to the uterus and implant in the lining. Specific tests for female infertility attempt to determine whether any of these processes are impaired.
- Ovulation testing
- Ovarian reserve testing
- Other hormone testing
- Imaging tests
Treatment depends on the cause of infertility. It may involve:
- Education and counseling
- Fertility treatments such as intrauterine insemination (IUI) and in vitro fertilization (IVF)
- Medicines to treat infections and clotting disorders
- Medicines that help the woman grow and release eggs from the ovaries
It is important to recognize and discuss the emotional impact that infertility has on you and your partner, and to seek medical advice from your health care provider.
You can increase your chances of becoming pregnant each month by having sex at least every 3 days before and during ovulation. It is especially important to do so before ovulation occurs. Sperm can live inside a woman's body for at least 3 days. However, a woman's egg can only be fertilized by the sperm for a few hours after it is released.
Ovulation occurs about 2 weeks before the next menstrual cycle (period) starts. If a woman gets her period every 28 days, the couple should have sex at least every 3 days between the 10th and 18th day after the period starts.
Common medicines used to treat infertility include clomiphene citrate, human menopausal gonadotropin (hMG), follicle-stimulating hormone (FSH), or gonadotropin-releasing hormone (Gn-RH) analog. Treatment can cause side effects but it is important that a person never changes their dosage or stops taking their medication without talking to their doctor or pharmacist.
Common side effects for the different medication options for infertility include:
- Human menopausal gonadotropin (hMG) — Injection site pain, lower-abdomen tenderness, fluid retention, headache, emotional irritability, breast discomfort and fatigue
- Follicle-stimulating hormone (FSH) — Injection site pain, abdominal pain, weight gain, breast discomfort, emotional irritability, nausea, vomiting and diarrhea
- Gonadotropin-releasing hormone(Gn-RH) — An irregular menstrual period (or no menstrual period at all); hot flashes; vaginal burning, itching or dryness; decreased sexual interest and increased acne or oily skin or hair.