Infertility

What is infertility?

Infertility is defined by the American Society for Reproductive Medicine (ASRM) as a disease of the reproductive system that impairs the body's ability to perform the basic function of reproduction. Although conceiving a child may seem to be simple and natural, the physiological process is quite complicated and relies on many bodily functions working properly, including the following, as listed by the ASRM:

  • production of healthy sperm by the man
  • production of healthy eggs by the woman
  • unblocked fallopian tubes that allow the sperm to reach the egg
  • the sperm's ability to fertilize the egg
  • the ability of the fertilized egg to become implanted in the uterus
  • adequate embryo quality

Who is affected by infertility?

Infertility affects about 12 percent of couples of childbearing age. Infertility is not solely dependent upon a woman’s body. A problem with the male is the sole cause or a contributing cause of infertility in about 50 percent of infertile couples. About one-third of infertile couples have more than one cause or factor that relates to their inability to conceive.

What causes infertility?

Many different factors and problems can cause infertility, including problems in the female reproductive system, problems in the male reproductive system, or a combination of the two.

The following are some of the conditions or factors that are associated with infertility:

  • Female factors
  • Male factors
  • Other factors may arise from the defective delivery of sperm into the female genital tract, which could be caused by impotence or premature ejaculation.

How is infertility diagnosed?

When conception does not occur after one year of unprotected intercourse, after six months in women over age 35, or if there are known problems causing infertility, we recommend a medical evaluation of both the male and female. Some obstetrician/gynecologists (OB/GYNs), certified nurse midwifes (CNMs) and nurse practitioners (NPs) are able to provide basic infertility evaluation and treatment. However, many causes of infertility are best treated by a board-certified reproductive endocrinologist. This is an OB/GYN who has had additional education and training in infertility and is certified with the American Board of Obstetrics and Gynecology in the sub-specialty of Reproductive Endocrinology and Infertility.

Generally, the OB/GYN or reproductive endocrinologist will evaluate specific situations and perform tests in both the male and female partners to determine the cause of infertility. The doctor is looking for answers to the following questions:

  • Is the female ovulating regularly?
  • Is the male producing healthy, viable sperm?
  • Are the female's egg and the male's sperm able to unite and grow normally?
  • Are there any obstacles to proper implantation and maintenance of the pregnancy?

The following tests are often part of the basic medical workup for infertility.

  • Both partners
    • Medical and sexual history. This is to evaluate possible physical causes of infertility and whether sexual intercourse has been appropriately timed.
    • Female
      • Physical examination. A complete physical examination (including a Pap smear and testing for infection) will be necessary.
      • Ovulation evaluation. An evaluation of ovulation function using an analysis of body temperatures and ovulation, called the basal body temperature chart, or using ovulation prediction methods obtained from urine samples, may be recommended.
      • Hormone testing. Hormone testing may be recommended, as certain hormones increase and decrease in production at various times during the monthly cycle.
      • Ultrasound. Ultrasound can show the presence of follicles (the sacs containing developing eggs) and the thickness of the uterine tissues. Ultrasound can also show abnormal conditions, such as ovarian cysts or fibroids (benign tumors in the uterus).
      • X-rays. A hysterosalpingogram may be recommended. This test uses a radio-opaque dye that is injected into the cervical opening to visualize the inside of the uterus and determine whether the fallopian tubes are open.
    • Male
      • Semen analysis. A collection of a semen sample obtained by masturbation is analyzed in the laboratory for the sperm count, sperm motility, and sperm shape and quantity, along with evaluation of the ejaculate liquid may be recommended.
      • Other tests may be performed that evaluate the sperm's ability to penetrate the egg, and male hormone testing may be recommended as well.

What is the treatment for infertility?

Specific treatment for infertility will be determined by your doctor based on:

  • your age, overall health and medical history
  • extent of the disorder
  • cause of the disorder
  • your tolerance for specific medications, procedures or therapies
  • expectations for the course of the disorder
  • your opinion or preference

Once your infertility specialist makes a diagnosis, he or she can work with you to determine the best course of treatment. According to the ASRM, most infertility cases (85 to 90 percent) are treated with conventional therapies, such as drug treatment or surgical repair of reproductive abnormalities. Depending on the cause of infertility, there are many options to offer an infertile couple.

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