Infertility

If a woman can get pregnant but keeps having miscarriages or stillbirths, that’s also called infertility.

Infertility is fairly common. After one year of having unprotected sex, about 15 percent of couples are unable to get pregnant. About a third of the time, infertility can be traced to the woman. In another third of cases, it is because of the man. The rest of the time, it is because of both partners or no cause can be found.

There are treatments that are specifically for men or for women. Some involve both partners. Drugs, assisted reproductive technology, and surgery are common treatments. Happily, many couples treated for infertility go on to have babies.

Prevention

Preventing sexually transmitted infections (STIs), such as gonorrhea and chlamydia, may reduce your risk of infertility.

Maintaining a healthy diet, weight, and lifestyle may increase your chance of getting pregnant and having a healthy pregnancy.

Risk Factors

Healthy couples under age 30 who have sex regularly will have a 25 to 30% chance of getting pregnant each month.

A woman is most fertile in her early 20s. The chance a woman can get pregnant drops greatly after age 35 (and especially after age 40). The age when fertility starts to decline varies from woman to woman.

Infertility problems and miscarriage rates increase significantly after 35. There are now options for early egg retrieval and storage for women in their 20’s. This will help ensure a successful pregnancy if childbearing is delayed until after age 35. This is an expensive option, but for women who know they will need to delay childbearing, it may be worth considering.

Causes

Many physical and emotional factors can cause infertility. It may be due to problems in the woman, man, or both.

FEMALE INFERTILITY

Female infertility may occur when:

• A fertilized egg or embryo does not survive once it attaches to the lining of the womb (uterus).
• The fertilized egg does not attach to the lining of the uterus.
• The eggs cannot move from the ovaries to the womb.
• The ovaries have problems producing eggs.

Female infertility may be caused by:

• Autoimmune disorders, such as antiphospholipid syndrome (APS)
• Birth defects that affect the reproductive tract
• Cancer or tumor
• Clotting disorders
• Diabetes
• Drinking too much alcohol
• Exercising too much
• Eating disorders or poor nutrition
• Growths (such as fibroids or polyps) in the uterus and cervix
• Medicines such as chemotherapy drugs
• Hormone imbalances
• Obesity
• Older age
• Ovarian cysts and polycystic ovary syndrome (PCOS)
• Pelvic infection or pelvic inflammatory disease (PID)
• Scarring from sexually transmitted infection, abdominal surgery or endometriosis
• Smoking
• Surgery to prevent pregnancy (tubal ligation) or failure of tubal ligation reversal (reanastomosis)
• Thyroid disease

MALE INFERTILITY

Male infertility may be due to:

• Decreased number of sperm
• Blockage that prevents the sperm from being released
• Defects in the sperm

Male infertility can be caused by:

• Birth defects
• Cancer treatments, including chemotherapy and radiation
• Exposure to high heat for prolonged periods
• Heavy use of alcohol, marijuana, or cocaine
• Hormone imbalance
• Impotence
• Infection
• Medicines such as cimetidine, spironolactone, and nitrofurantoin
• Obesity
• Older age
• Retrograde ejaculation
• Scarring from sexually transmitted infections, injury, or surgery
• Smoking
• Toxins in the environment
• Vasectomy or failure of vasectomy reversal

Diagnosis

Deciding when to get treated for infertility depends on your age. Healthcare providers often suggest that women under 30 try to get pregnant on their own for 1 year before getting tested.

Many experts recommend that women over 35 attempt conception for only 6 months. If a pregnancy does not occur within that time, they should talk to their provider.

Infertility testing involves a medical history and physical exam for both partners.

Blood and imaging tests are most often needed.

IN WOMEN THESE MAY INCLUDE:

• Blood tests to check hormone levels, including progesterone and follicle stimulating hormone (FSH)
• Home urine ovulation detection kits
• Measurement of body temperature every morning to see if the ovaries are releasing eggs
• FSH and clomid challenge test
• Antimullerian hormone testing (AMH)
• Hysterosalpingography (HSG)
• Pelvic ultrasound
• Laparoscopy
• Thyroid function tests

TESTS IN MEN MAY INCLUDE:

• Sperm testing
• Exam of the testes and penis
• Ultrasound of the male genitals
• Blood tests to check hormone levels
• Testicular biopsy

Treatment

Treatment depends on the cause of infertility.

IT MAY INVOLVE:

• Education and counseling about the condition
• Fertility treatments such as intrauterine insemination (IUI) and in vitro fertilization (IVF)
• Medicines to treat infections and clotting disorders
• Medicines that help the growth and release of eggs from the ovaries

Couples can increase the chances of becoming pregnant each month by having sex at least every 3 days before and during ovulation.

Ovulation occurs about 2 weeks before the next menstrual cycle (period) starts. Therefore, 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 her period starts.

HAVING SEX BEFORE OVULATION OCCURS IS ESPECIALLY HELPFUL.

• 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.

Women who are under or overweight may increase their chances of becoming pregnant by reaching a healthier weight.

Recovery

As many as 1 in 5 couples diagnosed with infertility eventually become pregnant without treatment.

More than half of couples with infertility become pregnant after treatment. This figure does not include advanced techniques such as in vitro fertilization (IVF).