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Infertility

Infertility means not being able to get pregnant after one year of trying. Or, six months, if a woman is 35 or older.  Women who are able to get pregnant but who cannot carry a pregnancy to term (birth) may also be considered infertile.

The term "infertility" is limited to those who are of normal childbearing age, not those who can’t get pregnant because they are near or past menopause.

Infertility is a common problem. About 1 out of 10 of women (10%) in the U.S. ages 15-44 have difficulty getting pregnant or staying pregnant.

About 1/3 of infertility cases are caused by women’s problems. Another 1/3 of fertility problems are due to the man. The other cases are caused by a mixture of male and female problems or by problems that cannot be determined.

What causes infertility?

There are many possible causes of infertility. Having a successful pregnancy involves many steps along a very complex path. Problems with any of these steps can lead to infertility.

Pregnancy involves some of the following steps at which points problems can arise:

The cause of infertility can rest in the woman or the man, or can be result from multiple factors.  In some cases, environmental factors can contribute to infertility, such as medications. In other cases, genetic conditions or other chronic health problems are the main cause of infertility.

Common causes for infertility can often be detected with the use of different tests. However, it may not always be possible to determine the cause of infertility.

Female infertility

Most cases of infertility in women result from problems with ovulation. Some conditions affecting ovulation include premature ovarian failure, in which the ovaries stop functioning before natural menopause. Primary ovarian insufficiency (POI)  occurs when a woman’s ovaries stop working normally before she is 40. POI is not the same as early menopause.

Polycystic ovary syndrome (PCOS), in which the ovaries may not release an egg regularly or may not release a viable, healthy egg is another cause of infertility. Among women who have PCOS, even when a healthy egg is released and fertilized, the uterus may not be receptive to implantation of a fertilized egg, which results in infertility.

Other causes of infertility might include:

A woman’s risk for infertility can also be affected by certain lifestyle and environmental factors, including (but not limited to):

A Woman's Age and Infertility

Many women are waiting until their 30s and 40s to have children. 20% of women in the U.S. now have their first child after age 35. So age is a growing cause of fertility problems. About one-third of couples in which the woman is over 35 have fertility problems.

Aging decreases a woman's chances of having a baby in the following ways:
    •    Her ovaries become less able to release eggs.
    •    She has a smaller number of eggs left.
    •    Her eggs are not as healthy.
    •    She is more likely to have health conditions that can cause fertility problems.
    •    She is more likely to have a miscarriage.

Male infertility

The male fertility process involves the production of mature sperm and getting the sperm to reach and fertilize the egg. Although it may seem to be a simpler process than female fertility, male fertility also requires many conditions to be met: the ability to have and sustain an erection, having enough sperm, having enough semen to carry the sperm to the egg, and having sperm of the right shape that move in the right way.  A problem meeting any of these conditions contributes to infertility.

Male infertility is most often caused by:

A man's sperm can be changed by his overall health and lifestyle. Some things that may reduce the health or number of sperm include:

How is infertility diagnosed?

Although not getting pregnant is an indication of possible infertility, only a health care provider can provide a diagnosis of infertility.

Doctors will do an infertility checkup. This involves a physical exam. The doctor will also ask for both partners’ health and sexual histories. Sometimes this can find the problem. However, most of the time, the doctor will need to do more tests.

In men, doctors usually begin by testing the semen. They look at the number, shape, and movement of the sperm. Sometimes doctors also suggest testing the level of a man's hormones.

Doctors can also check ovulation with blood tests. Or they can do an ultrasound of the ovaries.

If ovulation is normal, there are other fertility tests available.

Some common tests of fertility in women include:

Hysterosalpingography: Hysterosalpingography is an x-ray of the uterus and fallopian tubes. Doctors inject a special dye into the uterus through the vagina. This dye shows up in the x-ray. Doctors can then watch to see if the dye moves freely through the uterus and fallopian tubes. This can help them find physical blocks that may be causing infertility. Blocks in the system can keep the egg from moving from the fallopian tube to the uterus. A block could also keep the sperm from reaching the egg.

Laparoscopy: Laparoscopy involves the use of a small tube-like tool with a light at the end called a laparoscope which allows the doctor to see inside the abdomen. The doctor make a small cut in the lower abdomen and inserts the laparoscope. With the laparoscope, the doctor can check the ovaries, fallopian tubes, and uterus for disease and physical problems, such as scarring and endometriosis.

Finding the cause of infertility can be a long and emotional process. It may take time to complete all the needed tests. So don't worry if the problem is not found right away.

How Is Infertility Treated?

Infertility can be treated with medicine, surgery, artificial insemination, or assisted reproductive technology. Many times these treatments are combined. In most cases infertility is treated with drugs or surgery.

Doctors recommend specific treatments for infertility based on:

Although there are treatment options that can help improve a couple's chances of having a successful pregnancy, some causes may not be treatable.

Treatment for Female infertility

Some common medicines used to treat infertility in women include:

Many fertility drugs increase a woman's chance of having twins, triplets, or other multiples.

Women who are pregnant with multiple fetuses have more problems during pregnancy. Multiple fetuses have a high risk of being born too early (prematurely). Premature babies are at a higher risk of health and developmental problems.

In women, some physical problems can also be corrected with surgery.

Intrauterine insemination (IUI)

Intrauterine insemination (IUI) is an infertility treatment that is often called artificial insemination. In this procedure, the woman is injected with specially prepared sperm. Sometimes the woman is also treated with medicines that stimulate ovulation before IUI.

IUI is often used to treat:

Assisted Reproductive Technology (ART)

Assisted reproductive technology (ART) is a group of different methods used to help infertile couples. ART works by removing eggs from a woman's body. The eggs are then mixed with sperm to make embryos. The embryos are then put back in the woman's body.

Surrogacy

Women with no eggs or unhealthy eggs might also want to consider surrogacy. A surrogate is a woman who agrees to become pregnant using the man's sperm and her own egg. The child will be genetically related to the surrogate and the male partner. After birth, the surrogate will give up the baby for adoption by the parents.

Gestational Carrier

Women with ovaries but no uterus may be able to use a gestational carrier. This may also be an option for women who shouldn't become pregnant because of a serious health problem. In this case, a woman uses her own egg. It is fertilized by the man's sperm and the embryo is placed inside the carrier's uterus. The carrier will not be related to the baby and gives him or her to the parents at birth.

Treatment for male infertility

Doctors often treat infertility in men in the following ways:

Getting Help for Infertility

Those who suspect they are infertile should see their health care providers, including:

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