Infertility means that couples have been trying to get pregnant with frequent intercourse for at least a year with no success. An estimated 10 to 15 percent of couples have trouble getting pregnant or getting to a successful delivery.
Infertility results from female infertility factors about one-third of the time and male infertility factors about one-third of the time. In the rest, the cause is either unknown or a combination of male and female factors.
The cause of female infertility can be difficult to diagnose, but many treatments are available. Treatment options depend on the underlying problem. Treatment isn’t always necessary — many infertile couples will go on to conceive a child spontaneously.
Symptoms
The main symptom of infertility is the inability of a couple to get pregnant. A menstrual cycle that’s too long (35 days or more), too short (less than 21 days), irregular or absent can be a sign of lack of ovulation, which can be associated with female infertility. There may be no other outward signs or symptoms.
When to see a doctor
When to seek help depends, in part, on your age.
If you’re in your early 30s or younger, most doctors recommend trying to get pregnant for at least a year before having any testing or treatment.
If you’re between 35 and 40, discuss your concerns with your doctor after six months of trying.
If you’re older than 40, your doctor may want to begin testing or treatment right away.
Your doctor also may want to begin testing or treatment right away if you or your partner has known fertility problems, or if you have a history of irregular or painful periods, pelvic inflammatory disease, repeated miscarriages, prior cancer treatment, or endometriosis.
Causes
To become pregnant, each of these factors is essential:
You need to ovulate. Achieving pregnancy requires that your ovaries produce and release an egg, a process known as ovulation. Your doctor can help evaluate your menstrual cycles and confirm ovulation.
Your partner needs sperm. For most couples, this isn’t a problem unless your partner has a history of illness or surgery. Your doctor can run some simple tests to evaluate the health of your partner’s sperm.
You need to have regular intercourse. You need to have regular s*xual intercourse during your fertile time. Your doctor can help you better understand when you’re most fertile during your cycle.
You need to have open fallopian tubes and a normal uterus. The egg and sperm meet in the fallopian tubes, and the pregnancy needs a healthy place to grow.
For pregnancy to occur, every part of the complex human reproduction process has to take place just right. The steps in this process are as follows:
One of the two ovaries releases a mature egg.
The egg is picked up by the fallopian tube.
Sperm swim up the cervix, through the uterus and into the fallopian tube to reach the egg for fertilization.
The fertilized egg travels down the fallopian tube to the uterus.
The fertilized egg implants and grows in the uterus.
In women, a number of factors can disrupt this process at any step. Female infertility is caused by one or more of these factors.
1. Ovulation disorders
2. Polycystic ovary syndrome (PCOS).
3. Hypothalamic dysfunction.
4. Premature ovarian insufficiency.
5. Too much prolactin.
6. Damage to fallopian tubes (tubal infertility)
7. Pelvic inflammatory disease, an infection of the uterus and fallopian tubes due to chlamydia, gonorrhea or other sexually transmitted infections
8. Previous surgery in the abdomen or pelvis, including surgery for ectopic pregnancy, in which a fertilized egg becomes implanted and starts to develop in a fallopian tube instead of the uterus
9. Pelvic tuberculosis, a major cause of tubal infertility worldwide, although uncommon in the United States
10. Endometriosis
Endometriosis occurs when tissue that normally grows in the uterus implants and grows in other locations. This extra tissue growth — and the surgical removal of it — can cause scarring, which may obstruct the tube and keep the egg and sperm from uniting. It can also affect the lining of the uterus, disrupting implantation of the fertilized egg. The condition also seems to affect fertility in less-direct ways, such as damage to the sperm or egg.
11. Uterine or cervical causes
Several uterine or cervical causes can impact fertility by interfering with implantation or increasing the likelihood of a miscarriage.
12. Benign polyps or tumors (fibroids or myomas)
13. Uterine abnormalities present from birth, such as an abnormally shaped uterus, can cause problems becoming or remaining pregnant.
14. Cervical stenosis, a cervical narrowing, can be caused by an inherited malformation or damage to the cervix.
15. Unexplained infertility
In some instances, a cause for infertility is never found. It’s possible that a combination of several minor factors in both partners underlie these unexplained fertility problems. Although it’s frustrating to not get a specific answer, this problem may correct itself with time
Treatments and drugs
How your infertility is treated depends on the cause, your age, how long you’ve been infertile and personal preferences. Because infertility is a complex disorder, treatment involves significant financial, physical, psychological and time commitments. Although some women need just one or two therapies to restore fertility, it’s possible that several different types of treatment may be needed before you’re able to conceive.
Treatments can either attempt to restore fertility — by means of medication or surgery — or assist in reproduction with sophisticated techniques.
1. Fertility restoration: Stimulating ovulation with fertility drugs. Fertility drugs, which regulate or induce ovulation, are the main treatment for women who are infertile due to ovulation disorders. In general, they work like the natural hormones — follicle-stimulating hormone (FSH) and luteinizing hormone (LH) — to trigger ovulation. They are also used in women who ovulate to try to stimulate a better egg or an extra egg or eggs. Fertility drugs may include:
Clomiphene citrate.
Gonadotropins.
Metformin.
Letrozole.
Bromocriptine.
2. Fertility restoration: Surgery
Several surgical procedures can correct problems or otherwise improve female fertility. However, surgical treatments for fertility are rare these days now that other fertility treatments have high success. They include:
Laparoscopic or hysteroscopic surgery.
Tubal ligation reversal surgery (microscopic).
Tubal surgeries.
3. Reproductive assistance
The most commonly used methods of reproductive assistance include:
Intrauterine insemination (IUI). During IUI, millions of healthy sperm are placed inside the uterus close to the time of ovulation.
Assisted reproductive technology. These methods involve retrieving mature eggs from a woman, fertilizing them with a man’s sperm in a dish in a lab, then transferring the embryos into the uterus after fertilization. IVF is the most effective assisted reproductive technology. An IVF cycle takes several weeks and requires frequent blood tests and daily hormone injections.
Preventions
If you’re a woman thinking about getting pregnant soon or in the future, you may improve your chances of having normal fertility if you:
Maintain a normal weight. Overweight and underweight women are at increased risk of ovulation disorders. If you need to lose weight, exercise moderately. Strenuous, intense exercise of more than seven hours a week has been associated with decreased ovulation.
Quit smoking. Tobacco has multiple negative effects on fertility, not to mention your general health and the health of a fetus. If you smoke and are considering pregnancy, quit now.
Avoid alcohol. Heavy alcohol use may lead to decreased fertility. And any alcohol use can affect the health of a developing fetus. If you’re planning to become pregnant, avoid alcohol, and don’t drink alcohol while you’re pregnant.
Reduce stress. Some studies have shown that couples experiencing psychological stress had poorer results with infertility treatment. If you can, find a way to reduce stress in your life before trying to become pregnant.
Limit caffeine. Some physicians suggest limiting caffeine intake to less than 200 to 300 milligrams a day