What Is Infertility?
Infertility is defined as not being able to become pregnant after a year of trying—or after six months, if you are 35 or older (Mayo Clinic). And it’s not just a woman’s problem. One-third of infertility cases are due to male-only problems, one-third to female-only problems, and the final one-third to a mix of male and female problems or unknown problems (CDC).
It is estimated that 10 percent of women in the U.S. between the ages of 15 and 44 have problems becoming or staying pregnant due to issues with male or female infertility (CDC).
What Causes Infertility?
To become pregnant, many steps in the reproductive process have to be precisely aligned:
- A woman’s ovary must release an egg (ovulation).
- The egg must then travel through the fallopian tube toward the uterus, which is also called the womb.
- A man’s sperm must be in the woman’s body during this specific time. It must also meet and join with (fertilize) the egg as it is traveling through the fallopian tubes.
- The fertilized egg must then reach the uterus.
- At the uterus, it must push its way inside and implant itself (implantation).
If there is a problem with any of these steps, infertility can occur.
Infertility in Women
Female infertility is most often caused by problems in ovulation—marked by irregular or absent periods. These problems may be related to hormonal disorders, such as polycystic ovarian syndrome (PCOS), or primary ovarian insufficiency (POI), when a woman’s ovaries stop working before age 40.
Other causes include:
- uterine fibroids, benign growths that can keep fertilized eggs from implanting properly in the uterine lining
- scar tissue after surgery
- early menopause
- blocked or scarred fallopian tubes, due to infection or endometriosis
Endometriosis is an often painful condition in which the uterine tissue that is supposed to line the inside of your uterus begins to grow outside the uterus, causing it to become trapped as it has no place to go (uterine tissue inside the uterus is shed each month during the menstrual cycle). The surrounding body tissues become inflamed, and scar tissue may form—sometimes inside the fallopian tubes.
Infertility in Men
Problems with sperm production and delivery, low sperm count, and low motility (the ability of sperm to swim and fertilize the egg) can all affect male fertility.
Varicocele is a disorder where the veins servicing a man’s testicles have incompetent or leaky valves. The backflow of blood can enlarge the blood vessels and can raise the temperature of the testicles causing a low sperm count or abnormal sperm. Testicles are generally slightly below the core body temperature.
What Are Other Symptoms of Infertility?
The main sign of infertility is not being able to become pregnant after unprotected intercourse after a year of trying—or after six months, if you are 35 or older.
Women may also experience the following symptoms:
- irregular or absent menstrual periods
- painful periods
- multiple miscarriages
Men may also have a history of testicular, prostate, or sexual problems.
Who Is At Risk for Infertility?
Certain risk factors can make it more difficult for men and women to conceive.
Women older than 30 and men older than 40 are at a higher risk for infertility. Yet, according to the Centers for Disease Control and Prevention, about 20 percent of women in the U.S. are now waiting until their thirties or forties to have children (CDC).
Other lifestyle choices can impair healthy egg and sperm production, including:
- heavy alcohol use
- drug use
- being overweight or underweight
- an excessive amount of exercise
In men, environmental toxins, such as pesticides, and high temperatures (for example, in hot tubs) have also been shown to affect sperm count.
How Is Infertility Diagnosed?
Your doctor will usually start with a physical examination and will want to discuss your medical and sexual history. If no cause is immediately evident, additional tests may also be required.
In men, your doctor may ask for a semen analysis, which will look for problems with sperm, including low sperm count or motility issues.
A blood test to examine hormone levels and an ultrasound to look for certain conditions, such as retrograde ejaculation or ejaculatory duct obstruction, may also be needed. In retrograde ejaculation, semen (the white fluid that contains sperm) enters the bladder instead of exiting through the penis. Sometimes cysts may form on the ejaculatory ducts, which can block semen from exiting the duct and traveling to the penis for ejaculation. This is ejaculatory duct obstruction.
In women, the first concern is whether there are ovulation problems. Your doctor may ask you to track your ovulation, or may check your ovulation with a blood test.
If ovulation is normal, your doctor may look for other problems with the ovaries, fallopian tubes, or uterus. He or she will look for these problems by using an X-ray, ultrasound, or laparoscopy.
A laparoscopy is a minimally invasive procedure (performed under general anesthesia) in which your doctor makes a small incision under your navel. He or she will then insert a small camera in order to look at your fallopian tubes, ovaries, and uterus. This procedure is helpful in finding endometriosis, scarring, and fallopian tube blockages or abnormalities.
Not all tests (for men or women) may be required. However, identifying the cause of an infertility problem can take several months and can be expensive. In 30 percent of cases, a specific cause of infertility is never identified (Mayo Clinic).
How Is Infertility Treated?
Infertility treatments include:
- Fertility drugs. These medications help to regulate or to trigger ovulation, but can also increase a woman’s chance of having twins or other multiple births.
- Surgery. Laparoscopic, or minimally invasive surgery, can help open or repair damaged or blocked fallopian tubes.
- Artificial insemination. Fertility treatments are often combined with artificial insemination, also known as intrauterine insemination. This involves placing specially prepared sperm into a woman’s uterus. The sperm may be retrieved from a male partner or an anonymous sperm donor.
- In vitro fertilization (IVF). IVF is a process where eggs and sperm are retrieved from the couple in question, then combined in a laboratory, forming embryos. The embryos are then placed inside the woman’s uterus. IVF is usually recommended when all other treatments have failed. According to the Cleveland Clinic, the average success rate for IVF is 40 percent during a single monthly cycle (Cleveland Clinic).
What Is the Prognosis for Infertility?
If you are having problems becoming or staying pregnant, remember that you are not alone. Infertility is a problem that many men and women face. To help you cope, make sure to find support, consider your options, and manage your stress during diagnosis and treatment. If you want to have a child, a growing number of treatment options are available to make this possible.