Infertility

Infertility is a condition diagnosed in both men and women who cannot conceive a child together after at least one year of frequent, unprotected sex. Infertility may affect only one partner or it could be a problem stemming from both. Among all cases of infertility in developed countries, about 8 percent can be traced to male factors, 37 percent can be traced to female factors, and 35 percent can be traced to factors in both the male and female partners. In about 5 percent of couples, the cause of the infertility cannot be traced to specific factors in either partner. Because fertility involves a complex interaction of male and female factors, your doctor may involve both partners in the evaluation.
Infertility does not always mean that a couple will never have a baby together, but rather that they may need medical assistance in doing so. There are many treatments available to address infertility, many of which produce excellent success rates.

Did you know…

Around one in seven couples may have difficulty conceiving. About 84% of couples  conceive naturally within one year if they have regular unprotected sex (every two or three days). For couples who’ve been trying to conceive for more than three years without success, the likelihood of getting pregnant naturally within the next year is 25% or less.

Frequently Asked Questions

When to get help?

You may have reason to be concerned if you have been trying to get pregnant for at least one year and:

• You are in your late 30s and have been trying to get pregnant for six months or longer.
• Your menstrual cycles are either irregular or absent.
• You have painful periods.
• You have a known history of fertility problems.
• You have a history of pelvic inflammatory disease or endometriosis.
• You have had multiple miscarriages.
• You have been treated for cancer with drugs and radiation.

What are the causes?

Infertility can be present from birth (congenital) or can be acquired as you age. Some of the causes may include:

• Problems with ovulation: Certain conditions, like polycystic ovarian syndrome (ovaries secrete excessive amounts of male hormone testosterone) and hyperprolactinemia (produce high amounts of prolactin, a hormone that induces the production of breast milk), can prevent your ovaries from releasing eggs.
• Damaged fallopian tubes: Fallopian tubes carry the eggs from the ovaries to the uterus. Any damage to them can affect the fertilization of the egg by the sperm. Pelvic surgeries and infections can cause formation of scar tissue that can damage your fallopian tubes.
• Abnormalities of the cervix and uterus: Abnormal mucus production in the cervix, problems with the cervical opening, abnormal shape and presence of benign tumors in the uterus can all contribute to infertility.
• Premature menopause: Mostly caused by a condition known as primary ovarian insufficiency, premature menopause occurs when menstruation stops before the age of 40. The exact cause of this condition is unknown, though various treatments for cancer and abnormalities with the immune system have been known to contribute to it.
• Adhesions: Bands of scar tissue can form in the pelvis after an infection or surgery.
  Other medical conditions: Diabetes, endometriosis, thyroid disorders, and sickle cell disease or kidney diseases can affect the fertility of a woman.
• Medications: Certain medications have been known to cause temporary infertility. Stoppage of those medications can restore fertility in most of the cases.

Who is at risk?

Your risk for infertility increases with age. You are at a greater risk if you smoke, consume excess alcohol, or are overweight, obese, or underweight.

Diagnosis

Female infertility can be confirmed with the following tests:

• Blood tests measure your hormone levels and determine if you are ovulating.
• Ovarian reserve testing may be performed in order to determine the number and quality of eggs ready for ovulation.
• Imaging studies such as a pelvic ultrasound or hysterosonography may be performed to obtain a detailed view of your fallopian tubes and uterus.
• Hysterosalpingography involves obtaining an x-ray image after injecting a contrast material into your cervix which travels up to your fallopian tubes. This can help identify any blockages in your fallopian tubes.
• Laparoscopic evaluation involves inserting a thin tube fitted with a camera through an incision in your abdomen, in order to detect any abnormalities in your reproductive organs, such as the ovaries, uterus, and fallopian tubes.

What should I expect during my infertility consultation?

Your infertility visit will seek to find the reasons for your inability to conceive. You and your partner will attend together, at which time your fertility doctor will ask you about your medical history and menstruation. You’ll also be asked personal questions about you and your partner’s intimate relationship, such as how frequently you have sex and how long you have been trying to conceive. Additional screenings and tests may also be ordered to determine your ability to conceive individually and as a couple.

How is infertility treated?

Your doctor will suggest a treatment suitable for your problem. Fertility drugs may be recommended to stimulate and regulate ovulation, in women who are infertile due to ovarian disorders. You could also be chosen for assisted insemination, where healthy sperm is collected, concentrated, and placed directly into your uterus, when your ovary releases eggs to be fertilized. This procedure is also known as intrauterine insemination (IUI), and can be in tandem with your normal menstrual cycle or fertility drugs. Apart from these, problems with your uterus, such as intrauterine polyps or scar tissue, can be treated with surgery.

In vitro fertilization (IVF) is a type of assisted reproductive technique, which involves collecting multiple mature eggs from a woman and fertilizing them with sperm outside the body, in the lab. Once fertilized, the embryos are implanted into the uterus within three to five days, to grow and develop. The success rate of IVF depends on the age of the woman undergoing treatment, as well as the cause of the infertility. Younger women are more likely to have a successful pregnancy. IVF isn’t usually recommended for women above the age of 42, because the chances of a successful pregnancy are thought to be too low.

Conclusion

Infertility can be of a variety of causes, and the treatment may differ accordingly. Dealing with infertility can be difficult and can be stressful and emotional, but there is hope – about two-thirds of the couples treated for infertility conceive successfully. Your doctor will be the best person to address your concerns.