What Is It?
a man and a woman who are having frequent intercourse without using any
birth control, the average amount of time that it takes to conceive is
six months. Most couples are able to achieve a pregnancy within one
year if they have intercourse frequently (twice per week or more
often). Between 10% and 15% of couples will continue to have difficulty
conceiving after one year of trying. When pregnancy is this slow to
occur, the man and woman are diagnosed as infertile.
can be caused by health problems in the man, the woman or both
partners. In some infertile couples, no cause can be found to explain
the problem. In approximately 20% of couples, more than one cause of
the infertility is found. The cause of infertility occurs about as
often in men as in women.
Normal aging reduces a woman's
ability to become pregnant. Ovulation, the process of forming and
releasing an egg, becomes slower and less effective. Aging begins to
reduce fertility as early as age 30, and pregnancy rates are very low
after age 44, even when fertility medications are used. Even though
fertility is less reliable for women of older ages, approximately 20%
of women in the United States have their first child at or after age
primary symptom of infertility is difficulty getting pregnant. Various
causes of infertility may result in additional symptoms. Any of the
following problems may cause infertility:
(egg release from the ovary) accounts for 20% of female infertility
problems. If your ovulation is infrequent, your periods will be spaced
apart by longer than a month, or they will be absent. Common causes of
infrequent ovulation include body stresses such as eating disorders,
unusually ambitious exercise training, rapid weight loss, low body
weight and obesity. Some hormonal abnormalities such as thyroid
problems, pituitary-gland problems, adrenal-gland problems and
polycystic ovary syndrome can delay or prevent the ovaries from
releasing an egg. Some symptoms that might suggest a hormone
abnormality include unexpected weight loss or gain, fatigue, excessive
hair growth or hair loss, acne and ovarian cysts. Cysts in the ovary
can cause pelvic pain and also can interfere with the normal process of
Scarring in the fallopian tubes
can prevent pregnancy because it stops the egg from traveling into the
uterus. Fallopian-tube problems are the cause in approximately 30% of
female infertility problems. Damage can be from a previous surgery, a
previous ectopic (tubal) pregnancy, tubal scarring from endometriosis
or from pelvic inflammatory disease. Pelvic inflammatory disease is a
bacterial infection in the pelvis, caused by sexually transmitted
bacteria such as gonorrhea or chlamydia. It often scars, damages or
blocks the fallopian tubes. A history of pelvic pain, with or without
fever, may suggest a diagnosis of endometriosis or pelvic infection.
Abnormalities in the shape or lining of the uterus
account for almost 20% of female infertility problems. Fibroid tumors
or uterine polyps sometimes result in heavy menstrual bleeding, pelvic
pain or enlargement of the uterus. Scar tissue can develop within the
uterine cavity as a complication of uterine infections, miscarriages,
abortions, or surgical procedures such as a dilation and curettage
(D&C). Such scar tissue can lead to infrequent periods or minimal
important first step in diagnosing female infertility is figuring out
whether ovulation is occurring at predictable intervals. When an egg is
released, it causes a shift in the body's sex hormones. This shift in
sex hormones can be detected with these tests:
The body's early-morning core body temperature
is affected by hormone shifts. By using a precise thermometer (called a
basal body thermometer) to take your temperature every day when you
first wake up in the morning, you will be able to detect a slightly
higher temperature during the second half of your monthly cycle. This
slight temperature change occurs after ovulation.
An ovulation predictor test
is an over-the-counter urine test that can predict egg release. The
urine test checks for high levels of luteinizing hormone. A positive
test near the middle of your cycle means it is likely you have ovulated
recently or are about to ovulate. The ovulation predictor test kit is
available at most drug stores and pharmacies, and can be performed in
You also can examine your vaginal mucus
at home. With careful instruction, some women are able to interpret
changes in the appearance of the vaginal mucus and consistency of the
cervix as a sign of hormone shifts that show ovulation has occurred.
your doctor examines your vagina and pelvic organs, a sample of mucus
from your cervix and vagina may be tested for possible infection. If
necessary, blood tests also can be used to confirm normal ovulation by
measuring a high progesterone level in the later part of your menstrual
cycle. Blood levels of two additional sex hormones, follicle
stimulating hormone and estradiol, can help show that the ovaries are
functioning well enough to release eggs. These blood tests usually are
done at specific times in your menstrual cycle. Other blood tests may
be needed to measure the function of your thyroid gland, your pituitary
gland and your adrenal glands.
Other tests that are used to understand the cause of infertility examine the physical structure of pelvic organs.
is an X-ray study done after a liquid X-ray dye is allowed to flow into
your uterus through a slender catheter positioned just inside the
cervix. The dye outlines the shape of your uterine cavity and reveals
problems such as polyps, fibroid tumors or other variations in the
shape of the inside of your uterus. The dye also flows through the
fallopian tubes and can reveal problems such as partial or complete
An ultrasound reveals
the shape and size of the uterus, and gives some information about the
uterine cavity or inner lining. This test cannot determine if the
fallopian tubes are blocked. An ultrasound can identify the ovaries,
their shape and size, and the presence of developing cysts. Ultrasound
of the pelvis does not involve the use of X-rays or dye.
Hysteroscopy and laparoscopy
are surgical procedures performed by a gynecologist. Both procedures
use a small video camera to view the pelvic organs. Your gynecologist
can see the inside of your uterus during a hysteroscopy procedure, can
obtain biopsies, and, in some cases, can remove polyps, fibroids or
scar tissue. Laparoscopy allows your doctor to view the outside of your
uterus, and to inspect your ovaries. Sometimes, it is possible to
remove cysts or scar tissue from an ovary using laparoscopy.
a couple's difficulty in getting pregnant is caused by a fertility
problem in the woman, an explanation for her infertility can be found
in about four out of five cases. It is important for the man in the
couple to be checked for fertility problems, too. It is OK to continue
sexual activity during a fertility evaluation unless your doctor
advises you otherwise. With continued frequent sexual intercourse, even
without treatment, you have between a 1% and 3% chance of getting
pregnant during each new menstrual cycle after a single unsuccessful
fertility evaluation usually extends over several months because it
requires numerous tests, and because some tests must be done during a
specific time in the menstrual cycle. The treatments also require time,
careful planning and repeated office visits. The time that it takes to
complete a fertility evaluation can be frustrating, since couples who
need this evaluation already have spent a full year trying for a
You can optimize your chances of getting pregnant in a number of ways.
If you are exercising so heavily that your menstrual periods are
infrequent or absent, your fertility is likely to be impaired.
Avoid extremes of weight. An optimum body mass index (BMI) is at least 20 and below 27.
Avoid alcohol, smoking and excesses of caffeine (more than one cup of coffee per day) and avoid marijuana and cocaine.
Review your medicines with your doctor.
Drugs such as digoxin (Lanoxin); bodybuilding steroids; some drugs for
treatment of thyroid conditions, depression, hypertension, seizure and
asthma; and some prescription antacids can affect your ability to
conceive or carry a normal pregnancy.
you are thinking about parenthood, it is also important to optimize
your health before you get pregnant by making sure that your
immunizations are up-to-date, by avoiding alcohol, by reviewing whether
any medicines you take are safe during pregnancy, and by taking 0.4
milligrams (400 micrograms) of the vitamin folic acid every day,
beginning at least one month before planning to conceive. Starting to
take folic acid supplements a few months before conception greatly
reduces the chance of abnormal development of the baby's spinal column.
treatments for cancer, including chemotherapy and radiation, can cause
infertility. Techniques are now available to help a woman planning to
undergo these treatments to later have a baby from her own egg. Two
strategies have been successful:
Frozen storage — The woman's eggs are removed from her ovary surgically and are frozen.
cell transplantation — Ovary cells are transplanted into an area of the
woman's body that will not be exposed to radiation, such as the arm.
the woman is ready to have a baby, a fertility expert can combine the
egg with sperm and insert it into the woman's uterus. In some cases, if
the woman's uterus has been removed by surgery, a surrogate (different)
woman may volunteer to carry the pregnancy in her uterus.
depends on the results of your infertility evaluation. Some causes of
infertility have a specific treatment, such as surgery to remove a
fibroid tumor or medicines to treat a thyroid problem.
associated with infrequent or absent ovulation often can be treated
with hormone medications called fertility drugs. All fertility
medications have potential side effects, and can cause twins or even
more than two babies in one pregnancy. Most fertility treatments
require the supervision of a fertility specialist. Examples of
fertility medicines include:
citrate (Clomid, Milophene, Serophene) is a medicine that stimulates
the ovary to release one or more eggs. This medicine works indirectly
by adjusting levels of your natural hormones.
forms of luteinizing hormone and follicle-stimulating hormone may be
used when supervised by an infertility specialist. These medications
encourage the ovaries to release more than one egg at a time. This is
known as superovulation, or ovulation induction. These medicines are
sometimes given after a course of treatment by another hormone
medicine, known as a GnRH analogue, that quiets down all natural
hormone stimulation to the ovary in preparation for a precisely timed
cycle of ovulation.
fertility drug treatment, the eggs that mature in your ovary can be
allowed to travel naturally into the uterus if the fallopian tubes are
healthy. Sometimes surgery is used to harvest the eggs that mature
after fertility drug treatment, so they can be fertilized with greater
certainty in the laboratory and then placed into the uterus. Procedures
that can help you to start a pregnancy include:
is a procedure in which sperm are inserted into the uterus directly.
Semen is collected by the man, usually after he stimulates himself to
ejaculate, and is inserted into the uterus using a special catheter or
In vitro fertilization
(commonly called IVF, and known in the early days of the procedure as
"test tube baby") combines egg and sperm in a laboratory dish. Surgery
is required to collect the eggs that your ovary has been stimulated to
release. The eggs and sperm are combined in the laboratory, and the
embryos are inserted into your uterus. Multiple embryos may be placed
inside the uterus, but IVF does not guarantee that a pregnancy will
result. Sometimes, more than one embryo implants itself in the uterus,
which can result in twins, triplets or higher-order multiple
pregnancies. This procedure requires treatment with hormones
Zygote intrafallopian transfer (ZIFT) and gamete intrafallopian transfer
(GIFT) are variations of the surgical IVF procedure and require the
presence of at least one healthy fallopian tube. In ZIFT, eggs are
removed from the ovary by surgery and are combined with sperm in a
laboratory. The resulting embryos are placed in the fallopian tube.
GIFT is when eggs and sperm are placed in the fallopian tube before the
sperm and egg have fertilized together, allowing the eggs and sperm to
fertilize inside the woman. As with IVF, these procedures require
important for you to get counseling about all options for parenthood,
including procedures for adoption. Some health insurance plans do not
pay for infertility treatment or limit coverage to women
only up to a certain age.
When To Call A Professional
it may be possible to become pregnant on your own after one year of
trying to conceive, it is wise to speak with a physician after one year
and possibly begin an infertility evaluation. If you are over 35 and
want to become pregnant, you may want to consult your physician after
four to six months of trying to conceive, because pregnancy is less
likely to occur without fertility treatment at your age.
you are undergoing fertility treatment, including taking medications to
stimulate your ovaries, it is important for you to notify your
infertility specialist about symptoms of pelvic pain and abdominal
swelling. Unusually stimulated ovaries can lead to significantly
enlarged ovaries and cause excessive accumulation of fluid in your
pelvic area and abdomen as a complication of treatment.
chance of any woman having a successful pregnancy depends on the cause
of her infertility problem. It is currently possible for more than half
of couples who seek infertility treatments to eventually have a
American Society for Reproductive Medicine1209 Montgomery Highway
Birmingham, AL 35216-2809
Phone: (205) 978-5000
Fax: (205) 978-5005
RESOLVE: The National Infertility Association7910 Woodmont Ave.
Bethesda, MD 20814
Phone: (301) 652-8585
Fax: (301) 652-9375