What is infertility?
Infertility is defined as the inability to conceive after 12 months of unprotected sexual intercourse. Infertility may be attributed to the man, the woman, or both partners. Infertility does not mean that a couple is sterile and will never have a child. Approximately half of all couples who seek help for infertility will eventually conceive a child.
What's the difference between sterility and infertility?
Sterility means that it is impossible for a couple to conceive a child. A diagnosis of sterility is given after a thorough medical examination concludes that there is no sperm production and ovulation cannot occur. With infertility, the couple is not sterile, but for some reason they have not been able to conceive a child. There are three conditions that need to be met for conception to be possible: sperm must be present, the fallopian tubes must be open, and ovulation must be able to occur. If one or more of these conditions is not met, the couple suffers from infertility.
When should a couple seek treatment for infertility?
A couple with both partners under 35 years old should consult a physician if they are unable to conceive after 12 months of unprotected sexual intercourse. If the male or female is over 35 years old, they should consult a physician after six months if they are unable to conceive.
Are some people more at risk for infertility than others?
In some cases lifestyle factors such as obesity, smoking, and heavy alcohol or drug use can affect ovulation and sperm count and decrease levels of fertility. Some people may be more at risk for infertility which may include those with the following risk factors:
- Physical injuries to the reproductive organs
- Female physical conditions such as endometriosis, pelvic infection, polycystic ovarian syndrome
- Male physical conditions such as low sperm count, erectile dysfunction or varicoceles
- Genetic disorders
- Previous cancer treatments such as chemotherapy or radiation therapy
Is infertility more common in women or men?
Many assume that the issue of infertility only affects women, however, it equally affects men. Approximately 40 percent of infertility cases are diagnosed in the male partner, 40 percent are diagnosed in the female partner and another 20 percent may be caused by a combination of issues with both partners, or the cause may be unexplained.
What are options for treating infertility in women?
Treatment may vary depending on the cause of infertility, however, some options to treat women with fertility problems may include:
- Fertility drugs to induce ovulation
- Surgery to repair blocked or damaged fallopian tubes
- Surgery to correct problems with the uterus
- Hormone treatments
What are options for treating infertility in men?
Treatment may vary depending on the cause of infertility, however, some options to treat men with fertility problems may include:
- Surgery to correct a varicocle
- Medication to correct impotence
- Sperm retrieval
- Hormone treatments
What is assisted reproductive technology?
Assisted reproductive technology are methods of treatment used to achieve pregnancy artificially with the assistance of medical technology. Assisted reproductive technology is used primarily to assist couples or patients with infertility problems. Forms of assisted reproductive technology may include intrauterine insemination, in vitro fertilization, intracytoplasmic sperm injection, donor eggs or sperm, or a surrogate.
What is in vitro fertilization, or IVF?
In vitro fertilization, or IVF, is a type of assisted reproductive technology in which eggs are harvested from a woman's ovaries, and then fertilized in a laboratory with the sperm of either a donor or a male partner. The embryos are left to develop for several days, after which up to three of the healthiest embryos are placed in the uterus. The hope is that at least one embryo takes, resulting in a successful, full-term pregnancy. In vitro fertilization is usually recommended for patients who have not successfully conceived using other fertility options.
What is gestational surrogacy?
Gestational surrogacy, also known as third-party reproduction, uses the assistance of a surrogate in order to carry a pregnancy to term. A surrogate is a woman who is implanted with a fertilized egg using in vitro fertilization, or IVF, on behalf of a patient or couple. Unlike classic surrogacy where a surrogate is inseminated with the sperm from the male and her own egg is used, carrying the baby to term on the couple's behalf, the gestational surrogate has no genetic link to the child. In gestational surrogacy, an embryo may be produced entirely by the genetic parents, or from a combination of donated or genetic egg and sperm. The embryo is then placed into the uterus of the surrogate and carried to term. Gestational surrogacy is considered legally less risky than classic surrogacy and is the most common type of surrogacy chosen by couples or intended parents.
An infertility evaluation is performed to determine the source of a couples inability to become pregnant. Such an evaluation is typically performed when a couple has been having difficulty conceiving a child for an extended period of time, usually a year, even though they regularly engage in unprotected sexual intercourse. Diagnostic tests are used to detect any conditions or abnormalities that may interfere with the ability of one or both partners to conceive offspring.
Infertility does not mean that a couple is sterile and will never have a child. Approximately half of all couples who seek help for infertility will eventually conceive.
Candidates for Infertility Evaluation
Candidates for infertility evaluation include couples who have spent at least a year trying to conceive, couples in which the woman is older than age 35 who have spent at least 6 months trying to conceive, and couples in which one or both partners are known to have problems affecting fertility. Women may also be tested for infertility if they:
- Menstruate irregularly or not at all
- Are older than 40 years of age
- Have had more than one miscarriage
- Have a condition known to interfere with fertility
Men may also be tested for infertility if they:
- Are known to have a low sperm count
- Have a swelling in the scrotum
- Have had a vasectomy
- Have undergone scrotal or inguinal surgery
- Have abnormally small testicles
- Have diminished libido or erectile dysfunction
Either partner may want to be tested if they have undergone cancer treatments. At times, one or both partners may opt to have fertility testing just because they are curious, or worried, about their fertility status.
The Infertility Evaluation
During the initial infertility evaluation, both the female and male partner undergo a full physical examination. Their complete medical histories are reviewed and their urine and blood are tested.
Tests for Female Infertility
Tests for female infertility may include:
- Testing of reproductive hormone levels
- Ovulation testing
- Imaging tests of reproductive organs.
Tests for Male Infertility
Diagnostic tests for male infertility may include one or more of the following:
- Semen analysis
- Testing of testosterone levels
- Transrectal and scrotal ultrasound
- Testicular biopsy
- Pelvic ultrasound
Both partners may also be tested for any genetic defects possibly causing infertility. Once the cause of infertility is identified, an individualized treatment plan is designed to maximize the couple's fertility potential and allow for successful conception.