Infertility - An Overview
If you and your partner are having trouble getting pregnant, you are not alone. The Centers for Disease Control and Prevention estimate that 7.3 million people are affected by infertility in the United States -- that's roughly 12% of the reproductive-age population. Fortunately, there are many tests and procedures that can identify and treat the causes of infertility.
What Is Infertility?
According to the American Society for Reproductive Medicine, infertility is a medical condition of the reproductive system that results in the inability to conceive or carry a pregnancy to term. The condition is diagnosed after a couple has had a year of unprotected, regular intercourse without conceiving, or when pregnancy occurs but does not result in a live birth.
Causes Of Infertility
Infertility can be due to factors in either the female or the male. 35-40% of the time the cause can be traced to the female partner, and 35-40% of the time infertility can be linked to the male partner. Sometimes conditions in both partners play a role. Other times the reason for infertility remains unknown.
Common Causes For Women
- Advanced age
- Polycystic ovarian syndrome
- Impaired ovulation due to disease, birth defects, or abnormal hormone production
- Blocked fallopian tubes from infection or scar tissue
- Inability of the uterus to hold the embryo (this may be due to a variety of reasons, including scar tissue on the walls of the uterus)
Common Causes For Men
- Low sperm count
- High percent of abnormally shaped sperm
- High percent of sperm that are not moving forward
- Ejaculation dysfunction
Sperm production can be affected by blocked passageways, fevers, infections, or birth defects.
Other factors that can contribute to infertility include stress, smoking, alcohol use, excess weight and overall health.
When To See A Doctor
Most physicians will recommend that couples try to conceive for a year before seeking medical assistance. If a woman is over 30, has a history of pelvic disease, miscarriage, painful menstruation, irregular cycles, or if her partner has a low sperm count, the National Infertility Association recommends that she and her partner may want to seek professional advice sooner.
Testing For Infertility
A doctor may recommend a variety of diagnostic tests that can help determine why a couple is having trouble getting pregnant.
Diagnostic tests for women include a thorough medical history, blood tests to check hormone levels, an ultrasound to examine the lining of the uterus and look for any structural abnormalities of the uterus, and an X-ray to determine the shape of the uterine cavity and if the fallopian tubes are open. A doctor may also recommend laparoscopic surgery to check for endometriosis, adhesions or pelvic scarring. Laparoscopy is generally performed on an outpatient basis.
Tests may include:
Tests to evaluate male causes:
- Semen analysis to evaluate ejaculate; the specimen is collected after 2 to 3 days of complete abstinence to determine volume and viscosity of semen and sperm count, motility, swimming speed, and shape.
- Postcoital test (PCT) -- to evaluate sperm-cervical mucus interaction through analysis of cervical mucus collected 2 to 8 hours after the couple has intercourse.
- Testicular biopsy (rarely done).
Tests to check for how well a woman’s ovaries are functioning:
- Serum hormonal levels (blood tests). Your doctor may look for levels of follicle stimulating hormone, estrogen and lutenizing hormone. These tests are usually drawn on the second or third day of your menstrual cycle. A new test looking at levels of anti-mullerian hormone (AMH) may also be helpful in predicting ovarian reserve.
- Measuring basal body temperature -- a woman takes her temperature each morning to track the changes in body temperature associated with ovulation.
- Measuring serum progesterone (blood test).
- Measuring urinary luteinizing hormone by using kits commercially available for home use to predict ovulation and assist with timing of intercourse.
- A pelvic ultrasound may also be performed to look at the ovaries for any large cysts and the presence of follicles.
Tests to make sure a woman uterus and tubes are working:
- Hysterosalpingography (HSG) -- an X-ray procedure done with contrast dye that outlines the uterus and tubes, making sure there is a clear path for sperm traveling to meet the egg.
- Hysteroscopy -- an office procedure that guides a small camera into the uterus, allowing the doctor to see problems with the lining of the uterus that may contribute to infertility.
- Laparoscopy to allow direct visualization of the pelvic cavity.
Treatment depends on the cause of infertility for any given couple. It may include simple education and counseling, the use of medications that treat infections or promote ovulation, or highly sophisticated medical procedures such as in-vitro fertilization.
It is important for the couple to recognize and discuss the emotional impact of infertility, and to seek medical advice from a health care provider. Support groups for infertile couples may be an important source of strength and comfort. RESOLVE, a national organization, both provides informal support and serves as a referral base for professional counseling specific to infertility issues.
Zev Williams MD, PhD, FACOG, Reproductive Medicine and Infertility, Weill-Cornell Medical Center, New York, NY. Review provided by VeriMed Healthcare Network.
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