Infertility - An Overview
If you and your partner are finding it challenging to conceive, you are not alone. The American Society for Reproductive Medicine estimates there are 6.1 million people dealing with infertility in the United States alone -- that's roughly 10% of those trying to get pregnant. Fortunately, there are many tests and procedures that can identify and treat the causes of infertility.
What Is Infertility?
According to the National Infertility Association, 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 by a physician, usually 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 ( fig. 1, fig. 2). 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
- Impaired ovulation due to disease, infection, birth defects, or abnormal hormone production
- Blocked fallopian tubes from disease 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. Both men and women can develop antibodies that attack sperm and prevent fertilization.
Other factors that can contribute to infertility include stress, smoking, alcohol use, excess weight and overall health.
When To See A Doctor
The National Infertility Association says that most physicians will recommend that couples try to conceive for a year before seeking medical assistance. They also state that 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, they may want to seek professional advice sooner.
Testing For Infertility
The causes of infertility are not always easily recognizable. A doctor may recommend a variety of diagnostic tests that can help determine how to proceed.
Diagnostic tests for women include blood tests to check hormone levels, an X-ray to determine if the fallopian tubes are open, and an endometrial biopsy. 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:
- 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.
- Measuring basal body temperature -- taking the woman's temperature each morning before arising in an effort to note the 0.4 to 1.0 degree Fahrenheit temperature increase associated with presumptive ovulation.
- Monitoring cervical mucus changes throughout the menstrual cycle to note the wet, stretchy, and slippery mucus associated with the ovulatory phase.
- Postcoital test (PCT) -- to evaluate sperm-cervical mucus interaction through analysis of cervical mucus collected 2 to 8 hours after the couple has intercourse.
- Measuring serum progesterone (blood test)
- Endometrial biopsy
- Testicular biopsy (rarely done)
- Measuring urinary luteinizing hormone by using kits commercially available for home use to predict ovulation and assist with timing of intercourse.
- Progestin challenge -- with sporadic or absent ovulation
- Serum hormonal levels (blood tests) for either or both partners
- Hysterosalpingography (HSG) -- X-ray procedure done with contrast dye that enables evaluation of potential transport from the cervix through the uterus and fallopian tubes.
- Laparoscopy to allow direct visualization of the pelvic cavity.
- Pelvic exam (women) to determine if there are cysts.
Treatment depends on the cause of infertility for any given couple. It may range from simple education and counseling, to the use of medications that treat infections or promote ovulation, to highly sophisticated medical procedures such as in-vitro fertilization.
It is important for the couple to recognize and discuss the emotional impact that infertility has on them as individuals and together, and seek medical advice from their health care provider. As new treatments are announced, couples may either experience new hope or have to deal with old wounds being reopened. Support groups for infertile couples may be an important source of strength and comfort. RESOLVE, a national organization, provides both informal support and serves as a referral base for professional counseling specific to infertility issues
Review Date: June 29, 2001
Reviewed By: Peter Chen, M.D., Obstetrics and Gynecology, University of
Pennsylvania School of Medicine. Review provided by VeriMed Healthcare
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