Infertility is a problem that affects approximately 5 million people in the United States, or 10% of people of reproductive age.  The inability to conceive children can be devastating for a couple, but with new treatment options, many infertile couples can have children and complete their family.

 A couple is said to be infertile if they have been unable to conceive after one year of unprotected intercourse.  Infertility is caused by disease of the reproductive system, which interferes with conception.  About 40% of infertility may be attributed to a female factor, 40% to a male factor, and 20% is caused by a combination of problems.

Pregnancy Puzzle

Reproduction involves many factors, including healthy reproductive organs and a complex interplay of reproductive hormones.  The failure to ovulate and irregular ovulation account for about 30% of female infertility.  Other common causes are:

The most common male factor is the production of low-quantity or poor-quality sperm.  If the sperm aren’t sufficiently motile, they won’t be able to move up the fallopian tubes.  

In some cases, the sperm lack receptors and can’t bind to the egg.  In others, they lack an enzyme needed to break into the egg.  In others, the sperm may contain abnormal genetic material.  A semen analysis can reveal most abnormalities. 

An ART-ful Conception

Before the development of currently practiced assisted reproductive technologies (ART), infertile couples relied on adoption or the rare spontaneous pregnancy.  Today, thanks to modern science, two-thirds of all infertile couples that seek medical intervention eventually give birth. 

Treatment options for infertility vary and depend mostly on the diagnosis.  A basic infertility evaluation begins with a thorough medical history of the couple.  Both partners are interviewed together, and a physical examination is routinely done. 

Specific testing may be done, including blood tests for hormone levels, an ultrasound of the reproductive organs, an X-ray examination of the uterus and fallopian tubes and semen analysis.  A surgical technique called a laparoscopy which allows the surgeon to view the pelvic organs may also be performed.

Ninety percent of cases are treated with conventional therapies, including drugs and surgery.  When a woman doesn’t ovulate or has an irregular cycle, she may benefit from fertility drugs such as Clomid that induce ovulation.  This is prescribed to stimulate the pituitary gland to produce hormones to stimulate the ovaries to ripen and release an egg.  About 80% of all women successfully ovulate when taking such medication.

While Clomid can be very effective, it should not be used for more than 3 to 6 months.  

If the medication doesn’t induce ovulation, a more aggressive treatment plan may be appropriate.  Stronger injectable drugs that act directly on the ovaries, stimulating ovarian follicles to ripen and each release an egg, may be necessary.

Fertility drugs won’t help women whose fallopian tubes are blocked or damaged because the eggs cannot reach the uterus.  In these cases, surgery to unblock the tubes is an option. 

When the woman’s tubes are clear for conception to occur, intrauterine insemination (IUI) is often recommended.  The ovaries are stimulated by fertility drugs to produce no more than three eggs; then, at the time of ovulation, a sample of fresh semen from either the woman’s partner or a donor is prepared and placed high up in the uterus through a catheter. 

In gamete intrafallopian transfer (GIFT), the woman’s eggs are retrieved from her ovaries and placed in a catheter with the male sperm.  Eggs and sperm are then injected directly into the fallopian tubes. 

The most widely practiced reproductive technique, however, is in vitro fertilization (IVF).  Fertility drugs are used to produce multiple eggs and are then retrieved from the ovary and fertilized in the laboratory with sperm.  A small selection of the resulting embryos are then implanted in the uterus.  Unlike IUI and GIFT, in vitro fertilization can be used to treat women with tubal damage. 

It is important to note that no one can be blamed for infertility, any more than you can be blamed for diabetes or heart disease.  Infertility is a disease process that can be diagnosed and successfully treated.  

If you suspect a fertility problem, the first step in getting help is a basic infertility evaluation by a reproductive endocrinologist/infertility specialist.  The goal of an infertility evaluation is to find out why you and your partner cannot conceive and to plan treatment options.

Infertility testing begins with basic, less invasive testing and proceeds to more sophisticated and complex testing, usually after the first-line testing has failed to uncover the cause of infertility.  The infertility work-up is used to help determine why conception isn't happening and determine what may be done to correct the problem: