Infertility — the inability to become pregnant after a year of unprotected intercourse, six months if the female partner is older than 35 – can result from fertility problems with either the male or female partner, or both. The split is roughly down the middle: an estimated 40 percent of diagnosed cases of infertility are due to male factors; another 40 percent are due to female reproductive issues. In the remaining 20 percent of couples, there are contributing factors from both partners or doctors can find no cause for fertility issues (known as “unexplained infertility”).
Infertility is most often a treatable condition. Still, it can feel like a crisis. A sense of guilt or inadequacy about infertility is common. Fifteen percent of all couples are estimated to be infertile, but only up to two percent are completely sterile. Half of couples seeking help can bear a child, either with or without medical assistance.
Diagnosis begins with thorough medical histories of each partner. Doctors look at previous and present medical conditions, medications, sexual histories, and reproductive experiences, among other factors. Both male and female partners undergo examinations. For men, semen analysis assesses sperm health and functioning. For women, specialists assess ovulatory functions by monitoring menstrual cycle history, which may include daily basal body temperature. Doctors can also measure hormone levels with blood tests on the third day of the menstrual cycle. Additional testing may be required, including ultrasound examination of the ovaries and uterus, and hysterosalpingogram (HSG), an X-ray test to look for structural problems of the fallopian tubes or uterus.
In most couples, the cause of infertility is either sperm problems, inadequate ovulation, and/or tubal blockage. For about 15 percent of couples, all tests are normal and the diagnosis is unexplained infertility.