Infertility at a glance
- Infertility is a reproductive disease that exists when a woman under 35 or a couple cannot achieve pregnancy after a year of regular, unprotected sex, and after six months for a woman 35 and older.
- It can be caused by reproductive abnormalities in the male or female or both, including hormonal imbalances, ovulation disorders, poor sperm quality and genetics.
- Diagnosing infertility involves a medical history, a physical examination and testing of both partners for common causes.
- Unexplained infertility is when doctors cannot determine the exact cause of a person or couple’s difficulty conceiving.
- Treatments for infertility include lifestyle changes, fertility medication, assisted reproductive technologies such as in vitro fertilization (IVF) and integrative medicine.
What is infertility?
Infertility is a disease of the reproductive system that results in the inability to become pregnant after a year of somewhat frequent, unprotected intercourse when the woman is under age 35, and six months if the female partner is older than 35. About 15 percent of all couples are estimated to be infertile.
The inability to conceive can result from problems with the male (about a third of cases), the female (about a third) or both (about a third). In about 20 percent of cases doctors can’t identify the exact cause and diagnose “unexplained infertility.”
Infertility is most often a treatable condition, even if it is unexplained. Still, it can feel like a crisis. It is common for people to feel a sense of guilt or inadequacy after a diagnosis. Many fertility clinics offer emotional support and counseling to help patients understand and manage the effects of their diagnosis.
How one RSC patient overcame a heartbreaking diagnosis of infertility
What causes infertility?
Fertility problems can be caused by abnormalities in the structure or function of the reproductive system in females and males. Such problems may occur from genetic issues, hormone imbalances, surgeries and other medical treatments, injuries and lifestyle factors. Age naturally causes fertility decline in women as they cease ovulating and enter menopause.
Many cases are due to an ovulation disorder affecting the production and release of eggs to be fertilized by sperm. Age, hormonal imbalances, weight, diet and conditions like polycystic ovary syndrome (PCOS) can all prevent a woman from ovulating normally.
An estimated 25 percent of infertile women have malfunctioning fallopian tubes, where eggs are fertilized. Most often this is due to a blockage, which can be caused by certain conditions, including endometriosis, pelvic inflammatory disease and uterine fibroids.
A common reason for fertility issues in men is sperm problems, including low sperm count, poor sperm health and problems delivering sperm. These can be caused by an illness, genetic predisposition and developmental issues. Male fertility may also be affected by lifestyle choices, such as drinking, smoking, diet, weight, sexually transmitted disease and stress levels.
A diagnosis is a step-by-step process that can take one to three months. The doctor will first collect thorough medical histories of each partner, which includes present medical conditions, past injuries, medications, sexual histories, and reproductive experiences, among other things. The doctor will run a series of tests that look for common causes that affect fertility.
Female fertility tests
For women, fertility testing generally involves taking measurements of ovarian reserve (number of potential eggs available in the ovaries), ovulatory functions and hormone levels. This initial round of testing is noninvasive, and can involve blood tests and a pelvic exam.
If these tests are normal, a doctor may also perform an ultrasound examination of the ovaries and uterus or a hysterosalpingogram (HSG), which is an X-ray test of the uterus or fallopian tubes, to look for structural abnormalities that may be preventing pregnancy. In rare cases, a fertility specialist may also perform surgery to diagnose the problem.
Male fertility tests
For men, these tests generally examine sperm count, motility, morphology (shape) and other factors that can affect fertility. Male infertility testing is typically noninvasive and involves the collection of sperm, blood and urine samples. Diagnosis can also require an ultrasound of the scrotum if the doctor suspects there may be a blockage affecting the man’s ejaculation or sperm quality.
For about 20 percent of infertile couples and individuals, all standard infertility tests are normal, and doctor will give a diagnosis of unexplained infertility.
A number of complex processes are involved in getting pregnant, including normal egg production in the ovaries, healthy sperm production, effective fertilization, successful implantation of the embryo in the uterus and healthy pregnancy through live birth. Problems with any of these processes can contribute to infertility, and sometimes the exact cause is hard to diagnose.
Unexplained infertility is a term that encapsulates atypical causes for infertility that routine fertility testing may not be able to identify. These reasons may include the sperm being unable to reach the woman’s egg, problems with egg or embryo quality or problems with fertilization. However, even in cases of unexplained infertility, assisted reproductive treatments, including IUI and IVF, and other infertility treatments can improve chances of pregnancy.
How we treat infertility
The treatment for infertility depends on a person’s specific diagnosis. Primary treatments include:
- Fertility medications
- Assisted reproductive technologies such as IVF and associated services
- Reproductive surgery to correct structural problems
- Third-party reproductive assistance, such as donor eggs, donor sperm, surrogacy or gestational carrier
- Lifestyle changes
- Integrative medicine.
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