In general, infertility is defined as not being able to get pregnant (conceive) after one year of unprotected sex.
Impaired fecundity is a condition related to infertility and refers to women who have difficulty getting pregnant or carrying a pregnancy to term.
Yes. About 6% of married women 15–44 years of age in the United States are unable to get pregnant after one year of unprotected sex (infertility).
Also, about 11% of women 15–44 years of age in the United States have difficulty getting pregnant or carrying a pregnancy to term, regardless of marital status (impaired fecundity).
No, infertility is not always a woman’s problem. Both men and women contribute to infertility.
Many couples struggle with infertility and seek help to become pregnant; however, it is often thought of as only a women’s condition. A CDC study analyzed data from the 2002 National Survey of Family Growth and found that 7.5% of all sexually experienced men younger than age 45 reported seeing a fertility doctor during their lifetime—this equals 3.3–4.7 million men. Of men who sought help, 18% were diagnosed with a male-related infertility problem, including sperm or semen problems (14%) and varicocele (6%).
Infertility in men can be caused by a variety of factors and the first step in evaluation is typically a semen analysis. A specialist will evaluate the number of sperm (concentration), motility (movement), and morphology (shape). A slightly abnormal semen analysis does not mean that a man is necessarily infertile. Instead, a semen analysis helps determine if and how male factors are contributing to infertility.
Conditions that can contribute to abnormal semen analyses include—
• Blockage (obstruction) of the male reproductive tract
• Hormonal factors affecting the formation and development of sperm
• Varicocele (an enlargement of the veins within the scrotum)
• Certain genetic diseases (i.e. cystic fibrosis)
• Exposure to environmental toxins and excessive heat
• Lifestyle factors (smoking, drinking, drug use, steroids, obesity),
• Cancer and other medical conditions and treatments
Women need functioning ovaries, fallopian tubes, and a uterus to get pregnant. Conditions affecting any one of these organs can contribute to female infertility. Some of these conditions are listed below and can be evaluated using a number of different tests.
Female fertility is known to decline with age. Many women are waiting until their 30s and 40s to have children. In fact, about 20% of women in the United States now have their first child after age 35, and this leads to age becoming a growing cause of fertility problems. About one-third of couples in which the woman is older than 35 years have fertility problems. Aging not only decreases a woman’s chances of having a baby but also increases her chances of miscarriage and of having a child with a genetic abnormality.
• Aging decreases a woman’s chances of having a baby in the following ways—
• Her ovaries become less able to release eggs.
• She has a smaller number of eggs left.
• Her eggs are not as healthy.
• She is more likely to have health conditions that can cause fertility problems.
• She is more likely to have a miscarriage.
• Smoking.
• Excessive alcohol use.
• Extreme weight gain or loss.
• Excessive physical or emotional stress that results in amenorrhea (absent periods).
Most experts suggest at least one year for women younger than age 35. However, women aged 35 years or older should see a health care provider after 6 months of trying unsuccessfully. A woman’s chances of having a baby decrease rapidly every year after the age of 30.
Some health problems also increase the risk of infertility, so women should talk to a health care provider if they have
• Irregular periods or no menstrual periods.
• Very painful periods.
• Endometriosis.
• Pelvic inflammatory disease.
• More than one miscarriage.
It is a good idea for any woman and her partner to talk to a health care provider before trying to get pregnant. They can help a woman prepare her body for carrying a pregnancy and delivering a healthy baby, and can also answer questions on fertility and give tips on conceiving.
Doctors will begin by collecting a medical and sexual history from both partners. The initial evaluation usually includes a semen analysis, a tubal evaluation, and ovarian reserve testing.
Infertility can be treated with medicine, surgery, intra-uterine insemination, or assisted reproductive technology. Many times these treatments are combined. Doctors recommend specific treatments for infertility based on
• The factors contributing to the infertility.
• The duration of the infertility.
• The age of the female.
• The couple’s treatment preference after counseling about success rates, risks, and benefits of each treatment option.
Male infertility may be treated with medical, surgical, or assisted reproductive therapies depending on the underlying cause. Medical and surgical therapies are usually managed by a urologist who specializes in infertility. A reproductive endocrinologist may offer intrauterine inseminations (IUIs) or in vitro fertilization (IVF) to help overcome male factor infertility.
Some common medicines used to treat infertility in women include—
• Clomiphene citrate (Clomid®*) is a medicine that causes ovulation by acting on the pituitary gland. It is often used in women who have polycystic ovarian syndrome (PCOS) or other problems with ovulation. This medicine is taken by mouth.
• Human menopausal gonadotropin or hMG (Repronex®*; Pergonal®*) are medicines often used for women who don’t ovulate because of problems with their pituitary gland—hMG acts directly on the ovaries to stimulate ovulation. It is an injected medicine.
• Follicle-stimulating hormone or FSH (Gonal-F®*; Follistim®*) are medicines that work much like hMG. It causes the ovaries to begin the process of ovulation. These medicines are usually injected.
• Gonadotropin-releasing hormone (Gn-RH) analogs are medicines often used for women who don’t ovulate regularly each month. Women who ovulate before the egg is ready can also use these medicines. Gn-RH analogs act on the pituitary gland to change when the body ovulates. These medicines are usually injected or given with a nasal spray.
• Metformin (Glucophage®*) is a medicine doctors use for women who have insulin resistance and/or PCOS. This drug helps lower the high levels of male hormones in women with these conditions. This helps the body to ovulate. Sometimes clomiphene citrate or FSH is combined with metformin. This medicine is usually taken by mouth.
• Bromocriptine (Parlodel®*) is a medicine used for women with ovulation problems because of high levels of prolactin. Prolactin is a hormone that causes milk production.
Intrauterine insemination (IUI) is an infertility treatment that is often called artificial insemination. In this procedure, specially prepared sperm are inserted into the woman’s uterus. Sometimes the woman is also treated with medicines that stimulate ovulation before IUI.
Assisted reproductive technology (ART) includes all fertility treatments in which both eggs and sperm are handled outside of the body. In general, ART procedures involve surgically removing eggs from a woman’s ovaries, combining them with sperm in the laboratory, and returning them to the woman’s body or donating them to another woman. The main type of ART is in vitro fertilization (IVF).
Success rates vary and depend on many factors, including the clinic performing the procedure, the infertility diagnosis, and the age of the woman undergoing the procedure. This last factor—the woman’s age—is especially important.
According to the CDC’s 2011 Preliminary ART Success Rates, the average percentage of fresh, nondonor ART cycles that led to pregnancy were—
• 40% in women younger than 35 years of age.
• 32% in women aged 35–37 years.
• 22% in women aged 38–40 years.
• 12% in women aged 41–42 years.
• 5% in women aged 43–44 years.
• 1% in women aged 44 years and older.
Please see RSMC success rates here….
• 75% in women younger than 35 years of age.
• 73% in women aged 35–37 years.
• 55% in women aged 38–40 years.
• 44% in women aged 41–42 years.*
• 50% in women aged 43–44 years.*
• Women using Donor Eggs: 58% fresh 68% frozen.
* 2 years combined (2011-2012)
Common ART procedures include—
• Intrauterine insemination (IUI) in which processed sperm is injected directly into the uterus by-passing the cervix. Insemination may be combined with ovarian stimulation to increase the chance of fertilization of one or more eggs occurring inside the fallopian tubes.
• In vitro fertilization (IVF), meaning fertilization outside of the body. IVF is one of the most commonly used techniques in which eggs are combined with sperm in a dish in a laboratory. Once fertilization has occurred, the resulting embryos develop for several days before being placed into the uterus.
• Intracytoplasmic sperm injection (ICSI) is often used for couples with male factor infertility, unexplained infertility or for those patients with failed conventional IVF attempts. In ICSI, a single sperm is injected into a mature egg with a microscopic needle. Once fertilization occurs, the embryos are grown for several days and then transferred into the uterus.
• Egg Donation is used for women with no eggs or unhealthy eggs. A young egg donor undergoes ovarian stimulation and an egg retrieval procedure to donate her eggs to another patient. The eggs are fertilized with the partner’s sperm and resultant embryos transferred to the patient’s uterus.
• A Gestational Carrier (gestational surrogate) is implanted with an embryo that is not biologically related to her, for the purpose of achieving a pregnancy for an infertile couple. It is recommended for women who have no uterus or for medical reasons are unable to carry a pregnancy. Couples undergo an IVF procedure and the resultant embryos are transferred into the surrogate’s uterus.
• Donor Sperm or Donor Embryos for women who are unable to conceive using their own sperm or embryos.