Filed under: Pregnancy & Fertility
If getting pregnant has been a challenge for you and your partner, you're not alone. Ten to 15 percent of couples in the United States are infertile. Infertility is defined as not being able to get pregnant despite having frequent, unprotected sex for at least a year — or for at least six months if the woman is age 35 or older.
Infertility may be due to a single cause in either you or your partner, or a combination of factors that may prevent a pregnancy from occurring or continuing. Fortunately, there are many safe and effective therapies for overcoming infertility. These treatments significantly improve your chances of becoming pregnant.
Most couples achieve pregnancy within the first six months of trying. Overall, after 12 months of unprotected intercourse, approximately 90 percent of couples will become pregnant. The majority of the remaining couples will eventually conceive, with or without treatment.
The main sign of infertility is the inability for a couple to get pregnant. There may be no other obvious symptoms.
In some cases, an infertile woman may have abnormal menstrual periods. An infertile man may have some signs of hormonal problems, such as changes in hair growth or sexual function.
When to see a doctor
In general, don't be too concerned about infertility unless you and your partner have been trying regularly to conceive for at least one year. Talk with your doctor earlier, however, if you're a woman and:
If you're a man, talk with your doctor if you have:
To become pregnant, the complex processes of ovulation and fertilization need to work just right. For some couples attempting pregnancy, something goes wrong along the way, resulting in infertility.
The cause or causes of infertility can involve one or both partners. In general:
Causes of male infertility
A number of things can affect sperm count, ability to move (motility) or ability to fertilize the egg. The most common causes of male infertility include:
Causes of female infertility
The most common causes of female infertility include:
Other causes in women
Many of the risk factors for both male and female infertility are the same. They include:
If you and your partner have been trying to get pregnant for six months or longer, call your doctor. Depending on your age and personal health history, your doctor may recommend a medical evaluation.
A woman's gynecologist or a man's urologist or a family doctor can help determine whether there's a problem that requires a specialist or clinic that treats infertility problems. Both you and your partner will likely undergo a comprehensive infertility examination.
Here's some information to help you get ready for your first appointment, and know what to expect from your doctor.
What you can do
Prepare a list of questions so that you can make the most of your time with your doctor. For infertility, some basic questions to ask your doctor include:
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.
What to expect from your doctor
Your doctor is likely to ask each of you a number of questions. Being ready to answer them will help your doctor quickly determine next steps in making your diagnosis and starting care.
Questions for the couple
Questions for the woman
Questions for the man
Before undergoing infertility testing, be aware that a certain amount of commitment is required. Your doctor or clinic will need to determine what your sexual habits are and may make recommendations about how you may need to change those habits. The tests and periods of trial and error may extend over several months. In about one-third of infertile couples, no specific cause is found (unexplained infertility).
Evaluation is expensive and in some cases involves uncomfortable procedures, and the expenses may not be reimbursed by many medical plans. Finally, there's no guarantee — even after all the testing and counseling — that conception will occur.
Tests for men
For a man to be fertile, the testicles must produce enough healthy sperm, and the sperm must be ejaculated effectively into the woman's vagina. Tests for male infertility attempt to determine whether any of these processes are impaired.
Tests for women
For a woman to be fertile, the ovaries must release healthy eggs regularly, and her reproductive tract must allow the eggs and sperm to pass into her fallopian tubes to become fertilized by a sperm. Her reproductive organs must be healthy and functional.
After your doctor asks questions regarding your health history, menstrual cycle and sexual habits, you'll undergo a general physical examination. This includes a regular gynecological examination. Specific fertility tests may include:
Laparoscopy. Performed under general anesthesia, this procedure involves making a small incision (8 to 10 millimeters) beneath your navel and inserting a thin viewing device to examine your fallopian tubes, ovaries and uterus.
The most common problems identified by laparoscopy are endometriosis and scarring. Your doctor can also detect blockages or irregularities of the fallopian tubes and uterus. Laparoscopy generally is done on an outpatient basis.
Not everyone needs to undergo all, or even many, of these tests before the cause of infertility is found. Which tests are used and their sequence depend on discussion and agreement between you and your doctor.
Treatment of infertility depends on the cause, how long you've been infertile, your age and your partner’s age, and many personal preferences. Some causes of infertility can't be corrected. However, a woman can still become pregnant with assisted reproductive technology or other procedures to restore fertility.
Treatment for men
Approaches that involve the male include treatment for:
Treatment for women
Fertility drugs are the main treatment for women who are infertile due to ovulation disorders. These medications regulate or induce ovulation. In general, they work like natural hormones — such as follicle-stimulating hormone (FSH) and luteinizing hormone (LH) — to trigger ovulation. Commonly used fertility drugs include:
Depending on the cause, surgery may be a treatment option for infertility. Blockages or other problems in the fallopian tubes can often be surgically repaired. Laparoscopic techniques allow delicate operations on the fallopian tubes.
If you have endometriosis, your doctor may treat you with ovulation therapy, in which medication is used to stimulate or regulate ovulation, or in vitro fertilization, in which the egg and sperm are joined in the laboratory and transferred to the uterus.
Assisted reproductive technology (ART)
Each year thousands of babies are born in the United States as a result of ART. An ART health team includes physicians, psychologists, embryologists, laboratory technicians, nurses and allied health professionals who work together to help infertile couples achieve pregnancy.
The most common forms of ART include:
ART works best when the woman has a healthy uterus, responds well to fertility drugs, and ovulates naturally or uses donor eggs. The man should have healthy sperm, or donor sperm should be available. The success rate of ART is lower after age 35.
Complications of treatment
Certain complications exist with the treatment of infertility. These include:
Multiple pregnancy. The most common complication of ART is a multiple fetus pregnancy. Generally, the greater the number of fetuses, the higher the risk of premature labor. Babies born prematurely are at increased risk of health and developmental problems.
The number of quality embryos kept and matured to fetuses and birth ultimately is a decision made by the couple. If too many are conceived, the removal of one or more fetuses (multifetal pregnancy reduction) is possible to improve survival odds for the other fetuses.
Coping with infertility can be difficult. It's an issue of the unknown — you can't predict how long it will last or what the outcome will be. Infertility isn't necessarily solved with hard work. The emotional burden on a couple is considerable.
Taking these steps can help with coping:
Managing emotional stress during treatment
Managing emotional effects of the outcome
Whatever the result of your fertility treatment, you'll face the possibility of psychological challenges. Seek professional help if the emotional impact of any of these outcomes becomes too heavy for you or your partner:
Most types of male infertility aren't preventable. However, avoid drug and tobacco use and excessive alcohol consumption, which may contribute to male infertility. Also, high temperatures can affect sperm production and motility. Although this effect is usually temporary, avoid hot tubs and steam baths.
For couples, having intercourse two to three times a week may improve fertility. Too-frequent ejaculation can lessen sperm quality. Sperm survive in the female reproductive tract for up to 72 hours, and an egg can be fertilized for up to 24 hours after ovulation.
A woman can increase her chances of becoming pregnant in a number of ways:
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