Infertility is defined as an inability to conceive an intrauterine pregnancy
after a year of sexual intercourse without contraception. It is a condition
that affects nearly 15% of all people at some point in their lives. There
are many causes of infertility, and most can be diagnosed and treated.
If you and your partner are experiencing any difficulty in starting your
family, the first step is simply to contact a physician who is knowledgeable
People with infertility can usually be treated successfully. All too
often a couple may lose precious time if treatment is left in the hands
of less qualified physicians, whose technical training and experience
may be limited.
It is important to note that appropriate treatment plans for individuals
and couples with ethical or religious concerns can be developed in consultation
with your physician. Contrary to the sensational coverage often portrayed
in the media, today's reproductive technology treatment plans are safe,
usually highly effective, and sometimes surprisingly simple. For example,
despite all the media attention, only 3% of infertile patients undergo
the most sophisticated treatments of In Vitro Fertilization (IVF) or Gamete
Intra Fallopian Transfer (GIFT). These patients should be evaluated and
treated by reproductive endocrinologists. These physicians (called Reproductive
Endocrinologists) have special expertise in this area because they have
two or three years of fellowship training after completing four years
of obstetrics and gynecology residency. Most infertile patients can be
helped with less involved treatment.
What can be done to identify the reasons for your infertility problem?
Infertility can be caused by medical conditions in the female partner,
male partner, or both. Help typically begins with a comprehensive history
and physical examination, which is followed by diagnostic testing and
the development of an appropriate treatment plan in consultation with
your physician. The woman's age is the most important factor in determining
a couple's probability for a successful pregnancy. As indicated by the
charts on this page, fertility declines in women as age increases. For
women over 35, it is very important to consult an infertility specialist
as soon as possible.
For women, tests often begin by measuring the fertility potential of the
eggs - this can be assessed by a simple blood test. Egg quality is influenced
by a woman's age more than any other factor. Egg quality is assessed by
ovulation regularity and other factors related to the hormone system.
Abnormal ovulation can be associated with pituitary problems, luteal phase
defect, polycystic ovaries, thyroid disease, adrenal gland disease, high
prolactin levels, dietary alterations, weight problems, exercise patterns,
smoking, alcohol, stress and other factors. The receptivity of the endometrium
for the embryo to implant is also evaluated by hormonal and other tests.
The pelvic organs are often evaluated with a Hysterosalpingogram (HSG)
or possibly a sonohysterogram. An HSG involves injection of a fluid into
the uterus and fallopian tubes which is then photographed by X-rays to
check tubal patency, the shape of the uterus, and possible lesions inside
the uterus such as polyps, fibroids, and scar tissue. A sonohysterogram
is an ultrasound performed with a small amount of fluid in the uterus.
Sometimes a hysteroscopy or laparoscopy is performed as well. After these
diagnostic steps are taken, you and your physician will decide upon the
next step in the treatment process- which occasionally requires more detailed
For men, initial evaluation involves 2 semen analyses to quantify sperm
count, sperm morphology (shape) and motility (percentage of sperm which
move). Results may vary for the same man from day to day, which is why
two tests are usually performed to insure accuracy. Some of the more common
lifestyle patterns that may contribute to poor sperm quality include (but
are not limited to): excessive exposure to heat sources such as hot-tubs,
a medical history of venereal disease, a medical history of prostate inflammation,
and smoking or excessive alcohol or other drug use. Contrary to popular
opinion, boxer shorts or briefs have no effect on sperm parameters. Your
gynecologist usually performs the initial evaluation and will refer you
to a urologist or andrologist if further care is needed.
What can be done to treat your infertility problem?
Any problems identified by the initial evaluation should be thoroughly
and completely explained by your gynecologist. Following treatment of
specific problems, further management often involves controlled ovarian
stimulation using fertility drugs combined with partner insemination.
This helps insure that sperm and eggs meet at the appropriate time in
the fallopian tubes of the woman on the day of ovulation. There are many
additional treatment plans that can be undertaken if controlled ovarian
stimulation and partner insemination does not result in pregnancy. Depending
upon individual situations, such treatments may include gamete intra-fallopian
tube transfer (GIFT), in-vitro fertilization (IVF), intra-cytoplasmic
sperm injection (ICSI), zygote intra-fallopian tube transfer (ZIFT), laparoscopic
or laparotomy treatment of pelvic factors, and others.