What is infertility?
Infertility is defined as not getting pregnant after 1 year of having regular sexual intercourse without using birth control. If you are older than 35, an evaluation is recommended after 6 months of trying. If you are older than 40, talk with your obstetrician-gynecologist now about an evaluation.
What causes infertility?
The most common cause of female infertility is a problem with ovulation. The most common cause of male infertility is a problem with sperm cells and how they function. Other factors that may affect fertility include:
- Health conditions
Sometimes no cause is found. This is called unexplained infertility.
How does age affect fertility?
For healthy couples in their 20s or early 30s, the chance that a woman will get pregnant is about 25 to 30 percent in any single menstrual cycle. This percentage starts to decline in a woman’s early 30s. By age 40, a woman’s chance of getting pregnant drops to less than 10 percent per menstrual cycle. A man’s fertility also declines with age, but not as predictably.
How can lifestyle affect fertility?
Women who are underweight, overweight, or exercise too much may have a harder time getting pregnant. In women, smoking and drinking alcohol at moderate or heavy levels may reduce fertility. In men, smoking, heavy drinking, and using marijuana can reduce sperm count and movement.
How can health conditions affect fertility?
In women, several health problems can affect fertility, including:
- Problems with the reproductive organs or hormones
- Scarring or blockages of the fallopian tubes (from past sexually transmitted infections [STIs] or endometriosis)
- Problems with the thyroid gland or pituitary gland
In men, infertility can be caused when the tubes that carry sperm from the testicles are blocked.
What kind of doctor treats fertility?
When you seek treatment for infertility, you may start with your ob-gyn. Or you may see a reproductive endocrinologist, an ob-gyn with special training in infertility. Men may see a urologist. It is important to find a specialist you are comfortable with.
What treatment options are available for infertility?
Your treatment options will depend on the type of problem found. Recommendations may include:
- Lifestyle changes
- Surgery, or
Some treatments may be combined. In some cases, infertility can be successfully treated even if no cause is found.
What lifestyle changes may help improve my chances for pregnancy?
Staying at a healthy weight and eating a healthy diet can be helpful for both men and women with infertility. If you and your male partner smoke, use drugs, or drink alcohol, you should stop.
How is surgery used to treat infertility in women?
In women, surgery may be used to:
- Repair blocked or damaged fallopian tubes
- Treat endometriosis, which is commonly associated with infertility
- Remove polyps or fibroids in the uterus
How is surgery used to treat infertility in men?
A common problem that leads to male infertility is swollen veins in the scrotum. These sometimes can be treated with surgery.
How are hormone problems treated in women?
Abnormal levels of hormones can cause problems with ovulation. Your specialist may check your hormone levels. If a hormone problem is found, treatment often can correct it. This treatment also may improve your chances of getting pregnant.
What is ovulation stimulation?
Ovulation stimulation is the use of drugs to help your ovaries release an egg. This treatment is used when ovulation is not regular or does not happen at all and other causes have been ruled out. Ovulation stimulation may be used with other infertility treatments.
How is ovulation stimulation done?
Oral drugs used to stimulate ovulation include clomiphene citrate and aromatase inhibitors. While taking these drugs, you will be monitored to see if and when ovulation occurs. This can be done by tracking your menstrual cycle or with an ovulation-predictor kit (an at-home urine test). You may be asked to visit your doctor for a blood test or ultrasound exam.
What are gonadotropins?
Gonadotropins are another drug used to trigger ovulation. Gonadotropins are used if other drugs are not successful or if many eggs are needed for infertility treatments. Gonadotropins are given in a series of shots early in the menstrual cycle. Blood tests and ultrasound exams are used to track the development of the follicles. When test results show that the follicles have reached a certain size, another drug may be given to signal a follicle to release its matured egg.
What are the risks of ovulation stimulation?
- Multiple pregnancy is a risk when women are treated with clomiphene citrate, aromatase inhibitors, and gonadotropins. The risk is higher with gonadotropins. If too many eggs are developing, your specialist may postpone the cycle to reduce the chance of a multiple pregnancy.
- Ovulation stimulation, especially with gonadotropins, can lead to ovarian hyperstimulation syndrome. Most cases of this condition are mild. In severe cases, a hospital stay may be needed. Women taking medication to stimulate ovulation are monitored for this condition.
What is intrauterine insemination?
In intrauterine insemination (IUI), healthy sperm is placed in the uterus as close to the time of ovulation as possible. IUI can be used with ovulation stimulation. The woman’s partner or a donor may provide the sperm.
What are the risks of intrauterine insemination?
If ovulation drugs are used with IUI, multiple pregnancy can occur. If too many eggs are developing at the time of insemination, the insemination may be postponed.
What is assisted reproductive technology?
Assisted reproductive technology (ART) includes all fertility treatments in which both eggs and sperm are handled. ART usually involves in vitro fertilization (IVF). In IVF, sperm is combined with the egg in a laboratory, and the embryo is transferred to the uterus. IVF is done for the following causes of infertility:
- Damaged or blocked fallopian tubes that cannot be treated with surgery
- Severe endometriosis
- Primary ovarian insufficiency
- Some male infertility factors
- Unexplained infertility
How is in vitro fertilization done?
IVF is done in cycles. It may take more than one cycle to succeed. The steps include:
- Obtaining an egg. Ovulation usually is triggered with gonadotropins so that multiple eggs are produced. When your eggs are ready, a needle is used to remove mature eggs from the ovaries.
- Fertilization of eggs by the sperm. This can be done in two ways: 1) the sperm can be added to the eggs in a laboratory, or 2) a single sperm can be injected into each egg. The eggs are checked the next day to see if they have been fertilized.
- Embryo transfer. A few days after fertilization, one or more embryos are placed in the uterus through the vagina. Healthy embryos that are not transferred may be frozen and stored.
What are the risks of in vitro fertilization?
There is an increased risk of multiple pregnancy with IVF. Several things can be done to help prevent multiple pregnancy. If test results suggest that too many eggs are developing, the shot that triggers ovulation may be delayed or not given. Your specialist also may limit the number of embryos transferred to your uterus.
What else should I know about infertility treatment?
Infertility treatment takes time, and it can have high costs. It takes a big commitment from both partners. Some treatments are expensive and may not be covered by insurance.