What is Infertility?

Infertility is defined as the inability to conceive a child despite trying for 1 year.

The condition affects about 5.3 million Americans, or 9% of the reproductive age population.
To become pregnant, a couple must have intercourse during the woman’s fertile time of the month, which is right before and during ovulation. Because it is tough to pinpoint the exact day of ovulation, having intercourse every other day during this time maximizes the chances of conception.
After a year of frequent intercourse without contraception that does not result in pregnancy, a couple should go to a health-care professional for an evaluation. In some cases, it makes sense to seek help for fertility problems even before a year is up.
A woman over age 35 may wish to get an evaluation before 1 year. At age 35, a woman begins a slow decline in her ability to get pregnant. The older she gets, the greater her chance of miscarriage. However, fertility does not take a big drop until around age 40. Despite a decrease in sperm production that begins after age 25, some men remain fertile into their 60s and 70s.

A couple may also seek earlier evaluation if:
The woman is not menstruating regularly, which may indicate an absence of ovulation that would make it impossible for her to conceive without medical help.
The woman has had three or more miscarriages (or the man had a previous partner who had had three or more miscarriages).
The woman or man has had certain infections that sometimes affect fertility (for example, pelvic infection in a woman, or mumps or prostate infection in a man).
The woman or man suspects there may be a fertility problem (if, for example, attempts at pregnancy failed in a previous relationship).

What are some of the causes of infertility?

A successful pregnancy requires a healthy sperm to reach an egg allowing it form an embryo that can implant within a uterus. Any factors that disturb this process can impede or impair fertility. Common issues that prevent pregnancy include:
1) Infrequent intercourse events or during the wrong time of a woman’s cycle
2) Uterine anomalies that can distort the cavity
3) Fallopian tube blockage from a prior infection or surgery can prevent an egg from reaching the uterine cavity
4) Advanced Maternal Age
5) Maternal health issues – such as Polycystic Ovaries, uncontrolled Diabetes, high blood pressure, autoimmune disorders, hormonal problems arising from other endocrine glands (eg. thyroid).
6) Paternal issues – advanced paternal age, medications, testicular issues that affect semen production.
7) Endometriosis – a condition where the cells from the uterine wall are present outside of the uterus.

What tests are used to identify the cause of infertility?

A thorough history and physical exam is the first step in treating couples with infertility. It is important to identify unique factors that contribute to the couples infertility. Blood work is often utilized to screen for metabolic and hormonal issues that can impair fertility.

Imaging studies such as ultrasound to assess pelvic structures and hysterosalpingogram (HSG) to check the patency of fallopian tubes can be done. Semen Analysis is also done to check for semen quality and identify any male factors.

Some patients will require surgical evaluation using laparoscopic tools to identify any pelvic pathology (eg. Endometriosis) that may contribute to the infertility

What treatment options are available?

A treatment option is developed based on a patient’s unique needs and initial work up.

It may include medications and surgeries. The success of treatment is contingent upon the type of factor that is impairing your fertility.
Often fertility specialists are utilized for advanced treatment options to improve fertility.

Drugs or surgery are used to treat infertility in 80% to 90% of cases.