Infertility is a problem that affects
approximately 5 million people in the United States, or 10% of
people of reproductive age.
The inability to conceive children can be devastating for a
couple, but with new treatment options, many
infertile couples can have children and complete their
A couple is said to be
infertile if they have been unable to conceive after one year of
Infertility is caused by disease of the reproductive system,
which interferes with conception. About 40% of infertility may
be attributed to a female factor, 40% to a male factor, and 20% is
caused by a combination of problems.
Reproduction involves many factors, including healthy
reproductive organs and a complex interplay of reproductive
hormones. The failure
to ovulate and irregular ovulation account for about 30% of female
common causes are:
The most common male factor is the production of low-quantity
or poor-quality sperm.
If the sperm arenít sufficiently motile, they wonít be able
to move up the fallopian tubes.
In some cases, the sperm lack
receptors and canít bind to the egg. In others, they lack an
enzyme needed to break into the egg. In others, the sperm may
contain abnormal genetic material. A semen analysis can reveal
development of currently practiced assisted
reproductive technologies (ART), infertile couples relied on
adoption or the rare spontaneous pregnancy. Today, thanks to modern
science, two-thirds of all infertile couples that seek medical
intervention eventually give birth.
Treatment options for infertility vary and depend mostly on
the diagnosis. A basic
infertility evaluation begins with a thorough medical history of the
couple. Both partners
are interviewed together, and a physical examination is routinely
Specific testing may be done, including blood tests for
hormone levels, an ultrasound of the reproductive organs, an X-ray
examination of the uterus and fallopian tubes and semen
analysis. A surgical
technique called a laparoscopy which allows the surgeon to view the
pelvic organs may also be performed.
Ninety percent of cases are treated with conventional
therapies, including drugs and surgery. When a woman doesnít ovulate
or has an irregular cycle, she may benefit from fertility drugs such
as Clomid that induce ovulation. This is prescribed to
stimulate the pituitary gland to produce hormones to stimulate the
ovaries to ripen and release an egg. About 80% of all women
successfully ovulate when taking such medication.
While Clomid can be very
effective, it should not be used for more than 3 to 6
If the medication doesnít induce ovulation, a more aggressive
treatment plan may be appropriate. Stronger injectable drugs
that act directly on the ovaries, stimulating ovarian follicles to
ripen and each release an egg, may be necessary.
Fertility drugs wonít help women whose fallopian tubes are
blocked or damaged because the eggs cannot reach the uterus. In these cases, surgery to
unblock the tubes is an option.
When the womanís tubes are clear for conception to occur, intrauterine
insemination (IUI) is often recommended. The ovaries are stimulated
by fertility drugs to produce no more than three eggs; then, at the
time of ovulation, a sample of fresh semen from either the womanís
partner or a donor is prepared and placed high up in the uterus
through a catheter.
intrafallopian transfer (GIFT), the womanís eggs are retrieved
from her ovaries and placed in a catheter with the male sperm. Eggs and sperm are then
injected directly into the fallopian tubes.
The most widely practiced reproductive technique, however, is
vitro fertilization (IVF).
Fertility drugs are used to produce multiple eggs and are
then retrieved from the ovary and fertilized in the laboratory with
sperm. A small
selection of the resulting embryos are then implanted in the
uterus. Unlike IUI and
GIFT, in vitro fertilization can be used to treat women with tubal
It is important to note that no one can be blamed for
infertility, any more than you can be blamed for diabetes or heart
disease. Infertility is
a disease process that can be diagnosed and successfully
If you suspect a fertility problem, the first step in getting
help is a basic infertility evaluation by a reproductive
endocrinologist/infertility specialist. The goal of an
infertility evaluation is to find out why you and your partner
cannot conceive and to plan treatment options.
Infertility testing begins with
basic, less invasive testing and proceeds to more sophisticated and
complex testing, usually after the first-line testing has failed to
uncover the cause of infertility. The infertility work-up is
used to help determine why conception isn't happening and determine
what may be done to correct the problem: