Infertility

Answer 1

Definition

Primary infertility describes couples who have never been able to become pregnant after at least 1 year of unprotected sex (intercourse).

Secondary infertility describes couples who have been pregnant at least once, but have not been able to become pregnant again.

Alternative Names

Inability to conceive; Unable to get pregnant

Causes, incidence, and risk factors

Causes of infertility include a wide range of both physical and emotional factors. A couple's infertility may be due to female factors, male factors, or both:

FEMALE INFERTILITY:

Female infertility may be due to:

• Problems with a fertilized egg or embryo being able to survive once it is attached to the lining of the uterus
• Problems with the fertilized egg being able to attach to the lining of the uterus
• Problems with the eggs being able to move from the ovary to the uterus
• Problems with the ovaries producing eggs

Female infertility may be caused by:

• Autoimmune disorders, such as antiphospholipid syndrome (APS)
• Clotting disorders
• Defects of the uterus and cervix (myomas or fibroids, polyps, birth defects)
• Excessive exercising, eating disorders, or poor nutrition
• Exposure to certain medications or toxins
• Heavy use of alcohol
• Hormone imbalance or deficiencies
• Long-term (chronic) disease, such as Diabetes
• Obesity
• Ovarian cystsand polycystic ovary syndrome (PCOS)
• Pelvic infection or pelvic inflammatory disease(PID)
• Scarring from sexually transmitted infection or endometriosis
• Tumor

MALE INFERTILITY:

Male infertility may be due to:

• A decrease in the number of sperm
• Sperm being blocked from being released
• Sperm that do not work properly

Male infertility can be caused by:

• Environmental pollutants
• Exposure to high heat for prolonged periods
• Genetic abnormalities
• Heavy use of alcohol, marijuana, or cocaine
• Hormone deficiency or taking too much of a hormone
• Impotence
• Infections of the testes or epididymis
• Older age
• Previous chemotherapy
• Previous scarring due to infection (including sexually transmitted diseases), trauma, or surgery
• Radiation exposure
• Retrograde ejaculation
• Smoking
• Surgery or trauma
• Use of prescription drugs, such as cimetidine, spironolactone, and nitrofurantoin

In healthy couples both under age 30, having sex regularly, the chance of getting pregnant is only 25 - 30% per month. A woman's peak fertility occurs in her early 20s. As a woman ages beyond 35 (and especially after age 40), the likelihood of getting pregnant drops to less than 10% per month.

When to seek help for infertility depends on your age. For women under age 30, it is generally recommended to try to conceive for at least a year before seeking testing.

Symptoms

The physical symptom of infertility is the inability to become pregnant.

Experiencing infertility can bring on a range of painful emotions in one or both members of the couple. In general, having at least one child already tends to soften these painful emotions.

Signs and tests

A complete medical history and physical examination of both partners is essential.

Tests in women may include:

• Blood hormone levels
• FSH and clomid challenge test to check ovarian reserve
• Hysterosalpingography(HSG)
• Pelvic ultrasound
• Laparoscopy(especially if endometriosis is suspected)
• Luteinizing hormone urine test (ovulation predictor kit)
• Pelvic exam
• Progestin challenge if periods are infrequent
• Serum progesterone
• Temperature first thing in the morning to check for ovulation (basal body temperature charting)
• Thyroid function tests

Tests in men may include:

• Semen analysis
• Testicular biopsy (rarely done)

Treatment

Increase your chance of becoming pregnant each month by having sexual intercourse at least every 3 days in the weeks leading up to and through the expected time of ovulation. Ovulation occurs about 2 weeks before the next period starts. So, if you get your period every 28 days, you should have sexual intercourse at least every 3 days between the 10th and 18th day after you get your period, and concentrating on the 72 hours before ovulation occurs.

Treatment depends on the cause of infertility. It may involve:

• Education and counseling
• Medical procedures such as intrauterine insemination (IUI) and in vitro fertilization (IVF)
• Medicines to treat infections and clotting disorders, or promote ovulation

It is important to recognize and discuss the emotional impact that infertility has on you and your partner, and to seek medical advice from your health care provider.

Support Groups

Many organizations provide informal support and referrals for professional counseling. See infertility - support group.

Expectations (prognosis)

Up to 60% of couples who were considered infertile become pregnant after receiving appropriate therapies (not including advanced techniques such as in vitro fertilization).

However, as many as 1 in 5 couples diagnosed as infertile eventually become pregnant without treatment.

Complications

Although infertility itself does not cause physical illness, it can have a major emotional impact on the couples and individuals it affects.

Couples may have problems with their marriage. Individuals may experience depression and anxiety.

Calling your health care provider

Call for an appointment with your health care provider if you are unable to get pregnant.

Prevention

Because sexually transmitted infections (STIs) often cause infertility, practicing safer sex behaviors may minimize the risk. Gonorrhea and chlamydia are the two most common causes of STI-related infertility.

STIs often don't have symptoms at first, until PID or salpingitis develops. These conditions scar the fallopian tubes and lead to decreased fertility, infertility, or an increased risk of ectopic pregnancy.

Getting a mumps vaccine in men has been shown to prevent mumps and its complication, orchitis. The vaccine prevents mumps-related sterility.

Some forms of birth control, such as the intrauterine device (IUD), carry a risk for pelvic infection, especially in women with more than one sex partner and when sexually transmitted infections occur.

Maintain a healthy diet, weight, and lifestyle to optimize your chances for getting pregnant and having a healthy pregnancy.

Remember to take either prenatal or multivitamins containing folate starting before you are trying to become pregnant to decrease your risk for miscarriage and problems with the baby.

References

Jose-Miller AB, Boyden JW, Frey KA. Infertility. Am Fam Physician. 2007;75(6):894-856.

Lobo RA. Infertility: etiology, diagnostic evaluation, management, prognosis. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007: chap 41.

Speroff L, Fitz M, eds. Clinical Gynecologic Endocrinology and Infertility. 7th ed. Philadelphia, Pa; Lippincott Williams & Wilkins; 2005.

Brassard M, Melk YA, Baillargeon JP. Basic Infertility Including Polycystic Ovary Syndrome. Medical Clinics of North America. Sept 2008;92(5).

Answer 2

Definition

Infertility means you cannot make a baby (conceive).

Infertility is grouped into two categories:

• Primary infertility refers to couples who have not become pregnant after at least 1 year of unprotected sex (intercourse).
• Secondary infertility refers to couples who have been pregnant at least once, but never again.

Alternative Names

Inability to conceive; Unable to get pregnant

Causes, incidence, and risk factors

A wide range of physical and emotional factors can cause infertility. Infertility may be due to problems in the woman, man, or both.

FEMALE INFERTILITY:

Female infertility may occur when:

• A fertilized egg or embryo does not survive once it sticks to the lining of the womb (uterus)
• The fertilized egg does not attach to the lining of the uterus
• The eggs cannot move from the ovaries to the womb
• The ovaries have problems producing eggs

Female infertility may be caused by:

• Autoimmune disorders, such as antiphospholipid syndrome (APS)
• Cancer or tumor
• Clotting disorders
• Diabetes
• Growths (such as fibroids or polyps) in the uterus and cervix
• Birth defects that affect the reproductive tract
• Excessive exercising
• Eating disorders or poor nutrition
• Use of certain medications, including chemotherapy drugs
• Drinking too much alcohol
• Obesity
• Older age
• Ovarian cystsand polycystic ovary syndrome (PCOS)
• Pelvic infection or pelvic inflammatory disease(PID)
• Scarring from sexually transmitted infection or endometriosis
• Thyroid disease
• Too little or too much hormones

MALE INFERTILITY:

Male infertility may be due to:

• A decrease in sperm count
• Sperm being blocked from being released
• Sperm that do not work properly

Male infertility can be caused by:

• Environmental pollutants
• Being in high heat for prolonged periods
• Birth defects
• Heavy use of alcohol, marijuana, or cocaine
• Too little or too much hormones
• Impotence
• Infection
• Older age
• Cancer treatments, including chemotherapy and radiation
• Scarring from sexually transmitted diseases, injury, or surgery
• Retrograde ejaculation
• Smoking
• Use of certain drugs, such as cimetidine, spironolactone, and nitrofurantoin

In healthy couples under age 30 who have sex regularly, the chance of getting pregnant is about 25 - 30% per month.

A woman's peak fertility occurs in her early 20s. After age 35 (and especially 40), the chances that a woman can get pregnant drops considerably.

Symptoms

The main symptom of infertility is the inability to become pregnant. Specific symptoms depend on what is causing the infertility.

Infertility can cause many painful emotions in one or both partners.

Signs and tests

When you should seek treatment for infertility depends on your age. It is recommended that women under 30 should generally try to get pregnant on their own for 1 year before seeking testing.

Infertility testing involves a complete medical history and physical examination of both partners.

Blood and imaging tests will be done. In women, this may include:

• Blood tests to check hormone levels, including progesterone and follicle stimulating hormone
• Checking body temperature first thing in the morning to check if the ovaries are releasing eggs
• FSH and clomid challenge test
• Hysterosalpingography(HSG)
• Pelvic ultrasound
• Laparoscopy
• Luteinizing hormone urine test (ovulation prediction)
• Thyroid function tests

Tests in men may include:

• Sperm testing
• Testicular biopsy (rarely done)

Treatment

Treatment depends on the cause of infertility. It may involve:

• Education and counseling
• Fertility treatments such as intrauterine insemination (IUI) and in vitro fertilization (IVF)
• Medicines to treat infections and clotting disorders
• Medicines that help the woman grow and release eggs from the ovaries

It is important to recognize and discuss the emotional impact that infertility has on you and your partner, and to seek medical advice from your health care provider.

You can increase your chances of becoming pregnant each month by having sex at least every 3 days before and during ovulation. It is especially important to do so 72 hours before ovulation begins.

Ovulation occurs about 2 weeks before the next menstrual cycle (period) starts. If a woman gets her period every 28 days, the couple should have sex at least every 3 days between the 10th and 18th day after the period starts.

Support Groups

See: Infertility - support group

Expectations (prognosis)

As many as 1 in 5 couples diagnosed with infertility eventually become pregnant without treatment.

More than half of couples with infertility become pregnant after treatment, not including advanced techniques such as in vitro fertiliziation (IVF).

Complications

Infertility can have a big emotional impact on you and your partner.

Depression, anxiety, and marriage problems may occur.

Calling your health care provider

Call for an appointment with your health care provider if you are unable to get pregnant.

Prevention

Preventing sexually transmitted infections (STIs), such as gonorrhea and chlamydia, may reduce your risk of infertility.

Maintaining a healthy diet, weight, and lifestyle may increase your chances for getting pregnant and having a healthy pregnancy.

Take a prenatal or multivitamin containing folate before and during pregnancy. This lowers your risk for miscarriage and developmental problems in the baby.

References

Jose-Miller AB, Boyden JW, Frey KA. Infertility. Am Fam Physician. 2007;75(6):894-856.

Lobo RA. Infertility: etiology, diagnostic evaluation, management, prognosis. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007: chap 41.

Speroff L, Fitz M, eds. Clinical Gynecologic Endocrinology and Infertility. 7th ed. Philadelphia, Pa; Lippincott Williams & Wilkins; 2005.

Brassard M, Melk YA, Baillargeon JP. Basic Infertility Including Polycystic Ovary Syndrome. Medical Clinics of North America. Sept 2008;92(5).

Reviewed By

Review Date: 02/28/2011

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.