Infertility is defined as the inability to conceive after 12 months of unprotected sexual intercourse. Infertility may be attributed to the man, the woman, or both partners. Infertility does not mean that a couple is sterile and will never have a child. Approximately half of all couples who seek help for infertility will eventually conceive a child. There are several treatments available that may help to improve the chances of a conception and a successful pregnancy.
Causes of Infertility
Not all causes of infertility are known, however infertility may be affected by genetic disorders, previous radiation and chemotherapy treatments for cancer and medical conditions such as thyroid problems or diabetes. Other factors may also play a role in the cause of infertility and may include:
- Advanced age
- Ovulation disorders
- Abnormalities with the uterus or cervix
- Damage or blockage in the fallopian tubes
- Eating disorders
- Low sperm count
- Varicocele or other testicle problems
- Hormone problems
- Exposure to certain chemicals or toxins
In some cases lifestyle factors such as obesity, smoking, and heavy alcohol or drug use can affect ovulation and sperm count and decrease levels of fertility.
Diagnosis of Infertility
During the initial infertility evaluation, both the female and male partner will undergo a full physical examination and their complete medical histories will be reviewed. In addition, blood and urine tests will be performed. Additional tests to determine the cause of infertility will also be performed and may include:
- Hysterosalpingography to evaluate the condition of the uterus and fallopian tubes
- Hormone testing to check levels of hormones that control reproductive processes
- Ovulation testing
- Imaging tests of reproductive organs
- Semen analysis
- Hormone level testing to check testosterone levels
- Transrectal and scrotal ultrasound
Both partners may also be tested for any genetic defects that may be causing infertility.
Treatment of Infertility
Treatment for infertility aims to maximize the couple's fertility potential and allow for successful conception. Recommendations for increasing fertility may be as simple as quitting smoking, avoiding alcohol and losing weight. Treatments may vary depending on the cause and may include:
- Fertility drugs to induce ovulation
- Surgery to repair blocked or damaged fallopian tubes
- Surgery to correct problems with the uterus
- Hormone treatments
- Surgery to correct a varicocle
- Medication to correct impotence
- Sperm retrieval
- Hormone treatments
Intrauterine insemination may also be performed to assist with pregnancy. In this procedure, a large amount of healthy sperm is implanted directly into the uterus at the time of ovulation through a thin catheter. If these infertility treatments are unsuccessful, the couple may decide to use other assisted reproductive technology options such as in vitro fertilization, intracytoplasmic sperm injection, donor eggs or sperm, or a surrogate.
Infertility treatments may have side effects and the most common complication is multiple births, and as a result the greater the number of fetuses, the higher the risk of premature labor and delivery. In addition some infertility treatments that stimulate ovulation may cause a serious condition called ovarian hyperstimulation syndrome.
Many couples may experience physical and psychological stress during infertility treatments, which can be costly, and may not be covered by insurance. The couple should discuss all fertility treatment options with a physician in order to determine the best approach to treat issues of infertility.