[ Basics about Infertility ] [ Intrauterine Insemination ] [ Polycystic Ovarian Syndrome [PCOS] ] [ Ovarian Drilling for PCOS ] [ Ovulation Induction ]
What is infertility?
Most experts define infertility as not being able to get pregnant after at least
one year of trying. Women who are able to get pregnant but then have repeat
miscarriages are also said to be infertile.
Pregnancy is the result of a complex chain of events. In order to get pregnant:
* A woman must release an egg from one of her ovaries (ovulation).
* The egg must go through a fallopian tube toward the uterus (womb).
* A man's sperm must join with (fertilize) the egg along the way.
* The fertilized egg must attach to the inside of the uterus (implantation).
Infertility can result from problems that interfere with any of these steps.
Is infertility a common
About 20 percent of women aged 20-35 have difficulty getting pregnant or
carrying a baby to term.
Is infertility just a woman's
No, infertility is not always a woman's problem. In only about one-half of
cases is infertility due to the woman (female factors). In another one fourth of
cases, infertility is due to the man (male factors). The remaining cases are
caused by a mixture of male and female factors or by unknown factors.
What causes infertility in
Infertility in men is most often caused by:
* problems making sperm -- producing too few sperm or none at all
* problems with the sperm's ability to reach the egg and fertilize it --
abnormal sperm shape or structure prevent it from moving correctly
Sometimes a man is born with the problems that affect his sperm. Other times
problems start later in life due to illness or injury. For example, cystic
fibrosis often causes infertility in men.
What increases a man's risk
The number and quality of a man's sperm can be affected by his overall health
and lifestyle. Some things that may reduce sperm number and/or quality include:
* environmental toxins, including pesticides and lead
* smoking cigarettes
* health problems
* radiation treatment and chemotherapy for cancer
What causes infertility in women?
Problems with ovulation account for most cases of infertility in women. Without
ovulation, there are no eggs to be fertilized. Some signs that a woman is not
ovulating normally include irregular or absent menstrual periods.
Less common causes of fertility problems in women include:
* blocked fallopian tubes due to pelvic inflammatory disease, endometriosis, or
surgery for an ectopic pregnancy
* physical problems with the uterus
* uterine fibroids
What things increase a woman's risk of infertility?
Many things can affect a woman's ability to have a baby. These include:
* poor diet
* athletic training
* being overweight or underweight
* tobacco smoking
* sexually transmitted diseases (STDs)
* health problems that cause hormonal changes
How does age affect a woman's ability to have children?
More and more women are waiting until their 30s and 40s to have children.
Actually, about 20 percent of women in the United States now have their first
child after age 35. So age is an increasingly common cause of fertility
problems. About one third of couples in which the woman is over 35 have
Aging decreases a woman's chances of having a baby in the following ways:
* The ability of a woman's ovaries to release eggs ready for fertilization
declines with age.
* The health of a woman's eggs declines with age.
* As a woman ages she is more likely to have health problems that can interfere
* As a women ages, her risk of having a miscarriage increases.
How long should women try to get pregnant before calling their doctors?
Most healthy women under the age of 30 shouldn't worry about infertility unless
they've been trying to get pregnant for at least a year. At this point, women
should talk to their doctors about a fertility evaluation. Men should also talk
to their doctors if this much time has passed.
In some cases, women should talk to their doctors sooner. Women in their 30s
who've been trying to get pregnant for six months should speak to their doctors
as soon as possible. A woman's chances of having a baby decrease rapidly every
year after the age of 30. So getting a complete and timely fertility evaluation
is especially important.
Some health issues also increase the risk of fertility problems. So
women with the following issues should speak to their doctors as soon as
* irregular periods or no menstrual periods
* very painful periods
* pelvic inflammatory disease
* more than one miscarriage
No matter how old you are, it's always a good idea to talk to a doctor before
you start trying to get pregnant. Doctors can help you prepare your body for a
healthy baby. They can also answer questions on fertility and give tips on
How will doctors find out if
a woman and her partner have fertility problems?
Sometimes doctors can find the cause of a couple's infertility by doing a
complete fertility evaluation. This process usually begins with physical exams
and health and sexual histories. If there are no obvious problems, like poorly
timed intercourse or absence of ovulation, tests will be needed.
Finding the cause of infertility is often a long, complex and emotional process.
It can take months for you and your doctor to complete all the needed exams and
tests. So don't be alarmed if the problem is not found right away.
For a man, doctors usually begin by testing his semen. They look at the number,
shape, and movement of the sperm. Sometimes doctors also suggest testing the
level of a man's hormones.
For a woman, the first step in testing is to find out if she is ovulating each
month. There are several ways to do this. A woman can track her ovulation at
* recording changes in her morning body temperature (basal body temperature) for
* recording the texture of her cervical mucus for several months
* using a home ovulation test kit (available at drug or grocery stores)
Doctors nowadays check if a woman is ovulating by doing blood tests and an
ultrasound of the ovaries. If the woman is ovulating normally, more tests are
Some common tests of fertility in women include:
Hysterosalpingography: In this test, doctors use x-rays to check for physical
problems of the uterus and fallopian tubes. They start by injecting a special
dye through the vagina into the uterus. This dye shows up on the x-ray. This
allows the doctor to see if the dye moves normally through the uterus into the
fallopian tubes. With these x-rays doctors can find blockages that may be
causing infertility. Blockages can prevent the egg from moving from the
fallopian tube to the uterus. Blockages can also keep the sperm from reaching
Laparoscopy: During this
surgery doctors use a tool called a laparoscope to see inside the abdomen. The
doctor makes a small cut in the lower abdomen and inserts the laparoscope. Using
the laparoscope, doctors check the ovaries, fallopian tubes, and uterus for
disease and physical problems. Doctors can usually find scarring and
endometriosis by laparoscopy.
Hysteroscopy: With this the
inside of the uterus and the openings of the fallopian tubes are checked for any
potential problems. Usually hysteroscopy, laparoscopy and tube testing are
combined and done at the same sitting.
How do doctors treat infertility?
Infertility can be treated with medicine, surgery, artificial insemination or
assisted reproductive technology. Many times these treatments are combined.
About two-thirds of couples who are treated for infertility are able to have a
baby. In most cases infertility is treated with drugs or surgery.
Doctors recommend specific treatments for infertility based on:
* test results
* how long the couple has been trying to get pregnant
* the age of both the man and woman
* the overall health of the partners
* preference of the partners
Doctors often treat infertility in men in the following ways:
* Sexual problems: If the man is impotent or has problems with premature
ejaculation, doctors can help him address these issues. Behavioral therapy
and/or medicines can be used in these cases.
* Too few sperm: If the man produces too few sperm, sometimes surgery can
correct this problem. In other cases, doctors can surgically remove sperm from
the male reproductive tract. Antibiotics can also be used to clear up infections
affecting sperm count.
Various fertility medicines are often used to treat women with ovulation
problems. It is important to talk with your doctor about the pros and cons of
these medicines. You should understand the risks, benefits, and side effects.
Doctors also use surgery to treat some causes of infertility. Problems with a
woman's ovaries, fallopian tubes, or uterus can sometimes be corrected with
Intrauterine insemination (IUI) is another type of
treatment for infertility. IUI is known by most people as artificial
insemination. In this procedure, the woman is injected with specially prepared
sperm. Sometimes the woman is also treated with medicines that stimulate
ovulation before IUI.
IUI is often used to treat:
* mild male factor infertility
* women who have problems with their cervical mucus
* couples with unexplained infertility
What medicines are used to treat infertility in women?
Some common medicines used to treat infertility in women include:
* Clomiphene citrate (Clomid): This medicine causes ovulation by acting on the
pituitary gland. It is often used in women who have Polycystic Ovarian Syndrome
(PCOS) or other problems with ovulation. This medicine is taken by mouth.
* Human menopausal gonadotropin or hMG (Repronex, Pergonal): This medicine is
often used for women who don't ovulate due to problems with their pituitary
gland. hMG acts directly on the ovaries to stimulate ovulation. It is an
* Follicle-stimulating hormone or FSH (Gonal-F, Follistim): FSH works much like
hMG. It causes the ovaries to begin the process of ovulation. These medicines
are usually injected.
* Gonadotropin-releasing hormone (Gn-RH) analog: These medicines are often used
for women who don't ovulate regularly each month. Women who ovulate before the
egg is ready can also use these medicines. Gn-RH analogs act on the pituitary
gland to change when the body ovulates. These medicines are usually injected or
given with a nasal spray.
* Metformin (Glucophage): Doctors use this medicine for women who have insulin
resistance and/or Polycystic Ovarian
Syndrome (PCOS). This drug helps lower the high levels of male hormones in
women with these conditions. This helps the body to ovulate. Sometimes
clomiphene citrate or FSH is combined with metformin. This medicine is usually
taken by mouth.
* Bromocriptine (Parlodel): This medicine is used for women with ovulation
problems due to high levels of prolactin. Prolactin is a hormone that causes
Many fertility drugs increase a woman's chance of having twins, triplets or
other multiples. Women who are pregnant with multiple fetuses have more problems
during pregnancy. Multiple fetuses have a high risk of being born too early
(prematurely). Premature babies are at a higher risk of health and developmental
What is assisted reproductive technology (ART)?
Assisted reproductive technology (ART) is a term that describes several
different methods used to help infertile couples. ART involves removing eggs
from a woman's body, mixing them with sperm in the laboratory and putting the
embryos back into a woman's body.
How often is assisted reproductive technology (ART) successful?
Success rates vary and depend on many factors. Some things that affect the
success rate of ART include:
* age of the partners
* reason for infertility
* type of ART
* if the egg is fresh or frozen
* if the embryo is fresh or frozen
The U.S. Centers for Disease Prevention (CDC) collects success rates on ART for
some fertility clinics. According to the 2003 CDC report on ART, the average
percentage of ART cycles that led to a healthy baby were as follows:
* 37.3% in women under the age of 35
* 30.2% in women aged 35-37
* 20.2% in women aged 37-40
* 11.0% in women aged 41-42
ART can be expensive and time-consuming. But it has allowed many couples to have
children that otherwise would not have been conceived. The most common
complication of ART is multiple fetuses. But this is a problem that can be
prevented or minimized in several different ways.
What are the different types of assisted reproductive technology (ART)?
Common methods of ART include:
* In vitro fertilization (IVF) means fertilization outside of the body. IVF is
the most effective ART. It is often used when a woman's fallopian tubes are
blocked or when a man produces too few sperm. Doctors treat the woman with a
drug that causes the ovaries to produce multiple eggs. Once mature, the eggs are
removed from the woman. They are put in a dish in the lab along with the man's
sperm for fertilization. After 3 to 5 days, healthy embryos are implanted in the
* Zygote intrafallopian transfer (ZIFT) or Tubal Embryo Transfer is similar to
IVF. Fertilization occurs in the laboratory. Then the very young embryo is
transferred to the fallopian tube instead of the uterus.
* Gamete intrafallopian transfer (GIFT) involves transferring eggs and sperm
into the woman's fallopian tube. So fertilization occurs in the woman's body.
Few practices offer GIFT as an option.
* Intracytoplasmic sperm injection (ICSI) is often used for couples in which
there are serious problems with the sperm. Sometimes it is also used for older
couples or for those with failed IVF attempts. In ICSI, a single sperm is
injected into a mature egg. Then the embryo is transferred to the uterus or