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Infertility

Inability to conceive; Unable to get pregnant

Infertility means you cannot get pregnant (conceive).

There are 2 types of infertility:

  • Primary infertility refers to couples who have not become pregnant after at least 1 year having sex without using birth control methods.
  • Secondary infertility refers to couples who have been able to get pregnant at least once, but now are unable.

Causes

Many physical and emotional factors can cause infertility. It 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 attaches 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)
  • Birth defects that affect the reproductive tract
  • Cancer or tumor
  • Clotting disorders
  • Diabetes
  • Drinking too much alcohol
  • Exercising too much
  • Eating disorders or poor nutrition
  • Growths (such as fibroids or polyps) in the uterus and cervix
  • Medicines such as chemotherapy drugs
  • Hormone imbalances
  • Obesity
  • Older age
  • Ovarian cysts and polycystic ovary syndrome (PCOS)
  • Pelvic infection resulting in scarring or swelling of fallopian tubes (hydrosalpinx) or pelvic inflammatory disease (PID)
  • Scarring from sexually transmitted infection, abdominal surgery or endometriosis
  • Smoking
  • Surgery to prevent pregnancy (tubal ligation) or failure of tubal ligation reversal (reanastomosis)
  • Thyroid disease

MALE INFERTILITY

Male infertility may be due to:

  • Decreased number of sperm
  • Blockage that prevents the sperm from being released
  • Defects in the sperm

Male infertility can be caused by:

  • Birth defects
  • Cancer treatments, including chemotherapy and radiation
  • Exposure to high heat for prolonged periods
  • Heavy use of alcohol, marijuana, or cocaine
  • Hormone imbalance
  • Impotence
  • Infection
  • Medicines such as cimetidine, spironolactone, and nitrofurantoin
  • Obesity
  • Older age
  • Retrograde ejaculation
  • Scarring from sexually transmitted infections (STIs), injury, or surgery
  • Smoking
  • Toxins in the environment
  • Vasectomy or failure of vasectomy reversal

Healthy couples under age 30 who have sex regularly will have a 25% to 30% per month chance of getting pregnant each month.

A woman is most fertile in her early 20s. The chance a woman can get pregnant drops greatly after age 35 (and especially after age 40). The age when fertility starts to decline varies from woman to woman.

Infertility problems and miscarriage rates increase significantly after 35 years of age. There are now options for early egg retrieval and storage for women in their 20's. This will help ensure a successful pregnancy if childbearing is delayed until after age 35. This is an expensive option, but for women who know they will need to delay childbearing, it may be worth considering.

Exams and Tests

Deciding when to get treated for infertility depends on your age. Health care providers often suggest that women under 30 try to get pregnant on their own for 1 year before getting tested.

Many experts recommend that women over 35 attempt conception for only 6 months. If a pregnancy does not occur within that time, they should talk to their provider.

Infertility testing involves a medical history and physical exam for both partners.

Blood and imaging tests are most often needed. In women, these may include:

  • Blood tests to check hormone levels, including progesterone and follicle stimulating hormone (FSH)
  • Home urine ovulation detection kits
  • Measurement of body temperature every morning to see if the ovaries are releasing eggs
  • FSH and clomid challenge test
  • Antimullerian hormone testing (AMH)
  • Hysterosalpingography (HSG)
  • Pelvic ultrasound
  • Laparoscopy
  • Thyroid function tests

Tests in men may include:

  • Sperm testing
  • Exam of the testes and penis
  • Ultrasound of the male genitals (sometimes done)
  • Blood tests to check hormone levels
  • Testicular biopsy (rarely done)

Treatment

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

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

Couples can increase the chances of becoming pregnant each month by having sex at least every 3 days before and during ovulation.

Ovulation occurs about 2 weeks before the next menstrual cycle (period) starts. Therefore, 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 her period starts.

Having sex before ovulation occurs is especially helpful.

  • Sperm can live inside a woman's body for at least 3 days.
  • However, a woman's egg can only be fertilized by the sperm for a few hours after it is released.

Women who are under or overweight may increase their chances of becoming pregnant by getting to a healthier weight.

Support Groups

Many people find it helpful to take part in support groups for people with similar concerns. You can ask your provider to recommend local groups.

Outlook (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. This figure does not include advanced techniques such as IVF.

When to Contact a Medical Professional

Call your provider if you are unable to get pregnant.

Prevention

Preventing STIs, such as gonorrhea and chlamydia, may reduce your risk of infertility.

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

References

Barak S, Gordon Baker HW. Clinical management of male infertility. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 141.

Broekmans FJ, Fauser BCJM. Female infertility: evaluation and management. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 132.

Lobo RA. Infertility: etiology, diagnostic evaluation, management, prognosis. In: Lobo RA, Gershenson DM, Lentz GM, Valea FA, eds. Comprehensive Gynecology. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 42.

Practice Committee of the American Society for Reproductive Medicine. Diagnostic evaluation of the infertile female: a committee opinion. Fertil Steril. 2015;103(6):e44-e50. PMID: 25936238 www.ncbi.nlm.nih.gov/pubmed/25936238.

Practice Committee of the American Society for Reproductive Medicine. Diagnostic evaluation of the infertile male: a committee opinion. Fertil Steril. 2015;103(3):18-25. PMID: 25597249 www.ncbi.nlm.nih.gov/pubmed/25597249.

Rebar RW, Catherino WH. Reproductive endocrinology and infertility. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 236.

  • Pelvic laparoscopy

    Pelvic laparoscopy - illustration

    Laparoscopy is performed when less-invasive surgery is desired. It is also called Band-Aid surgery because only small incisions need to be made to accommodate the small surgical instruments that are used to view the abdominal contents and perform the surgery.

    Pelvic laparoscopy

    illustration

  • Female reproductive anatomy

    Female reproductive anatomy - illustration

    External structures of the female reproductive anatomy include the labium minora and majora, the vagina and the clitoris. Internal structures include the uterus, ovaries, and cervix.

    Female reproductive anatomy

    illustration

  • Male reproductive anatomy

    Male reproductive anatomy - illustration

    The male reproductive structures include the penis, the scrotum, the seminal vesicles, and the prostate.

    Male reproductive anatomy

    illustration

  • Primary infertility

    Primary infertility - illustration

    Primary infertility is a term used to describe a couple that has never been able to conceive a pregnancy after a minimum of 1 year of attempting to do so through unprotected intercourse. Causes of infertility include a wide range of physical as well as emotional factors.

    Primary infertility

    illustration

  • Sperm

    Sperm - illustration

    The male reproductive system creates sperm that is manufactured in the seminiferous tubules within each testicle. The head of the sperm contains the DNA, which when combined with the eggs DNA, will create a new individual. The tip of the sperm head is the portion called the acrosome, which enables the sperm to penetrate the egg. The midpiece contains the mitochondria which supplies the energy the tail needs to move. The tail moves with whip-like movements back and forth to propel the sperm towards the egg. The sperm have to reach the uterus and the fallopian tube in order to fertilize a womans egg.

    Sperm

    illustration

    • Pelvic laparoscopy

      Pelvic laparoscopy - illustration

      Laparoscopy is performed when less-invasive surgery is desired. It is also called Band-Aid surgery because only small incisions need to be made to accommodate the small surgical instruments that are used to view the abdominal contents and perform the surgery.

      Pelvic laparoscopy

      illustration

    • Female reproductive anatomy

      Female reproductive anatomy - illustration

      External structures of the female reproductive anatomy include the labium minora and majora, the vagina and the clitoris. Internal structures include the uterus, ovaries, and cervix.

      Female reproductive anatomy

      illustration

    • Male reproductive anatomy

      Male reproductive anatomy - illustration

      The male reproductive structures include the penis, the scrotum, the seminal vesicles, and the prostate.

      Male reproductive anatomy

      illustration

    • Primary infertility

      Primary infertility - illustration

      Primary infertility is a term used to describe a couple that has never been able to conceive a pregnancy after a minimum of 1 year of attempting to do so through unprotected intercourse. Causes of infertility include a wide range of physical as well as emotional factors.

      Primary infertility

      illustration

    • Sperm

      Sperm - illustration

      The male reproductive system creates sperm that is manufactured in the seminiferous tubules within each testicle. The head of the sperm contains the DNA, which when combined with the eggs DNA, will create a new individual. The tip of the sperm head is the portion called the acrosome, which enables the sperm to penetrate the egg. The midpiece contains the mitochondria which supplies the energy the tail needs to move. The tail moves with whip-like movements back and forth to propel the sperm towards the egg. The sperm have to reach the uterus and the fallopian tube in order to fertilize a womans egg.

      Sperm

      illustration

    A Closer Look

     
     

    Review Date: 8/26/2017

    Reviewed By: Peter J Chen, MD, FACOG, Associate Professor of OBGYN at Cooper Medical School at Rowan University, Camden, NJ. Review provided by VeriMed Healthcare Network. Internal review and update on 11/06/2018 by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

    The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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