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Infertility is a reproductive system disease that prevents the ability to conceive children. Many factors are needed for conception. A woman’s body must release an egg from one of her ovaries. A man must produce healthy sperm, which must travel the fallopian tubes, to reach a woman’s healthy egg. This fertilized egg must then successfully implant into a woman’s uterus. Lastly, the embryo must be healthy and the woman’s hormonal environment must be balanced for the embryo to develop. If any point of this process is damaged or impaired, infertility can result.
Infertility is defined as the inability to conceive children after 12 months of unprotected sex. Infertility can result as a problem from men or women. Approximately one-third of infertility problems are caused by women, one-third by men, and the last one-third as either a combination of the two or unknown problems.
Most cases of female infertility are problems with ovulation. Ovulation problems can result from multiple different syndromes. Some of these include
- Polycystic ovary syndrome (PCOS)
- Functional hypothalamic amenorrhea
- Diminished ovarian reserve
- Premature ovarian insufficiency
Another common cause in women is tubal patency (whether the fallopian tubes are open, blocked, or swollen).
Another common cause is uterine contour abnormalities, or abnormal physical characteristics of the uterus.
Male Infertility is caused by defects in sperm quantity, morphology, or motility. These can be caused by
- Varicoceles, a condition in which the veins on a man’s testicles are large and cause them to overheat.
- Medical conditions or exposures such as, diabetes, cystic fibrosis, trauma, infection, testicular failure, or treatment with chemotherapy or radiation.
- Unhealthy habits such as heavy alcohol use, testosterone supplementation, smoking, anabolic steroid use, and illicit drug use.
- Environmental toxins including exposure to pesticides and lead.
There are often no signs or symptoms of infertility. Couples are encouraged to seek medical attention from a reproductive endocrinologist (infertility specialist) after 1 year of unprotected sex without conception. Also women who do not have regular menstrual cycles, are older than 35 years and have not conceived after 6 months of trying should consider making an appointment.
Diagnosis and Testing
Doctors will begin diagnosis and testing by collecting both a medical and sexual history from both partners. The initial evaluation also generally includes a semen analysis, a tubal evaluation, and ovarian reserve testing.
- Semen analysis—Tests the number, shape, and movement of the sperm
- Tubal Evaluation—Multiple tests can be utilized to determine if the Fallopian tubes are obstructed. Tests include sonography, laparoscopy, and hysterosalpingogram.
- Ovarian reserve testing—Provides an indirect estimate of a woman’s remaining follicular pool.
Women may also be asked to record body temperature and ovulation to be analyzed.
Infertility can be treated with medicine, surgery, intra-uterine insemination, or assisted reproductive technology. Many times these treatments are combined. Doctors recommend specific treatments for infertility based on
- The factors contributing to the infertility.
- The duration of the infertility.
- The age of the female.
- The couple’s treatment preference after counseling about success rates, risks, and benefits of each treatment option.
American Society for Reproductive Medicine (ASRM)—www.asrm.org
American Fertility Association (AFA)—www.theafa.org
Centers for Disease Control and Prevention (CDC)—www.cdc.gov/reproductivehealth/infertility
Society for Assisted Reproductive Technology—www.sart.org
Centers for Disease Control and Prevention. http://www.cdc.gov/reproductivehealth/infertility.
National Institutes of Health. NICHD. Infertility/Fertility. http://www.nichd.nih.gov/health/topics/infertility_fertility.cfm.
The National Infertility Association. http://www.resolve.org.