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Infertility
It is not uncommon to have trouble becoming pregnant or
to experience infertility.
Infertility is defined as not being able to become pregnant,
despite trying for one year, in women under age 35, or after
six months in women 35 and over. Pregnancy is the result
of a chain of events. As described in the Fertility
Awareness section, a woman must release an egg from one
of her ovaries (ovulation). The egg must travel through a
fallopian tube toward her uterus. A man's sperm must join
with (fertilize) the egg along the way. The fertilized egg
must then become attached to the inside of the uterus. While
this may seem simple, in fact many things can happen to prevent
pregnancy.
Reasons for Infertility
Age
There are many different reasons why a couple might have
infertility. One is age-related. Women today are often delaying
having children until later in life, when they are in their
30s and 40s. A couple of things add to this trend. Birth
control is easy to obtain and use, more women are in the
work force, women are marrying at an older age, the divorce
rate remains high, and married couples are delaying pregnancy
until they are more financially secure. But the older you
are, the harder it is to become pregnant. Women generally
have some decrease in fertility starting in their early 30s.
And while many women in their 30s and 40s have no problems
getting pregnant, fertility especially declines after age
35.
As a woman ages, there are normal changes that occur in
her ovaries and eggs. All women are born with over a million
eggs in their ovaries (all the eggs that they will ever have),
but only have about 300,000 left by puberty.
Then of these, only about 300 eggs will be ovulated during
the reproductive years. Even though menstrual cycles continue
to be regular in a woman's 30s and 40s, the eggs that ovulate
each month are of poorer quality than those from her 20s.
It is harder to get pregnant when the eggs are poorer in
quality.
Ovarian reserve is the number and quality of eggs in
your ovaries and how well the ovarian follicles respond
to hormones in your body. As you approach menopause,
your ovaries don't respond as well to your hormones, and
in time they may not release an egg each month. A reduced
ovarian reserve is natural as a woman ages, but young women
might have reduced ovarian reserves due to smoking, a prior
surgery on their ovaries, or a family history of early menopause.
Also, as a woman and her eggs age, if she becomes pregnant,
there is a greater chance of having genetic problems, such
as having a baby with Down
Syndrome. Embryos formed
from eggs in older women also are less likely to fully develop,
a main reason for miscarriage (early pregnancy loss).
Health Problems
Couples
also can have fertility problems because of health problems,
in either the woman or the man. Common problems with a woman's
reproductive organs, like uterine
fibroids, endometriosis,
and pelvic inflammatory
disease can worsen with age and also affect fertility.
These conditions might cause the fallopian
tubes to be blocked, so the egg can't travel through
the tubes into the uterus.
Some people also have diseases or conditions that affect
their hormone levels, which can cause infertility in women
and impotence and infertility in men. Polycystic Ovarian
syndrome (PCOS) is one such hormonal condition that affects
many women, and is the most common cause of anovulation,
or when a woman rarely or never ovulates. Another hormonal
condition that is a common cause of infertility is when a
woman has a luteal
phase defect (LPD). A luteal phase is the time in the
menstrual cycle between ovulation and the start of the next
menstrual period. LPD is a failure of the uterine lining
to be fully prepared for a fertilized egg to implant there.
This happens either because a woman's body is not producing
enough progesterone, or the uterine lining isn't responding
to progesterone levels at some point in the menstrual cycle.
Since pregnancy depends on a fertilized egg implanting in
the uterine lining, LPD can interfere with a woman getting
pregnant and with carrying a pregnancy successfully.
Certain lifestyle choices also can have a negative effect
on a woman's fertility, such as smoking, alcohol use, weighing
much more or much less than an ideal body weight, a lot of
strenuous exercise, and having an eating
disorder.
Unlike women, some men remain fertile into their 60s and
70s. But as men age, they might begin to have problems with
the shape and movement of their sperm, and have a slightly
higher risk of sperm gene defects. They also might produce
no sperm, or too few sperm. Lifestyle choices also can affect
the number and quality of a man's sperm. Alcohol and drugs
can temporarily reduce sperm quality. And researchers are
looking at whether environmental toxins, such as pesticides and
lead,
also may be to blame for some cases of infertility. Men also
can have health problems that affect their sexual and reproductive
function. These can include sexually transmitted diseases
(STDs), diabetes,
surgery on the prostate
gland, or a severe testicle injury
or problem.
If you or your partner has a problem with sexual function
or libido,
don't delay seeing your doctor for help.
Treating Infertility
You should talk to your doctor about your fertility if you:
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are under age 35 and, after a year of frequent
sex without birth control, you are having problems getting
pregnant, or
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are age 35 or over and, after six months
of frequent sex without birth control, you are having
problems getting pregnant, or
-
believe you or your partner might have
fertility problems in the future (even before you begin
trying to get pregnant).
Your doctor can refer you to a fertility specialist, a doctor
who focuses in treating infertility. This doctor can recommend
treatments such as drugs, surgery, or assisted
reproductive technology. Don't delay seeing your
doctor because age also affects the success rates of these
treatments.
There are many ways to treat infertility. They include:
Tests
The first step to treat infertility is to see a doctor for
a fertility evaluation. He or she will test both the woman
and the man, to find out where the problem is. Testing on
the man focuses on the number and health of his sperm. The
lab will look at a sample of his sperm under a microscope
to check sperm number, shape, and movement. Blood tests also
can be done to check hormone levels. More tests might be
needed to look for infection, or problems with hormones.
These tests can include:
-
an x-ray (to look at his reproductive organs)
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a mucus penetrance test (to see if sperm
can swim through mucus)
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a hamster-egg penetrance assay (to see
if sperm can go through hamster egg cells, somewhat showing
their power to fertilize human eggs)
Testing for the woman first looks at whether she is ovulating
each month. This can be done by having her chart changes
in her morning body
temperature, by using an FDA-approved home ovulation
test kit (which she can buy at a drug store), or by looking
at her cervical mucus, which changes throughout her menstrual
cycle. Ovulation also can be checked in her doctor's office
with an ultrasound test
of the ovaries, or simple blood tests that check hormone
levels, like the follicle-stimulating
hormone (FSH) test. FSH is produced by the pituitary
gland. In women, it helps control the menstrual cycle
and the production of eggs by the ovaries. The amount of
FSH varies throughout the menstrual cycle and is highest
just before an egg is released. The amounts of FSH and other
hormones (luteinizing
hormone, estrogen,
and progesterone)
are measured in both a man and a woman to determine why the
couple cannot achieve pregnancy. If the woman is ovulating,
more testing will need to be done. These tests can include:
-
an hysterosalpingogram (an x-ray to check
if the fallopian tubes are open and to show the shape
of the uterus)
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a laparoscopy (an exam of the tubes and
other female organs for disease)
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an endometrial biopsy (an exam of a small
shred of the uterine lining to see if monthly changes
in it are normal)
Other tests can be done to show whether the sperm and mucus
are interacting in the right way, or if the man or woman
is forming antibodies that
are attacking the sperm and stopping them from getting to
the egg.
Drugs and Surgery
Different treatments for infertility are recommended depending
on what the problem is. About 90 percent of cases are treated
with drugs or surgery. Various fertility drugs may be used
for women with ovulation problems. It is important to talk
with your doctor about the drug to be used. You should understand
the drug's benefits and side effects. Depending on the type
of fertility drug and the dosage of the drug used, multiple
births (such as twins) can occur in some women. If needed,
surgery can be done to repair damage to a woman's ovaries,
fallopian tubes, or uterus. Sometimes a man has an infertility
problem that can be corrected by surgery.
Assisted Reproductive Technology (ART)
Assisted reproductive technology (ART) uses special methods
to help infertile couples, and involves handling both the
woman's eggs and the man's sperm. Success rates vary and
depend on many factors. But ART has made it possible for
many couples to have children that otherwise would not have
been conceived. ART can be expensive and time-consuming.
Many health insurance companies do not provide coverage for
infertility or provide only limited coverage. Check your
health insurance contract carefully to learn about what is
covered. Also, some states have laws for infertility insurance
coverage. Some of these include Arkansas, California, Connecticut,
Hawaii, Illinois, Maryland, Massachusetts, Rhode Island,
Texas, and West Virginia.
In vitro fertilization (IVF) is a type of ART that
is often used when a woman's fallopian tubes are blocked
or when a man has low sperm counts. A drug is used to stimulate
the ovaries to produce multiple eggs. Once mature, the eggs
are removed and placed in a culture dish with the man's sperm
for fertilization. After about 40 hours, the eggs are examined
to see if they have become fertilized by the sperm and are
dividing into cells. These fertilized eggs (embryos)
are then placed in the woman's uterus, thus bypassing the
fallopian tubes. Gamete intrafallopian transfer (GIFT) is
similar to IVF, but used when the woman has at least one
normal fallopian tube. Three to five eggs are placed in the
fallopian tube, along with the man's sperm, for fertilization
inside the woman's body. Zygote intrafallopian transfer
(ZIFT), also called tubal embryo transfer, combines
IVF and GIFT. The eggs retrieved from the woman's ovaries
are fertilized in the lab and placed in the fallopian tubes
rather than the uterus.
ART sometimes involves the use of donor eggs (eggs from
another woman) or previously frozen embryos. Donor eggs may
be used if a woman has impaired ovaries or has a genetic
disease that could be passed on to her baby. And if a woman
does not have any eggs, or her eggs are not of a good enough
quality to produce a pregnancy, she and her partner might
want to consider surrogacy. A surrogate is a woman
who agrees to become pregnant using the man's sperm and her
own egg. The child will be genetically related to the surrogate
and the male partner, but the surrogate will give the baby
to the couple at birth.
A gestational carrier might be an option for women
who do not have a uterus, from having had a hysterectomy,
but still have their ovaries, or for women who shouldn't
become pregnant because of a serious health problem. In this
case, the woman's eggs are fertilized by the man's sperm
and the embryo is placed inside the carrier's uterus. In
this case, the carrier will not be related to the baby, and
will give the baby to the parents at birth.
Counseling and Support Groups
If you've been having problems getting pregnant, you know
how frustrating it can feel. Not being able to get pregnant
can be one of the most stressful experiences a couple has.
Both counseling and support groups can help you and your
partner talk about your feelings, and to help you meet other
couples like you in the same situation. You will learn that
anger, grief, blame, guilt, and depression are all normal.
Couples do survive infertility, and can become closer and
stronger in the process. Ask your doctor for the names of
counselors or therapists with an interest in fertility.
To read more about fertility and infertility from WomensHealth.gov,
please click here: http://womenshealth.gov/pregnancy/tryingtogetpregnant/tryingtoconceive.cfm
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