What is Infertility? A Guide to Causes, Symptoms, and Diagnosis
Many couples dream of having children, but getting pregnant isn't always easy. One of the most common roadblocks is infertility. "Sixty percent of couples will become pregnant after six months of regular unprotected intercourse. For a young and healthy couple, the chance of conceiving is 20 percent per month," says Amy Schutt, M.D., a reproductive endocrinologist at the Family Fertility Center at Texas Children's Pavilion for Women. "Infertility is the inability to conceive after 12 months of trying, or after six months in women over age 35." If a woman has trouble carrying a pregnancy to term, she may also be diagnosed with infertility.
It's important to realize that infertility is a fairly common condition. Dr. Schutt says about one in eight couples have difficulties conceiving or maintaining a pregnancy. And despite common misconception, men and women are equally likely to suffer from infertility. The inability to conceive stems from women 40 percent of the time and from men 40 percent of the time. Unknown causes account for the remaining 10 percent of cases, says Timothy Hickman, M.D., the medical director of CCRM Houston and director of the Division of Reproductive Endocrinology and Infertility at Houston Methodist Hospital.
Fortunately, most couples dealing with infertility don't need to give up their dreams of having babies. By diagnosing and treating the underlying causes, 85 to 90 percent end up overcoming their issues. Read on to learn more about the causes, symptoms, and treatment options for infertility.
Infertility in Women
To conceive a child, the ovaries, fallopian tubes, and uterus work in tandem. If one of these reproductive parts functions abnormally, infertility can occur. Here are the common causes of infertility in women.
- Maternal age. "One of the most common infertility causes is the age of the eggs," says Nicole Noyes, M.D., a reproductive endocrinology and infertility specialist at the NYU Langone Fertility Center. Females are born with their eggs, and the quality and quantity of eggs decreases over time. Dr. Noyes says women lose around two-thirds of fertility potential from 35 to 40 years. That's why women over 35 are advised to seek medical attention after six months of trying. On the other hand, those younger than 35 should wait one year.
- Ovulation disorders like polycystic ovary syndrome (PCOS) or premature menopause
- Fallopian tube blockage. This often results from pelvic inflammatory disease, endometriosis, surgery for ectopic pregnancies, and sexually transmitted diseases like chlamydia or gonorrhea.
- Uterine fibroids, which may increase the risk of miscarriage
- Congenital anomalies, or birth defects like being born with an abnormal reproductive tract
Other factors that negatively impact female fertility include smoking, excessive weight fluctuation, eating disorders, smoking, and heavy alcohol use.
Infertility in Men
About half of all fertility problems stem from male sperm, says Dr. Noyes. Male infertility causes can be broken down into two main categories: sperm production and sperm motility.
Sperm motility. To make a baby, a sperm cell needs to reach and penetrate an egg. Sperm might not make the trek if they're abnormally shaped, low in number (oligospermia), or not being produced (azoospermia). Some men also suffer from varicocele, or large veins on the testicles that produce excess heat and decrease sperm count.
Sperm production. In some cases, sperm doesn't leave the penis at all, so the egg doesn't have a chance to be fertilized. Causes include sexual problems (like premature ejaculation), retrograde ejaculation (semen flows into the bladder), and blockages in the testicles or tubes.
Risk factors for infertility in men include:
- Hormonal imbalance
- Genetic disease like cystic fibrosis or diabetes
- Chromosomal abnormality
- Excessive alcohol, cigarette, or drug usage
- Certain medications like steroids
- Environmental toxins
- Untreated infections like chlamydia and gonorrhea
- Cancer, radiation, and chemotherapy
Infertility Symptoms and Diagnosis
The majority of infertile men and women don't have any symptoms besides the inability to conceive, says Dr. Hickman. But having abnormal, painful, or irregular menstrual cycles could potentially indicate infertility, since these issues point to problems with ovulation.
The American Society of Reproductive Medicine advises couples to seek medical advice after one year of unsuccessfully trying to conceive. Women over age 35 should consult an expert after six months of trying. Those with a pre-existing medical condition (like endometriosis, pelvic inflammatory disease, or history of miscarriage) should visit their doctor right away.
Your healthcare specialist will probably perform several fertility tests to reach a diagnosis. According to Dr. Schutt, fertility testing looks to evaluate ovarian function. (Are you ovulating, and how many eggs do you have in your ovaries?). Doctors will also examine pelvic anatomy with ultrasound and hysterosalpingogram. This will look at your uterus and fallopian tubes to see if they're functioning properly.
For infertility in men, doctors focus on sperm parameters to verify that enough healthy sperm is present in the ejaculate. "These tests include a combination of blood work, ultrasound, X-ray, and semen analysis," says Dr. Schutt.
Infertility Treatment Options
Here's a silver lining for those with infertility: With conventional treatment, the American Society of Reproductive Medicine says about 85 to 90 percent of cases can be resolved. Dr. Schutt says infertility treatment usually aims to correct the underlying fertility problem, and it includes the following methods:
- Correction of hormonal imbalances, often involving thyroid and prolactin
- Medications to improve ovulation
- Surgery to fix problems with the uterus, fallopian tubes, or testicles
Some infertility treatment options rely on assisted reproductive technology, including intrauterine insemination (IUI) and in vitro fertilization (IVF).
Intrauterine insemination (IUI): Doctors inject prepared sperm directly into the uterus with a catheter. This procedure is commonly used if the man has comprised sperm count, or if the infertility cause is unknown.
In vitro fertilization (IVF): Eggs from the ovaries are surgically removed and fertilized with sperm in a laboratory. The fertilized eggs are then transplanted into the uterus. Women with blocked fallopian tubes may choose IVF since tubes aren't needed for conception. A couple or individual could also use donor sperm or hire a traditional or gestational carrier for surrogacy.
Infertility Awareness: How to Learn More
Although infertility is a fairly common condition, it is often misunderstood and misrepresented. Those seeking support can participate in National Infertility Awareness Week (NIAW). Founded by RESOLVE: The National Infertility Association, it usually takes place in the last full week of April. People can use the week to raise awareness and share their struggles with others. The National Infertility Association promotes the cause through collaboration with businesses and professionals. It also spreads the hashtags #FlipTheScript and #NIAWand and hosts awareness walks. You can peruse RESOLVE's events here.
To read about couple's real-life infertility journeys, check out these links: