Reviewed by Richard Alweis, MD
Infertility is defined as the inability of a man and a woman to conceive a child after 12 months of attempting to do so, or 6 months if the woman is over 35. Forty percent of cases have causes related to the woman, forty percent have causes related to the man, ten percent are caused by problems with both the man and the woman, and in ten percent of cases the cause cannot be identified.
Infertility is not an uncommon phenomenon. Fourteen percent of couples trying to conceive will experience infertility at some point. It is becoming more common as more older women are trying to conceive. At age 25, a woman has a 75 percent chance of getting pregnant within 6 months; by age 40 that number drops to 22 percent.
Luckily, infertility treatments have growing success rates. Without treatment, five percent of couples that have been infertile for one year will be able to conceive. With treatment, 65 percent of infertile couples eventually succeed in having children, 50 percent within two years.
Trying to conceive can be an emotional roller coaster. Don’t be afraid to seek help from friends or others who have had the same experience. There are several easy-to-find Web sites exclusively about infertility.
Detailed Description
Infertility has a variety of causes. For more information, click on the bolded name of the cause to go to Body1.com’s listing on that condition:Pelvic Inflammatory Disease (PID): Pelvic Inflammatory Disease is a sexually transmitted infection that is a major cause of infertility worldwide. PID affects one million women every year in the United States, and it causes infertility in 20 percent. PID can be a complication of gonorrhea or chlamydia if they are left untreated.
Endometriosis: The endometrium is the tissue lining the inside of the uterus. In approximately five million North American women, it grows in patches outside the uterus. This can cause cysts or scar tissue to form, and it can block the fallopian tubes. Thirty to forty percent of cases of endometriosis result in infertility. However, only 6 percent of infertility cases with biological causes are caused by endometriosis.
Hormonal and ovulatory problems: Hormonal and ovulatory problems combined cause 33 percent of infertility cases. These problems might be characterized by painful or irregular cycles, excess body or facial hair, severe acne, or secretion from breasts. However, there may be no symptoms. It is even possible to have regular periods without actually ovulating.
Often, hormonal and ovulatory problems are caused by environment and lifestyle. Use or abuse of alcohol, tobacco and caffeine; depression; and extreme weight levels, either high or low, can all contribute to infertility. One study found that drinking one cup of coffee a day increases your risk of infertility by 55 percent. Two to three cups of coffee a day increases your risk of infertility by 100 percent, and doubles the risk of miscarriage. Exposure to certain chemicals at work may also increase risk of infertility and miscarriage. Some of the chemicals that have been shown to affect fertility are xylene, acetone, trichlorethylene, petroleum distillates and solder vapors. These elements of environment and lifestyle can cause a follicle to fail to rupture, lead to empty follicles, or they could prevent the egg from being released.
Other factors that can cause hormonal problems include abnormalities of the adrenal and thyroid glands or a high level of prolactin, which may indicate a pituitary tumor. A luteal phase defect is another possible problem—it occurs when the endometrium (uterine lining) hasn’t developed correctly because of lack of the hormone progesterone.
Polycystic ovaries: Polycystic ovaries are different from ovarian cysts, which rarely cause infertility. Polycystic ovary syndrome is both a structural and a hormonal problem that accounts for 50 percent of all hormonally-caused cases of infertility.
Treatment
Treatment for infertility in women depends on the cause. It may include medication or surgery.The doctor will order a variety of diagnostic tests to determine the source of the problem. An internal examination, including a pelvic exam and Pap smear will probably be the first steps. The doctor will want to rule out cervical cancer, and may do a culture or an endometrial biopsy. A hysterosalpingogram can detect blockages in the reproductive organs.
A first step in treating fertility is the Basal Body Temperature Test. The patient keeps track of her body temperature in order to determine the best time of the month to conceive. If this method doesn’t work, the doctor may prescribe drugs to alter the patient’s hormones.
There are several procedures where the fertilization is done for you, in a lab. These are called assisted reproductive technologies (ART). Two of the most common are in vitro fertilization (IVF) and gamete intrafallopian transfer (GIFT). Each of these treatments can be used when the problem is the male sperm count or endometriosis, or when the cause is unknown. Both can cause multiple births.
With IVF, the ovaries are stimulated to produce multiple follicles (follicles are the fluid-filled sacs that develop around the egg as it matures and prepares to ovulate). Eggs are gathered using a thin catheter guided into the ovaries with help of an ultrasound. The eggs are then fertilized in a laboratory and, several days later, reinserted into the uterine cavity. This process increases the chance of multiple pregnancies. With GIFT, a laparoscope is used to insert a mixture of sperm and eggs directly into the fallopian tubes. IVF is a more common procedure, but GIFT may be more successful. There is much debate over the precise success rates of these procedures; however, one estimation is that GIFT has a 28 percent success rate and IVF has an 19 percent success rate. However, GIFT requires that the woman have healthy fallopian tubes.
Last updated: 29-Oct-03
