Frequently asked questions about fertility
What is infertility?
Most experts define infertility as not being able to get pregnant after
at least 1 year of trying. Women who are able to get pregnant but then have
repeat miscarriages are also said to be infertile.
Pregnancy is the result of
a complex chain of events. In order to get pregnant:
-
A woman must release
an egg from one of her ovaries (ovulation)
-
The egg must go
through a fallopian tube toward the uterus (womb)
-
A man's sperm must
join with (fertilize) the egg along the way
-
The fertilized egg
must attach to the inside of the uterus (implantation)
Infertility can result
from problems that interfere with any of these steps.
Is infertility a common
problem?
About 12% of women (7.3 million) in the U.S. aged 15-44 had difficulty
getting pregnant or carrying a baby to term in 2002, according to the
National Center for Health Statistics of the Centers for Disease Control and
Prevention.
Is infertility just a
woman's problem?
No, infertility is not always a woman's problem. In only about 1/3 of
cases is infertility due to the woman (female factors). In another 1/3 of
cases, infertility is due to the man (male factors). The remaining cases are
caused by a mixture of male and female factors or by unknown factors.
What causes infertility
in men?
Infertility in men is most often caused by:
Sometimes a man is born
with the problems that affect his sperm. Other times problems start later in
life due to illness or injury. For example, cystic fibrosis often causes
infertility in men.
What increases a man's
risk of infertility?
The number and quality of a man's sperm can be affected by his overall
health and lifestyle. Some things that may reduce sperm number and/or
quality include:
What causes infertility
in women?
Problems with ovulation account for most cases of infertility in women.
Without ovulation, there are no eggs to be fertilized. Some signs that a
woman is not ovulating normally include irregular or absent menstrual
periods. Less common causes of fertility problems in women include:
-
blocked fallopian
tubes due to pelvic inflammatory disease, endometriosis, or surgery for
an ectopic pregnancy
-
physical problems with
the uterus
-
uterine fibroids
What things increase a
woman's risk of infertility?
Many things can affect a woman's ability to have a baby. These include:
-
age
-
stress
-
poor diet
-
athletic training
-
being overweight or
underweight
-
tobacco smoking
-
alcohol
-
sexually transmitted
diseases (STDs)
-
health problems that
cause hormonal changes
How does age affect a
woman's ability to have children?
More and more women are waiting until their 30s and 40s to have
children. Actually, about 20% of women in the U.S. now have their first
child after age 35. So age is an increasingly common cause of fertility
problems. About 1/3 of couples in which the woman is over 35 have fertility
problems.
Aging decreases a woman's
chances of having a baby in the following ways:
-
The ability of a
woman's ovaries to release eggs ready for fertilization declines with
age
-
The health of a
woman's eggs declines with age
-
As a woman ages she is
more likely to have health problems that can interfere with fertility
-
As a women ages, her
risk of having a miscarriage increases.
How long should women
try to get pregnant before calling their doctors?
Most healthy women under the age of 30 shouldn't worry about infertility
unless they've been trying to get pregnant for at least a year. At this
point, women should talk to their doctors about a fertility evaluation. Men
should also talk to their doctors if this much time has passed.
In some cases, women
should talk to their doctors sooner. Women in their 30s who've been trying
to get pregnant for 6 months should speak to their doctors as soon as
possible. A woman's chances of having a baby decrease rapidly every year
after the age of 30. So getting a complete and timely fertility evaluation
is especially important.
Some health issues also
increase the risk of fertility problems. So women with the following issues
should speak to their doctors as soon as possible:
No matter how old you are,
it's always a good idea to talk to a doctor before you start trying to get
pregnant. Doctors can help you prepare your body for a healthy baby. They
can also answer questions on fertility and give tips on conceiving.
How will doctors find
out if a woman and her partner have fertility problems?
Sometimes doctors can find the cause of a couple's infertility by doing
a complete fertility evaluation. This process usually begins with physical
exams and health and sexual histories. If there are no obvious problems,
like poorly timed intercourse or absence of ovulation, tests will be needed.
Finding the cause of
infertility is often a long, complex and emotional process. It can take
months for you and your doctor to complete all the needed exams and tests.
So don't be alarmed if the problem is not found right away.
For a man, doctors usually
begin by testing his semen. They look at the number, shape, and movement of
the sperm. Sometimes doctors also suggest testing the level of a man's
hormones.
For a woman, the first
step in testing is to find out if she is ovulating each month. There are
several ways to do this. A woman can track her ovulation at home by:
-
Recording changes in
her morning body temperature nasal body temperature) for several months
-
Recording the texture
of her cervical mucus for several months
-
Using a home ovulation
test kit (available at drug or grocery stores)
Doctors can also check if
a woman is ovulating by doing blood tests and an ultrasound of the ovaries.
If the woman is ovulating normally, more tests are needed.
Some common tests of
fertility in women include:
-
Hysterosalpingography: In this test, doctors use x-rays to check for
physical problems of the uterus and fallopian tubes. They start by
injecting a special dye through the vagina into the uterus. This dye
shows up on the x-ray. This allows the doctor to see if the dye moves
normally through the uterus into the fallopian tubes. With these x-rays
doctors can find blockages that may be causing infertility. Blockages
can prevent the egg from moving from the fallopian tube to the uterus.
Blockages can also keep the sperm from reaching the egg.
-
Laparoscopy:
During this surgery doctors use a tool called a laparoscope to see
inside the abdomen. The doctor makes a small cut in the lower abdomen
and inserts the laparoscope. Using the laparoscope, doctors check the
ovaries, fallopian tubes, and uterus for disease and physical problems.
Doctors can usually find scarring and endometriosis by laparoscopy.
How do doctors treat
infertility?
Infertility can be treated with medicine, surgery, artificial
insemination or assisted reproductive technology. Many times these
treatments are combined. About 2/3 of couples who are treated for
infertility are able to have a baby.
In most cases infertility
is treated with drugs or surgery. Doctors recommend specific treatments for
infertility based on:
-
Test results
-
How long the couple
has been trying to get pregnant
-
The age of both the
man and woman
-
The overall health of
the partners
-
Preference of the
partners
Doctors often treat
infertility in men in the following ways:
-
Sexual problems:
If the man is impotent or has problems with premature ejaculation,
doctors can help him address these issues. Behavioral therapy and/or
medicines can be used in these cases.
-
Too few sperm:
If the man produces too few sperm, sometimes surgery can correct this
problem. In other cases, doctors can surgically remove sperm from the
male reproductive tract. Antibiotics can also be used to clear up
infections affecting sperm count.
Various fertility
medicines are often used to treat women with ovulation problems. It is
important to talk with your doctor about the pros and cons of these
medicines. You should understand the risks, benefits, and side effects.
Doctors also use surgery
to treat some causes of infertility. Problems with a woman's ovaries,
fallopian tubes, or uterus can sometimes be corrected with surgery.
Intrauterine
insemination (IUI) is another type of treatment for infertility. IUI is
known by most people as artificial insemination. In this procedure, the
woman is injected with specially prepared sperm. Sometimes the woman is also
treated with medicines that stimulate ovulation before IUI. IUI is often
used to treat:
-
Mild male factor
infertility
-
Women who have
problems with their cervical mucus
-
Couples with
unexplained infertility
What medicines are used
to treat infertility in women?
Some common medicines used to treat infertility in women include:
-
Clomiphene citrate
(Clomid): This medicine causes ovulation by acting on the pituitary
gland. It is often used in women who have Polycystic Ovarian Syndrome
(PCOS) or other problems with ovulation. This medicine is taken by
mouth.
-
Human menopausal
gonadotropin or hMG (Repronex, Pergonal): This medicine is often
used for women who don't ovulate due to problems with their pituitary
gland. hMG acts directly on the ovaries to stimulate ovulation. It is an
injected medicine.
-
Follicle-stimulating hormone or FSH (Gonal-F, Follistim): FSH works
much like hMG. It causes the ovaries to begin the process of ovulation.
These medicines are usually injected.
-
Gonadotropin-releasing hormone (Gn-RH) analog: These medicines are
often used for women who don't ovulate regularly each month. Women who
ovulate before the egg is ready can also use these medicines. Gn-RH
analogs act on the pituitary gland to change when the body ovulates.
These medicines are usually injected or given with a nasal spray.
-
Metformin
(Glucophage): Doctors use this medicine for women who have insulin
resistance and/or Polycystic Ovarian Syndrome (PCOS). This drug helps
lower the high levels of male hormones in women with these conditions.
This helps the body to ovulate. Sometimes clomiphene citrate or FSH is
combined with metformin. This medicine is usually taken by mouth.
-
Bromocriptine
(Parlodel): This medicine is used for women with ovulation problems
due to high levels of prolactin. Prolactin is a hormone that causes milk
production.
Many fertility drugs
increase a woman's chance of having twins, triplets or other multiples.
Women who are pregnant with multiple fetuses have more problems during
pregnancy. Multiple fetuses have a high risk of being born too early
(prematurely). Premature babies are at a higher risk of health and
developmental problems.
What is assisted
reproductive technology (ART)?
Assisted reproductive technology (ART) is a term that describes several
different methods used to help infertile couples. ART involves removing eggs
from a woman's body, mixing them with sperm in the laboratory and putting
the embryos back into a woman's body.
How often is assisted
reproductive technology (ART) successful?
Success rates vary and depend on many factors. Some things that affect
the success rate of ART include:
The U.S. Centers for
Disease Prevention (CDC) collects success rates on ART for some fertility
clinics. According to the 2003 CDC report on ART, the average percentage of
ART cycles that led to a healthy baby were as follows:
-
37.3% in women under
the age of 35
-
30.2% in women aged
35-37
-
20.2% in women aged
37-40
-
11.0% in women aged
41-42
See
our success rates
ART can be expensive and
time-consuming. But it has allowed many couples to have children that
otherwise would not have been conceived. The most common complication of ART
is multiple fetuses. But this is a problem that can be prevented or
minimized in several different ways.
What are the different
types of assisted reproductive technology (ART)?
Common methods of ART include:
-
In vitro
fertilization (IVF) means fertilization outside of the body. IVF is
the most effective ART. It is often used when a woman's fallopian tubes
are blocked or when a man produces too few sperm. Doctors treat the
woman with a drug that causes the ovaries to produce multiple eggs. Once
mature, the eggs are removed from the woman. They are put in a dish in
the lab along with the man's sperm for fertilization. After 3 to 5 days,
healthy embryos are implanted in the woman's uterus.
-
Zygote
intrafallopian transfer (ZIFT) or Tubal Embryo Transfer is similar
to IVF. Fertilization occurs in the laboratory. Then the very young
embryo is transferred to the fallopian tube instead of the uterus.
-
Gamete
intrafallopian transfer (GIFT) involves transferring eggs and sperm
into the woman's fallopian tube. So fertilization occurs in the woman's
body. Few practices offer GIFT as an option.
-
Intracytoplasmic
sperm injection (ICSI) is often used for couples in which there are
serious problems with the sperm. Sometimes it is also used for older
couples or for those with failed IVF attempts. In ICSI, a single sperm
is injected into a mature egg. Then the embryo is transferred to the
uterus or fallopian tube.
 ART
procedures sometimes involve the use of donor eggs (eggs from another
woman), donor sperm, or previously frozen embryos. Donor eggs are sometimes
used for women who can not produce eggs. Also, donor eggs or donor sperm is
sometimes used when the woman or man has a genetic disease that can be
passed on to the baby.
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