Infertility

About 10 percent of women (6.1 million), between the ages of ages 15-44, in the United States have a difficult time becoming pregnant or staying pregnant.

Infertility is when a women is not able to to become pregnant after a year of trying (or six months if a woman is 35 or older).

Infertility also includes if a woman continues to have miscarriages or stillbirths.

Infertility can affect both women and men. Infertility also means if a man has not been able to get a woman pregnant after at least one year of trying.

Infertility is common. After one year of having unprotected sex, about 15 percent of couples are not able to become pregnant. About a third of the time, infertility is due to the woman. In another third of cases, it is due to the man. The rest of the time, infertility is may be due to both partners or there is not a cause that can be found.

There are specific treatments for men and for women, but some treatments will involve both women and males. Treatments may include medications, surgery, artificial insemination, or assisted reproductive technologies. After treatments, many couples are able to have babies.

Infertility is not being able to become pregnant after a year of trying (or six months if a woman is 35 or older). Infertility also includes if a woman continues to have miscarriages or stillbirths.

Infertility also means if a man has not been able to get a woman pregnant after at least one year of trying.

Both women and men can have problems that cause infertility.

About a third of the time, infertility can be due to the woman.

• Female infertility can result from:
  • Blocked fallopian tubes due to pelvic inflammatory disease, endometriosis, or surgery for an ectopic pregnancy
  • Physical problems with the uterus
  • Uterine fibroids
  • Hormone problems
  • Lifestyle or environmental factors
  • Ovulation problem
    • Most cases of infertility in women are due to problems with ovulation such as:
      • Premature ovarian failure -the ovaries stop working early
      • Polycystic ovary syndrome (PCOS)- irregular release of an egg or releases unhealthy eggs

In another third of cases, infertility is due to the man.

• Infertility is when a man has not been able to get a woman pregnant after at least one year of trying. Causes of male infertility may include:
  • Physical problems with the testicles
  • Movement of the sperm
  • Not able to produce enough sperm
  • A block in the ducts that carry sperm
  • Hormone problems
  • A history of high fevers or mumps
  • Genetic disorders
  • Lifestyle or environmental factors

The rest of the time, infertility may be due to both partners or there is not a cause that can be found.

Doctors will do a physical exam as well as ask for both partners' health and sexual histories. Sometimes this can find identify the issue. However, in most cases, more testes may be needed.

Doctors usually will start by testing the semen. In some cases, the doctor will order labs to evaluate the man's hormone levels.

Doctors will need to determine if the women is ovulating each month. Women can track her ovulation at home; Ask your doctor on what would be the best method.

Doctors can also check ovulation with blood tests or through an ultrasound of the ovaries.

Common tests of fertility in women include:

• Hysterosalpingography: - an x-ray of the uterus and fallopian tubes.
• Laparoscopy: - a minor surgery to see inside the abdomen.

Finding the cause of infertility and treatment can be a long and emotional process. It may take time to complete all the needed tests and /or treatments. Talk to your doctor about the different treatments.

Assisted reproductive technology (ART) can be expensive and be a long process. However, ART has allowed many couples to have children. ART may result in multiple fetuses. However, this can be prevented or chances of multiple fetuses can be reduced by several methods.

Infertility can be treated with medications, surgery, artificial insemination, or assisted reproductive technology. In most cases, these treatments are done in combination. In most cases infertility is treated with medications or surgery.

Your doctors will recommend specific treatments based on a variety of factors.

Medications:

Some common medicines used to treat infertility in women include:

• Clomiphene citrate (Clomid)
• Human menopausal gonadotropin or hMG (Repronex, Pergonal)
• Follicle-stimulating hormone or FSH (Gonal-F, Follistim)
• Gonadotropin-releasing hormone (Gn-RH) analog
• Metformin (Glucophage)
• Bromocriptine (Parlodel)

Many fertility medications increase the chance of having twins, triplets, or other multiples. There are several medications that may be used to treat problems with ovulation. Talk to your doctor about what is the best treatment for you. He/she will discuss the advantages and disadvantages of the different treatments.

Surgery:

In women, surgery can correct some physical problems.

Artificial insemination:

Intrauterine insemination (IUI), otherwise known as artificial insemination, is when specially prepared sperm is injected into  the woman. In some cases, medication to stimulate ovulation will be given before IUI.

IUI is often given in the following cases:

• Mild male factor infertility
• Women with cervical mucus issues
• Infertility cause that can not be determined

Assisted reproductive technology (ART):

Assisted reproductive technology (ART) is a group of different methods. ART works by mixing the eggs, taken from the woman's body, with sperm to make embryos. The embryos are then put back in the woman's body.

Common methods of ART include:

• In vitro fertilization (IVF) means fertilization outside of the body. IVF is the most effective ART. Women are given medications to stimulate the ovaries to produce multiple eggs. Once mature, the eggs are removed from the woman. They are mixed with sperm. After a few days, the healthy embryos are put back in the woman's body.
• Zygote intrafallopian transfer (ZIFT) or Tubal Embryo Transfer is similar to IVF. The embryo is transferred to the fallopian tube.
• Gamete intrafallopian transfer (GIFT) method involves the transfer of eggs and sperm into the woman's fallopian tube.
• Intracytoplasmic sperm injection (ICSI) is a method where a single sperm is injected into a mature egg, and 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.

Other available options:

• Surrogate: A surrogate is a woman who becomes pregnant using the man's sperm and her own egg. The child will be genetically related to the surrogate and the male partner.

• Gestational carrier: A woman uses her own egg, which is fertilized by the man's sperm and the embryo is then placed in the uterus.
  • Recent research showed ART babies are two to four times more likely to have certain kinds of birth defects.

Doctors often treat infertility in men in the following ways:

• Sexual problems: Behavioral therapy and/or medicines can be used to manage sexual problems.
• Surgery can help manage limited sperm and sperm movement.

The success rates will vary for assisted reproductive technology (ART) and will depend on a variety of factors such as

• Age of the partners
• Reason for infertility
• Type of ART
• If the egg or embryo is fresh or frozen

According to 2006 data from the U.S. Centers for Disease Control and Prevention (CDC), the average percentage of ART cycles that led to a live birth were:

• 39 percent in women under the age of 35
• 30 percent in women aged 35-37
• 21 percent in women aged 37-40
• 11 percent in women aged 41-42

ART can be expensive and a long process. However, ART has allowed many couples to have children. ART may result in multiple fetuses. However, this can be prevented or chances of multiple fetuses can be reduced by several methods.