Infertility at a glance
- Infertility is defined as the inability to achieve pregnancy after one year of unprotected intercourse.
- A woman’s fertility can be affected by several factors, including age, uterine abnormalities, cervical conditions, and endometriosis; ovulation problems and issues with the fallopian tubes are the most common causes of infertility.
- In about 40 percent of couples struggling to conceive, the male partner is either the sole or a contributing cause of infertility due to sperm issues or other problems.
- Pregnancy loss (miscarriage) occurs in up to 30 percent of all pregnancies; recurrent miscarriage is defined by two or three obvious miscarriages, requiring the attention of a fertility specialist.
- Unexplained infertility is a diagnosis that follows all tests for infertility causes coming back normal, and there seems to be no apparent cause for infertility.
Definition of infertility: lack of pregnancy despite trying
Infertility is defined as the inability to achieve pregnancy after one year of unprotected intercourse, according to the American Society for Reproductive Medicine (ASRM), the group fertility doctors are members of that governs the field. One in seven couples has trouble conceiving, according to the ASRM.
A woman younger than 30 should not worry too much about infertility unless she and her partner have been trying to conceive for at least a year.
After one year of trying, a couple may need to have an infertility evaluation. There are many factors to consider in infertility. A woman 35 years of age or older might begin the infertility evaluation sooner so as not to delay treatment.
If a woman has irregular menstrual cycles or if a woman or her partner has known fertility problems (trouble ovulating, tubal blockages, any factors affecting the male, history of endometriosis, history of uterine or cervical disorders, age greater than 35 (for women), it may be prudent not to wait the entire year before seeking an evaluation.
Miscarriages: recurrent pregnancy loss
Pregnancy loss is a common event occurring in up to 30 percent of all pregnancies, and some of the miscarriages occur naturally without the woman even noticing. Generally, two or three obvious miscarriages would be considered recurrent miscarriages, and at that point, a couple could consider consulting with a fertility specialist. However, any woman who has suffered a miscarriage may have a treatable cause for pregnancy loss.
The decision to pursue a workup for pregnancy loss therefore becomes a choice based on the couple’s age, the number of miscarriages they have had, a family history of recurrent miscarriages, or known risk factor for recurrent pregnancy loss.
Problems with ovulation are one of the most common causes of infertility. In fact, the American Society for Reproductive Medicine reports that ovulation problems account for approximately 25 percent of all infertility cases. Ovulation means an egg suitable for fertilization is developed. Common symptoms of ovulation factor include excessive weight fluctuation and extreme emotional stress.
Even women who have regular menses might have an ovulatory problem since pregnancy is the only proof that a normal ovulation has occurred.
In about 40 percent of infertile couples, the male partner is either the sole or a contributing cause of infertility, according to the American Society for Reproductive Medicine. About 10 percent of men with male infertility have hormonal problems that lead to very low sperm counts.
Conversely, about 10 percent of men who have infertility problems make sperm normally but have an obstruction in their genital tract. This prohibits sperm from getting from the testis into the ejaculate. However, most men with male infertility have a problem within the testes themselves.
The key diagnostic test to evaluate male infertility is a semen analysis. A semen sample is produced by masturbation after two to three days of abstinence. The specimen is evaluated in our laboratory for number, shape, and movement of sperm. Once a specialist evaluates the semen sample, the likelihood of pregnancy may be determined.
Tubal Factors are disorders in the fallopian tubes, which carry the egg to the uterus. Tubal issues may be an even more frequent problem than ovulation factor infertility. The American Society for Reproductive Medicine (ASRM) reports that tubal problems account for about 35 percent of all infertility problems. The fallopian tubes are an intricate and fragile part of the reproductive system. If the tubes become blocked, sperm cannot fertilize the egg and the embryo cannot settle in the uterus.
There are several tests to confirm tubal blockages, such as hysterosalpingogram and laparascopy, and in some cases blocked tubes may be corrected by surgery. If the blockage cannot be removed, or the tubes are severely damaged, then in vitro fertilization (IVF) may become the best hope for successful pregnancy.
Other factors: uterine/cervical factors, peritoneal factor
Women are born with a fixed number of eggs in their ovaries, so age plays a big role in fertility. Eggs are continually lost through menstruation until the woman reaches menopause. This reduction of the ovarian egg reserve makes it more difficult for women to become pregnant.
Studies indicate the probability of pregnancy decreases from 55 percent for women younger than 30 years of age to 40 percent for women between the ages of 31 and 35, and to less than 10 percent for women aged 35 and older.
If you are younger than 30, you shouldn’t worry too much about infertility unless you have a known problem like tubal blockage or endometriosis or uterine fibroids or some other reproductive system condition that has already been diagnosed.
Uterine abnormalities are less common than tubal or ovulatory factors but can also cause infertility. Examples include uterine fibroids which are benign tumors of the uterine muscle. Fibroids can cause fertility problems when located either within or very close to the uterine cavity or when they are so large the uterine cavity itself is distorted.
Other uterine causes of infertility include scarring or benign glandular tumors inside the uterus (uterine polyps).
Conditions within the cervix, which is muscle that controls the opening at the lower part of the uterus through which sperm enter the uterus on their way to the fallopian tubes and through which the fetus passes on its way into the world, rarely are the sole cause of infertility. Important issues to let your doctor know about, according to the American Society for Reproductive Medicine (ASRM), are: whether you’ve had biopsies of the cervix or abnormal PAP smears, freezing or laser treatments, surgery, or whether your mother took DES, diethylstilbestrol.
Endometriosis causes the tissue that normally lines the uterus to grow outside the uterus, sometimes causing abdominal discomfort or even severe pain. The invading tissue may attach itself and grow upon any organ or structure within a woman’s pelvis, including her ovaries, which can lead to removal of one or both ovaries.
Endometriosis is found in 35 percent of infertile women who have no other diagnosed problem, according to the American Society for Reproductive Medicine (ASRM).
Unexplained infertility is a diagnosis that follows all tests for infertility causes coming back normal, and there seems to be no apparent cause for infertility. Unexplained infertility occurs in approximately 5 percent to 10 percent of couples trying to conceive, according the American Society for Reproductive Medicine (ASRM), and in a somewhat higher percentage, testing shows only minor abnormalities that are not severe enough to cause infertility. In these cases, the diagnosis is also unexplained infertility.
The duration of infertility is important. The longer the period of infertility, the less likely the couple is to conceive on their own. After five years of infertility, a couple with unexplained infertility has less than a 10-percent chance for success on their own.
Assisted reproductive technologies such as Intrauterine Insemination (IUI – also called artificial insemination), and in vitro fertilization (IVF) have high success rates for women who have unexplained infertility.
Contact us to schedule an appointment with our reproductive specialists to learn more about your fertility and treatment options.