Infertility is defined by the American Society for Reproductive Medicine (ASRM) as a disease of the reproductive system that impairs the body's ability to perform the basic function of reproduction. Although conceiving a child may seem to be simple and natural, the physiological process is quite complicated and depends on the proper function of many factors, including the following, as listed by the ASRM:
Infertility affects about 12 percent of couples of childbearing age. Infertility is not just a woman's concern. A problem with the male is the sole cause, or a contributing cause, of infertility in about 50 percent of infertile couples. About one-third of infertile couples have more than one cause or factor related to their inability to conceive.
Many different factors and problems can cause infertility, including problems in the female reproductive system, the male reproductive system, or a combination of the two. The following are some of the conditions or factors that are associated with infertility:
When conception does not occur after one year of unprotected intercourse, after six months in women over age 35, or if there are known problems causing infertility, a medical evaluation of both the male and female is recommended. Some obstetrician/gynecologists (OB/GYNs), certified nurse midwives (CNMs), and nurse practitioners (NPs) are able to provide basic infertility evaluation and treatment. However, many causes of infertility are best treated by a board-certified reproductive endocrinologist. This is an OB/GYN who has had additional education and training in infertility and is certified with the American Board of Obstetrics and Gynecology in the sub-specialty of Reproductive Endocrinology and Infertility.
Generally, the OB/GYN or reproductive endocrinologist will evaluate specific situations and perform tests in both the male and female partners to determine the cause of infertility. The doctor is looking for answers to the following questions:
Is the female ovulating regularly?
Is the male producing healthy, viable sperm?
Are the female's egg and the male's sperm able to unite and grow normally?
Are there any obstacles to proper implantation and maintenance of the pregnancy?
The following tests are often part of the basic medical workup for infertility.
Men may be referred to a urologist for further evaluation.
Specific treatment for infertility will be determined by your doctor based on:
Once a diagnosis is made, the specialist can work with you to determine the course of treatment. According to the ASRM, most infertility cases (85 to 90 percent) are treated with conventional therapies, such as drug treatment or surgical repair of reproductive abnormalities. Depending on the cause of infertility, there are many options to offer an infertile couple.
Types of treatments for women may include the following:
There is a range of treatment options currently available for male factor infertility. Treatment may include:
About 5 to 10 percent of couples have unexplained infertility, for which a cause, despite all investigations, is not found. Unexplained infertility does not mean there is no reason for the problem, but that the reason is unable to be identified at the present time.
If you suspect you are experiencing infertility, seek medical consultation early. The age of the woman and the duration of the couple's infertility may influence the success of treatment.