Infertility is a condition medically defined as the inability to achieve a pregnancy after one year of regular intercourse without using birth control. Secondary infertility refers to couples who have been pregnant at least once, but who have not been successful in achieving subsequent pregnancies. Infertility is distinct from sterility, in which an individual is incapable of reproducing.
According to the American Society for Reproductive Medicine, about 10 percent of the nation's population is affected by infertility -- some 6.1 million adults. In recent decades, however, advances in procedures to overcome infertility, including assisted reproductive techniques (ART), have resulted in a successful pregnancy for more than half the couples that have sought help. More than one factor can contribute to infertility. Tubal blockage, ovulation problems, hormone imbalances, endometriosis and low sperm count are common causes. Frustratingly, one in six (actually 17 percent) couples having a complete work-up will find that no specific cause can be identified.
In many cases, infertility requires medical treatment. About half the couples that take advantage of the expertise offered by reproductive medicine specialists respond to treatment and are able to conceive. Of those who choose not to seek help, only five percent achieve pregnancy. If a couple is concerned about their inability to conceive, an evaluation by an infertility specialist is recommended. In certain circumstances, it is appropriate to seek help earlier than one year. This is particularly important if:
- The female partner is over 35 years old, has irregular or painful menstrual cycles, has had miscarriages, used an intrauterine device (IUD) or had a pelvic infection or injury to the abdominal area
- The male partner has had injuries to the testicles or frequent genitourinary infections
- Either partner was exposed to the synthetic hormone diethylstilbestrol (DES) through their mother's pregnancy
- Medications. Clomiphene, GnRH, gonadotropins and bromocriptine are drugs used to stimulate egg production and release in women. Using these hormones increases the chances of multiple births. In males who have sperm production difficulties, specialists may recommend medications and hormones to assist the hypothalamus and pituitary gland in producing sperm.
- Surgery may be recommended when a structural problem exists. For men, this may involve a vasectomy reversal, correction of a varicocele (enlarged vein in the scrotum) or clearing blockages in the reproductive tract. Women may undergo surgery to reverse a tubal ligation, clear fallopian tube blockages, or remove growths like endometriosis from the reproductive tracts. Laparoscopic ovarian drilling is sometimes done to stimulate ovulation in women who have multiple ovarian cysts, especially when medications and weight loss have failed to trigger ovulation.
- Intrauterine insemination may be done in order to bypass a narrow cervical opening or when sperm antibodies are present in either partner. The sperm are deposited directly into the uterus.
- In vitro fertilization (IVF), where eggs and sperm -- from both of the partners or from donors -- are joined (fertilized) in the lab. The woman's eggs are surgically removed from her ovaries, combined with sperm in a laboratory dish, and if fertilization takes place, the embryos are replaced back into the woman's uterus.
- Intracytoplasmic sperm injection (ICSI) is used in conjunction with IVF. A single sperm is injected directly into an egg to facilitate fertilization. The embryos (fertilized eggs) are then transferred to the uterus.
- In cases of retrograde ejaculation (semen ejaculates into the bladder rather that out through the penis), sperm can be collected from the bladder and used for insemination.
- Gamete intrafallopian transfer (GIFT) involves collecting eggs from the ovaries and mixing them in a tube with sperm. The mixture is injected into the fallopian tube, in the operating room through laparoscopy, where fertilization can take place.
- Zygote intrafallopian transfer (ZIFT) combines IVF and GIFT procedures. Sperm and eggs are combined outside the body. Fertilized eggs (zygotes) are returned to the fallopian tube in the operating room, where they make their way to the uterus.
