Female infertility, male infertility or a combination of the two affects millions of couples in the United States. An estimated 10 to 15 percent of couples are infertile, which means that they've been trying to get pregnant for at least a year — or for at least six months if you're a woman age 35 or older.
Generally, infertility results from female infertility factors about one-third of the time and male infertility factors about one-third of the time. In the rest, the cause is either unknown or a combination of male and female factors.
The cause of female infertility can be difficult to diagnose, but many treatments are available. Treatment isn't always necessary: Half of all infertile couples will go on to conceive a child spontaneously within the next 24 months.
The main symptom of infertility is the inability of a couple to get pregnant. An abnormal menstrual cycle that's too long (35 days or more) or too short (less than 21 days) can be a sign of female infertility. There may be no other outward signs or symptoms.
When to see a doctor
If you're age 35 to 40, discuss your concerns with your doctor after six months of trying.
If you're over 40 or have a history of irregular or painful periods, pelvic inflammatory disease (PID), repeated miscarriages, prior cancer treatment or endometriosis, your doctor may want to begin testing or treatment right away.
In order for you to become pregnant, each of these factors is essential:
For pregnancy to occur, every part of the complex human reproduction process — from the ovary's release of a mature egg to the fertilization of the egg to the fertilized egg's implantation and growth in the uterus — has to take place just right. In women, a number of factors can disrupt this process at any stage. Female infertility is caused by one or more of these factors.
Damage to fallopian tubes (tubal infertility)
Cervical narrowing or blockage
Female reproductive system
The ovaries, fallopian tubes, uterus, cervix and vagina make up the female reproductive system. ...
During each menstrual cycle, an egg is released by one of the ovaries (ovulation). The egg travels into the fallopian tube. If fertilization is to occur, sperm ejaculated into the vagina must swim up ...
Some things may put you at higher risk of infertility. They include:
Preparing for your appointment
For an infertility evaluation, you'll most likely see a reproductive endocrinologist — a doctor who specializes in treating disorders that prevent couples from conceiving. Because infertility is a condition that involves both you and your partner, your doctor will likely want to evaluate both of you to identify potential causes — and possible treatments — for your infertility.
Here's some information to help you prepare for your appointment, and what to expect from your doctor.
What you can do
Some basic questions to ask include:
Make sure that you understand everything that your doctor tells you. Don't hesitate to ask your doctor to repeat information or to ask follow-up questions for clarification.
What to expect from your doctor
Tests and diagnosis
If you've been unable to conceive within a reasonable period of time, seek help from your doctor for further evaluation and treatment of infertility.
Fertility tests may include:
Treatments and drugs
How your infertility is treated depends on the cause, your age, how long you've been infertile and personal preferences. Although some women need just one or two therapies to restore fertility, it's possible that several different types of treatment may be needed before you're able to conceive.
Treatments can either attempt to restore fertility — by means of medication or surgery — or assist in reproduction with sophisticated techniques.
Fertility restoration: Stimulating ovulation with fertility drugs
Using fertility drugs carries some risks:
There are several fertility drugs for abnormal LH and FSH production. These drugs include:
Clomiphene citrate (Clomid, Serophene). This drug is taken orally and stimulates ovulation in women who have PCOS or other ovulation disorders. It causes the pituitary gland to release more FSH and LH, which stimulate the growth of an ovarian follicle containing an egg. Clomiphene citrate also improves fertility in normally ovulating women, and is often used as an initial treatment for unexplained infertility.
Gonadotropins. Instead of stimulating the pituitary gland to release more hormones, these treatments stimulate the ovary directly. Often, gonadotropin medications are used in combination with intrauterine insemination (IUI) — a procedure during which sperm is injected into your uterus via a thin tube (catheter) — to increase the odds of a pregnancy. Gonadotropin medications include:
Metformin (Glucophage). This oral drug is used when insulin resistance is a known or suspected cause of infertility, usually in women with a diagnosis of PCOS. Metformin improves insulin resistance, normalizing the insulin level and making ovulation more likely to occur.
Letrozole (Femara). Letrozole belongs to a class of drugs known as aromatase inhibitors. Letrozole, also used to treat some breast cancers, may induce ovulation. However, the effect the medication has on early pregnancy isn't yet known, so this medication isn't used for ovulation induction as frequently as others.
Fertility restoration: Surgery
Reproductive assistance: In vitro fertilization
Coping and support
Dealing with female infertility can be physically and emotionally exhausting. To cope with the ups and downs of infertility testing and treatment, consider these options:
If you're a woman thinking about getting pregnant soon or in the future, there are a few ways you can improve your chances of having normal fertility:
Last Updated: 2011-09-09
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