What is in fertility?

Infertility is the inability to conceive or carry a child to delivery. The term is usually limited to situations where the couple has been unable to conceive for one year without using birth control. The term sterility is restricted to lack of sperm production or inability to ovulate.

Approximately 40 percent of reported cases of infertility are due to problems in the male; another 40 percent to problems in the female; the remaining 20 percent are of unknown cause or due to problems in both the male and female.

Causes of infertility

Infertility can be caused by any interruption in the usual process of fertilization, pregnancy, and birth, which includes ejaculation of normal amounts of healthy sperm, passage of the sperm through the cervix and into the fallopian tube of the female, capture of the ovum ( egg) by the fallopian tube at the time of ovulation, fertilization in the fallopian tube, passage of a fertilized egg ( embryo) down the fallopian tube, implantation of the fertilized egg in a receptive uterus, and the ability to carry the fetus to term.

In women, the most common problems are failure to ovulate and damage to the reproductive organs. In men, abnormal sperm function is the most common problem. In about 20 percent of couples, we find no abnormal tests (unexplained infertility).

The number of couples seeking treatment for infertility has increased as more of them have postponed childbearing to a later age. In women, fertility begins to decline in the mid-twenties, and continues to decline, more and more sharply, until menopause.

Pregnancy rates of women in their early 40s are about 20 to 25 percent that of women in their 20s and early 30s. Male fertility declines gradually but the relationship between age and fertility is more difficult to define.

Evaluation and Treatment

Evaluation includes examination of sperm, observation of basal body temperature or luteinizing hormone peaks in the female to determine whether ovulation is taking place, the ruling out of obstructions or abnormalities of the fallopian tubes or uterus, and blood tests that measure hormone levels.

Doctors tailor treatment to the specific problem. The first step may be treatment of underlying disease and, in men, avoidance of substances that might affect sperm quality.

Doctors also may prescribe fertility drugs, some of which increase the likelihood of multiple births. If necessary, a doctor may perform surgical correction of blocked tubes.

A primary infertility treatment method is in vitro fertilization (IVF), in which a doctor takes several eggs from the woman or from an egg donor. An embryologist then fertilizes one or more eggs outside the body with the father’s sperm or a sperm donor. A fertility doctor then inserts the resulting embryo into the mother’s uterus.

IVF is becoming a first-line therapy due to the consistently high success rates some treatment centers, such as ours, are able to achieve. Another method is artificial insemination, in which a fertility specialist inserts sperm directly into the woman or a surrogate mother.

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