What is Infertility?
For couples hoping to become parents, difficulty conceiving a baby can be frustrating and unexpected. Many couples who struggle with infertility do end up having children, sometimes with medical help. An important early step is understanding possible causes of infertility.
Infertility is generally defined as not being able to get pregnant after 1 year of unprotected sex. Most experts recommend visiting a fertility specialist at this point. Because fertility in women is known to decline steadily with age, women who are 35 or older may consider seeking evaluation and treatment after 6 months of trying, and women over 40 may consider seeking more immediate evaluation and treatment. Couples with infertility should consider making an appointment with a reproductive endocrinologist—a doctor who specializes in managing infertility.
Pregnancy is the result of a process that has many steps. To get pregnant:
- An egg must be released from one of the ovaries (ovulationexternal icon).
- Sperm must fertilize the egg.
- The fertilized egg (embryo) must travel from a fallopian tubeexternal icon toward the uterusexternal icon (womb).
- The embryo must attach to the inside of the uterus (implantation).
Infertility may result from a problem with any or several of these steps.
Couples with the following conditions, signs, or symptoms should not delay seeing their health care provider when they are trying to become pregnant:
- Irregular menstrual periods or no periods.
- Endometriosisexternal icon.
- A history of pelvic inflammatory disease
- Known or suspected uterine or tubal disease
- A history of more than one miscarriage
- Genetic or acquired conditions that predispose to diminished ovarian reserve (chemotherapy, radiation)
- A history of testicular trauma
- Prior hernia surgery
- Prior use of chemotherapy
- A history infertility with another partner
- Sexual dysfunction
Yes. In the United States, about 1 in 5 (19%) heterosexual women aged 15 to 49 with no prior births in the United States are unable to get pregnant after 1 year of trying. Also, about 1 in 4 (26%) women in this group have difficulty getting pregnant or carrying a pregnancy to term.
Though it is often thought of as a woman’s problem, infertility can affect both men and women.
Infertility in men can be caused by different factors, including disruption of testicular or ejaculatory function, hormonal, and genetic disorders, and is typically evaluated by a semen analysis. A specialist will study the volume, number, movement, and shape of the sperm in a semen sample to determine if a male factor is involved.
- Couples in which the male partner is 40 or older are more likely to report difficulty conceiving.
- Having overweight or obesity.
- Excessive alcohol or drug use (opioids, marijuana).
- A history of trauma to the testes.
- Exposure to testosterone, radiation, certain medicines, or certain environmental toxins.
- Frequent exposure of the testes to high temperatures.
- Hormonal disorders caused by improper function of the hypothalamus or pituitary glands, which maintain normal testicular function.
- Genetic disorders such as Klinefelter’s syndrome, Y-chromosome microdeletion, myotonic dystrophy, or other, less common genetic disorders.
Women need functioning ovariesexternal icon, fallopian tubesexternal icon, and a uterusexternal icon to get pregnant. Conditions affecting any one of these organs can contribute to female infertility. Some of these conditions are listed below and can be evaluated with tests.
Disruption of ovarian function and effects of ovarian “age”
A woman’s menstrual cycleexternal icon is, on average, 28 days. Regular, predictable periods that occur every 21 to 35 days mean that the woman is likely to be ovulating. A woman with irregular periods may not be ovulating. Not ovulating can be caused by the following:
- Polycystic ovary syndrome (PCOS).external icon PCOS is a condition that causes women to not ovulate or to ovulate irregularly. PCOS is the most common cause of female infertility.
- Diminished ovarian reserve (DOR). Women are born with all the eggs they will have in their lifetime, and the egg count naturally decreases over time. DOR is a condition in which there are fewer eggs remaining in the ovaries than normal.
- Functional hypothalamic amenorrhea (FHA). Women with FHA do not get their periods because of excessive exercise, stress, weight loss, or a combination of these factors.
- Improper function of the hypothalamus and pituitary glands. These glands in the brain produce hormones that maintain normal ovarian function.
- Premature ovarian insufficiencyexternal icon (POI). POI, sometimes referred to as premature menopause, occurs when a woman’s ovaries stop producing eggs before she is 40.
- Menopause.external icon Menopause is a natural decline in ovarian function that usually occurs around age 50. By definition, a woman in menopause has not had a period in 1 year.
Fallopian tube obstruction
Physical characteristics of the uterus
Depending on a woman’s symptoms, the uterusexternal icon may be evaluated by transvaginal ultrasound to look for fibroidsexternal icon or other problems, including intrauterine adhesions, endometrial polyps, adenomyosisexternal icon, and congenital anomalies of the uterus.
- Age. About 1 in 5 (22%) couples in which the woman is 30-39 have problems conceiving their first child compared to about 1 in 8 (13%) couples in which the woman is younger than 30. Fertility declines with age primarily because egg quality declines over time. In addition, older women have fewer eggs left and they are more likely to have health conditions that can cause fertility problems. Aging also increases a woman’s chances of miscarriageexternal icon and of having a child with a genetic abnormality.
- Excessive alcohol use.
- Extreme weight gain or loss.
- Excessive physical or emotional stress that results in amenorrhea (not having periods).
Doctors recommend specific treatments for infertility based on the factors contributing to infertility, its duration, and the age of the female.