Infertility is more common than previously thought and occurs in approximately 10 to 15 percent of couples at some time during their reproductive lives.

Infertility is defined as the inability to conceive after one year of unprotected intercourse.

Infertility is a condition that can affect either or both partners so each should be thoroughly evaluated. Male infertility is a factor about 47 percent of the time.

Women over age 35 are advised to start infertility evaluation after 6 months of unprotected intercourse so as not to delay treatment.

The Reproductive Process

A complex series of biologic events must occur for pregnancy to result.

  • The ovary must contain eggs that will develop to maturity within the ovarian follicles under the influence of follicle stimulating hormone (FSH).
  • The egg must be released (ovulated) from the follicle and travel through an open fallopian tube to the end near the uterus where fertilization occurs.
  • The male must produce enough sperm to cause fertilization. A significant number of these sperm must be “normal” as determined by their shape, swimming ability, and several other characteristics.
  • The sperm must travel through the vas deferens and urethra and be ejaculated into the vagina.
  • Once deposited, the sperm must swim through the cervical mucus into the uterus.
  • Once the sperm reaches the egg it must attach to and penetrate the outer membrane (zona pellucida). The DNA of the male and female must combine to produce a full complement of chromosomes.
  • After the egg is fertilized, it divides to become an embryo. The embryo must travel into the uterus where it implants in the endometrial lining.
  • Once the embryo implants, its nourishment and development are supported by progesterone and other hormones.
  • The uterus must be capable of supporting the growing fetus.

Infertility Causes

When one or more of the steps in the reproductive process are impaired, infertility can result. Most cases of female infertility are due to medical conditions that cause these impairments.

Infertility Diagnosis

Infertility tests assess the processes that must occur for pregnancy to result.

Both male and female partners should be tested for infertility if pregnancy fails to occur after 1 year of regular unprotected sexual intercourse.

An analysis of the man’s semen should be performed before the female partner undergoes any invasive testing.

Laboratory Tests

Various tests are used to evaluate hormone function and ovarian reserve (the number of follicles and quality of the eggs).

Clomiphene citrate challenge tests may also be used to test for ovarian reserve.

Imaging Tests

Imaging tests such as ultrasound, sonohysterogram and hysterosalpingogram are used to examine your fallopian tubes and uterus.

Surgical Diagnostic Procedures

Hysteroscopy uses a long tube with a camera on the end which is inserted into the vagina and advanced through the cervix so the doctor can view the uterus, ovaries and fallopian tubes.

A laparoscopy is often performed to view and evaluate the reproductive organs. Many times conditions, such as endometriosis, can be treated during a diagnostic laparoscopy.

Infertility Treatment

Several approaches are used to treat female infertility:

Treatment of “infertility of unknown causes” may consist of intrauterine insemination followed by IVF if pregnancy does not occur. Intracytoplasmic sperm injection will often be recommended since there could be an “unknown” male factor infertility component.