What Is Infertility?

Infertility is a condition of the reproductive system in either a male or female that impairs the conception of children. The diagnosis of infertility is usually given to couples who have been trying to get pregnant without contraception for at least 1 year without success. Among the factors necessary for pregnancy are: healthy sperm produced by the man, healthy eggs produced by the woman, fallopian tubes that are open and allow the sperm to reach the egg, the ability of a sperm to fertilize an egg to create an embryo, the ability of the embryo to successfully implant in the woman's uterus, a sufficiently robust embryo, and a hormonal balance within the woman's body that permits the embryo to fully develop inside the uterus. With so many factors in play, it's easy to see how infertility might result, and also how difficult it can be to pinpoint the problem.

While it's often assumed that infertility is a female problem, the truth is that only about 33% of infertility cases are related to factors within the woman alone. Another 33% of cases are based on male factors, and the remainder are from either a combination of factors or for reasons that are never uncovered. In fact, unknown causes account for approximately twenty percent of infertility cases.

Male Factor Infertility

The most common male infertility factors go by the following fancy names: azoospermia means that no sperm cells are produced in a man's semen, and oligospermia means that not enough sperm cells are produced. Sometimes, sperm cells are malformed, and some are not robust enough to survive until they reach the egg. Although male factor infertility is usually a problem with the sperm, there may be other factors in a male that contribute to infertility such as chromosomal problems or a chronic disease.

Female Factor Infertility

By far the most common female infertility factor is a problem with ovulation. There are a number of underlying causes of ovulation problems, including polycystic ovaries and hormonal problems. Female infertility may also be a matter of blocked fallopian tubes, usually because of a past pelvic inflammatory disease or endometriosis. A woman with structural problems with the uterus or uterine fibroids can have trouble carrying a pregnancy to term even if conception occurs. Aging is another important factor in female infertility, as a woman is less able to produce healthy eggs as she gets older. There is a dramatic decline in the ability to produce robust eggs after age 35.

The American Society of Reproductive Medicine recommends that women under 35 begin testing after trying to conceive unsuccessfully for 12 months. The recommendation for women over 35 is to begin testing after trying to conceive for 6 months without success. These are rough guidelines, and nothing should prevent a couple from getting testing earlier on if it will provide them comfort. Just be aware that most insurance companies follow the guidelines set forth above, so unless there is an obvious risk factor like a known hormonal imbalance, early testing may not be covered by insurance. Testing for infertility usually starts with a physical examination of both partners to determine their general state of health and to evaluate any physical disorders that may be causing infertility. Usually both partners are interviewed about their sexual habits in order to determine whether the couple is properly timing sexual activity around the day a woman is likely to be ovulating. If the preliminary exam doesn't uncover a cause of the infertility, more specific tests may be considered. For women, these include an analysis of body temperature and ovulation, x-ray of the fallopian tubes and uterus, and laparoscopy. For men, initial tests focus on semen analysis. The analysis determines whether enough sperm are being produced, whether those sperm have good motility (ability to swim), and whether there are any structural defects in the sperm (for example head and tail that are poorly shaped or out of proportion).

While high-tech solutions like IVF receive a lot of attention in the media, approximately 85 to 90 percent of infertility cases can be resolved with more conventional therapies, such as non-invasive treatment with medications, or surgical repair of improperly functioning reproductive organs (for example, unblocking of fallopian tubes).