Infertility
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Infertility is usually defined as not being able to get pregnant despite
trying for one year. A broader view of infertility includes not being able to
carry a pregnancy to term and have a baby. Infertility affects about 6.1 million
Americans, or 10 percent of the reproductive age population, according to the
American Society for Reproductive Medicine.
Pregnancy is the result of a chain of events. A woman must release an egg
from one of her ovaries
(ovulation). The egg must travel through a fallopian
tube toward her uterus
(womb). A man's sperm must join with (fertilize) the egg along the way. The
fertilized egg must then become attached to the inside of the uterus. While this
may seem simple, in fact many things can happen to prevent pregnancy from
occurring.
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It is a myth that infertility is always a "woman's problem." About one third
of infertility cases are due to problems with the man (male factors) and one
third are due to problems with the woman (female factors). Other cases are due
to a combination of male and female factors or to unknown causes.
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Infertility in men is often caused by problems with making sperm or getting
the sperm to reach the egg. Problems with sperm may exist from birth or develop
later in life due to illness or injury. Some men produce no sperm, or produce
too few sperm. Lifestyle can influence the number and quality of a man's sperm.
Alcohol and drugs can temporarily reduce sperm quality. Environmental toxins,
including pesticides and lead, may cause some cases of infertility in men.
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Problems with ovulation account for most infertility in women. Without
ovulation, eggs are not available to be fertilized. Signs of problems with
ovulation include irregular menstrual periods or no periods. Simple lifestyle
factors - including stress, diet, or athletic training - can affect a woman's
hormonal balance. Much less often, a hormonal imbalance from a serious medical
problem such as a pituitary
gland tumor can cause ovulation problems.
Aging is an important factor in female infertility. The ability of a woman's
ovaries to produce eggs declines with age, especially after age 35. About one
third of couples where the woman is over 35 will have problems with fertility.
By the time she reaches menopause,
when her monthly periods stop for good, a woman can no longer produce eggs or
become pregnant.
Other problems can also lead to infertility in women. If the fallopian tubes
are blocked at one or both ends, the egg can't travel through the tubes into
the
uterus. Blocked tubes may result from pelvic inflammatory
disease, endometriosis,
or surgery for an ectopic
pregnancy.
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If you have been trying to have a baby without success, you may want to seek
medical help. If you are over 35, or if you have reason to believe that there
may be a fertility problem, you should not wait for one year of trying before
seeing a health care provider. A medical evaluation may determine the reasons
for a couple's infertility. Usually this process begins with physical exams and
medical and sexual histories of both partners. If there is no obvious problem,
like improperly timed intercourse or absence of ovulation, tests may be needed.
For a man, testing usually begins with tests of his semen to look
at the number, shape, and movement of his sperm. Sometimes other kinds of tests,
such as hormone tests, are done.
For a woman, the first step in testing is to find out if she is ovulating
each month. There are several ways to do this. For example, she can keep track
of changes in her morning body temperature and in the texture of her cervical
mucus. Another tool is a home ovulation test kit, which can be bought at drug or
grocery stores.
Checks of ovulation can also be done in the doctor's office, using blood
tests for hormone levels or ultrasound
tests of the ovaries. If the woman is ovulating, more tests will need to be
done.
Some common female tests include:
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Hysterosalpingogram: An x-ray of the fallopian tubes
and uterus after they are injected with dye. It shows if the tubes are open
and shows the shape of the uterus.
-
Laparoscopy: An exam of the tubes and other female
organs for disease. An instrument called a laparoscope is used to see
inside the abdomen.
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Depending on the test results, different treatments can be suggested.
Eighty-five to 90 percent of infertility cases are treated with drugs or
surgery.
Various fertility drugs may be used for women with ovulation problems. It is
important to talk with your health care provider about the drug to be used. You
should understand the drug's benefits and side effects. Depending on the type of
fertility drug and the dosage of the drug used, multiple births (such as twins)
can occur in some women.
If needed, surgery can be done to repair damage to a woman's ovaries,
fallopian tubes, or uterus. Sometimes a man has an infertility problem that can
be corrected by surgery.
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Assisted
reproductive technology (ART) uses special methods to help
infertile couples. ART involves handling both the woman's eggs and the man's
sperm. Success rates vary and depend on many factors. ART can be expensive and
time-consuming. But ART has made it possible for many couples to have children
that otherwise would not have been conceived.
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In vitro fertilization (IVF) is a procedure made famous
with the 1978 birth of Louise Brown, the world's first "test tube baby." IVF
is often used when a woman's fallopian tubes are blocked or when a man has low
sperm counts. A drug is used to stimulate the ovaries to produce multiple
eggs. Once mature, the eggs are removed and placed in a culture dish with the
man's sperm for fertilization. After about 40 hours, the eggs are examined to
see if they have become fertilized by the sperm and are dividing into cells.
These fertilized eggs (embryos) are then placed in the woman's uterus, thus
bypassing the fallopian tubes.
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Gamete intrafallopian transfer (GIFT) is similar to
IVF, but used when the woman has at least one normal fallopian tube. Three to
five eggs are placed in the fallopian tube, along with the man's sperm, for
fertilization inside the woman's body.
-
Zygote intrafallopian transfer (ZIFT), also called
tubal embryo transfer, combines IVF and GIFT. The eggs retrieved from the
woman's ovaries are fertilized in the lab and placed in the fallopian tubes
rather than the uterus.
ART procedures sometimes involve the use of donor eggs (eggs from another
woman) or previously frozen embryos. Donor eggs may be used if a woman has
impaired ovaries or has a genetic disease that could be passed on to her baby.
Food and Drug Administration (FDA)
American College of Obstetricians and Gynecologists
(ACOG)
American Society for Reproductive Medicine
Resolve: The National Infertility Association
InterNational Council on Infertility Information Dissemination,
Inc.
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Andropause
