Infertility

This is an abbreviated version of the complete article.* Basic Facts Infertility is defined as the lack of conception after a year of unprotected sex in women younger than age 35, or after 6 months in women age 35 and older. Male infertility is not greatly affected by age; in women, infertility is more common after age 30, and increases dramatically after age 40. Many cases of infertility stem from a couple not having sex during the woman's fertile period.

Infertility is the inability to become pregnant and it currently affects more than 2.5 million couples in the United States. Physicians commonly define infertility as the lack of conception after a year of unprotected sex if the woman is younger than 35 years of age or after 6 months if the woman is older than 35.

WHAT ARE THE SYMPTOMS?

Infertility has no specific symptoms, other than the woman not becoming pregnant. However, symptoms can point to the conditions that lead to infertility. In men, being unable to maintain an erection or to ejaculate can indicate a health problem that could cause infertility. Irregular or painful menstruation may hint at problems with the female reproductive system.

CAUSES AND RISK FACTORS

Problems with the male reproductive system, the female reproductive system, or even a couple's behavior and sexual technique can cause infertility.

In general, men and women have similar rates of infertility. Risk factors include:

• Age: Infertility becomes more common in women older than 30; after age 40, it increases dramatically. With age, a woman's eggs may develop abnormalities, become harder for sperm to penetrate, or be more likely to die after fertilization.
• Diseases: In men, childhood mumps, as well as diabetes, prostate or testicular cancer, and spinal cord injuries can contribute to infertility. Men taking prescription drugs for other diseases, such as high blood pressure, also have an increased risk of infertility. Gynecologic diseases such as endometriosis, pelvic inflammatory disease, or ovarian cancer can limit a woman's ability to conceive. Men and women who have had venereal disease can be infertile.
• Emotional factors: Depression and stress may alter the hormones that regulate sperm production and ovulation.
• Environment: Exposure to high levels of radiation, to some industrial chemicals, and to pesticides can affect fertility.
• Weight: Being very overweight or very underweight can make a woman's ovulation cycle irregular.
• Smoking
• Substance abuse

DIAGNOSIS

A fertility specialist will evaluate the man and the woman using several different tests, including:

• Clinical history
• Semen analysis (Measures sperm count, movement, ability to penetrate eggs, and other factors.)
• Ultrasound
• Hormone evaluation
• Hysterosalpingogram (X rays and contrast dye create a picture of the uterus that shows scarring or other anatomic changes.)
• Postcoital testing (The physician collects a sample of the mucus that lines the cervix hours after intercourse, just before ovulation. The test will reveal any problems with the mucus, such as the presence of antibodies that attack the man's sperm.)

TREATMENT APPROACH

Treatments for infertility depend on whether the couple's behavior or sexual technique might be preventing conception or whether a physical problem is causing the man's or the woman's infertility.

• Changing behavior or sexual technique: A man and a woman can increase their chances of getting pregnant by having sex more often during the woman's fertile period, and less often during non-fertile times. Home ovulation kits can identify the fertile period. Education in sexual techniques to avoid premature ejaculation or early withdrawal also can improve a couple's fertility.
• Hormone or drug therapy: Sex hormone injections may improve sperm or treat erectile dysfunction, both causes of male infertility. In women, hormones or drugs that induce ovulation can cure infertility.
• Surgery: Surgery can correct some obstructions or minor abnormalities in the male reproductive tract. In women, surgery can treat obstructions (usually found in the fallopian tubes) but success rates are low.
• Assisted reproductive technologies: Physicians may treat female infertility with in vitro fertilization (IVF), or implanting a fertilized egg into the uterus. Other forms of assisted reproductive technologies include intrauterine insemination, or inserting a syringe filled with semen into the uterus.

LIFESTYLE

Lifestyle changes that may help reduce many infertility risk factors include:

• Quitting smoking;
• Exercising to relieve stress;
• Losing weight;
• Curtailing alcohol use;
• Practicing stress-reduction techniques such as meditation or yoga; and
• Avoiding exposure to pesticides and industrial chemicals.

Additionally, men should avoid overheating the testes (which results from sitting in hot tubs for too long or wearing tight underwear) and cycling more than 50 miles a week, both of which can adversely affect sperm count. Some high blood pressure medications, antihistamines, antifungals, and psychiatric drugs decrease sperm production or are toxic to sperm. Temporarily halting these drugs, when possible and with a physician's guidance, may increase male fertility.

Medical Review Date: March 17, 2006

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