What is Infertility?
In general, infertility is a term used to describe a couple’s inability to achieve pregnancy despite having intercourse for a year or more, without using birth control. There are numerous causes of infertility. A couple may be infertile due to factors affecting the health of the woman, man, or both. In some cases, no specific cause can be identified. This is referred to as “unexplained infertility.”
Conditions which may contribute to infertility include hormonal problems, physical disorders in women, and a variety of factors related to sperm production in men. A couple’s infertility may be related to one or more of these causes.
If you suspect you have a fertility problem
If you have tried for at least a year to achieve a pregnancy only to be disappointed each month, you should consider being evaluated for infertility. Because factors affecting men and women may impact fertility, both partners should be evaluated. Consult your primary care physician or obstetrician/gynecologist. If these exams fail to reveal anything suspicious, consider seeking the care of a physician who specializes in reproductive endocrinology.
Reproductive endocrinologists are obstetrician/gynecologists with fellowship training in infertility. You should seek the care of a physician who is board certified in reproductive endocrinology, an indication that he or she meets certain high standards of expertise and experience in diagnosing and treating infertility.
If in vitro fertilization is among the options you are considering, success rates of fertility clinics are one helpful way to identify reputable programs. The Centers for Disease Control (CDC) publishes a report each year that summarizes these statistics. This report is available on the CDC’s web site at www.cdc.gov.
Diagnosing infertility
Identifying a cause for a couple’s infertility is key to recommending treatment when a couple chooses to seek such services. Both partners are involved in the process and the cause may be linked to either or both the man or woman.
- Tubal/peritoneal factor (including endometriosis) —Tubal disease accounts for approximately one third of all causes of infertility. Hysterosalpingogram (HSG) is the most common test for assessing tubal disease, which may identify tubal obstructions or abnormalities in the uterine cavity. A diagnostic laparoscopy, which allows a physician to see inside the pelvic structures, is usually done if HSG findings are abnormal.
- Ovulatory factor — Basal body temperature (BBT) charting is the simplest method for determining when and if a woman is ovulating. Testing the concentration of progesterone or an endometrial biopsy may also be used to identify ovulatory dysfunction. Once ovulatory problems are identified, hormonal testing may be done to identify a cause for the ovulatory problems.
- Cervical factor — Cervical mucus is assessed within two to 12 hours after intercourse to determine the concentration of sperm and their motility.
- Male factor — A semen analysis is the first test used to determine whether or not a male factor is contributing to infertility. Sperm is examined for its volume and concentration, motility and normal appearance.
- Unexplained infertility — In about 15 percent of infertility cases, the routinely done diagnostic studies are normal, and a diagnosis of “unexplained infertility” is made.
Emotional Concerns
There is no doubt that infertility can cause great emotional stress for all those involved. It is important to remember that these emotional concerns are real and that there are counselors, specializing in infertility, who are ready to help you through this trying time.