Infertility :: Overview :: Signs, Symptoms and Diagnosis :: Treatment Options
Infertility: Overview
Millions of women in the World have difficulty conceiving. If you
have not
been able to become pregnant, despite months of trying, you or your partner
might be infertile. This overview should help you better understand
infertility.
Infertility is the inability to conceive despite trying for 12 months.
Infertile couples have a reduced ability to conceive. However, infertility
should not be confused with sterility, which is the inability to become
pregnant.
Causes of female infertility
Infertility is the result of abnormalities in the human reproductive process.
In order for you to become pregnant, hundreds of variables must occur in just
the right way.
Each month, your body prepares for pregnancy. Your brain's pituitary gland
produces hormones that signal your ovaries to prepare an egg for ovulation
(release of a mature egg from an ovary). These hormones are called
follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
After ovulation, the egg is captured by your fallopian tube. For
fertilization to occur naturally, a man's sperm must unite with the egg in the
fallopian tube. Infertility occurs when something goes wrong in this
process.
Infertility can result from abnormalities in either your body or your
partner's body. In some cases, the causes of infertility may involve both of
you. Among women, ovulation irregularities are often the culprit. Sometimes this
is a result of a breakdown in a woman's hormonal communication cycle. This can
cause shortages in the production of LH and FSH. As a result of this shortage,
the woman's eggs are not released. Causes of this disorder include direct injury
to the hypothalamus or pituitary gland, pituitary tumors, excessive exercise and
anorexia nervosa.
Ovulation problems can also occur when the ovaries no longer contain eggs, or
scar tissue prevents ovulation from occurring. Irregular menstrual periods or
the absence of menstruation may indicate that you have ovulation problems.
Common sources of female infertility include:
- Fallopian tube damage or blockage
- Endometriosis,
a condition in which the tissue that makes up the lining of the uterus (womb) is
found outside the uterus
- Hormonal imbalances
- Polycystic
ovarian syndrome, a reproductive disorder in which excessive amounts of male
hormones are produced by the ovaries
- Sexually
transmitted diseases(STDs)
Additional sources include:
- Early menopause
- Uterine
fibroids, small noncancerous tumors of the uterine wall
- Pelvic adhesions, bands of scar tissue that bind organs
- Thyroid
problems
- Certain cancers or cancer treatments
- Diseases associated with amenorrhea (absence of menstruation) or delayed
puberty (such as Cushing's disease, sickle-cell disease, HIV and AIDS, kidney
disease and diabetes)
- Multiple miscarriages
Being overweight can also reduce your ability to conceive. Age is a factor as
well. After age 35, a woman's fertility rapidly declines as her ovaries produce
fewer viable eggs.
Causes of male infertility
Sperm deficiencies are frequently the cause of infertility in men. These may
include:
- Low sperm production (oligospermia)
- Lack of sperm (azoospermia)
- Poor motility, failure of sperm to move properly inside the female
reproductive tract
In other cases, a man's sperm may be malformed or die before reaching the
egg. Causes may include:
- Variocele, a varicose vein in the scrotum
- An undescended testicle
- A testosterone deficiency
- Infection may also affect the ability of the sperm to reach the egg
Factors that impair the delivery of sperm from the penis to the vagina (e.g.,
erectile dysfunction or misplaced urinary opening in the penis) can likewise
cause infertility.
General health and lifestyle issues can affect a man's fertility too. Health
and lifestyle factors that may affect your partner's ability to impregnate you
include obesity, emotional stress, alcohol use, drug use and being over age
35.
Both you and your partner will need to be tested to determine who is
infertile and what is causing it.
Dealing with infertility can be a very emotional, difficult and frustrating
process. However, there are increasing options to help couples have children.
There has been incredible progress in the field of infertility
treatment in the last 40 years, with new treatments continually being
developed. Talk
with your doctor to find out which treatment is best for you and your
partner.
Infertility: Signs, Symptoms & Diagnosis
Diagnosing Infertility
In order to determine the cause of infertility, a couple will need to consult
a fertility specialist, an expert who has received special training in issues
relating to treating infertility.
Most experts suggest that couples with no known fertility problems should
seek help only after one year of regular unprotected sex. However, it is
recommended that women over age 35 who are trying for their first pregnancy and
women with certain disorders seek assistance prior to trying to get pregnant.
These disorders include a history of menstrual
or ovulatory irregularities, tubal problems, miscarriages, thyroid
conditions, sexual dysfunction and pelvic disease. In addition, couples may
want to seek fertility help if the man has known sperm deficiencies or a history
of illness or surgery in the genital area.
During a visit to a fertility specialist, the physician is likely to obtain a
medical history of both partners, including previous history of sexually
transmitted diseases (STDs), pelvic infections and other illnesses.
A physical examination of the woman's fallopian tubes, cervix and uterus
(womb) will be performed. In addition, blood tests may be performed to check for
hormonal imbalances in both you and your partner. Your ovulatory regularity will
be examined, and an X-ray of the fallopian tubes and uterus -- called a
hysterosalpingogram -- will also be performed. Finally, your partner's sperm
will be evaluated.
In some cases, you will also undergo an examination known as laparoscopy.
Performed using general anesthesia, it involves inserting a thin viewing device
through an incision and into the abdomen and pelvis to examine the fallopian
tubes, ovaries and uterus.
The majority of fertility problems are diagnosed after the first evaluation.
When a diagnosis is not made, additional testing may be necessary. In some
cases, testing can take up to three months or longer.
Once the cause of infertility has been determined, you and your partner may
want to pursue infertility
treatment. There are a variety of treatments targeted at both male and
female infertility. A fertility specialist can help decide which treatment
option is best for you.
Infertility: Treatment Options
If you and your partner are struggling with infertility, you will most likely
have several options to help increase your odds of becoming pregnant.
Medications
Fertility drugs are usually the first option for couples. Up to 90 percent of
women who seek fertility treatment will use medications at some point, according
to the National Women's Health Resource Center (NWHRC). These drugs are designed
to correct hormonal imbalances and to stimulate the production of mature eggs.
They include clomiphene
citrate, gonadotropins, follicle-stimulating
hormone (FSH), letrozole, metformin and bromocriptine.
Fertility drugs work for many women. However, use of fertility drugs raises
your risk of having multiple births. In addition, some experts believe that
using these drugs may increase your risk of developing ovarian cancer. This link
has not been confirmed.
Assisted Reproductive Technology (ART)
If medications fail to help you become pregnant, other options may be used.
Most involve implantation of a fertilized egg into your uterus (womb). Such
methods are known as assisted reproductive technology (ART).
Several factors can reduce the odds of successful fertilization using ART,
including advancing maternal age, large submucous fibroids or polyps, abnormal
endometrial development or the presence of a hydrosalpinx (a collection of
watery fluid in the fallopian tube).
As a result, a number of tests have been developed to determine if you are a
good candidate for implantation. They include hysterosalpingogram
(HSG), which involves the use of radiopaque dye during X-ray of the abdomen;
saline-infusion sonogram (SIS), which involves the insertion of sterile saline
into the uterus; and transvaginal ultrasound.
If you are considered a good candidate for ART, you will have several
implantation options. Techniques include:
- In vitro fertilization (IVF). During this procedure, eggs
are removed from your ovary through your vagina. The eggs are then combined with
sperm in a petri dish, which is placed into an incubator. Once fertilization
occurs, the resulting embryos are either transferred to your uterus (in a
separate procedure) or frozen for later use. You may receive fertility drugs
prior to IVF to ensure that enough eggs will be available for removal. IVF is
usually performed in a physician's office using a local anesthetic.
- Gamete intrafallopian transfer (GIFT). ZIFT
uses the same stimulation process as IVF, except eggs and sperm are combined and
immediately transferred to your fallopian tube. This allows fertilization to
take place in your body. GIFT can be performed only if you have normal fallopian
tube function, and it requires general anesthesia in most cases.
- Zygote intrafallopian transfer (ZIFT). ZIFT is a
combination of IVF and GIFT, and it has a similar success rate to those
procedures. Eggs are retrieved from your ovaries via a laparoscope (a thin,
lighted instrument used to examine tissues and organs inside the abdomen), and
combined with sperm in a petri dish. Twenty-four hours later, the fertilized egg
is placed in your fallopian tube. As with GIFT, general anesthesia is used and
your fallopian tubes must be functional for the procedure to work.
- Intracytoplasmic sperm injection (ICSI). This technique is
used when your partner's sperm function is problematic or when the number of
sperm is inadequate for fertilization. It can also be used if a fertilization
defect is discovered when trying IVF. In this procedure, sperm is injected into
the cytoplasm (cell matter, excluding the nucleus) of a single egg. ICSI is
highly specialized and may not be available in your area.
- Egg donation. Women who cannot produce their own quality
eggs may use an egg donated by another woman, to be used for an IVF. In this
method, you biologically give birth to your child, but the child does not share
your genetic makeup. The procedure is successful between 30 and 60 percent of
the time, according to the NWHRC.
- Sperm donation. If your partner's sperm is inadequate -- or
if you don't have a partner in mind to be the biological father of your baby --
donor sperm can be used to fertilize your egg.
- Gestational hosting. Some women can't carry a pregnancy. In
such circumstances, your eggs and your partner's sperm may be placed in another
woman's uterus. The woman who gives birth to your baby doesn't share her genetic
makeup with the child. In a variation on this procedure, the surrogate mother
may also donate her egg. In such instances, the woman who gives birth to your
child also shares her genetic makeup with the child. Surrogacy laws vary from
state to state.
In some IVF or combination IVF/ICSI procedures, a technique known as assisted
hatching will be used to improve implantation rates. Once the embryo has formed,
the outer covering (zona pellucida) is thinned with a special solution. This
helps in the hatching process, allowing the cells of the embryo to emerge from
the outer shell and implant in your uterus. The method is most likely to be used
if you are over age 35 or if you have experienced repeated failure of IVF
attempts.
Similar to fertility drugs, ART techniques come with some risks. These
include higher incidences of multiple births, enlarged ovaries (ovarian
hyperstimulation syndrome), bleeding, infection, low birth weight and birth
defects.
It is important to know that it may take several attempts for some of these
treatments to work. If one treatment doesn't work for you, your doctor may try
another treatment, or combination of treatments, to help you.
Cost can be a big factor in deciding if and how to treat infertility. Not all
health insurance plans cover infertility treatments, and the ones that do often
cover a limited amount. Check with your insurance provider regarding your health
plan benefits.
This process can be very stressful for you and your partner. Take
steps to reduce stress, guilt, blame and other emotions that can arise
during treatment. Every individual and couple handles the emotions of
infertility treatment differently.
Infertility: Dealing Day to Day
Allow yourself to cry and be angry
You may feel a wide
range of emotions after you and your partner are diagnosed as infertile. The
period during which a couple undergoes fertility
treatment is also emotionally difficult. It is often a time of uncertainty
and frustration.
During these times, it is important to address your
feelings. You should not "turn off" or ignore them. Know that it is okay to cry
after hearing news of a friend or relative's pregnancy. Understand that you
don't have to attend the birthday party your friend is throwing for her young
child. Such feelings are normal, and there is no need to feel guilty when you
experience them.
Allow partners to cope in their own way
People deal with
their emotions differently. It is unfair to expect your partner to feel or act
as upset as you are. On the other hand, it is also important for your partner to
allow you to be upset and cope in your own special ways.
Turn to your friends and family for support
The physical
and emotional toll of infertility can impact your professional and social lives.
To avoid straining these relationships, be honest and up-front with your friends
and family. Let them know of ways they can be helpful and supportive. Also tell
them exactly how you wish to be treated.
Take steps to reduce stress
Infertility can cause stress
for you and your partner. Infertile women typically have higher levels of stress
than fertile women. Taking steps to reduce stress can help you feel better
overall. Try to identify the triggers of stress. Once you identify the factors
that generate stress in your life, the easier it will be to avoid them and
prevent stress in the future.
Research and discuss your options
It is important for
you and your partner to research and discuss your treatment options. It is also
important for you and your partner to understand that treatment may be
unsuccessful. At some point, you may find yourselves having to accept that
conception is not going to occur, and that it is time to stop treatments and
choose another option, such as adoption or child-free living.
Seek therapy if you need to
Although friends and family
can provide support, you may want to talk with someone who has a better
understanding of what you are going through. Many couples benefit from seeing an
infertility counselor or a therapist. Attending a support group may also help
you work through your feelings.
Infertility: Key Q&A
What is infertility?
Infertility is defined as an
inability to conceive a child despite consistently trying to become pregnant
over the course of 12 months. It is a separate disorder from sterility, which is
an inability to become pregnant.
Is infertility a medical problem
related to woman only?
No. In fact, infertility affects men and
women almost equally.
How common is
infertility?
About 60 million couples in the World-- or 10
percent of all couples of childbearing age -- experience infertility, according
to the National Women's Health Resource Center.
What causes
infertility?
There are many different causes of infertility.
Ovulation abnormalities and sperm deficiencies are responsible for two-thirds of
infertility problems.
How is infertility diagnosed?
A
fertility specialist, an expert with specialized training in the area of
infertility, may use a number of tests to diagnose
infertility. The physician typically begins by collecting the medical
histories of both partners. Tests that may follow include a physical examination
of the woman's fallopian tubes, cervix and uterus (womb), blood tests and X-rays
of the fallopian tubes and uterus ( hysterosalpingogram).
An examination of a man's sperm will also be undertaken. A postcoital test (a
test in which the female's cervix is examined for the presence of sperm) and a
laparoscopy may be performed as well.
How is infertility
treated?
In most cases, infertility is treated
with either medication or surgery. Just 5 percent of infertility treatments
involve in vitro fertilization or other kinds of assisted reproductive
technologies.
What is assisted reproductive technology
(ART)?
ART is a term used to describe fertility treatments in which
the eggs as well as the sperm are handled. These generally involve surgically
removing eggs, combining them with sperm in a laboratory, and returning them to
the woman's body or the body of a surrogate mother.
Does
insurance cover infertility treatment?
In some cases, insurance will
cover diagnostic testing. However, couples should consult with their provider
before undergoing tests.
Infertility: Fast Facts
Approximately 60 million couples in the World -- or 10 percent of
all couples of childbearing age -- have difficulty conceiving, according to the
National Women's Health Resource Center (NWHRC).
About one-third of infertility cases can be attributed to males, another
one-third to females and the remaining one-third to both members of a couple. At
least 10 percent of infertility cases go unexplained, although these couples
often later succeed in becoming pregnant.
Ovulation abnormalities and sperm deficiencies are responsible for
two-thirds of infertility problems.
About 20 percent of infertility cases are the result of fallopian tube
disease, according to the NWHRC.
Between 30 and 40 percent of women with endometriosis
are infertile, according to the National Institutes of Health (NIH).
The sexually
transmitted diseases (STDs) chlamydia and gonorrhea are the most important
preventable causes of infertility, according to the U.S. Centers for Disease
Control and Prevention (CDC).
Between 75 and 85 percent of fertility problems are diagnosed
after a patient's initial evaluation.
Most women are about 30 percent less fertile in their late 30s than they
were in their early 20s, according to the National Women's Health Resource
Center.
In 85 to 90 percent of all cases, infertility is treated with either
medication or surgery, according to the NWHRC. Just 5 percent of infertility
treatments involve in vitro fertilization or other kinds of assisted
reproductive technologies, in which a laboratory is used to try to help a couple
become pregnant.
More than 70,000 babies have been born in the Western Countries using assisted
reproductive technologies, including 45,000 born as a result of in vitro
fertilization, according to the NWHRC.
Women are most fertile during ovulation, which occurs around the 14th day of
their menstrual cycle. However, the exact time of ovulation varies among women
due to normal differences in the length of the menstrual cycle.
When no fertility problems are present, the average couple between ages 29
and 33 has about a 20 to 25 percent chance of becoming pregnant during any given
menstrual cycle, according to the NWHRC.
The greatest odds of fertilization occur in the first 12 hours after the
sperm are ejaculated in the vagina. However, sperm can fertilize the egg for up
to 72 hours after ejaculation.
Infertility: Questions to Ask Your Doctor
When should my partner and I be evaluated for infertility?
Am I taking medications that may reduce my fertility?
How often should my partner and I have sex?
Are there any lifestyle
changes that I or we can make to increase my chances of getting
pregnant?
What testing will be performed?
What are my options for treatment?
What type of treatment would you recommend first?
How much will the treatment cost?
If I take fertility drugs and they fail, what are my other options?
What are the risks associated with fertility treatments?
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