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Infertility is defined as not getting pregnant after one year of regular sexual intercourse without using birth control. Women older than 35 are advised to seek an evaluation after six months of trying. Women older than 40 are encouraged to talk with an obstetrician-gynecologist (OB-GYN) about an evaluation right away.
Causes
Infertility can stem from a range of factors, and sometimes more than one is involved. The most common cause of female infertility is a problem with ovulation. A hormone imbalance, in which the body makes too much or too little estrogen, can prevent the ovaries from releasing an egg or from securing it to the uterine wall.
Age also plays a role. A woman’s chance of getting pregnant starts to decline in her early 30s. By age 40, that chance drops to less than 10 percent per menstrual cycle. Male fertility declines with age as well, though less predictably.
Lifestyle factors matter too. Being underweight or overweight may make conception harder. In women, smoking and moderate to heavy drinking may reduce fertility. In men, smoking, heavy drinking, and marijuana use can lower sperm count and movement.
Several health conditions can affect fertility. These include problems with the reproductive organs or hormones, scarring or blockages of the fallopian tubes from past infections or endometriosis, and problems with the thyroid gland or pituitary gland. Cysts, fibroids, and polyps can also make it difficult for an egg to reach its destination.
For men, the most common cause is a problem with sperm cells and how they function. Infertility can also occur when the tubes that carry sperm from the testicles are blocked. In some cases, no cause is found. This is called unexplained infertility.
Treatments
Treatment depends on the type of problem identified. Recommendations may include lifestyle changes, medication, or surgery, and some treatments may be combined. In some cases, infertility can be treated successfully even when no cause is found.
Lifestyle changes can help both men and women. Staying at a healthy weight and eating a healthy diet are useful steps. Stopping smoking, drug use, and alcohol use is also advised.
When abnormal hormone levels cause ovulation problems, a specialist may check hormone levels and correct the imbalance. This treatment can improve the chances of getting pregnant.
Intrauterine insemination (IUI) places healthy sperm in the uterus as close to ovulation as possible. The sperm may come from a partner or a donor. IUI can be combined with ovulation stimulation.
Assisted reproductive technology (ART) covers fertility treatments in which both eggs and sperm are handled. ART usually involves in vitro fertilization (IVF). In IVF, sperm is combined with the egg in a laboratory, and the embryo is transferred to the uterus. IVF is used for blocked tubes that cannot be repaired with surgery, severe endometriosis, primary ovarian insufficiency, some male infertility factors, and unexplained infertility. It carries an increased risk of multiple pregnancy.
Surgeries
Surgery is one option for treating certain causes of infertility. In women, surgery can repair blocked or damaged fallopian tubes. It can also address endometriosis, which is commonly linked to infertility. Surgery can remove polyps or fibroids in the uterus as well. In men, surgery can sometimes treat swollen veins in the scrotum.
Get Help for Infertility
If you and your partner have been trying to conceive without success, an evaluation can help identify the cause and guide treatment. You may start with your OB-GYN, see a reproductive endocrinologist, or, for men, consult a urologist. Talk with a provider you are comfortable with to learn which options fit your situation.
