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Infertility is generally defined as the inability to get pregnant after 12 months of unprotected sex. This affects about 10-15 percent of couples in the United States.

Infertility can be caused a by a few factors: ovulation problems, low egg number or poor egg quality, tubal injury or blockage, low sperm count or abnormal sperm, uterine malformations, medical conditions (such as diabetes, uncontrolled thyroid disorders, or autoimmune diseases), and lastly — the most frustrating of all — unexplained infertility. The causes occur in roughly these proportions:

  • Ovulation disorders: 30 percent
  • Tubal problems: 30 percent
  • Male-associated: 20 percent
  • Other: 10 percent
  • Unexplained: 10 percent

Your doctor will usually suggest a fertility work-up after you’ve been unsuccessfully trying to get pregnant for 1 year (if you are under 35 years old) or 6 months (if you are older than that). Other reasons to start testing sooner include an irregular menstrual cycle or documented fertility problems for you or your partner.

A basic fertility investigation starts with a very thorough history. Your doctor may then order blood tests or urine tests to prove you are ovulating normally, tests to rule out infections or medical conditions (such as a thyroid disorder), or an ultrasound to evaluate the shape of the uterus and see whether or not the fallopian tubes are blocked. A semen analysis is also usually done, so let your partner know to expect this! Lastly, surgery may be indicated to look for problems such as endometriosis or adhesions.

The treatment for infertility depends on the cause. You may be given medications to help stimulate the release of an egg if the issue is ovulation. Alternatively, surgery may be needed if your tubes are blocked. Other more advanced treatments, such as intrauterine insemination (IUI) or in vitro fertilization (IVF), may be used if needed. These are performed by infertility specialists.

Infertility can be an extremely emotional issue for couples trying to expand their families. The cost associated with it often adds to that stress. It is important to have a support system in place if you are going through this. Things like local support groups and online groups can help you feel less alone.

Takeaways

  • Infertility is the inability to get pregnant after 12 months of trying.
  • There are multiple causes of infertility, including ovulation disorders and tubal problems.
  • An infertility work-up is often tailored to a patient’s history.
  • A basic fertility investigation can include blood or urine tests or an ultrasound.

References

  1. American College of Obstetricians/Gynecologists. FAQ 136: Evaluating Infertility.
  2. American College of Obstetricians/Gynecologists. FAQ 137: Treating Infertility.
  3. The American Society for Reproductive Medicine. Diagnostic evaluation of the infertile female: a committee opinion.
  4. JS Berek. Berek and Novak’s Gynecology, 14th ed. Infertility. p1185-1276.

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