Infertility 101

Amy Hendel Health Guide
  • Thanks to the national coverage of the recent birth of octuplets, infertility and its various treatments have become everyday conversation.  It's important to understand that infertility or reproductive problems are often treatable.  It's also important for couples to understand that male infertility is as common as female infertility, so when a couple presents with "trouble making a baby," both partners need to be medically assessed.


    The Basics

    The actual diagnosis of infertility is made when a couple has tried to become pregnant after a year of having unprotected intercourse (with an average of 3 times per week).  A person who is infertile has a reduced ability to have a child.  A person who is sterile is physically unable to have a child.  The diagnosis of infertility can be devastating to a couple.  According to the American Society for Reproductive Medicine, 1/3 of the time the contributor is te female partner, 1/3 of the time it is the male parner, and 1/3 of the time it is due to a combination of health issues.   It is important to understand that about 50% of couple who seek help for infertility will eventually have a child, either on their own or with medical intervention.  In about 15% of cases, no cause of infertility is ever diagnosed.

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    Causes of infertility in men can include:

    • Low sperm count
    • Low sperm motility (they don't move well)
    • Malformed sperm
    • Blocked sperm ducts
    • Temporary drop in sperm production which can be caused by injury to the testes (prolonged heat, exposure to certain medications or chemicals), wearing very tight underwear
    • Varicocele (varicose veins in the testes)
    • Excessive use of alcohol and smoking


    Causes of infertility in women:

    The primary cause of infertility in women is lack of ovulation or anovulation, meaning the eggs are not being released from the ovary.  A major cause of this could be PCOS, or polycystic ovary disease.  Other causes of female infertility include:


    • Scarred fallopian tubes from an infection (PID or pelvic inflammatory disease) or from endometriosis.
    • Cervix mucus issue that damages the sperm when it enters
    • Uterine fibroids
    • Uterine tumor
    • Cervical problem
    • Irregular uterine shape
    • Older female (over age 35)


    Clearly if a woman has missed or irregular periods, severe menstrual cramps, which could be a sign of secondary dysmenorrhea (a disorder in a woman's reproductive organs), or if a man knows he has retrograde ejaculation, then it may be obvious that medical intervention is necessary as soon as the decision to have a child is made.  In some cases, the woman is able to get pregnant but experiences frequent miscarriages.  As many as 50% of pregnancies end in miscarriage, and quite often, before a woman even misses her period.  About 15% of recognized pregnancies will end in a miscarriage.  Of those, 80% will occur in the first trimester of pregnancy. 


    Causes of miscarriage can include:

    • Chromosomal abnormality in the fetus (causes a miscarriage)
    • Infection
    • Exposure to toxic agents or radiation
    • Hormonal problems
    • Incompetent cervix (cervix opens prematurely during the pregnancy)
    • Uterine abnormalities
    • Immune disorders like lupus
    • Smoking, drinking excessively, using illicit drugs
    • Uncontrolled diabetes
    • Severe kidney or heart disease
    • Thyroid disease
    • Accutane (prescription acne medication) and certain other medications
    • Aging increases the risk as well


  • Only your doctor can establish a diagnosis of infertility.  He will evaluate you and your partner and the exam can include a semen analysis and physical examination of the male, and a pelvic examination, hormone testing, hysteroscopy(to see if a uterus defect is present), postcoital test (done hours after intercourse), hysterosalpingogram (to see if the fallopian tubes are blocked) and even an ultrasound of the pelvis, in the case of the female partner.

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    Up next: What Are My Options?



Published On: March 12, 2009