Infertility

Causes

A wide range of physical and emotional factors can cause infertility. Infertility may be due to problems in the woman, man, or both.

FEMALE INFERTILITY:

Female infertility may occur when:

• A fertilized egg or embryo does not survive once it sticks to the lining of the womb (uterus)
• The fertilized egg does not attach to the lining of the uterus
• The eggs cannot move from the ovaries to the womb
• The ovaries have problems producing eggs

Female infertility may be caused by:

• Autoimmune disorders, such as antiphospholipid syndrome (APS)
• Cancer or tumor
• Clotting disorders
• Diabetes
• Growths (such as fibroids or polyps) in the uterus and cervix
• Birth defects that affect the reproductive tract
• Excessive exercising
• Eating disorders or poor nutrition
• Use of certain medications, including chemotherapy drugs
• Drinking too much alcohol
• Obesity
• Older age
• Ovarian cysts and polycystic ovary syndrome (PCOS)
• Pelvic infection or pelvic inflammatory disease (PID)
• Scarring from sexually transmitted infection or endometriosis
• Surgery to prevent pregnancy (tubal ligation) or failure of tubal ligation reversal
• Thyroid disease
• Too little or too much of certain hormones

MALE INFERTILITY:

Male infertility may be due to:

• A decrease in sperm count
• Sperm being blocked from being released
• Sperm that do not work properly

Male infertility can be caused by:

• Environmental pollutants
• Being in high heat for prolonged periods
• Birth defects
• Heavy use of alcohol, marijuana, or cocaine
• Too little or too much hormones
• Impotence
• Infection
• Older age
• Cancer treatments, including chemotherapy and radiation
• Scarring from sexually transmitted diseases, injury, or surgery
• Surgery to prevent pregnancy (vasectomy), or failure of vasectomy reversal
• Retrograde ejaculation
• Smoking
• Use of certain drugs, such as cimetidine, spironolactone, and nitrofurantoin

In healthy couples under age 30 who have sex regularly, the chance of getting pregnant is about 25 - 30% per month.

A woman's peak fertility occurs in her early 20s. After age 35 (and especially 40), the chances that a woman can get pregnant drops considerably.

Symptoms

The main symptom of infertility is the inability to become pregnant. Specific symptoms depend on what is causing the infertility.

Infertility can cause many painful emotions in one or both partners.

Exams and Tests

When you should seek treatment for infertility depends on your age. It is recommended that women under 30 should generally try to get pregnant on their own for 1 year before seeking testing.

Infertility testing involves a complete medical history and physical examination of both partners.

Blood and imaging tests will be done. In women, this may include:

• Blood tests to check hormone levels, including progesterone and follicle stimulating hormone
• Checking body temperature first thing in the morning to check if the ovaries are releasing eggs
• FSH and clomid challenge test
• Hysterosalpingography (HSG)
• Pelvic ultrasound
• Laparoscopy
• Luteinizing hormone urine test (ovulation prediction)
• Thyroid function tests

Tests in men may include:

• Sperm testing
• Testicular biopsy (rarely done)

Treatment

Treatment depends on the cause of infertility. It may involve:

• Education and counseling
• Fertility treatments such as intrauterine insemination (IUI) and in vitro fertilization (IVF)
• Medicines to treat infections and clotting disorders
• Medicines that help the woman grow and release eggs from the ovaries

It is important to recognize and discuss the emotional impact that infertility has on you and your partner, and to seek medical advice from your health care provider.

You can increase your chances of becoming pregnant each month by having sex at least every 3 days before and during ovulation. It is especially important to do so before ovulation occurs. Sperm can live inside a woman's body for at least 3 days. However, a woman's egg can only be fertilized by the sperm for a few hours after it is released. 

Ovulation occurs about 2 weeks before the next menstrual cycle (period) starts. If a woman gets her period every 28 days, the couple should have sex at least every 3 days between the 10th and 18th day after the period starts.

Support Groups

See: Infertility - support group

Outlook (Prognosis)

As many as 1 in 5 couples diagnosed with infertility eventually become pregnant without treatment.

More than half of couples with infertility become pregnant after treatment, not including advanced techniques such as in vitro fertiliziation (IVF).

Possible Complications

Infertility can have a big emotional impact on you and your partner.

Depression, anxiety, and marriage problems may occur.

When to Contact a Medical Professional

Call for an appointment with your health care provider if you are unable to get pregnant.

Prevention

Preventing sexually transmitted infections (STIs), such as gonorrhea and chlamydia, may reduce your risk of infertility.

Maintaining a healthy diet, weight, and lifestyle may increase your chances for getting pregnant and having a healthy pregnancy.

Take a prenatal or multivitamin containing folate before and during pregnancy. This lowers your risk for miscarriage and developmental problems in the baby.

Alternative Names

Inability to conceive; Unable to get pregnant

References

Rebar RW, Erickson GF. Reproductive endocrinology and infertility In: Goldman L, Ausiello D, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 244.

Lobo RA. Infertility: etiology, diagnostic evaluation,management, prognosis. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007: chap 41.

Bulun SE. Physiologyand pathology of the female reproductive axis. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 17.

Update Date: 2/26/2012

Updated by: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington. Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.