How to Get Pregnant

Cause of Infertility, Male Infertility, Female Infertility

Learn about your infertility treatment options.

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Many couples expect their relationship to naturally progress to the birth of a child. Unfortunately, one in every five couples experience infertility problems. Infertility treatment by a specialist (reproductive endocrinologist) can help make pregnancy possible for those who might otherwise remain childless.

How long should a couple try to get pregnant before seeing a Fertility Specialist?

Women under the age of 35 are usually advised to try for 12 months before consulting a physician. A couple that knows of adverse medical conditions, such as irregular menstrual cycles or a history of tubal infections, should consider a basic examination sooner. Doctors usually advise women over age 35 to have an initial examination after only six months of trying, while those over 40 may begin fertility tests immediately.

Couples should have sexual relations 3 to 4 times a week during the week before ovulation. The egg (oocyte) only survives for 24 hours after ovulation, so good timing is essential.

What is infertility?

Infertility is a disease of the reproductive system that impairs one of the body's most basic functions: the conception of children. Conception is a complicated process that depends upon many factors:

• the production of healthy sperm by the man and healthy eggs by the woman
• unblocked fallopian tubes that allow the sperm to reach the egg
• the sperm's ability to reach the egg
• the sperm's ability to fertilize the egg when they meet
• the ability of the fertilized egg (embryo) to become implanted in the woman's uterus
• a good quality embryo

For the pregnancy to continue to full term, the embryo must be healthy and the woman's hormonal environment adequate for its development. When any one of these factors is impaired, infertility can result.

A couple is considered infertile if the woman does not conceive a child after one year of unprotected, well-timed intercourse or she has been unable to carry a pregnancy to a live birth. The diagnosis is sped up for women over 35--treatment is normally recommended after six months of trying to conceive.

Infertility is not a "woman's" problem. It is a medical problem of the male or female reproductive system. In about one third of cases, the cause is traced to the woman, another third of cases are traced to the man. The rest are caused by unknown factors or a physiological incompatibility.

Infertility is not only a physical condition--it is an emotional and social condition with accompanying feelings and issues. The infertile couple needs support and consideration from the treatment team, friends, family, and each other.

What is the cause of male infertility and female infertility?

Roughly one-third of infertility cases can be attributed to male factors and another one-third to factors that affect women. For the remaining infertile couples, infertility is caused by a combination of problems in both partners (about 13%) or is unexplained (about 10%).

The most common causes of male infertility include azoospermia (no sperm cells are produced) and oligospermia (few sperm cells are produced). Sometimes, sperm cells are malformed or they die before they can reach the egg. In rare cases, male infertility is caused by a genetic disease such as cystic fibrosis or a chromosomal abnormality.

The most common cause of female infertility is an ovulation disorder. Other causes of female infertility include blocked fallopian tubes, polycystic ovary syndrome (PCOS) and endometriosis. Repeated miscarriages may be caused by congenital anomalies (birth defects) involving the structure of the uterus and uterine fibroids.

How is infertility diagnosed?

Couples are generally advised to seek medical help if they are unable to achieve pregnancy after a year of unprotected intercourse. The doctor conducts a physical examination of both partners to determine their general state of health and to evaluate physical factors that may be causing infertility. Usually both partners are interviewed about their sexual habits in order to determine whether intercourse is taking place for conception.

If the physician cannot find a cause for infertility at this point, more specific tests may be recommended. For women, these include an analysis of body temperature and ovulation (by charting the basal body temperature), an x-ray of the fallopian tubes and uterus, and laparoscopy. For men, initial tests focus on semen analysis.

Infertility Treatment

In the past several years, fertility specialists have made great strides in diagnosing and treating infertility. Surgery and hormone therapy can correct some infertility problems. If those methods fail, doctors now have access to more advanced procedures, collectively known as Assisted Reproductive Technology (ART). For many couples, ART is the best chance and last hope for achieving pregnancy.

The evaluation and treatment of infertility requires a great deal of time, resources, and energy. It requires the participation of the couple, physicians, nurses, technicians, counselors, and many others.

How successful are infertility treatments?

Each couple's condition and response to infertility treatment is unique. The answer is difficult to calculate, because it depends on several factors: the woman's body, the man's body, the clinic's success rate, and luck. Physiological factors that affect success include the age of the woman, uterine abnormalities, and whether both partners have infertility factors.

Should a woman see her gynecologist or an infertility specialist?

Most gynecologists have ample training to handle the basic infertility workup, although some refer patients to a specialist immediately. Usually, the OB/GYN begins the testing process and appropriate treatments, then refers the couple to a fertility specialist if simple treatments are not successful.

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We're a national network of over 100 fertility specialists.