Infertility Questions and Answers
What is infertility?
Primary infertility describes a couple that after having regular intercourse without contraception are not able to get pregnant by one year.
Those with secondary infertility are couples who have previously been able to achieve pregnancy at least once, but later attempts are unsuccessful.
What causes infertility?
Causes of infertility can include a wide range of factors. Approximately 30-40% of all infertility is due to a “male” factor.
These include – retrograde ejaculation (the entry of semen into the bladder instead of going out through the urethra during ejaculation), impotence, hormone deficiency, environmental pollutants, scarring from sexually transmitted disease (STDs), and/or decreased sperm count.
A “female” factor (such as, scarring from STDs or endometriosis, ovulation dysfunction, poor nutrition, hormone imbalance, ovarian cysts, pelvic infection, and/or tumors), is responsible for 40-50% of infertility. The remaining 10% to 30% of causes are often times unexplained.
What are the risks that contribute to infertility?
In addition to age-related factors, increased risk for infertility can include:
Multiple sexual partners (increases the risk for STDs)
Sexually transmitted disease (STD)
History of pelvic inflammatory disease (PID)
A varicocele (varicose veins within the scrotum)
Past medical history of DES exposure (men and women)
Eating disorders (women)
Anovulatory menstrual cycles (menstrual cycles where no egg was produced)
Abnormalities of the uterus of cervical obstruction
Chronic diseases, such as diabetes
What can be done to prevent infertility?
Because STDs frequently cause infertility, practicing safer sex may reduce the risk of future infertility. Gonorrhea and Chlamydia are the most frequent causes of STD- related infertility. These diseases can cause scarring of the fallopian tubes and subsequent decreased fertility, absolute infertility, or an increased incidence of ectopic pregnancy. Mumps immunization to prevent mumps in males is important in preventing mumps-related sterility. Some forms of birth control carry a higher risk for future infertility (such as the IUD). Women who choose the IUD as a form of birth control must be willing to accept the very slight risk of infertility associated with its use.
What are the symptoms of infertility?
Basically, the inability to become pregnant is the first sign of potential infertility. However, emotional issues can also be a contributing factor. Couples should keep an open and candid line of communication with their physician.
What is the treatment for infertility?
Treatment will depend upon the cause of the infertility for any given couple. Options range from education and counseling, to the use of medications that treat infections or promote ovulation. Sometimes artificial reproductive technologies, such as in-vitro fertilization (IVF) or Intra-Cytoplasmic Sperm Injections (ICSI), are the appropriate form of treatment.
What tests are used to diagnose infertility?
A comprehensive medical examination of both partners is the first step to an accurate diagnosis. Tests that may be performed include:
Measuring basal body temperature to determine the woman’s time of ovulation
Monitoring cervical mucus changes throughout the menstrual cycle
Postcoital test to measure the serum hormone levels for either or both partners
Progestin challenge is sometimes performed with sporadic or absent ovulation
Hysterosalpingography (HSG) is an X-ray procedure done with contrast dye that enables evaluation of potential transport from the cervix through the uterus and fallopian tubes.
Laproscopy is sometimes used for direct visualization of the pelvic cavity.
Pelvic exam (women) to determine if there are cysts.
What is Artificial Reproductive Technology?
The types of Artificial Reproductive Technology (ART) include:
In Vitro Fertilization (IVF) – This is the original “test tube” technique
Intra-Cytoplasmic Sperm Injection (ICSI) – With this technique, a single human sperm is injected into the cytoplasm of the egg.
Gamete Intra-Fallopian Transfer (GIFT) – Gametes are transferred to the fimbrial end of the fallopian tube immediately after ova aspiration.
Zygote Intra-Fallopian Transfer (ZIFT) – The transfer of the early-fertilized egg into the fallopian tube.
Micro-Epididymal Sperm Aspiration (MESA) / Testicular Sperm Aspiration (TESA) – Sperm harvested by these techniques is specific to male infertility.
Important Facts to Know
Natural fertility is 20% per menstrual cycle, increasing to 50% by three months and 85% by one year.
Approximately 15-20% of all couples experiences infertility.
Females, while still in the womb, have the most number of eggs at 16-20 million. By birth that number has already decreased to around 8 million. As they age, females lose many eggs each day until menopause. Since the eggs they carry at age 35 are the same ones they carried even before birth, the chance for chromosomal abnormalities increases. Males are able to produce sperm throughout their entire life. However, a decrease in sperm production due to health complications can occur. There are numerous conditions that can contribute to infertility.
A woman’s peak fertility is in her early 20s. As a woman ages beyond 30 (and particularly after 35), the likelihood of conceiving is less than 10% per month.