Infertility affects about 6.1 million Americans or 10 percent of the reproductive-age population. Frequent, unprotected intercourse leads to conception in 50 percent of couples within three months, 75 percent within six months, and 90 percent within a year.
Infertility is often characterized as the failure to get pregnant (conceive) even after having unprotected sex for 12 months.
- In almost one-third of all cases of infertility, the female partner has a condition that prevents them from getting pregnant. Endometriosis, obstructed fallopian tubes, and polyps or fibroids in the uterus are common causes of infertility in women.
- In another one-third of cases, the male partner may have reproductive issues, such as poor sperm count, motility, or quality.
- In the remaining one-third of cases, either the female or male partner or both are experiencing reproductive issues or there is no apparent cause of infertility.
Two types of infertility
- Primary infertility: Those couples who have never achieved a full-term pregnancy.
- Secondary infertility: The couple has already had a child, but they are unable to achieve another full-term pregnancy again. Most infertile couples worldwide have primary infertility.
Infertility impacts relationships and creates emotional and psychological discomfort in people. Despite the numerous social, psychological, economic, and physical consequences, infertility prevention and care are largely neglected in public health concerns. However, there has been a growing understanding in recent years of the importance of infertility prevention, maintenance, and treatment within basic health care services.
What are the common causes of infertility?
The causes of infertility are diverse and include both genders. This includes issues with sperm or egg production, the structure or function of male or female reproductive systems, and/or hormonal and immunological disorders.
- Most common causes of infertility
- Maternal age 35 years or older
- Ovulatory disorders
- Obstacles in the uterus or fallopian tubes
- Sperm abnormalities
- Causes of infertility in men
- Low sperm count or a lack of sperm
- A history of sexually transmitted infection
- Hormonal imbalances
- Poor sperm quality
- Causes of infertility in women
- Age (fertility decreases after 35 years)
- Having a sexually transmitted infection
- Problems producing eggs
- Problems in the uterus (such as fibroids or polyps)
- Problems with the fallopian tubes
- Endometriosis (excess of tissue that gathers around the reproductive organs)
- Hormonal imbalances
- Early menopause (before 40 years)
- Common causes of infertility in both men and women
Up to 20 percent of infertile couples in the United States experience unexplained infertility. In many circumstances, abnormalities are likely to exist yet are undetectable with existing procedures.
Unexplained causes may include:
- The egg may not be released at the optimal moment for fertilization
- The egg may not enter the fallopian tube; the sperm may not reach the egg
- Failure of fertilization
- Transport of the zygote could be disrupted or implantation may fail
The egg’s health and quality are crucial. People of advanced maternal age have eggs that have reduced ability for normal and adequate fertilization. In addition, polymorphisms in folate pathway genes could be one cause of reproductive difficulties in particular women with unexplained infertility.
What are the treatment options for people with infertility?
Medical treatment for infertility generally involves using fertility medication, medical devices, surgery, or a combination of these. Depending on the cause, underlying health issues, and age, doctors may recommend individualized treatment options.
People will be able to make better decisions if they are educated on the normal process of fertility, disorders that impair fertility, and treatment alternatives—understanding the natural reproductive process help them know when to seek assistance.
- Medications to induce egg development and ovulation
- There are two ways to stimulate the ovary to produce mature eggs for ovulation. They are pills and injections.
- Pills may induce ovulation and are usually used between the third and seventh menstrual cycle days.
- Gonadotropins are the most regularly administered injections that stimulate the ovaries. These injections are administered at night for 5 to 10 days and work directly on ovarian cells to boost egg formation.
- Once a follicle carrying an egg has matured, a human chorionic gonadotropin injection is frequently administered to replicate the natural luteinizing hormone spike during ovulation. This results in the egg's maturation and release.
- Intrauterine insemination
- Washes and prepares sperm for implantation into the uterine cavity, bypassing the cervix and providing a higher concentration of motile sperm closer to the tubes and ovulated egg.
- The sperm is cleaned with a safe solution before centrifugation. Motile and viable sperm are then deposited in a very minimal amount of fluid and inserted very softly and painlessly into the uterine cavity using a very thin, soft, and flexible catheter to achieve fertilization.
- In vitro fertilization (IVF)
- Eggs are retrieved and subsequently fertilized by sperm outside of the body in an embryology laboratory. The embryos go directly into the uterus, skipping the tubes.
- Has enabled successful births in women who were previously thought to be infertile for life.
Another person contributes sperm or eggs or another woman acts as a gestational surrogate to assist a person or couple to have a child.
- Sperm donation: Using donated sperm for uterine insemination or egg fertilization using the IVF procedure.
- Egg or ovum donation:
- An egg donor goes through an IVF round to extract eggs, which are subsequently donated and fertilized.
- The resultant embryos are subsequently transplanted into the uterus of the person.
- Only one or two embryos are usually transplanted. Extra embryos can be stored or cryopreserved for future use.
- Embryo donation: A fully developed embryo from another person is donated to another person to transfer into their uterus.
- Gestational surrogacy:
- A procedure in which another woman receives an embryo transfer and carries another person's pregnancy.
If these childbirth methods are appropriate for your situation, your doctor will discuss them with you.
Your doctor may recommend surgery to correct an abnormality after a thorough history, physical examination, and ultrasound. The most common surgical procedures in reproductive medicine are laparoscopy, hysteroscopy, and abdominal myomectomy removal of uterine fibroids).
For couples, both partners must be involved in all aspects of management. It is crucial to discuss preferences, plans, beliefs, and motivations. Counseling should be available to all infertile couples to help them make the best choice after going through all possible options to become parents.
Infertility FAQs. https://www.cdc.gov/reproductivehealth/infertility/index.htm Infertility. https://www.womenshealth.gov/a-z-topics/infertility
Defining Infertility. https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/defining-infertility/
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