What is infertility and who does it effect?
More than 7.3 million American couples, 1 in 8, experience infertility. Infertility is not uncommon and you are not alone. Did you know that infertility is one of the most common diseases for people between the ages of 20 and 45?
What exactly is infertility? Infertility is a disease of the reproductive system that inhibits a couple’s ability to have a baby. It is defined as not being able to achieve a pregnancy after 6 months of unprotected intercourse. This includes the time when you are not “trying” to get pregnant but are not using any form of birth control to prevent a pregnancy. Based on the study of National Survey of Family Growth, 7% of married women aged 15-24, 9% of married women aged 25-29 and 30-34, 25% of women 35-39, and 30% of women 40-44 all suffer from infertility. Typically, in a young healthy fertile couple, 80% will conceive during the first year while attempting to achieve pregnancy.
Interestingly enough, both men and women contribute to infertility equally without discrimination. Approximately 35% of fertility problems are due to female factors and 35% of fertility problems are due to male factors. Approximately 20% is a combination of both male and female factors affecting fertility. In about 10% of cases, the problem is “unexplained” meaning all testing yielded normal results. For this reason both partners should actively participate in the diagnosis and treatment process. There are many different contributing factors to fertility.
Fertility in Women
Female fertility can be affected by all of the following including age, polycystic ovary syndrome (PCOS), endometriosis, irregular ovulation, uterine abnormalities, sexually transmitted infections (STIs), thyroid disease, reproductive organ surgery, smoking, premature menopause and cancer treatment.
Fertility in Men
On the male side, age, abnormal or low sperm production, testicular surgery or injury, exposure to chemicals/recreational drugs, exposure to significant amounts of heat, sexually transmitted infections, hypothalamic/pituitary dysfunction, congenital disorders, structural abnormalities, hormonal and receptor abnormalities, and testicular cancer can all affect male fertility.
So what’s the big deal?
Women are born with a fixed number of eggs that decline with age. A woman’s fertility peaks in her mid-twenties and begins to decline around 27 and drops significantly after the age of 35. A woman’s fertility is measured by her ability to achieve a pregnancy on a given month. At the age of 30 a healthy woman has about a 20% chance per month of conceiving and by the time a woman reaches 40 her chances drop to 5% per month. For women, the ability to conceive is tied to the quality of her eggs. As women age, hormonal changes begin to take place which decrease egg quality. Decreased egg quality means it becomes more difficult for the sperm to fertilize the egg naturally.
How does it work?
When it comes to fertility there are multiple steps in the process that need to work perfectly for a pregnancy to occur. First of all, a sperm and an egg must meet – meaning that during a natural conception the sperm must be able to swim through the cervical mucus, into the uterus and into the fallopian tubes. At the SAME time the egg must be released, picked up by the fallopian tubes and then allowed to travel through the fallopian tube. Then, when they meet, the sperm must be able to penetrate the egg in order to fertilize it, creating an embryo. Then implantation must occur where the embryo attaches to the uterine wall. After implantation, maintaining the pregnancy is also very important. With the intricate process the body goes through to become pregnant there are many steps that must occur in the right order to achieve a pregnancy, as well as maintain it through the duration of the pregnancy. That being said, problems with any one or more of these steps can be a contributing factor to one’s fertility outcomes.
When it comes to diagnostic testing for infertility, both men and women should be tested for possible influences. By beginning with labs and performing a 3D saline sonogram for her, and getting a semen analysis for him, your doctor will be able to determine the best treatment plan for you and your partner’s future family planning.
Treatment for infertility
Based on your specific situation, your doctor will explain to you what options will provide the best opportunity for pregnancy for you and your partner. Fertility treatments include interventions aimed at correcting the identified cause for infertility, as well as treatments to enhance fertility in couples with unexplained infertility. Fertility medications can improve the timing and quality of ovulation as well as correct hormonal deficiencies. In some instances women may need minimally invasive surgeries such a as laparoscopy to remove scar tissue, endometriosis, or to open a blocked fallopian tube. Some may also need a hysteroscopy to remove uterine septum or endometrial polys.
The treatment options available for infertility treatment include but are not limited to, monitored time intercourse, intrauterine insemination (IUI) and in vitro fertilization (IVF). Unfamiliar with these treatment options? Download an information sheet comparing the 2 treatments here: IUI vs. IVF IUI’s seek to improve the probability of more sperm reaching the egg by washing and concentrating the sperm and placing the sperm past the cervical mucus directly into the uterus. In combination with fertility medications (both oral and injectable) and ultrasound monitoring IUI’s can greatly increase the chances of egg and sperm interacting. Almost 60% of couples are able to conceive with this type of therapy and for the majority of couples it is very successful. Of the 40% of couples who are unable to conceive pregnancy with the above treatment or in whom this treatment would not be appropriate, the vast majority are able to build a family with the help of IVF. IVF involves the use of injectable fertility medications to increase the number of eggs produced, removing the eggs directly from the ovaries and uniting the eggs and the sperm together. Fertilization and cell division are confirmed before the embryos are replaced directly into the uterus. Follow up testing then ensures that pregnancy has occurred.
Who should seek treatment?
If you are a women who has been unsuccessful in trying to conceive for over 6 months, we recommend seeking medical advice to help you with your fertility needs and future family planning. Additionally, males who have a known or suspected low sperm count, woman who have had a tubal ligation or blocked/surgically removed tubes, recurrent miscarriages, or a history of pelvic inflammatory disease, painful periods, or irregular periods should seek treatment sooner.