What is infertility?

Infertility is not being able to get pregnant after having regular sexual intercourse without birth control for at least 1 year (or 6 months if the woman is 35 or older).

Infertility can be caused by problems in a man’s or a woman’s reproductive system. Problems in the woman’s body are responsible for about half of the cases of infertility.

What is the cause?

A woman may be infertile because her ovaries are not releasing eggs. Or the ovaries may have trouble releasing healthy eggs. This is more likely to be a problem when a woman is over age 35. Other things that may affect the eggs and the release of eggs (ovulation) are:

• Hormone problems
• Being overweight or underweight
• Smoking
• Too much stress
• Unhealthy diet
• Ovarian tumors or cysts
• Intense exercise, such as long-distance running
• Abuse of alcohol or drugs
• Tumors in the pituitary gland
• Long-term illness, such as diabetes or thyroid disease
• Some medicines

An abnormal or damaged fallopian tube or uterus can be another cause of infertility. When an egg is released, it must pass through a fallopian tube to the uterus. A man’s sperm must join with (fertilize) the egg along the way. The fertilized egg must then attach to the inside of the uterus. A fallopian tube or the uterus may be damaged by:

• An infection, such as sexually transmitted diseases and infections (STDs and STIs)
• Growths in the uterus, such as polyps or fibroids
• Scar tissue from surgery
• Endometriosis, which is tissue from the lining of the uterus growing outside the uterus
• A birth defect in the female organs

Problems with your cervix (the lower part of the uterus) can make it hard for the sperm to reach and fertilize the egg. For example:

• Your cervix may be very narrow or closed.
• Your cervical mucus may not be normal.
• Your cervix may be infected.

A woman may have trouble getting pregnant because of a problem with her partner’s sperm. In rare cases, a woman’s body is allergic to sperm and destroys it.

Often the cause of infertility cannot be found.

How is it diagnosed?

At first, you and your partner will probably see your healthcare provider. Your provider may refer you to a specialist.

You and your partner will have thorough physical exams. You will be asked about:

• Your sexual history, including previous pregnancies
• Your medical and family history
• Medicines that you take
• Your use of drugs, alcohol, and tobacco
• Your diet and exercise habits, which may help your healthcare provider diagnose other problems that can lead to infertility, such as diabetes
• Stress
• Your sexual practices, such as how often you have sex, whether you use lubricants, and if you have any problems during sex

Tests may include:

• Blood tests
• Urine tests
• Test of fluid from the vagina or cervix
• Ultrasound scan, which uses sound waves to show pictures of the pelvic organs
• Tests of your partner’s semen
• Hysterosalpingogram, which uses X-rays and a dye put into your vagina to show the uterus and fallopian tubes
• Hysteroscopy, which uses a small lighted tube put into your vagina, through the cervix, and into the uterus to examine the inside of the uterus
• Laparoscopy, which uses a small lighted tube put into the belly through a small cut to look at the female organs

How is it treated?

Treatment for infertility depends on the cause. Treatment may include:

• Taking hormones for a hormone imbalance
• Taking medicine to make you release more eggs
• Taking an antibiotic for an infection
• Having surgery to remove a blockage of the fallopian tubes, ovarian cysts, scarring, or growths on or around your uterus

If your partner’s sperm count is low, artificial insemination may be an option. Semen is collected at several different times and stored until there are enough sperm. The semen is then put into your uterus or fallopian tubes during the most fertile time of your menstrual cycle.

If artificial insemination doesn’t work, you may want to consider using sperm donated by another man. Use only sperm banks that properly screen for sexually transmitted diseases and infections (STDs and STIs) and other illnesses in the donor and his family.

In vitro fertilization is a procedure that may be done if your partner’s sperm count is low or your fallopian tubes are blocked or damaged. For this procedure, eggs are removed from your body and fertilized with sperm in the lab. The fertilized eggs are then put back into your body.

Sometimes both partners need treatment. Looking for and treating causes of infertility can be stressful for a couple. It can put unusual strain on your relationship. Counseling may help.

How can I help prevent infertility?

To lower your risk of infertility:

• Prevent sexually transmitted diseases and infections (STDs and STIs) by using latex or polyurethane condoms. Also, have just 1 sexual partner who is not sexually active with anyone else.
• Don’t use lubricants during sex. It can make it harder for sperm to reach the egg.
• Limit the amount of alcohol you drink to no more than 1 to 2 drinks a week.
• Don’t overuse prescription and nonprescription drugs.
• Don’t smoke or use illegal drugs.
• Keep your genital area clean to prevent infections.
• Get prompt treatment if you have signs of an infection such as bleeding, discharge, swelling, sores, or itching in your genital or rectal area.
• Take any hormones, antibiotics, or other medicines as prescribed by your healthcare provider.