What is Infertility? An Infertility Tutorial

What is Infertility?

Couple consulting with Physician

What is infertility and who can help you? Infertility is defined as an inability to conceive an intrauterine pregnancy after a year of sexual intercourse without contraception. It is a condition that affects nearly 15% of all people at some point in their lives. There are many causes of infertility, and most can be diagnosed and treated. If you and your partner are experiencing any difficulty in starting your family, the first step is simply to contact a physician who is knowledgeable about infertility. Some physicians have special expertise in this area because they have two or three years of fellowship training after completing four years of obstetrics and gynecology residency- these physicians are called Reproductive Endocrinologists (RE) or fertility physicians. People with infertility can usually be treated successfully by fertility specialists who have extensive training and experience in treating this specific problem. All too often a couple may lose precious time if treatment is left in the hands of less qualified physicians, whose technical training and experience may be limited. It is important to note that appropriate fertility treatment plans for individuals and couples with ethical or religious concerns can be developed in consultation with your physician. Contrary to the sensational coverage often portrayed in the media, today’s reproductive technology treatment plans are safe, usually highly effective, and sometimes surprisingly simple. For example, despite all the media attention, only 3% of infertile patients undergo the most sophisticated treatments of In Vitro Fertilization (IVF) or Gamete Intra Fallopian Transfer (GIFT). Most infertile patients can be helped with less involved treatment.

What can be done to identify the reasons for your infertility problem?

fecundity3Infertility can be caused by medical conditions in the female partner, male partner, or both. Help typically begins with a comprehensive history and physical examination, which is followed by diagnostic testing and the development of an appropriate treatment plan in consultation with your physician. The woman’s age is the most important factor in determining a couple’s probability for a successful pregnancy. As indicated by the charts on this page, fertility declines in women as age increases. For women over 35, it is very important to consult an infertility specialist – usually a reproductive endocrinologist – as soon as possible.

For women, tests often begin by measuring the fertility potential of the eggs- this can be assessed by a simple blood test. Egg quality is influenced by a woman’s age more than any other factor (see Figs.1&2). Egg quality is assessed by ovulation regularity and other factors related to the hormone system. Abnormal ovulation can be associated with pituitary problems, luteal phase defect, polycystic ovaries, thyroid disease, adrenal gland disease, high prolactin levels, dietary alterations, weight problems, exercise patterns, smoking, alcohol, stress and other factors. The receptivity of the endometrium for the embryo to implant is also evaluated by hormonal and other tests (Note: if you would like any of the medical terms on this page clarified, feel free to click on the Glossary link).

The pelvic organs are often evaluated with a Hysterosalpingogram (HSG) or possibly a Sonohysterogram. An HSG involves injection of a fluid into the uterus and fallopian tubes which is then photographed by X-rays to check tubal patency, the shape of the uterus, and possible lesions inside the uterus such as polyps, fibroids, and scar tissue. A sonohysterogram is an ultrasound performed with a small amount of fluid in the uterus. Sometimes a hysteroscopy or laparoscopy is performed as well. After these diagnostic steps are taken, you and your physician will decide upon the next step in the treatment process – which occasionally requires more detailed testing. For further information on treatment process, please visit our Treatments section.

For men, initial evaluation involves 2 semen analyses to quantify sperm count, sperm morphology (shape) and motility (percentage of sperm which move). HEPA (Hamster Egg Penetration Assays) tests – where hamster eggs and human sperm are combined in a petri dish – are occasionally performed to test the sperm’s ability to penetrate eggs. Results may vary for the same man from day to day, which is why two tests are usually performed to insure accuracy. Some of the more common lifestyle patterns that may contribute to poor sperm quality include (but are not limited to): excessive exposure to heat sources such as hot-tubs, a medical history of venereal disease, a medical history of prostate inflammation, and smoking or excessive alcohol or other drug use. Your reproductive endocrinologist usually performs the initial evaluation and treatment, and will refer you to a urologist or andrologist if further care is needed.

What can be done to treat your infertility problem?

The first step in treatment is to treat any problems which have been specifically diagnosed by the testing. Following treatment of specific problems, further management often involves controlled ovarian stimulation using fertility drugs combined with partner insemination. This helps insure that sperm and eggs meet at the appropriate time in the fallopian tubes of the woman on the day of ovulation. There are many additional treatment plans that can be undertaken if controlled ovarian stimulation and partner insemination does not result in pregnancy. Depending upon individual situations, such treatments may include gamete intra-fallopian tube transfer (GIFT), in-vitro fertilization (IVF), intra-cytoplasmic sperm injection (ICSI), zygote intra-fallopian tube transfer (ZIFT), Intra-Uterine Insemination (IUI), assisted hatching, laparoscopic or laparotomy treatment of pelvic factors, and others.