Diseases

Infertility can be treated with medicine, surgery, intra-uterine insemination, or assisted reproductive technology. Many times these treatments are combined. Doctors recommend specific treatments for infertility based on -

• The factors contributing to the infertility.
• The duration of the infertility.
• The age of the female.
• The couple's treatment preference after counseling about success rates, risks, and benefits of each treatment option.

Most experts suggest at least one year for women younger than age 35. However, women aged 35 years or older should see a health care provider after 6 months of trying unsuccessfully. A woman's chances of having a baby decrease rapidly every year after the age of 30.Some health problems also increase the risk of infertility. So, women should talk to a health care provider if they have-

• Irregular periods or no menstrual periods.
• Very painful periods.
• Endometriosis.
• Pelvic inflammatory disease.
• More than one miscarriage.

It is a good idea for any woman and her partner to talk to a health care provider before trying to get pregnant. They can help you get your body ready for a healthy baby, and can also answer questions on fertility and give tips on conceiving.

Doctors will begin by collecting a medical and sexual history from both partners. The initial evaluation usually includes a semen analysis, a tubal evaluation, and ovarian reserve testing.

Yes. About 6% of married women 15-44 years of age in the United States are unable to get pregnant after one year of unprotected sex (infertility).Also, about 12% of women 15-44 years of age in the United States have difficulty getting pregnant or carrying a pregnancy to term, regardless of marital status (impaired fecundity).

No, infertility is not always a woman's problem. Both men and women contribute to infertility.Many couples struggle with infertility and seek help to become pregnant; however, it is often thought of as only a women's condition. A CDC study analyzed data from the 2002 National Survey of Family Growth and found that 7.5% of all sexually experienced men younger than age 45 reported seeing a fertility doctor during their lifetime - this equals 3.3-4.7 million men. Of men who sought help, 18% were diagnosed with a male-related infertility problem, including sperm or semen problems (14%) and varicocele (6%).

Male infertility may be treated with medical, surgical, or assisted reproductive therapies depending on the underlying cause. Medical and surgical therapies are usually managed by an urologist who specializes in infertility. A reproductive endocrinologist may offer intrauterine inseminations (IUIs) or in vitro fertilization (IVF) to help overcome male factor infertility.

Common methods of ART include:

• In vitro fertilization (IVF), meaning fertilization outside of the body. IVF is the most effective and the most common form of ART.
• Zygote intrafallopian transfer (ZIFT) or tubal embryo transfer. This is similar to IVF. Fertilization occurs in the laboratory. Then the very young embryo is transferred to the fallopian tube instead of the uterus.
• Gamete intrafallopian transfer (GIFT), involves transferring eggs and sperm into the woman's fallopian tube. Fertilization occurs in the woman's body. Few practices offer GIFT as an option.
• Intracytoplasmic sperm injection (ICSI) is often used for couples with male factor infertility. Sometimes it is also used for older couples or for those with failed IVF attempts. In ICSI, a single sperm is injected into a mature egg as opposed to "conventional" fertilization where the egg and sperm are placed in a petri dish together and the sperm fertilizes an egg on its own.

ART procedures sometimes involve the use of donor eggs (eggs from another woman), donor sperm, or previously frozen embryos. Donor eggs are sometimes used for women who can not produce eggs. Also, donor eggs or donor sperm is sometimes used when the woman or man has a genetic disease that can be passed on to the baby. An infertile woman or couple may also use donor embryos. These are embryos that were either created by couples in infertility treatment or were created from donor sperm and donor eggs. The donated embryo is transferred to the uterus. The child will not be genetically related to either parent.

Infertility in men can be caused by different factors and is typically evaluated by a semen analysis. A specialist will evaluate the number of sperm (concentration), motility (movement), and morphology (shape). A slightly abnormal semen analysis does not mean that a man is necessarily infertile. Instead, a semen analysis helps determine if and how male factors are contributing to infertility. Conditions that can contribute to abnormal semen analyses include -

• Varicoceles, a condition in which the veins on a man's testicles are large and cause them to overheat. The heat may affect the number or shape of the sperm.
• Medical conditions or exposures such as diabetes, cystic fibrosis, trauma, infection, testicular failure, or treatment with chemotherapy or radiation.
• Unhealthy habits such as heavy alcohol use, testosterone supplementation, smoking, anabolic steroid use, and illicit drug use.
• Environmental toxins including exposure to pesticides and lead.

Women need functioning ovaries, fallopian tubes, and a uterus to get pregnant. Conditions affecting any one of these organs can contribute to female infertility. Some of these conditions are listed below and can be evaluated using a number of different tests.

Assisted Reproductive Technology (ART) includes all fertility treatments in which both eggs and sperm are handled outside of the body. In general, ART procedures involve surgically removing eggs from a woman's ovaries, combining them with sperm in the laboratory, and returning them to the woman's body or donating them to another woman. The main type of ART is in vitro fertilization (IVF).How often is assisted reproductive technology (ART) successful? Success rates vary and depend on many factors, including the clinic performing the procedure, the infertility diagnosis, and the age of the woman undergoing the procedure. This last factor - the woman's age - is especially important.CDC collects success rates on ART for some fertility clinics. According to the CDC's 2013 ART Success Rates, the average percentage of fresh, nondonor ART cycles that led to a live birth were -40% in women younger than 35 years of age.

• 32% in women aged 35–37 years.
• 21% in women aged 38–40 years.
• 11% in women aged 41–42 years.
• 5% in women aged 43–44 years.
• 2% in women aged 44 years and older.

Success rates also vary from clinic to clinic and with different infertility diagnoses.ART can be expensive and time-consuming, but it has allowed many couples to have children that otherwise would not have been conceived. The most common complication of ART is a multiple fetus pregnancy. This is a problem that can be prevented or minimized by limiting the number of embryos that are transferred back to the uterus. For example, transfer of a single embryo, rather than multiple embryos, greatly reduces the chances of a multiple fetus pregnancy and its risks such as preterm birth.

In general, infertility is defined as not being able to get pregnant (conceive) after one year of unprotected sex. Women who do not have regular menstrual cycles, or are older than 35 years and have not conceived during a 6-month period of trying, should consider making an appointment with a reproductive endocrinologist - an infertility specialist. These doctors may also be able to help women with recurrent pregnancy loss - 2 or more spontaneous miscarriages.Pregnancy is the result of a process that has many steps.To get pregnant -

• A woman's body must release an egg from one of her ovaries (ovulation).
• A man's sperm must join with the egg along the way (fertilize).
• The fertilized egg must go through a fallopian tube toward the uterus (womb).
• The fertilized egg must attach to the inside of the uterus (implantation).

Infertility may result from a problem with any or several of these steps.Impaired fecundity is a condition related to infertility and refers to women who have difficulty getting pregnant or carrying a pregnancy to term.

Intrauterine insemination (IUI) is an infertility treatment that is often called artificial insemination. In this procedure, specially prepared sperm are inserted into the woman's uterus. Sometimes the woman is also treated with medicines that stimulate ovulation before IUI.IUI is often used to treat-

• Mild male factor infertility.
• Couples with unexplained infertility.

Some common medicines used to treat infertility in women include -

• Clomiphene citrate (Clomid®*) is a medicine that causes ovulation by acting on the pituitary gland. It is often used in women who have polycystic ovarian syndrome (PCOS) or other problems with ovulation. This medicine is taken by mouth.
• Human menopausal gonadotropin or hMG (Repronex®*; Pergonal®*) are medicines often used for women who don't ovulate because of problems with their pituitary gland-hMG acts directly on the ovaries to stimulate ovulation. It is an injected medicine.
• Follicle-stimulating hormone or FSH (Gonal-F®*; Follistim®*) are medicines that work much like hMG. It causes the ovaries to begin the process of ovulation. These medicines are usually injected.
• Gonadotropin-releasing hormone (Gn-RH) analog are medicines often used for women who don't ovulate regularly each month. Women who ovulate before the egg is ready can also use these medicines. Gn-RH analogs act on the pituitary gland to change when the body ovulates. These medicines are usually injected or given with a nasal spray.
• Metformin (Glucophage®*) is a medicine doctors use for women who have insulin resistance and/or PCOS. This drug helps lower the high levels of male hormones in women with these conditions. This helps the body to ovulate. Sometimes clomiphene citrate or FSH is combined with metformin. This medicine is usually taken by mouth.
• Bromocriptine (Parlodel®*) is a medicine used for women with ovulation problems because of high levels of prolactin. Prolactin is a hormone that causes milk production.

*Note: Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services. Many fertility drugs increase a woman's chance of having twins, triplets, or other multiples. Women who are pregnant with multiple fetuses have more problems during pregnancy. Multiple fetuses have a high risk of being born prematurely (too early). Premature babies are at a higher risk of health and developmental problems.

Female fertility is known to decline with

• Age. Many women are waiting until their 30s and 40s to have children. In fact, about 20% of women in the United States now have their first child after age 35, and this leads to age becoming a growing cause of fertility problems. About one-third of couples in which the woman is older than 35 years have fertility problems. Aging not only decreases a woman's chances of having a baby but also increases her chances of miscarriage and of having a child with a genetic abnormality.
• Aging decreases a woman's chances of having a baby in the following ways
• Her ovaries become less able to release eggs.
  • She has a smaller number of eggs left.
  • Her eggs are not as healthy.
  • She is more likely to have health conditions that can cause fertility problems.
  • She is more likely to have a miscarriage.
• Smoking.
• Excessive alcohol use.
• Extreme weight gain or loss.
• Excessive physical or emotional stress that results in amenorrhea (absent periods).