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Infertility
Defined as not being able to get pregnant (conceive) after one year (or longer) of unprotected sex. Because fertility in women is known to decline steadily with age, some providers evaluate and treat women aged 35 years or older after 6 months of unprotected sex.
Women with infertility should consider making an appointment with a reproductive endocrinologist—a doctor who specializes in managing infertility. Reproductive endocrinologists may also be able to help women with recurrent pregnancy loss, defined as having two 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 ovariesexternal icon.
- A man’s sperm must join with the egg along the way (fertilize).
- The fertilized egg must go through a fallopianexternal icon toward the uterusexternal icon (womb).
- The embryo 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.
What Causes Infertility?
All of the steps during ovulation and fertilization need to happen correctly in order to get pregnant. Sometimes the issues that cause infertility in couples are present at birth, and sometimes they develop later in life.
Infertility causes can affect one or both partners. Sometimes, no cause can be found.
Causes of Male Fertility
These may include:
- Abnormal sperm production or function due to undescended testicles, genetic defects, health problems such as diabetes, or infections such as chlamydia, gonorrhea, mumps or HIV. Enlarged veins in the testes (varicocele) also can affect the quality of sperm.
- Problems with the delivery of sperm due to sexual problems, such as premature ejaculation; certain genetic diseases, such as cystic fibrosis; structural problems, such as a blockage in the testicle; or damage or injury to the reproductive organs.
- Overexposure to certain environmental factors, such as pesticides and other chemicals, and radiation. Cigarette smoking, alcohol, marijuana, anabolic steroids, and taking medications to treat bacterial infections, high blood pressure and depression also can affect fertility. Frequent exposure to heat, such as in saunas or hot tubs, can raise body temperature and may affect sperm production.
- Damage related to cancer and its treatment, including radiation or chemotherapy. Treatment for cancer can impair sperm production, sometimes severely.
Causes of Female Infertility
Causes of female infertility may include:
- Ovulation disorders, which affect the release of eggs from the ovaries. These include hormonal disorders such as polycystic ovary syndrome. Hyperprolactinemia, a condition in which you have too much prolactin — the hormone that stimulates breast milk production — also may interfere with ovulation. Either too much thyroid hormone (hyperthyroidism) or too little (hypothyroidism) can affect the menstrual cycle or cause infertility. Other underlying causes may include too much exercise, eating disorders or tumors.
- Uterine or cervical abnormalities, including abnormalities with the cervix, polyps in the uterus or the shape of the uterus. Noncancerous (benign) tumors in the uterine wall (uterine fibroids) may cause infertility by blocking the fallopian tubes or stopping a fertilized egg from implanting in the uterus.
- Fallopian tube damage or blockage, often caused by inflammation of the fallopian tube (salpingitis). This can result from pelvic inflammatory disease, which is usually caused by a sexually transmitted infection, endometriosis or adhesions.
- Endometriosis, which occurs when endometrial tissue grows outside of the uterus, may affect the function of the ovaries, uterus and fallopian tubes.
- Primary ovarian insufficiency (early menopause), when the ovaries stop working and menstruation ends before age 40. Although the cause is often unknown, certain factors are associated with early menopause, including immune system diseases, certain genetic conditions such as Turner syndrome or carriers of Fragile X syndrome, and radiation or chemotherapy treatment.
- Pelvic adhesions, bands of scar tissue that bind organs that can form after pelvic infection, appendicitis, endometriosis or abdominal or pelvic surgery.
- Cancer and its treatment. Certain cancers — particularly reproductive cancers — often impair female fertility. Both radiation and chemotherapy may affect fertility.
Can I Get Treatment for Infertility?
At VERITAS OBGYN, your dedicated practitioner runs one or more fertility screenings, such as ovulation testing, hormone testing, or a hysterosalpingography, to pinpoint the cause of your infertility.
What Medicines are Used to Treat Infertility in Women?
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 ovary syndrome (PCOS)external icon or other problems with ovulation. It is also used in women with normal ovulation to increase the number of mature eggs produced. This medicine is taken by mouth.
- Letrozole (Femara®*) is a medication that is frequently used off-label to cause ovulation. It works by temporarily lowering a woman’s progesterone level, which causes the brain to naturally make more follicle-stimulating hormone (FSH). It is often used to induce ovulation in woman with PCOS, and in women with normal ovulation to increase the number of mature eggs produced in the ovaries. It is taken by mouth.
- Human menopausal gonadotropin or hMG (Menopur®*; Repronex®*; Pergonal®*) is an injectable medication often used for women who don’t ovulate because of problems with their pituitary gland—hMG acts directly on the ovaries to stimulate development of mature eggs.
- Follicle-stimulating hormone or FSH (Gonal-F®*; Follistim®*) is an injectable medication that works much like hMG. It stimulates development of mature eggs within the ovaries.
- Gonadotropin-releasing hormone (GnRH) analogs and GnRH antagonists are medications that act on the pituitary gland to prevent a woman from ovulating. They are used during in vitro fertilization cycles, or to help prepare a woman’s uterus for an embryo transfer. These medications are usually injected or given with a nasal spray.
- Metformin (Glucophage®*) is a medicine doctors use for women who have insulin resistance or diabetes and PCOSexternal icon. 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 taken by mouth.
- Bromocriptine (Parlodel®*) and Cabergoline (Dostinex®*) son medicamentos utilizados para mujeres con problemas de ovulación debido a los altos niveles de prolactina. Estos medicamentos se toman por vía oral.
- Human menopausal gonadotropin or hMG (Menopur®*; Repronex®*; Pergonal®*) is an injectable medication often used for women who don’t ovulate because of problems with their pituitary gland—hMG acts directly on the ovaries to stimulate development of mature eggs.
- Follicle-stimulating hormone or FSH (Gonal-F®*; Follistim®*) is an injectable medication that works much like hMG. It stimulates development of mature eggs within the ovaries.
- Gonadotropin-releasing hormone (GnRH) analogs and GnRH antagonists are medications that act on the pituitary gland to prevent a woman from ovulating. They are used during in vitro fertilization cycles, or to help prepare a woman’s uterus for an embryo transfer. These medications are usually injected or given with a nasal spray.
- Metformin (Glucophage®*) is a medicine doctors use for women who have insulin resistance or diabetes and PCOSexternal icon. 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 taken by mouth.
- Bromocriptine (Parlodel®*) and Cabergoline (Dostinex®*) son medicamentos utilizados para mujeres con problemas de ovulación debido a los altos niveles de prolactina. Estos medicamentos se toman por vía oral.
What is Intrauterine insemination (IUI)?
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.
Assisted Reproductive Technology (ART)
Assisted Reproductive Technology (ART) includes all fertility treatments in which either eggs or embryos are handled outside of the body. In general, ART procedures involve removing mature eggs from a woman’s ovaries using a needle, combining the eggs with sperm in the laboratory, and returning the embryos to the woman’s body or donating them to another woman. The main type of ART is in vitro fertilization (IVF).
What are the different types of Assisted Reproductive Technology (ART)?
- In vitro fertilization (IVF), meaning fertilization outside of the body, is the most common form of ART. Eggs and sperm are combined in a laboratory to create embryos. After about three to five days, the embryo (or embryos) is transferred into the woman’s uterus. Embryos can also be frozen for a future transfer. When a frozen embryo is thawed and transferred into a woman’s uterus it is called a frozen embryo transfer (FET).
- Intracytoplasmic sperm injection (ICSI) is a type of IVF that is often used for couples with male factor infertility. With ICSI, a single sperm is injected into a mature egg. The alternative to ICSI is “conventional” fertilization where the egg and many sperm are placed in a petri dish together and the sperm fertilizes an egg on its own.
- Zygote intrafallopian transfer (ZIFT) or tubal embryo transfer and gamete intrafallopian transfer (GIFT) are other ART methods that are rarely used in the United States today. With ZIFT, fertilization occurs in the laboratory similar to IVF. Then the very young embryo is transferred to the fallopian tube instead of the uterus. GIFT involves transferring eggs and sperm into the woman’s fallopian tube and fertilization occurs in the woman’s body.
ART procedures sometimes involve the use of donor eggs (eggs from another woman), donor sperm, or donated embryos. Donor eggs are sometimes used for women who cannot produce eggs. Also, donor eggs or donor sperm are 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. Donor eggs, sperm, or embryos may also be used by same-sex couples.
Women with ovaries but no uterus may be able to use a gestational carrier. This may also be an option for women who shouldn’t become pregnant because of a serious health problem. In this case, a woman uses her own egg and it is fertilized by her partner’s sperm. Then, the embryo is placed inside the carrier’s uterus.
Prevention
Some types of infertility aren’t preventable. But several strategies may increase your chances of pregnancy.
Couples
Have regular intercourse several times around the time of ovulation for the highest pregnancy rate. Intercourse beginning at least five days before and until a day after ovulation improves your chances of getting pregnant. Ovulation usually occurs in the middle of the cycle — halfway between menstrual periods — for most women with menstrual cycles about 28 days apart.
Men
Although most types of infertility aren’t preventable in men, these strategies may help:
- Avoid drug and tobacco use and drinking too much alcohol, which may contribute to male infertility.
- Avoid high temperatures found in hot tubs and hot baths, as they can temporarily affect sperm production and motility.
- Avoid exposure to industrial or environmental toxins, which can affect sperm production.
- Limit medications that may impact fertility, both prescription and nonprescription drugs. Talk with your doctor about any medications you take regularly, but don’t stop taking prescription medications without medical advice.
- Exercise moderately. Regular exercise may improve sperm quality and increase the chances for achieving a pregnancy.
Women
For women, a number of strategies may increase the chances of becoming pregnant:
- Quit smoking. Tobacco has many negative effects on fertility, not to mention your general health and the health of a fetus. If you smoke and are considering pregnancy, quit now.
- Avoid alcohol and street drugs. These substances may impair your ability to conceive and have a healthy pregnancy. Don’t drink alcohol or use recreational drugs, such as marijuana, if you’re trying to get pregnant.
- Limit caffeine. Women trying to get pregnant may want to limit caffeine intake. Ask your doctor for guidance on the safe use of caffeine.
- Exercise moderately. Regular exercise is important, but exercising so intensely that your periods are infrequent or absent can affect fertility.
- Avoid weight extremes. Being overweight or underweight can affect your hormone production and cause infertility.
Nuestras especialistas
Pankak Singhal, MD, MS, MHCM, FACOG
Dr. Singhal is the Chairman of the Department of Obstetrics & Gynecology at Good Samaritan, as well as the System Chairman for Obstetrics, Gynecology and Women’s Health for Catholic Health Services. He earned his medical degree from Madras Medical College in India, as well as a master in health care management from Harvard University. He is an SRC-accredited Surgeon of Excellence with Good Samaritan’s Center of Excellence designations in Robotic Surgery and Minimally Invasive Gynecology.
Virginia Elizabeth Mclean, MD, FACOG
La Dra. Virginia McLean, MD es especialista en obstetricia y ginecología en Nueva York, NY. Su oficina acepta citas de telesalud.
La Dra. Mclean se graduó de la Facultad de Medicina de la Universidad Médica de Carolina del Sur en 2014. Trabaja en Port Jefferson Station, NY y en otras 8 ubicaciones y se especializa en Obstetricia y Ginecología.
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