Infertility Treatment

Overview

Infertility primarily refers to the biological inability of a person to contribute to conception. Infertility may also refer to the state of a woman who is unable to carry a pregnancy to full term.

A woman under 35 has not conceived after 12 months of contraceptive-free intercourse.

A woman over 35 has not conceived after 6 months of contraceptive-free sexual intercourse.

Sub fertility

A couple that has tried unsuccessfully to have a child after a certain period of time (often a short period, but definitions vary) is sometimes said to be sub fertile, meaning less fertile than a typical couple

Causes and Risk Factors

A wide range of physical and emotional factors can cause infertility. Infertility may be due to problems in the woman, man, or both

Female Infertility

Female infertility may occur when:
  • A fertilized egg or embryo does not survive once it sticks to the lining of the womb (uterus)
  • The fertilized egg does not attach to the lining of the uterus
  • The eggs cannot move from the ovaries to the womb
  • The ovaries have problems producing eggs
Female infertility may occur when:
  • Autoimmune disorders, such as antiphospholipid syndrome (APS)
  • Clotting disorders
  • Diabetes
  • Growths (such as fibroids or polyps) in the uterus and cervix
  • Excessive exercising
  • Eating disorders or poor nutrition
  • Use of certain medications, including chemotherapy drugs
  • Drinking too much alcohol, tobacco usage
  • Obesity
  • Older age
  • Ovarian cysts and polycystic ovary syndrome (PCOS)
  • Pelvic infection or pelvic inflammatory disease (PID)
  • Scarring from sexually transmitted infections or endometriosis
  • Thyroid disease
  • too little or too much hormones

Male infertility

Male infertility results from:
  • A decrease in sperm count
  • Sperm being blocked from being released
  • Sperm that do not work properly
Male infertility can be caused by:
  • Environmental pollutants
  • Being in high heat for prolonged periods
  • Birth defects
  • Heavy use of alcohol, marijuana, or cocaine
  • Too little or too much hormones
  • Impotence
  • Infection
  • Older age
  • Cancer treatments, including chemotherapy and
  • Scarring from sexually transmitted diseases, injury, or surgery
  • Retrograde ejaculation
  • Smoking
  • Use of certain drugs, such as cimetidine, spironolactone, and nitrofurantoin

In healthy couples under age 30 who have sex regularly, the chance of getting pregnant is about 25 - 30% per month. A woman's peak fertility occurs in her early 20s. After age 35 (and especially 40), the chances that a woman can get pregnant drops considerably.

Managing Infertility

When you should seek professional support for managing infertility depends on your age. It is recommended that women under 30 should generally try to get pregnant on their own for 1 year before exploring treatment options.

Infertility testing involves a complete medical history and physical examination of both partners. Blood and imaging tests are required. In women, this may include:

  • Blood tests to check hormone levels, including progesterone and follicle stimulating hormone
  • Checking body temperature first thing in the morning to check if the ovaries are releasing eggs
  • FSH and clomid challenge test
  • Hysterosalpingography (HSG)
  • Pelvic ultrasound
  • Laparoscopic and hysteroscoic evaluation
  • Luteinizing hormone urine test (ovulation prediction)
  • Thyroid function tests

Tests in men may include in addition to above,

  • Sperm testing
  • Testicular biopsy (rarely done

Infertility Treatment

It is important to recognize and discuss the emotional impact that infertility has on you and your partner, and to seek medical advice from your health care provider.

You can increase your chances of becoming pregnant each month by having sex at least every 3 days before and during ovulation. It is especially important to do so 72 hours before ovulation begins. Ovulation occurs about 2 weeks before the next menstrual cycle (period) starts. If a woman gets her period every 28 days, the couple should have sex at least every 3 days between the 10th and 18th day after the period starts.

Treatment depends on the cause of infertility

  • Education and counseling
  • Fertility treatments such as intrauterine insemination (IUI) and in vitro fertilization (IVF)
  • Medicines to treat infections and clotting disorders
  • Medicines that help the woman grow and release eggs from the ovaries)