Find out about the challenges of infertility, when to seek help, causes, risk factors, and treatments including insemination and in vitro fertilization.
If you and your partner are struggling to have a baby, you're not alone. In the United States, 10% to 15% of couples are infertile. Infertility is defined as not being able to get pregnant despite having frequent, unprotected sex for at least a year for most couples.
Infertility may result from an issue with either you or your partner, or a combination of factors that prevent pregnancy. Fortunately, there are many safe and effective therapies that significantly improve your chances of getting pregnant.
The main symptom of infertility is not getting pregnant. There may be no other obvious symptoms. Sometimes, women with infertility may have irregular or absent menstrual periods. In some cases, men with infertility may have some signs of hormonal problems, such as changes in hair growth or sexual function.
Most couples will eventually conceive, with or without treatment.
You probably don't need to see your health care provider about infertility unless you have been trying regularly to get pregnant for at least one year. Women should talk with a care provider earlier, however, if they:
Men should talk to a health care provider if they have:
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.
These may include:
Causes of female infertility may include:
The ovaries, fallopian tubes, uterus, cervix and vagina (vaginal canal) make up the female reproductive system.
Many of the risk factors for both male and female infertility are the same. They include:
Some types of infertility aren't preventable. But several strategies may increase your chances of pregnancy.
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.
Although most types of infertility aren't preventable in men, these strategies may help:
For women, a number of strategies may increase the chances of becoming pregnant:
Before infertility testing, your doctor or clinic works to understand your sexual habits and may make recommendations to improve your chances of getting pregnant. In some infertile couples, no specific cause is found (unexplained infertility).
Infertility evaluation can be expensive, and sometimes involves uncomfortable procedures. Some medical plans may not cover the cost of fertility treatment. Finally, there's no guarantee — even after all the testing and counseling — that you'll get pregnant.
Male fertility requires that the testicles produce enough healthy sperm, and that the sperm is ejaculated effectively into the vagina and travels to the egg. Tests for male infertility attempt to determine whether any of these processes are impaired.
You may have a general physical exam, including examination of your genitals. Specific fertility tests may include:
Fertility for women relies on the ovaries releasing healthy eggs. The reproductive tract must allow an egg to pass into the fallopian tubes and join with sperm for fertilization. The fertilized egg must travel to the uterus and implant in the lining. Tests for female infertility try to find out if any of these processes are impaired.
You may have a general physical exam, including a regular gynecological exam. Specific fertility tests may include:
Depending on your situation, rarely your testing may include:
Not everyone needs to have all, or even many, of these tests before the cause of infertility is found. You and your doctor will decide which tests you will have and when.
During hysteroscopy, a thin, lighted instrument (hysteroscope) provides a view of the inside of the uterus.
Infertility treatment depends on:
Some causes of infertility can't be corrected.
In cases where spontaneous pregnancy doesn't happen, couples can often still achieve a pregnancy through use of assisted reproductive technology. Infertility treatment may involve significant financial, physical, psychological and time commitments.
Men's treatment for general sexual problems or lack of healthy sperm may include:
Some women need only one or two therapies to improve fertility. Other women may need several different types of treatment to achieve pregnancy.
Assisted reproductive technology (ART) is any fertility treatment in which the egg and sperm are handled. There are several types of ART.
In vitro fertilization (IVF) is the most common ART technique. IVF involves stimulating and retrieving multiple mature eggs, fertilizing them with sperm in a dish in a lab, and implanting the embryos in the uterus several days after fertilization.
Other techniques are sometimes used in an IVF cycle, such as:
Complications of infertility treatment may include:
During in vitro fertilization, eggs are removed from mature follicles within an ovary (A). An egg is fertilized by injecting a single sperm into the egg or mixing the egg with sperm in a petri dish (B). The fertilized egg (embryo) is transferred into the uterus (C).
Coping with infertility can be extremely difficult because there are so many unknowns. The journey can take an emotional toll on a couple. Taking these steps can help you cope:
Try these strategies to help manage emotional stress during treatment:
You'll face the possibility of psychological challenges no matter your results:
Seek professional help if the emotional impact of the outcome of your fertility treatments becomes too heavy for you or your partner.
Depending on your age and personal health history, your doctor may recommend a medical evaluation. A gynecologist, urologist or family doctor can help determine whether there's a problem that requires a specialist or clinic that treats infertility problems. In some cases, both you and your partner may require a comprehensive infertility evaluation.
To get ready for your first appointment:
For infertility, some basic questions to ask your doctor include:
Don't hesitate to ask your doctor to repeat information or to ask follow-up questions.
Be ready to answer questions to help your doctor quickly determine next steps in making a diagnosis and starting care.
Possible questions for couples include:
Your doctors may ask:
Your doctors may ask: