incidence of infertility has continued to rise over
the last ten years and it is estimated that it affects
at least 11% of couples of reproductive age. This number
represents over 10 million couples in the United States!
About 2 million couples seek infertility treatments
American Society of Reproductive Medicine defines infertility
as the inability to conceive after one year of unprotected
intercourse in women under the age of 35. In women over
35, the time frame is shortened to six months.
incidence of infertility increases as the female ages
reflecting the normal decline in egg quality experienced
with age. Infertility in men is not age dependent (until
after 55 year of age) thus, a child can be fathered
until very late in life. On average, a normal fertile
couple has a 20% - 25% chance of conceiving during any
cycle (month) where regular intercourse occurs.
women are choosing to have children later in life, after
they have established their careers and achieved financial
security. Unfortunately, the biological time clock does
not match these socioeconomic choices as peak fertility
usually occurs between the ages of eighteen and twenty-five.
Women over the age of thirty five have a much higher
incidence of infertility and are more likely to miscarry
or have a child with a chromosomal abnormality. Women
over forty are unlikely (10-15% chance ) to become pregnant
even using assisted reproductive technology such as
IVF, unless they use donor eggs from a younger woman
(which gives them perhaps as high as 65-70% chance of
the last several years, specialists have become much
more aware of the role of male infertility. It is estimated
that there is a male component is up to 49% of infertility
cases. Rarely, should any treatment of the female begin
until the male evaluation is complete. Male fertility
is evidenced by a low sperm count and/or abnormalities
in one or more of many other measured parameters( motility,
sperm shape, viability). The male partner must receive
a thorough semen analysis at the beginning of the infertility
evaluation before treatment of the female begins.
is a complex condition with numerous potential causes.
Reproductive Endocrinologists are Infertility Specialists
who undergo years of advance training, enabling them
to diagnose and treat infertility. There is no short
cut or "magic treatment". Each couple is different
and thorough evaluation of the male and female are always
brief description of the common causes of infertility
links to a complete discussion:
One cause of infertility is failed ovulation, which
is termed anovulation (lack of ovulation) or oligoovulation
(irregular ovulation). Ovulatory disorders can be caused
by many conditions including PCOS, excessive exercise,
a small tumor benign tumor on the pituitary gland, ovarian
failure due to age, genetics, premature menopause (age
less than 40), radiation or chemotherapy.
is controlled by a complex interaction of several hormones
including follicle stimulating hormone, leutinizing
hormone, and estrogen. The hypothalamus, a small gland
at the base of the brain, is responsible for monitoring,
or regulating, the levels of these hormones. The action
and interaction of these hormones is discussed in detail
in the section on ovulatory failure.
such as Clomid or gonadotropins-FSH or HMG (Gonal-F,
Follistim, Menopur, Repronex, Bravelle) are often used
to regulate or cause ovulation. Clomid acts at the level
of the hypothalamus while FSH and HMG act directly upon
egg must travel to the end of the fallopian tube where
fertilization occurs. If the tube is blocked or damaged,
the eggs movement is impeded. Endometriosis can attach
to, and penetrate, the tubes causing damage and blockage.
tubes can be scarred by previous surgery (tubal ligation,
ectopic pregnancy, ruptured appendix), damaged by pelvic
inflammatory disease, gonorrhea or chlamydia infections,
or the tubes may be deformed or missing at birth (rare).
In many cases, women who previously had their tubes
"tied", as a means of birth control, seek
to have the procedure reversed.
is a common cause of infertility and can affect reproductive
organs including the tubes, uterus, and ovaries. Endometrial
tissue (cells of the uterine lining) can attach to virtually
any internal organ where it grows causing damage and
inflammation. If some cases, the endometrial tissue
can penetrate the organ it is attached to. Therapy consists
of medications which lower the level of estrogen and/or
fertilization occurs, the embryo travels to the uterus
where it implants in the endometrium (lining of the
uterus). The endometrium must be thick and vascular
to provide an optimal environment for the developing
embryo. Estrogen and progesterone stimulate endometrial
development and must be present in the correct amounts
at the right time in the cycle. The uterine cavity must
also be free of fibroids or polyps which could interfere
with embryo implantation. Medications can be used to
stimulate endometrial development. hysteroscopic surgery
(going inside the uterine cavity with telescope, without
any external incisions) is usually effective in removing
polyps and fibroids.
ejaculated the sperm must "swim" from the
vagina through the cervix to the end of the fallopian
tubes. There must be sufficient "high quality"
mucus to provide support for the sperm. The cervical
fluid must also be free of antibodies produced by the
female that can destroy the sperm. IUI is usually the
treatment of first choice for cervical factor infertility.
ovarian syndrome is a common cause of infertility in
women. PCOS is characterized by ovaries with many small
cysts, being overweight, excess body hair, and a "pear
shaped" body appearance. Women with PCOS have abnormally
high levels of male hormones "androgens".
PCOS is treated with Clomid or FSH stimulation and sometimes
with surgery (ovarian drilling).
no exact cause for a couple's infertility can be identified
and this is termed "unexplained infertility".
There is a cause(s) but science has not advanced to
the point where it can be identified. These couples
may receive up to three cycles of IUI and if this is
not successful IVF is usually indicated.
Male Factor- The
importance of male factor cannot be overemphasized since
almost 50% of couples have some degree of male infertility.
The semen analysis is the cornerstone test to measure
the quantity and quality of sperm.
sure and read the detailed descriptions of each of the