A brief look at infertility causes and treatments
What is infertility?
Infertility is the inability to conceive or carry a child to delivery. The term is usually limited to situations where the couple has been unable to conceive for one year without using birth control. The term sterility is restricted to lack of sperm production or inability to ovulate. Approximately 40% of reported cases of infertility are due to problems in the male; another 40% to problems in the female; the remaining 20% are of unknown cause or due to problems in both the male and female.
Infertility can be caused by any interruption in the usual process of fertilization, pregnancy, and birth, which includes ejaculation of normal amounts of healthy sperm, the passage of the sperm through the cervix and into the fallopian tube of the female, the capture of the ovum (egg) by the fallopian tube at the time of ovulation, fertilization in the fallopian tube, the passage of a fertilized egg (embryo) down the fallopian tube, implantation of the fertilized egg in a receptive uterus, and the ability to carry the fetus to term.
In women, the most common problems are failure to ovulate and damage to the reproductive organs. In men, abnormal sperm function is the most common problem. In about 20% of couples, we find no abnormal tests (unexplained infertility).
The number of couples seeking treatment for infertility has increased as more of them have postponed childbearing to a later age. In women, fertility begins to decline in the mid-twenties and continues to decline, more and more sharply, until menopause. Pregnancy rates of women in their early 40’s are about 20-25% that of women in their 20’s and early 30’s. Male fertility declines gradually but the relationship between age and fertility is more difficult to define.
Evaluation and Treatment
Evaluation includes an examination of sperm, observation of basal body temperature or luteinizing hormone peaks in the female to determine whether ovulation is taking place, the ruling out of obstructions or abnormalities of the fallopian tubes or uterus, and blood tests that measure hormone levels. Treatment is geared to the specific problem.
The first step may be the treatment of underlying disease and, in men, avoidance of substances that might affect sperm quality. Fertility drugs, some of which increase the likelihood of multiple births, are often prescribed. If necessary, surgical correction of blocked tubes can be attempted.
A primary infertility treatment method is In Vitro Fertilization (IVF), in which several eggs are taken from the woman or an egg donor and fertilized outside the body by the father’s sperm or a sperm donor. The resulting embryo is then inserted into the mother’s uterus.
IVF is becoming a first-line therapy due to the consistently high success rates some treatment centers, such as ours, are able to achieve. Another method is Artificial Insemination, in which the man’s sperm or donor sperm from a sperm bank is inserted directly into the woman or a surrogate mother.