Infertility means not being able to become pregnant, within certain parameters.

• Infertility is a common problem of about 10% of women aged 15 to 44.
• Infertility can be due to the woman (33%), the man (33%) and by both sexes or due to unknown problems (33%), approximately.
• Infertility in men can be due to varicocele, low or absent sperm count, sperm damage or certain diseases.
• Risk factors for men's infertility include alcohol and drug use, toxins, smoking, age, health problems, medicines, radiation, and chemotherapy.
• Risk factors for women's infertility include ovulation problems, blocked Fallopian tubes, uterine problems, uterine fibroids, age, stress, poor diet, athletic training, and those risk factors listed for men.
• Aging decreases a woman's fertility; after age 35 about 33% of couples have fertility problems; older women's eggs are reduced in number, not as healthy and less likely to be released by the ovary – the woman is also more likely to have a miscarriage and other health problems.
• Women under 35 should try for a year or 6 months if 35 or older to become pregnant before contacting their doctor if they have no health problems.
• Doctors use the histories of both partners and may run tests such as sperm studies, ovulation tests, ultrasound, hysterosalpingography, or laparoscopy.
• Infertility may be treated with medicine, surgery, artificial insemination, or assisted reproductive technology, based on the couples test results and other factors.
• There are multiple medicines that may be used to treat infertility in women.
• Intrauterine insemination is artificial insemination where a woman is injected with sperm into the uterus.
• ART (assisted reproductive technology) is when a woman's eggs are removed, mixed with sperm to make embryos that are placed back in the woman's body; it's successful about 11% to 39%, depending on the woman's age.
• There are several types of ART; in vitro fertilization, Zygote transfer, Gamete transfer and intracytoplasmic sperm injection.
• Surrogacy (the woman's male partner sperm is used to fertilize another woman egg and that other woman carries the fetus to term and the infant is then adopted ) is a way for some couples to obtain a baby.
• A gestational carrier is a woman who has an embryo placed in her uterus, carries the fetus to term and gives the baby to the couple (or responsible persons) that produced the embryo.

What is infertility?

Infertility means not being able to get pregnant after one year of trying. Or, six months, if a woman is 35 or older. Women who can get pregnant but are unable to stay pregnant may also be infertile.

Pregnancy is the result of a process that has many steps. To get pregnant:

• A woman must release an egg from one of her ovaries (ovulation).
• The egg must go through a Fallopian tube toward the uterus (womb).
• A man's sperm must join with (fertilize) the egg along the way.
• The fertilized egg must attach to the inside of the uterus (implantation).

Infertility can happen if there are problems with any of these steps.

Is infertility a common problem?

Yes. About 10 percent of women (6.1 million) in the United States ages 15-44 have difficulty getting pregnant or staying pregnant, according to the Centers for Disease Control and Prevention (CDC).

Is infertility just a woman's problem?

No, infertility is not always a woman's problem. Both women and men can have problems that cause infertility. About one-third of infertility cases are caused by women's problems. Another one third of fertility problems are due to the man. The other cases are caused by a mixture of male and female problems or by unknown problems.

The main symptom of Infertility is not getting pregnant. There may be no other obvious symptoms. Sometimes, an infertile woman may have irregular or absent menstrual periods. Rarely, an infertile man 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.

When to see a doctor

You probably don't need to see a doctor about Infertility unless you have been trying regularly to conceive for at least one year. Talk with your doctor earlier, however, if you're a woman and:

• You're age 35 to 40 and have been trying to conceive for six months or longer
• You're over age 40
• You menstruate irregularly or not at all
• Your periods are very painful
• You have known fertility problems
• You've been diagnosed with endometriosis or pelvic inflammatory disease
• You've had multiple miscarriages
• You've undergone treatment for cancer

Talk with your doctor if you're a man and:

• You have a low sperm count or other problems with sperm
• You have a history of testicular, prostate or sexual problems
• You've undergone treatment for cancer
• You have testicles that are small in size or swelling in the scrotum known as a varicocele
• You have others in your family with Infertility problems

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. In general:

• In about one-third of cases, there is an issue with the male.
• In about one-third of cases, there is an issue with the female.
• In the remaining cases, there are issues with both the male and female, or no cause can be identified.

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 — may also 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 excessive exercise, eating disorders, injury or tumors.
• Uterine or cervical abnormalities, including abnormalities with the opening of the cervix, polyps in the uterus or the shape of the uterus. Noncancerous (benign) tumors in the uterine wall (uterine fibroids) may rarely cause infertility by blocking the fallopian tubes. More often, fibroids interfere with implantation of the fertilized egg.
• 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, radiation or chemotherapy treatment, and smoking.
• Pelvic adhesions, bands of scar tissue that bind organs after pelvic infection, appendicitis, or abdominal or pelvic surgery.

Other causes in women include:

• Cancer and its treatment. Certain cancers — particularly female reproductive cancers — often severely impair female fertility. Both radiation and chemotherapy may affect fertility.
• Other conditions. Medical conditions associated with delayed puberty or the absence of menstruation (amenorrhea), such as celiac disease, poorly controlled diabetes and some autoimmune diseases such as lupus, can affect a woman's fertility. Genetic abnormalities also can make conception and pregnancy less likely.

Infertility treatment depends on:

• What's causing the infertility
• How long you've been infertile
• Your age and your partner's age
• Personal preferences

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.

Treatment for women

Some women need only one or two therapies to improve fertility. Other women may need several different types of treatment to achieve pregnancy.

• Stimulating ovulation with fertility drugs. Fertility drugs are the main treatment for women who are infertile due to ovulation disorders. These medications regulate or induce ovulation. Talk with your doctor about fertility drug options — including the benefits and risks of each type.
• Intrauterine insemination (IUI). During IUI, healthy sperm are placed directly in the uterus around the time the ovary releases one or more eggs to be fertilized. Depending on the reasons for infertility, the timing of IUI can be coordinated with your normal cycle or with fertility medications.
• Surgery to restore fertility. Uterine problems such as endometrial polyps, a uterine septum, intrauterine scar tissue and some fibroids can be treated with hysteroscopic surgery. Endometriosis, pelvic adhesions, and larger fibroids may require laparoscopic surgery or surgery with a larger incision of the abdomen.

Assisted Reproductive technology

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:

• Intracytoplasmic sperm injection (ICSI). A single healthy sperm is injected directly into a mature egg. ICSI is often used when there is poor semen quality or quantity, or if fertilization attempts during prior IVF cycles failed.
• Assisted hatching. This technique assists the implantation of the embryo into the lining of the uterus by opening the outer covering of the embryo (hatching).
• Donor eggs or sperm. Most ART is done using a couple's own eggs and sperm. However, if there are severe problems with either the eggs or the sperm, you may choose to use eggs, sperm or embryos from a known or anonymous donor.
• Gestational carrier. Women who don't have a functional uterus or for whom pregnancy poses a serious health risk might choose IVF using a gestational carrier. In this case, the couple's embryo is placed in the uterus of the carrier for pregnancy.

Complications of treatment

Complications of infertility treatment may include:

• • Multiple pregnancy. The most common complication of infertility treatment is a multiple pregnancy — twins, triplets or more. Generally, the greater the number of fetuses, the higher the risk of premature labor and delivery, as well as problems during pregnancy such as gestational diabetes. Babies born prematurely are at increased risk of health and developmental problems. Talk to your doctor about any concerns you have about a multiple pregnancy before starting treatment.
  • Ovarian hyperstimulation syndrome (OHSS). Fertility medications to induce ovulation can cause OHSS, particularly with ART, in which the ovaries become swollen and painful. Symptoms may include mild abdominal pain, bloating, and nausea that lasts about a week, or longer if you become pregnant. Rarely, a more severe form causes rapid weight gain and shortness of breath requiring emergency treatment.
  • Bleeding or infection. As with any invasive procedure, there is a rare risk of bleeding or infection with assisted reproductive technology or reproductive surgery.

Many of the risk factors for both male and female infertility are the same. They include:

• Age. A woman's fertility gradually declines with age, especially in her mid-30s, and it drops rapidly after age 37. Infertility in older women may be due to the number and quality of eggs, or to health problems that affect fertility. Men over age 40 may be less fertile than younger men are and may have higher rates of certain medical conditions in offspring, such as psychiatric disorders or certain cancers.
• Tobacco use. Smoking tobacco or marijuana by either partner reduces the likelihood of pregnancy. Smoking also reduces the possible benefit of fertility treatment. Miscarriages are more frequent in women who smoke. Smoking can increase the risk of erectile dysfunction and a low sperm count in men.
• Alcohol use. For women, there's no safe level of alcohol use during conception or pregnancy. Avoid alcohol if you're planning to become pregnant. Alcohol use increases the risk of birth defects, and may contribute to infertility. For men, heavy alcohol use can decrease sperm count and motility.
• Being overweight. Among American women, an inactive lifestyle and being overweight may increase the risk of infertility. A man's sperm count may also be affected if he is overweight.
• Being underweight. Women at risk of fertility problems include those with eating disorders, such as anorexia or bulimia, and women who follow a very low calorie or restrictive diet.
• Exercise issues. Insufficient exercise contributes to obesity, which increases the risk of infertility. Less often, ovulation problems may be associated with frequent strenuous, intense exercise in women who are not overweight.

Medications that regulate or stimulate ovulation are known as fertility drugs. Fertility drugs are the main treatment for women who suffer from infertility, due to ovulation disorders.

Fertility drugs generally work like natural hormones — follicle-stimulating hormone (FSH) and luteinizing hormone (LH) — to trigger ovulation. They're also used in women who ovulate to try to stimulate a better egg or an extra egg or eggs.

Fertility drugs include:

• Gonadotropins: These injected treatments stimulate the ovary to produce multiple eggs. Gonadotropin medications include human menopausal gonadotropin or hMG (Menopur) and FSH (Gonal-F, Follistim AQ, Bravelle).
• Clomiphene citrate: Taken by mouth, this drug stimulates ovulation by causing the pituitary gland to release more FSH and LH, which stimulate the growth of an ovarian follicle containing an egg. This is generally the first-line treatment for women younger than 39 who don't have PCOS.
• Metformin: This drug is used when insulin resistance is a known or suspected cause of infertility, usually in women with a diagnosis of PCOS. Metformin (Fortamet) helps improve insulin resistance, which can improve the likelihood of ovulation.
• Letrozole: Letrozole is usually used for women younger than 39 who have PCOS.
• Bromocriptine: Bromocriptine (Cycloset, Parlodel), a dopamine agonist, might be used when ovulation problems are caused by excess production of prolactin (hyperprolactinemia) by the pituitary gland.
• Surgical procedures like
• Laparoscopic or hysteroscopic surgery: Surgery might involve correcting problems with the uterine anatomy, removing endometrial polyps and some types of fibroids that misshape the uterine cavity, or removing pelvic or uterine adhesions.
• Tubal surgeries: If your fallopian tubes are blocked or filled with fluid, your doctor might recommend laparoscopic surgery to remove adhesions, dilate a tube or create a new tubal opening.

Symptoms
Not getting pregnant,Irregular or absent menstrual periods
Conditions
Not getting pregnant,Irregular or absent menstrual periods
Drugs
Hysteroscopy,Laparoscopy