By Richard N. Waldman, MD
President, The American Congress of Obstetricians and Gynecologists
More than 7 million people in the United States – roughly 12 percent of the reproductive-age population – struggle with infertility, the inability to conceive after six months to a year of unprotected sex.
Infertility can make the journey to having a child a frustrating and confusing one. Fortunately, many people who are treated for fertility problems are able to conceive after therapy.
Infertility affects men and women nearly equally. About one-third of cases can be attributed to the male partner, one-third are related to the female partner, and the remainder are caused by a combination of problems with both partners or by unknown factors.
In women, increasing age, irregular ovulation (release of eggs from the ovaries), abnormal anatomy, or scarring or blockages in the fallopian tubes are the main causes of infertility. Gynecologic conditions, such as polycystic ovary syndrome, endometriosis, and fibroids, can also make it difficult for a woman to conceive. Lifestyle factors such as smoking, eating a poor diet, or being underweight, overweight, or obese may also make it harder to get pregnant.
Male fertility also declines with age, but at a slower rate. Infertility in men usually involves problems with the sperm. Sexually transmitted diseases (STDs) or an injury to the testicles, such as overheating (from spending too much time in a hot tub, for example) or a reaction to medication, can lead to short term fertility issues.
If you are having trouble getting pregnant, see your ob-gyn. Your doctor may order tests to understand what is causing the problem. You may also be referred to a doctor who specializes in infertility (reproductive endocrinologist) or other counselors and specialists.
Standard fertility testing for women includes a physical exam and a health history survey that focuses on menstrual function and a woman’s history of pregnancy, STDs, and birth control use. Blood and urine samples may be analyzed to confirm that normal ovulation is taking place. X-rays or ultrasounds may be used to view and inspect the reproductive organs for any abnormalities. To test for male fertility, a semen sample will be checked for the number, shape, and movement of the sperm and for signs of infection.
Infertility can be treated in a variety of ways depending on the cause. If you are overweight or obese, losing weight may improve your chances of getting pregnant. Medications that stimulate the ovaries or regulate blood insulin levels (which can interfere with ovulation) may be prescribed. Your doctor can also help you decide if surgery or assisted reproductive therapies, such as in vitro fertilization, are right for you.
For more information, the ACOG Patient Education Pamphlets “Evaluating Infertility” and “Treating Infertility” are available in English and Spanish at www.acog.org/publications/patient_education.