From Encyclopedia of Sex and Sexuality
An inability to achieve conception after a year of unprotected intercourse, or an inability to carry a pregnancy through its full term to a live birth. Of the estimated 28 million couples of reproductive age, at least 15 percent will experience some aspect of infertility. About 4 million couples wanting children will experience the emotional frustration of having their child-bearing plans go awry.
The cause or causes of infertility may be difficult to diagnose, since they can be due to a number of factors with either or both partners. Female problems are the cause of infertility in 30 to 40 percent of cases; another 30 to 40 percent are due to male problems; approximately 25 percent are due to a combination of male and female problems, and approximately 5 percent are unexplained.
A diagnosis of infertility once was considered to be final and treatment was not even offered. Today there are many treatments and, while not all causes of infertility can be resolved, some causes have up to a 50 percent treatment success rate. A couple experiencing difficulty in conceiving should seek a physician who specializes in infertility. These doctors are more often aware of the problems that couples with infertility face and are also expert in specific treatments for various types of difficulties. For their part the couple must be prepared to talk freely about their questions and feelings and must realize that infertility is a problem they are experiencing together and not the fault of one or the other.
The most common causes of female infertility are endometriosis, blocked fallopian tubes, lack of ovulation, poor hormonal support of ovulation, and polycystic ovarian disease. Less common causes are uterine or fallopian tube abnormalities. Endometriosis, which is the growth of the uterine lining outside of the uterus, is the single most common cause of female infertility. Endometriosis also can be quite painful. Ovulation disorders, such as anovulation, polycystic ovarian disease, or insufficient luteal phase can be detected with hormone tests, as hormone levels will indicate whether ovulation occurs and if it is well supported. In many cases, if the hormones produced by the ovary are not adequate for successful reproduction, they can be supplemented. Women with menstrual irregularities and anovulation can be given hormones that will simulate the natural process and cause or support ovulation. Surgery may be necessary to remove endometriosis or to clear blocked fallopian tubes before other treatments can be tried.
The most common causes of male infertility are low sperm count, poor sperm motility, abnormal physical structure, low volume of seminal fluid, or sperm that do not function well. Less common causes are azoospermia (lack of any sperm), absence of the vas deferens, a lack of hormonal stimulation, or an inability to respond to hormonal stimulation. While the presence of any sperm at all indicates a potential for fertility, it is hard to determine the ability of sperm to perform the functions needed for fertilization. The sperm’s ability to fertilize the egg, and the embryo’s ability to implant in the uterus and continue growth are the ultimate tests of fertility. Hormonal treatment for male infertility has had only limited success. The most common treatment is to prepare the sperm for artificial insemination directly into the woman’s uterus. This procedure gets sperm closer to the site of fertilization and also provides supplemental fluid for their support.
For fertilization to occur sperm must be able to traverse the female reproductive tract and penetrate the oocyte (egg). In addition, the female reproductive tract should be able to assist sperm transport and an oocyte must be in the proper part of the fallopian tube, ready to be fertilized. After fertilization has occurred, the fertilized egg, or zygote, is transported to the uterus, where the uterine lining should be ready for implantation. The hormonal controls are extremely important, since hormones determine the readiness of the oocyte and uterus, as well as preparing sperm for transport. The failure of any part of this complex process can cause infertility.
In vitro fertilization (IVF) and gamete intra-fallopian tube transfer (GIFT) are new and difficult techniques that are used when other treatments have failed. The egg can be removed from the ovary, incubated with the sperm out of the body, and then the fertilized egg can be placed back into the mother’s uterus or into the uterus of a woman who is not the genetic mother but who is willing to carry the embryo and fetus until natural birth occurs. A woman with blocked tubes or a man with a low sperm count are good candidates for IVF or GIFT. Ultrasound and microsurgical tools and techniques have made these treatments less invasive.
Dealing with infertility can be most difficult time for a couple. It is often a time of crisis and breakdown of communication. Diagnosis may require precise timing of intercourse and treatment may call for the male partner to collect a semen sample in the doctor’s office. Infertility can create an atmosphere of tension and stress in a relationship that can disrupt an everyday life-style. Normal sexual relations often become frustrated due to lack of spontaneity or to the timing necessary for the meeting of the sperm and egg. Couples often find this difficult to talk about with their doctor, which can add to the frustration and anxiety. Support groups are available and most infertility doctors are open to discussing problems. Taking time to choose the best doctor and to deal with aspects of the problems of infertility can ease many of these tensions.