If you are thinking about trying to get pregnant, you should know that infertility is a common condition affecting approximately 10% – 15% of couples.
It’s worth remembering than one unusual aspect of this field of medicine is that it involves two patients who each need to be evaluated; in many cases, both also need to be treated. Some couples have difficulty in conceiving their first pregnancy (primary infertility), whereas other couples experience problems after conceiving pregnancies in the past (secondary infertility). In either case, stress and grief are common when couples have difficulty.
Infertility is commonly defined as the lack of pregnancy following 12 months of unprotected intercourse. Couples with no infertility problems have a monthly pregnancy rate of 20 – 25% following properly timed intercourse. As a result, it is not uncommon for couples to take several months to conceive a pregnancy.
Since approximately 90% of young couples will conceive a pregnancy within one year, if a pregnancy has not happened within a year, an evaluation for possible reasons is warranted. Sometimes the evaluation should begin even sooner than one year.
Conditions that warrant an infertility evaluation if a pregnancy has not been achieved within 6 months:
- Woman’s age greater than 35
- Very irregular menstrual cycles
- A woman with a past history of pelvic inflammatory disease, extensive pelvic surgery or known severe endometriosis (when tissue similar to the lining of the uterus is found outside the uterus)
Is Infertility Increasing?
We do not know for sure if the prevalence of infertility is increasing, but certainly the use of treatments for infertility is increasing, probably due to several societal trends. In most developed countries, there is a trend toward later age of marriage and first pregnancy in women, often for educational and career purposes. Because a female’s fertility declines with age, this naturally leads to an increasing time to conception and problems with infertility.
In addition, couples today are more aware of infertility treatment options, in part through media coverage of infertile couples and infertility treatments. This may also increase demand for the services.
Causes of Infertility
It’s worth remembering that for pregnancy to occur, the following must take place:
- Motile sperm must be deposited near the cervix.
- The sperm must be able to ascend through the cervix, uterus and fallopian tubes, arriving at the same time that a woman has ovulated (released an egg).
- Fertilization usually occurs near the end of the fallopian tube and the fertilized egg (embryo) is then transported over several days into the uterine cavity.
- The embryo must be able to implant into endometrium, the tissue that lines the uterus.
Infertility can result from a disruption in any of these normal events, including:
- Male-related problems with sperm production and/or sperm transport through the male reproductive tract and delivery into the female reproductive tract.
- On the female side, infertility may be caused by anovulation (a lack of ovulation), blocked fallopian tubes, or inability of an embryo to implant and establish a pregnancy in the uterus.
Infertility often results from combinations of several problems on both the male and female sides. Fortunately, there are an increasing number of strategies available to address the issue.