Infertility

  • Basics

    Infertility refers to the inability of a couple of child-bearing age to conceive a child after one year of regular sexual activity without contraceptive use.

    Infertility is very common, affecting about 6 million Americans.

    Infertility treatment is available, but it can be quite costly and physically and emotionally challenging. Only a handful of states have mandatory insurance coverage for infertility treatment; many couples facing the challenge of infertility are also facing the challenge of paying for treatment.

    Both men and women are about equally affected by infertility. The diagnosis and treatment of infertility in women is much more complex than for men, and this chapter will focus on infertility in women.

  • Causes

    The causes of infertility can be divided into primary and secondary infertility. Women who have primary infertility have never been able to conceive a child. Women with secondary infertility develop this condition after having delivered a child or children previously.

    Both primary and secondary infertility can be cause by ovulatory problems, structural pelvic problems, and unknown causes.

    About 30% of women with infertility have problems ovulating. They may have irregular periods in which they fail to release an egg every month. This may be caused by polycystic ovary syndrome or by premature ovarian failure. Polycystic ovary syndrome is a condition that tends to occur in overweight women who may also have facial hair. These women have hormonal imbalances that prevent regular ovulation. Premature ovarian failure, or early menopause, refers to the cessation of normal periods in a woman younger than age 40.

    About 20% of women with infertility have scarring or blockages in their fallopian tubes or uterus. Women who have a history of pelvic inflammatory disease or who have had a previous tubal pregnancy (ectopic pregnancy) may have subsequent scarring in their tubes. They may be releasing an egg each month, but the scarring prevents proper passage of the egg down the tube where it would normally be fertilized, hence preventing the chance of fertilization.

    Endometriosis affects about 5% to 10% of infertile women. In this condition, uterine tissue grows outside of the uterus. The extent of tissue growth and symptoms varies greatly from one individual to another, but the excess tissue can block eggs from properly traveling down tubes.

    Simply getting older is another common cause of infertility. An individual woman's ability to conceive starts to decrease after age 35, and by the time a woman is 40 years old, she has a much smaller likelihood of conceiving with her own eggs. This drop in fertitility is caused by older eggs and by the natural drop of estrogen that occurs as a woman starts to approach menopause.

    Despite doing regular tests, doctors sometimes cannot determine the cause of infertility. About 30% of couples have unexplained infertility, or fertility without a known cause. They can still receive treatment for infertility.

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