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Infertility

What is infertility?

Infertility is a condition that affects many couples. Some may know the reason for their infertility, but many do not. A couple is considered infertile after trying to become pregnant for one year without success.

What are they types of infertility?

Primary infertility is when a couple has never been able to conceive a pregnancy, after a minimum of one year of attempting to do so through unprotected intercourse.

Secondary infertility is when couples who have previously been pregnant at least once, have not been able to achieve another pregnancy.

What are the causes of infertility?

Causes of infertility include a wide range of physical, as well as emotional factors. Approximately 30-40% of all infertility is due to a "male" factor. A "female" factor is responsible for 40-50% of infertility in couples. The remaining 10-30% may be caused by contributing factors by both partners, or no cause can be adequately identified. 10-20% of couples will be unable to conceive after one year of attempting to become pregnant. It is important that pregnancy be attempted for an extended period (at least one year); the chance for pregnancy occurring in young healthy couples, having intercourse regularly, is only 25-30% per month.

A probable cause can be determined for about 85-90% of infertile couples. Appropriate therapy (not including advanced techniques such as in-vitro fertilization) allows pregnancy to occur in 50-60% of previously infertile couples. Without any treatment intervention 15-20% of couples previously diagnosed as infertile will eventually become pregnant.

What tests can be done to determine the cause of infertility?

Semen analysis evaluating ejaculate is helpful in determining if ther eis a problem in sperm production as a cause of infertility. A semen sample is collected after 2-3 days of complete abstinence from sex to determine the volume; number and structure (shape) of the sperm; sperm movement (motility and swimming speed); the fluid thickness; acidity; and sugar content. The normal volume of semen varies from 1.5-5.0 millileter per ejaculation. The sperm count varies from 20-150 million sperm per milliliter. AT least 60% of the sperm should have a normal shape and show normal forward movement (motility).

Measuring basal body temperature- taking the woman's temperature each morning before arising in an effort to note the 0.4-1.0 degree Fahrenheit temperature increase assocuated with presumptive ovulation.

Monitoring cervical mucus changes throughout the menstrual cycle to note the wet, stretchy and slippery mucus associated with the ovulatory phase.

Postcoital test (PCT)- to evaluate sperm-cervical mucus interaction through analysis of cervical mucus collected 2-8 hours after intercourse.

Measuring serum progesterone (blood test)

Hysterosalpingography (HSG)- x-ray procedure done with contrast dye that enables evaulation of potential transport from the cervix through the uterus and fallopian tubes.

Why are hysterosalpingograms done?

Hysterosalpingography is helpful in finding uterine tumors, intrauterine adhesions, developmental disorders, obstruction of the fallopian tubes, traumatic injury, tubal adhesions, or the presence of foreign bodies.

How is a hysterosalpingogram done?

The woman is asked to lie on a table in the radiology department and pull her knees to her chest. A speculum is then inserted into the vagina, and the cervix is cleaned. A fluoroscope is insterted through the cervix and dye is injected, filling the uterus and fallopian tubes. The dye makes the genital organs more visible under x-ray, which is then performed and any abnormalities noted.

Laparoscopy to allow direct visualization.

Pelvic exam to determine if there are cysts or damage to the endometrium.

What are the treatments for infertility?

Treatment can range from simple education and counseling to the use of medications that treat infections or promote ovulation, to highly sophisticated medical procedures such as in-vitro fertilization.

What are the side effects of infertility?

The psychological impact of infertility upon individuals or couples affected by it may be severe.

For more information on infertility, please check out these sites:

Resolve- A site for a support group for infertile couples

Inferendo- A site for a support group for those suffering from both infertility and endometriosis