Most people plan to have children at some point in their lives, and many assume that when they are ready they will be able to conceive without trouble. However, that is not always the case. Infertility refers to the biological inability of a person to contribute to conception. There are many biological causes of infertility, some which may be bypassed with medical intervention.
Infertility is when a couple has not conceived after months of contraceptive-free intercourse if the female is under the age of 34. Infertility in a couple can be due to either the woman or the man, not necessarily both. Infertility is not a sexual disorder.
Approximately 10 to 15 percent of North American couples who want children are infertile. Worldwide it is estimated that one in seven couples have problems conceiving.
There are many options available to help women and men address infertility. Medications and surgery are the traditional approaches to correcting infertility. Modern technology has created a new group of fertility solutions called assisted reproductive technologies, or ART, in which a portion of the conception process may occur outside the body. The most common ART is in vitro fertilization (IVF) but a variety of others have been developed to address specific fertility problems.
These procedures include:
- In Vitro Fertilization
- Intra-Uterine Insemination
- Ovulation Induction
- Male Treatments
Infertility in Women
A woman’s age is probably the most significant factor related to her ability to conceive. While many women today are waiting until later in life to attempt pregnancy, the ovary’s ability to produce normal, healthy eggs declines with age, increasing the risk of chromosomal abnormalities and unsuccessful implantation.
The likelihood for successful pregnancy generally begins to decrease in women in their early 30s or possibly in their late 20s. While this decline is initially quite minimal, it begins to accelerate at about age 38 and fall even more rapidly at age 42 and beyond.
Many doctors recommend that women over 35 have a fertility evaluation after attempting pregnancy for six months. Couples under age 35 should consider evaluation if conception does not occur after trying for a year. A woman using donor insemination should ask her physician about an infertility evaluation after six months.
Other conditions that can interfere with a woman’s ability to conceive and carry a child to term include:
- Endometriosis or uterine fibroids, although many women with these conditions conceive healthy children without trouble.
- Polycystic ovarian syndrome (PCOS)
- Pituitary tumors
- Pelvic Inflammatory Disease (PID)
Infertility in Men
A couple’s failure to achieve conception is equally as likely to result from a problem with the man as with the woman.
Male infertility can be divided into problems with:
- Ejaculation and erection
- The fine, small reproductive tract ducts
- Sperm production
Problems with sperm production is by far the most common of the three and can be detected during semen analysis. There are many causes of abnormal sperm production, including:
- Varicocele (varicose veins)
- Genetic problems
- Exposures to heat or toxic chemicals
- Drugs and medications
- Hormonal imbalance
Over the last several decades, concern has risen about the impact of industrialization on reproductive health. This concern stems largely from reports showing that semen quality of men in Europe and North America has decreased over the latter half of the 20th century. The environmental toxins most often cited as potential contributors to infertility can be organized into physical, chemical, occupational and lifestyle factors.
- Physical factors include hyperthermia (increased temperature), radiation and electromagnetic fields
- Chemical causes include cigarette smoking, excessive alcohol consumption, marijuana and cocaine use as well as caffeine intake
- Occupational hazards include some pesticides, industrial toxins like dioxin and polychlorinated biphenyls (PCBs), and exposure to heavy metals
- Stress, nutrition and other lifestyle factors also can play a role
Any fertility treatment may be expected to have an effect on semen quality roughly three months after it is started, as this is the length of time required for a single cycle of spermatogenesis, or sperm production. If neither surgical nor medical therapy is appropriate, assisted reproductive technologies are possible.