Infertility is defined as one year of unprotected sexual intercourse without conception. It affects approximately 10-15% of couples and is referred to as Primary Infertility. Couples with previous children may also suffer from infertility, known as Secondary Infertility, although their chance of conceiving is higher than couples with no prior pregnancies. Women in their late 30’s and early 40’s have a higher risk of infertility and a lower chance of success, although many ultimately conceive. With proper evaluation and treatment, approximately 50-70% on infertile couples will become pregnant, however, evaluation and therapy may extend for many months or even years before pregnancy is achieved.
There are many causes of infertility. In approximately 40% of couples the man has a low or abnormal sperm count. This problem will be detected by examining a fresh semen (sperm) sample called a Semen Analysis.
Twenty percent of infertile women will have irregular or Absent Ovulation and will usually complain of an irregular menstrual cycle. These women are not releasing an egg every month in a predictable fashion. There are a number of different reasons for failure of ovulation and additional blood tests may need to be performed.
Some women may ovulate, but produce an inadequate amount of progesterone after ovulation. This is called Luteal Phase Deficiency and can be diagnosed by an endometrial biopsy (sample taken from the uterus) performed shortly before the menstrual period.
Approximately 20-30% of infertile women will have blocked fallopian tubes (Tubal Disease). A special x-ray known as a Hysterosalpingogram (HSG) is performed to examine the uterus and tubes.
The inability of sperm to penetrate the cervical mucus may be the reason for infertility in 5-10 % of infertile couples, as shown by a postcoital test or special sperm antibody tests.
The last test to investigate the cause of infertility is an outpatient surgical procedure, a laparoscopy. The procedure will uncover endometriosis in about 40% of infertile women, as well as scar tissue around the ovaries and tubes. It is not uncommon for couples to have more than one problem diagnosed during an infertility evaluation. Each condition needs to be treated appropriately.
Infertility therapy may involve medications, surgery, inseminations, in vitro fertilization, or other therapies. Your doctor will discuss these with you in detail.