What is infertility?

Infertility is a condition that makes natural conception difficult. The diagnosis of infertility is usually given to couples who have been attempting to conceive for at least one year (or six months if the woman is 35 or older) without success. Women who can get pregnant, but are unable to stay pregnant, may also be infertile.

Conception and pregnancy are complicated processes that depend upon a number of factors, including:

  • Healthy sperm production by the man
  • Healthy egg production by the woman
  • A woman’s fallopian tubes must be open to allow sperm to reach the egg
  • Sperm must be able to fertilize the egg
  • The fertilized egg (the embryo) must be able to implant in the woman’s uterus
  • The quality of the embryo must be sufficient

Infertility may result if there is a problem with any of these steps.

What causes infertility?

Infertility may result from one or multiple causes. Some of the most common causes include:

  • Ovulation disorders, such as polycystic ovarian syndrome (PCOS)
  • Damaged or blocked fallopian tubes
  • Endometriosis
  • Uterine problems, such as fibroids
  • Age (the number of healthy eggs a woman has decreases with age)
  • Smoking (it can also reduce the number of eggs a woman has)
  • Problems with the quantity or quality of the man’s sperm

Is Infertility a common problem?

Yes. According to the Centers for Disease Control and Prevention (CDC), more than 7.3 million Americans, or 1 in 8 couples of childbearing age, have problems conceiving.

Is infertility strictly a woman’s problem? What increases a woman’s risk of infertility?

Infertility is not only a woman’s problem — many men have fertility problems, too. For women, smoking, increased age, pelvic infections, endometriosis, thyroid disease, stress and some cancer treatments can make conceiving more difficult.

How does age affect a woman’s ability to have children?

Many women are waiting until their thirties and forties to have children, which makes it more likely that they will have problems conceiving. A woman’s fertility decreases with age, especially after about 35 years of age. This decrease in fertility is largely due to reduced quality of the woman’s eggs.

What increases a man’s risk of infertility?

A man’s sperm can be affected by his overall health and lifestyle. Some things that may reduce the health or number of a man’s sperm include heavy alcohol consumption, drug use, smoking cigarettes, and exposure to environmental toxins, such as pesticides and lead.

How long should we try before seeking the care of a specialist?

According to the American Society for Reproductive Medicine, you should seek the care of a specialist if you are unable to achieve pregnancy after 12 months of unprotected intercourse if the woman is under the age of 35, or after six months if the woman is 35 years of age or older.

You should seek care sooner if:
• Your periods are irregular, absent or painful
• You have endometriosis or pelvic inflammatory disease (PID)
• You’ve had more than one miscarriage
• The inability to conceive is affecting any relationship

Men should speak with their doctor if they have a low sperm count or history of testicular, prostate or sexual problems.

What does the evaluation for infertility involve?

The process for women usually begins with a discussion of your medical history and any relevant lifestyle factors. For example, things you may be asked about include menstruation, pregnancy, surgical history, birth control usage, current sexual patterns, medications, other health problems, lifestyle factors and your work environment.

An ultrasound is usually then done to examine your uterus and ovaries. Other tests may be necessary and could include hormone testing and a more thorough evaluation of your reproductive organs through a hysterosalpingogram (HSG).

Your husband’s medical history will also be reviewed. The single most important test of male fertility is the semen analysis, which assesses sperm count, the ability of the sperm to swim (motility) and the total semen volume. If any significant abnormalities are discovered, a consultation with a urologist may be recommended. At A Bella Baby OBGYN, we will not ask the husband to masterbate, but will arrange for testing using the marital act.

What Types of medicines are used to treat infertility?

Most fertility treatments require the woman to take medication. Some common infertility medications for women include:

  • Clomiphene citrate (Clomid) causes ovulation by acting on the pituitary gland. It is often used in women who have polycystic ovarian syndrome (PCOS) or other problems with ovulation. It is taken by mouth.
  • Human menopausal gonadotropin or hMG (Repronex, Menopur) is often used for women who do not ovulate due to problems with their pituitary gland. It is an injected medicine that acts directly on the ovaries to stimulate ovulation.
  • Follicle-stimulating hormone or FSH (Gonal-F, Follistim) works much like hMG and stimulates the ovaries to begin the process of ovulation. It is usually an injected medication.
  • Metformin (Glucophage) is usually taken by mouth and is used for women who have insulin resistance and/or PCOS. This drug helps lower the elevated levels of male hormones in women with these conditions and helps the body to ovulate. Sometimes clomiphene citrate or follicle-stimulating hormone is used in combination with metformin.
  • Bromocriptine (Parlodel) is prescribed for women whose ovulation problems are due to high levels of prolactin, a hormone that causes milk production.

Drugs are not as important in the treatment of male infertility as they are in the treatment of female infertility. Medicines may however, occasionally be prescribed in certain situations, such as antibiotics to treat infections or inflammation.

Is surgery ever used to treat infertility?

Reproductive surgery is sometimes performed if there is a structural problem associated with a man or woman’s infertility. It is also recommended in many cases of otherwise unexplained infertility. The vast majority of surgical procedures used to address infertility in women can now be performed on an outpatient basis, using either a laparoscope inserted through a small incision in the navel or a hysteroscope inserted through the vagina.

For women, surgery can also be done to remove scar tissue from inside the uterus (known as Asherman’s syndrome), treat endometriosis, remove cysts from the ovaries, and remove fibroids or polyps. For men, surgery can be used to attempt to reverse a vasectomy, correct a blockage of the reproductive tract or a varicocele (an enlarged vein in the scrotum).

What are the best days of the month to conceive?

The number one most important factor affecting your chances of conceiving is when and how often you have intercourse within your “fertile window”, which is made up of the days in your menstrual cycle when there is the greatest possibility of pregnancy. The length of this fertile phase is determined by the lifespan of the sperm and egg. Sperm can survive a maximum of five days in fertile cervical fluid and an egg can survive for up to one day. Your theoretical fertile window is thus six days long, including the five days leading up to ovulation and the day of ovulation.

Note that the stress of having strictly scheduled intercourse can decrease fertility. It is recommended that when trying to conceive, you have intercourse on at least a couple different days each week, without worrying about the timing. This will help ensure you have intercourse during your fertile window and will potentially reduce the stress associated with trying to adhere to a strict schedule.

How often should we engage in marital activity?

It has sometimes been suggested that couples who are trying to conceive should reduce the frequency of sexual intercourse during the fertile window in order to increase sperm supply. This is not true for most couples, however. If a couple has known sperm problems, they should consult their doctor on the best strategies for intercourse, but couples who have no known sperm issues should not reduce the frequency of intercourse during the fertile window. Your odds of conception increase when you have intercourse multiple times within your fertile window. While it is true that sperm concentrations decrease slightly with more frequent intercourse, having intercourse more often is still more likely to result in conception for couples who do not have known male fertility problems. 

What are some other ways to improve fertility?

  • Control your weight. Excess body fat can lead to overproduction of certain hormones that disrupt ovulation, resulting in less regular menstrual cycles with less frequent ovulation, which lowers a woman’s chances of getting pregnant. On the flip side, having too little body fat may mean the body is not able to produce enough hormones for ovulation each month or to sustain a pregnancy if does conception occur.
  • Maintain a healthy diet. Staying well-nourished boosts your odds of conceiving. Make sure to take a prenatal vitamin every day. The folic acid in these vitamins is very important for reducing the risk of birth defects.
  • Do not smoke. Smoking cigarettes can impair both male and female fertility. Cigarette toxins damage a woman’s eggs and cause the ovaries to age. In men, smoking can reduce sperm production and damage DNA.
  • Track your cycle. Take advantage of your fertile window and aim to have intercourse during the six days when you are most fertile.
  • Limit alcohol and caffeine consumption. It is probably best to limit your caffeine intake to one or two regular-sized cups of coffee a day. Also, keep in mind that excessive alcohol consumption can negatively affect reproductive functioning.
  • Avoid excessive heat. Men should avoid exposing their testicles to excessive heat, such as in hot tubs or saunas, which can damage sperm. Note that recovery from heat damage can take up to 72 days.
  • Avoid exposure to certain chemicals. Pesticides, especially agricultural pesticides, may harm both male and female fertility. Exposure to some solvents and toxins, including those used in printing businesses and dry cleaning establishments, can adversely affect female fertility.

Can Acupuncture improve infertility?

Acupuncture can help you relax and overcome some of the stresses associated with infertility and undergoing infertility treatments. The use of acupuncture during fertility treatment carries minimal risks. Eastern healing is a local clinic that uses acupuncture and eastern medicine to assist in treatment.


What emotional challenges are associated with Infertility?

Infertility is a major life crisis for one in eight couples. It may affect self-esteem, body image, sexual identity, life goals and sexual relations. When faced with the possibility or diagnosis of infertility, you may experience a broad range of emotions that could include:

• Initial disbelief and denial, followed by anger and grief
• Loss of control
• Guilt and blame – finding out that one partner is infertile can place strain on a relationship
• Increased stress, particularly if treatment requires frequent testing and intercourse on a specific schedule
• Monthly cycles of hopeful anticipation followed by depression when menstruation begins
• Feelings of isolation – a desire to keep infertility problems a secret can often isolate a couple from important support systems that can be found in friends and family members

Social exchanges and situations may be painful when you see others with babies or are asked about your plans for having children. Having family members who are expecting children may contribute to your feelings of stress, as may your parents’ desires for grandchildren if they are expressed.

Infertility often creates one of the most distressing life crises that a couple has ever experienced together. The long-term inability to conceive a child can evoke significant feelings of loss. Coping with the multitude of medical decisions and the uncertainties that infertility brings can create great emotional upheaval for most couples. If you find yourself feeling anxious, depressed, out of control or isolated, you are not alone. Please let your team of health care providers know what you are struggling with so they can provide you with the right resources to help you cope. There are several professionals with experience in supporting couples with infertility challenges. Just ask for a referral.