Infertility means that couples have been trying to get pregnant with frequent intercourse for at least a year with no success. Female infertility, male infertility or a combination of the two affects millions of couples. An estimated 10 to 15 percent of couples have trouble getting pregnant or getting to a successful delivery.
Infertility results from female infertility factors about one-third of the time and male infertility factors about one-third of the time. In the rest, the cause is either unknown or a combination of male and female factors. The cause of female infertility can be difficult to diagnose, but many treatments are available. Treatment options depend on the underlying problem. Treatment isn't always necessary many infertile couples will go on to conceive a child spontaneously.
The main symptom of infertility is the inability of a couple to get pregnant. A menstrual cycle that's too long (35 days or more), too short (less than 21 days), irregular or absent can be a sign of lack of ovulation, which can be associated with female infertility. There may be no other outward signs or symptoms.
When to see a doctor?
When to seek help depends, in part, on your age.
►If you're in your early 30s or younger, most doctors recommend trying to get pregnant for at least a year before having any testing or treatment.
►If you're between 35 and 40, discuss your concerns with your doctor after six months of trying.
►If you're older than 40, your doctor may want to begin testing or treatment right away.
Your doctor also may want to begin testing or treatment right away if you or your partner has known fertility problems, or if you have a history of irregular or painful periods, pelvic inflammatory disease, repeated miscarriages, prior cancer treatment, or endometriosis.
Tests and diagnosis:
If you've been unable to conceive within a reasonable period of time, seek help from your doctor for further evaluation and treatment of infertility.
Fertility tests may include:
►Ovulation testing: An over-the-counter ovulation prediction kit a test that you can perform at home detects the surge in luteinizing hormone (LH) that occurs before ovulation. If you have not had positive home ovulation tests, a blood test for progesterone — a hormone produced after ovulation — can document that you're ovulating. Other hormone levels, such as prolactin, also may be checked.
►Hysterosalpingography: During hysterosalpingography, X-ray contrast is injected into your uterus and an X-ray is taken to determine if the uterine cavity is normal and whether the fluid passes out of the uterus and spills out of your fallopian tubes. If abnormalities are found, you'll likely need further evaluation. In a few women, the test itself can improve fertility, possibly by flushing out and opening the fallopian tubes.
►Ovarian reserve testing: This testing helps determine the quality and quantity of eggs available for ovulation. Women at risk of a depleted egg supply — including women older than 35 — may have this series of blood and imaging tests.
►Other hormone testing: Other hormone tests check levels of ovulatory hormones as well as thyroid and pituitary hormones that control reproductive processes.
►Imaging tests: Pelvic ultrasound looks for uterine or fallopian tube disease. Sometimes a hysterosonography is used to see details inside the uterus that are not seen on a regular ultrasound.
Depending on your situation, rarely your testing may include:
► Other imaging tests: Depending on your symptoms, your doctor may request a hysteroscopy to look for uterine or fallopian tube disease.
►Laparoscopy: This minimally invasive surgery involves making a small incision beneath your navel and inserting a thin viewing device to examine your fallopian tubes, ovaries and uterus. Laparoscopy may identify endometriosis, scarring, blockages or irregularities of the fallopian tubes, and problems with the ovaries and uterus.
►Genetic testing: Genetic testing helps determine whether there's a genetic defect causing infertility.
Coping and support:
Dealing with female infertility can be physically and emotionally exhausting. To cope with the ups and downs of infertility testing and treatment, consider these strategies:
►Be prepared: The uncertainty of infertility testing and treatments can be difficult and stressful. Ask your doctor to explain the steps for the therapy you've chosen so that you and your partner can prepare for each one. Understanding the process may help reduce your anxiety.
►Seek Support: Although infertility can be a deeply personal issue, reach out to your partner, close family members or friends for support. Many online support groups allow you to maintain your anonymity while you discuss issues related to infertility. Seek professional help if the emotional burden gets too heavy for you or your partner.
►Consider other options: Determine alternatives — adoption, donor sperm or egg, or even having no children — as early as possible in the infertility treatment process. This can reduce anxiety during treatments and disappointment if conception doesn't occur.
You Are Not Alone:
We are here to help you, to teach you and to see you become inspired as you bring positive changes to your own health and fertility. We are here to help you maximize your chances for getting pregnant, no matter what your path.
Whether you are here to find ways to conceive naturally, or you want to find ways to maximize your chances with your Reproductive Endocrinologist, we are here to help. Give your body and your child the best chance for the healthiest conception and pregnancy possible.