What is infertility?
Infertility is not being able to get pregnant after trying to have a baby for at least a year.
For most couples, having frequent sex without birth control results in a pregnancy within a year. For about half of couples, pregnancy happens within the first 3 months.
Not getting pregnant can be caused by problems with the man, the woman, or both
For women, eggs may not be released from the ovary or the eggs may not get through the tubes that lead to the womb
For men, there may be a problem making sperm, or the sperm may not get through the tubes that lead to the penis
Doctors do tests to look for the cause of infertility
For the highest chance of pregnancy, couples should have sex in the 3 days right before ovulation
If having sex at the right time doesn't work, there are drugs and medical techniques to help women get pregnant
Locating the Female Reproductive Organs
What is ovulation?
Ovulation is the release of an egg from a woman’s ovary.
Typically, women ovulate about halfway between one period and the next. For example, if your menstrual cycle is 28 days (counting from the first day of one period to the first day of the next period), you usually ovulate around day 14.
A woman is most likely to get pregnant if she has frequent sex during the 3 days before ovulation. This is when there's the best chance for the egg to be exposed to sperm. For couples that have a lot of sex, it probably doesn't help to try to time sex around ovulation. But couples that don't have sex often should try to have sex during the few days before ovulation.
If you want to figure out when you ovulate, there are better ways than counting days. These methods are more accurate:
Measuring body temperature
Using a home ovulation predictor kit
Body temperature: Take your temperature at the same time each morning before you get out of bed. This is your basal body temperature. Your temperature will be a little lower starting a few days before ovulation. Then when you ovulate, your temperature goes up and stays up until your next period.
Ovulation predictor kit: You can buy a home ovulation prediction kit in the drugstore. The kit tests your urine for a hormone that goes up right before you ovulate. These kits are more accurate than the body temperature method.
What causes infertility?
Infertility in women is most often caused by:
Lack of ovulation—sometimes, the woman’s ovaries don’t release an egg each month
Blocked or damaged fallopian tubes (the tubes that carry eggs from the ovaries to the uterus)
Problems in the abdomen or in the uterus (womb)
Lack of ovulation has many possible causes. For example, it can be due to hormone problems, polycystic ovaries Polycystic Ovary Syndrome (PCOS) Polycystic ovary syndrome is characterized by slight obesity, irregular or no menstrual periods, and symptoms caused by high levels of male hormones (androgens). It involves disruption of the... read more , eating disorders, early menopause Menopause Menopause is when women stop having periods (stop menstruating) and can no longer get pregnant. Menopause usually happens after age 40. In the United States, the average age for menopause is... read more , too much exercise, and use of certain drugs.
Blocked fallopian tubes prevent sperm from reaching the egg or keep a fertilized egg from entering the uterus. Tubes may be blocked by scar tissue. Scar tissue may result from infections such as pelvic inflammatory disease Pelvic Inflammatory Disease (PID) Pelvic inflammatory disease may affect the lining of the uterus, the fallopian tubes, and sometimes the ovaries. Pelvic inflammatory disease is usually caused by bacteria from the vagina. The... read more , a ruptured appendix, or having had a pregnancy in the tubes (ectopic pregnancy Ectopic Pregnancy An ectopic pregnancy is a pregnancy that grows in the wrong place It's dangerous for you It doesn't last long enough to result in having a baby In a healthy pregnancy, a sperm enters (fertilizes)... read more ).
Problems in the abdomen or womb can keep an egg from entering the fallopian tubes or keep a fertilized egg from attaching inside the uterus. Problems in the abdomen or womb include scar tissue from previous surgery, birth defects of the uterus, and abnormal growths such as endometriosis Endometriosis Endometrium is the tissue that lines the inside of your uterus (womb). That tissue grows every month during your menstrual cycle because it's getting ready to support a baby. If you don't become... read more or fibroids Fibroids A fibroid is a tumor in a woman's uterus (womb). The uterus is the organ where babies grow before they are born. Fibroids aren't cancer, but they can be painful and cause bleeding and other... read more .
Other things that make it harder for a woman to get pregnant include getting older, having diabetes, being overweight, drinking a lot of coffee (more than 5 or 6 cups a day), and smoking.
Infertility in men is most often caused by:
Low numbers of sperm (low sperm count) or slow-moving sperm
Problems getting sperm from the testicles to the penis
Low sperm count has many possible causes. It can be due to hormone problems, too much heat on the testicles, infections such as mumps Mumps Mumps is a contagious viral infection that causes painful enlargement of the salivary glands. The infection may also affect the testes, brain, and pancreas, especially in adults. Mumps is caused... read more , undescended testicles Undescended Testes and Retractile Testes Undescended testes (cryptorchidism) are testes that remain in the abdomen or the groin instead of descending into the scrotum. Retractile testes (hypermobile testes) have descended into the... read more , and varicose veins of the testicles Scrotal Swelling Swelling of the scrotum (the sac that surrounds and protects the testes) on one or both sides may be a symptom of a urinary tract disorder. Swelling can be small and detectable only by carefully... read more . Certain medical treatments, including many drugs, chemotherapy, and radiation, can affect sperm count. Too much alcohol or marijuana can also lower the number of sperm.
Problems getting sperm from the testicles to the penis may happen if the pathway is blocked or damaged because of previous surgery or certain birth defects. Diabetes or nerve problems can also affect how sperm gets from the testicles to the penis.
Sometimes doctors can't figure out the reason why a couple is infertile.
When should I see a doctor about infertility?
Doctors will examine both of you after you've been trying to get pregnant without success for a year.
They'll see a woman sooner if:
She's 35 or older and has been trying to get pregnant for more than 6 months
She doesn't have regular periods or has very painful periods
She has a known problem with her uterus, fallopian tubes, or ovaries
What tests will my doctor do?
Doctors may do tests, including:
Blood tests, including hormone tests
X-rays, ultrasound, and other imaging tests of the woman's womb and fallopian tubes or the man's sex organs
In women, using a viewing tube to look inside the pelvis or womb
In men, sperm count and looking at the sperm under a microscope to see if they're normal in shape and move normally
Sometimes, genetic tests
How do doctors treat infertility?
Doctors will treat the cause of infertility, if known. They'll advise the couple to stop smoking and to not drink too much alcohol, to watch their weight, and to exercise regularly.
Sometimes doctors can’t identify the cause of infertility. But they can still treat you to raise the chances of getting pregnant or getting pregnant sooner.
Give the woman medicine that stimulates the ovaries to release eggs
Do intrauterine insemination (IUI), a procedure in which doctors select the most active sperm and use a syringe to place them in the womb
Do surgery to treat blocked tubes or other problems
In some cases, doctors may recommend assisted reproductive techniques. With these techniques, a woman's eggs are fertilized with a man's sperm in the laboratory to produce one or more embryos. Fertilizing eggs in a laboratory is called in vitro fertilization. The embryo can then be put into the woman's womb.
These treatments don't always work. Couples may want to consider adoption as an alternative to pregnancy.
Being treated for infertility can be very stressful. You may feel frustrated, upset, or guilty. This can put a strain on your relationship. Infertility treatment can also cost a lot and take a lot of time. The stress can lead to anxiety, sleep or eating problems, and can interfere with your life and work. This is normal. Counseling and support groups can help.