Infertility Overview

Typically infertility is defined as not being able to get pregnant after a minimum of one year of trying to conceive.  It also includes a woman who are able to get pregnant but then has repeated miscarriages.  There are many reasons why a couple may not be infertile or may not be able to conceive without medical assistance.

Infertility is a growing problem in the U.S. and in many other countries. In the United States for women in their child bearing years, approximately 10-12% have fertility issues.

The physical and psychological impact of infertility can be devastating to the infertile person, their partner, and their relationship. It can result in anger, depression, anxiety, and feelings of worthlessness. Psychological counseling and adoption are two of the options open to those individuals and couples for whom infertility cannot be overcome.

The following has been adapted from the websites listed at the bottom of this page.

The International Council on Infertility Information Dissemination (INCIID) considers a couple to be infertile if they have not conceived after 6 months of unprotected intercourse, or after 12 months if the woman is over 35 years of age; or if there is incapability to carry a pregnancy to term. Healthy couples in their mid-20s having regular sex have a one-in-four chance of getting pregnant in any given month. This is called "Fecundity".

Pregnancy is the result of a complex chain of events. Infertility can result from problems that interfere with any of these steps:

Healthy sperm must be produced by the man.
Healthy eggs need to be produced by the woman.
A woman must release an egg from one of her ovaries (ovulation).
The egg must go through a fallopian tube toward the uterus (womb).
Unblocked fallopian tubes that allow the sperm to reach the egg.
A man's sperm must join with (fertilize) the egg along the way.
The fertilized egg must attach to the inside of the uterus (implantation).
Finally, for the pregnancy to continue to full term, the embryo must be healthy and the woman's hormonal environment adequate for its development.

Infertility is not always a woman's problem. According to the American Society for Reproductive Medicine, infertility affects about 6.1 million people in the U.S., equivalent to 10% of the reproductive age population. In only about one-third of cases is infertility due to the woman (female factors). In another one third of cases, infertility is due to the man (male factors). The remaining cases are caused by a mixture of male and female factors or by unknown factors.

Female infertility: Factors include diseases such as diabetes, thyroid and hypothalamic problems, ovarian factors, tubal/peritoneal factors (such as endometriosis, pelvic adhesions, and pelvic inflammatory disease), uterine, cervical, and vaginal factors, genetic conditions, and psychological factors.

Male infertility: Factors include pre-testicular causes (such as endocrine problems), drugs, alcohol, and psychological factors, testicular factors (such as varicocele, trauma, and mumps), post-testicular causes (such as vas deferens obstruction, infection, retrograde ejaculation and impotence), and genetic causes.

Combined infertility: In some cases both the man and woman may be infertile or sub-fertile, and the couple's infertility arises from the combination of these conditions. In other cases, the cause is suspected to be immunological or genetic. It may also be the case that each partner is independently fertile but the couple cannot conceive together without assistance.

Unexplained infertility: In about 15% of cases the infertility investigation will show no abnormalities. In these cases abnormalities are likely to be present but not detected by current methods. Possible problems could be that the egg is not released at the optimum time for fertilization, it may not enter the fallopian tube, sperm may not be able to reach the egg, fertilization may fail to occur, transport of the zygote may be disturbed, or implantation fails. It is increasingly recognized that egg quality is of critical importance and women of advanced maternal age have eggs of reduced capacity for normal and successful fertilization.

"Secondary infertility" is difficulty conceiving after already having conceived and carried a normal pregnancy. Apart from various medical conditions (e.g. hormonal), this may come as a result of age and stress felt to provide a sibling for their first child. Technically, secondary infertility is not present if there has been a change of partners.

For definitions of the many infertility terms, please visit Terms and definitions.

Evaluation of Infertility

Sometimes doctors can find the cause of a couple's infertility by doing a complete fertility evaluation. This process usually begins with physical exams and health and sexual histories. If there are no obvious problems, like poorly timed intercourse or absence of ovulation, tests will be needed and, accordingly, finding the cause of infertility can be a long, complex and emotional process.

For a man, doctors usually begin by testing his semen. They look at the number, shape, and movement of the sperm. Sometimes doctors also suggest testing the level of a man's hormones. For a comprehensive review please visit Male infertility.

For a woman, the first step in testing is to find out if she is ovulating each month. Doctors can also check if a woman is ovulating by doing blood tests and an ultrasound of the ovaries. If the woman is ovulating normally, more tests are needed. For a comprehensive review please visit the Female infertility.

Treatment of Infertility

Infertility can be treated with medicine, surgery, artificial insemination or assisted reproductive technology. Many times these treatments are combined. About two-thirds of couples who are treated for infertility are able to have a baby. In most cases infertility is treated with drugs or surgery.  For detailed information on infertility treatment please visit the Infertility treatments and Infertility drugs links. 

You can also find out more about infertility by contacting the National Women's Health Information Center (NWHIC) at 1-800-994-9662.

For more about infertility and adoption and/or for more specific information on receiving psychological help and treatment, visit the websites and resources listed below and please feel free to contact me, Dr. Vince Berger, a call at 717 737 9068 or 717 761 5989. I have been helping people with infertility issues and adoption for over 35 years.