Considerations in infertility

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By Beth Krueger
The National Institutes of Health defines infertility as “the inability of a woman or man to conceive a child or the inability of a woman to carry a pregnancy to term.” The Centers for Disease Control includes a description of infertility as not being able to get pregnant (conceive) after one year of unprotected sex. CDC adds age and condition factors, suggesting that women who do not have regular menstrual cycles or are older than 35 years and have not conceived during a 6-month period of trying, should consider making an appointment with a reproductive endocrinologist—an infertility specialist.
It’s not rare. Studies show 12% of women 15–44 years of age in the United States have difficulty getting pregnant or carrying a pregnancy to term. Problems in the functioning of ovaries, fallopian tubes, and uterus can contribute to infertility. Age is a growing cause of infertility problems. Currently approximately 20% of women in the U.S. have their first child after age 35 and one-third of couples in which the woman is older than 35 years have fertility problems. Other risks factors include smoking, excessive alcohol use, extreme weight gain or loss, and excessive physical or emotional stress that results in amenorrhea (absent periods).
It’s not a situation confined to women. According to a CDC analysis of a 2002 National Survey of Family Growth, of 7.5% of all sexually experienced men younger than age 45 who reported seeing a fertility doctor during their lifetime, 18% were diagnosed with a male-related infertility problem.
The National Institute of Child Health and Human Development notes that in about a third of cases, infertility can be traced to the woman; another third, the man; and the remainder, both partners or when no cause can be found. Infertility often can be successfully treated even if no cause is found.

Types of treatments
If infertility is found following a review by medical professionals of the conditions and histories, infertility in women may be treated with medicine, surgery, intra-uterine insemination, or assisted reproductive technology (includes fertility treatments in which both eggs and sperm are handled and usually involves in vitro fertilization) or a combination. Many fertility drugs increase a woman’s chance of having twins, triplets, or other multiples. Multiple fetuses have a high risk of being born prematurely and premature babies are at a higher risk of health and developmental problems.
Procedures for men may include medical and surgical therapies, usually managed by an urologist who specializes in infertility, or assisted reproductive therapies depending on the underlying cause. A reproductive endocrinologist may offer intrauterine inseminations or in vitro fertilization to help overcome male factor infertility.
Some advice from the CDC: Partners should talk to a health care provider before trying to get pregnant to discuss fertility and conception and help you get the body ready for a healthy baby.

More information
• American Society for Reproductive Medicine – Multidisciplinary organization that provides information, education, advocacy, and standards in reproductive medicine. (www.asrm.org)
• Infertility FAQs – From the Centers for Disease Control and Prevention (www.cdc.gov/reproductivehealth/Infertility)
• Infertility and Fertility – From the National Institute of Child Health and Human Development (www.nichd.nih.gov)
• Preconception Health – Centers for Disease Control (www.cdc.gov/preconception/index.html)
• RESOLVE: The National Infertility Association – Consumer organization that offers support for men and women experiencing infertility, public education and advocacy (www.resolve.org)
• Society for Assisted Reproductive Technology – Promotes and advances the standards for the practice of assisted reproductive technology to the benefit of patients, members, and society at large (www.sart.org)
• Treating Infertility – Patient FAQ from the American College of Obstetricians and Gynecologists (www.acog.org)
• Trying to Get Pregnant? – Public education information from the March of Dimes (www.marchofdimes.org)

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