If getting pregnant has been a challenge for you and your partner, you're not alone. Ten to 15 percent of couples in the United States are infertile. Infertility is defined as not being able to get pregnant despite having frequent, natural sex for at least a year — or for at least six months if the woman is age 35 or older.
Infertility affects about 6.1 million people in the United States, about 10% of men and women of reproductive age.
Infertility affects men and women equally.
Most infertility cases (85-90%) are treated with medication or surgery.
About 85% of couples will conceive naturally within one year if they have regular natural sex. For every 100 couples trying to conceive naturally:
20 will conceive within one month
70 will conceive within six months
85 will conceive within one year
90 will conceive within 18 months
95 will conceive within two years
For couples who have been trying to conceive for more than three years without success, the likelihood of pregnancy occurring within the next year is 25% or less.
Infertility can occur in both men and women. It can be caused by either the male or female reproductive system. Infertility can be caused by many different factors. Around a third of infertility is due to problems with the woman, and another third is due to problems with the man. In 23% of cases, a cause cannot be identified. Infertility can be a devastating problem for couples, and medical treatment may never resolve the problem. There are a number of causes of infertility in both men and women.
The most common infertility problem in men is a low sperm count. It is very rare for absolutely no sperm to be present, but this problem does affect some men. One common cause of low sperm count is injury to the testicular area. Exposure to radiation or toxic chemicals can also cause a low sperm count. Men may also suffer from problems with the pituitary gland, which may be unable to produce the hormones that enable the testicles to produce testosterone.
Other known causes of low sperm count are drug related. Smoking is known to cause a low sperm count. Prescription medications and heavy intake of alcohol or other drugs are often major factors in a low sperm count. Men may also experience a condition known as retrograde ejaculation, in which the sperm is released into the bladder instead of through the penis.
A number of things can affect sperm count, ability to move (motility) or ability to fertilize the egg. The most common causes of male infertility include:
Abnormal sperm production or function due to various problems, such as undescended testicles, genetic defects or repeated infections.
Problems with the delivery of sperm due to sexual problems, such as premature ejaculation or painful intercourse (dyspareunia); health issues, such as retrograde ejaculation; certain genetic diseases, such as cystic fibrosis; or structural problems, such as blockage of the part of the testicle that contains sperm (epididymis).
General health and lifestyle issues, such as poor nutrition, obesity, or use of alcohol, tobacco and drugs.
Overexposure to certain environmental factors, such as pesticides and other chemicals. In addition, frequent exposure to heat, such as in saunas or hot tubs, can elevate your core body temperature. This may impair your sperm production and lower your sperm count.
Damage related to cancer and its treatment. Both radiation and chemotherapy treatment for cancer can impair sperm production, sometimes severely. The closer radiation treatment is to the testicles, the higher the risk of infertility. Removal of one or both testicles due to cancer also may affect male fertility.
Age. Men older than age 40 may be less fertile than younger men.
In women, the most common cause of infertility is problems with the Fallopian tubes. There may be a blockage in the Fallopian tubes, or they may be infected due to sexually transmitted diseases. Endometriosis, a growth of tissue that becomes attached to the ovaries or Fallopian tubes, is also a common cause of infertility in women.
Previous pelvic surgery may have left scars on the Fallopian tubes that may be a contributing factor to infertility in women. Problems with ovulation are the cause of infertility in 40% of women. These may be due to some form of hormonal imbalance. Abnormal structure of the ovaries can also present a problem. There may also be other abnormalities in the structure of the reproductive organs that can lead to problems with the ovaries.
The most common causes of female infertility include:
Fallopian tube damage or blockage, which usually results from inflammation of the fallopian tube (salpingitis). Chlamydia, a sexually transmitted infection, is the most frequent cause.
Endometriosis, which occurs when the uterine tissue implants and grows outside of the uterus — often affecting the function of the sperm, egg and ovaries, uterus, and fallopian tubes.
Ovulation disorders, which can prevent the ovaries from releasing eggs (anovulation). Underlying causes may include injury, tumors, excessive exercise and starvation. In addition, some medications can be associated with ovulation disorders.
Elevated prolactin (hyperprolactinemia), the hormone that stimulates breast milk production. High levels in women who aren't pregnant or nursing may affect ovulation.
Polycystic ovary syndrome (PCOS), a condition in which your body produces too much of the hormone androgen causing ovulation problems. PCOS is also associated with insulin resistance and obesity.
Early menopause, which is the absence of menstruation and the early depletion of ovarian follicles before age 40. Although the cause is often unknown, certain conditions are associated with early menopause, including immune system diseases, radiation or chemotherapy treatment, and smoking.
Uterine fibroids, which are benign tumors in the wall of the uterus and are common in women in their 30s and 40s. Rarely, they may cause infertility by blocking the fallopian tubes. More often, fibroids interfere with proper implantation of the fertilized egg.
Pelvic adhesions, bands of scar tissue that bind organs after pelvic infection, appendicitis, or abdominal or pelvic surgery. This scar tissue formation may impair fertility.
Other causes in women
Medications. Temporary infertility may occur with the use of certain medications. In most cases, fertility is restored when the medication is stopped.
Thyroid problems. Disorders of the thyroid gland, either too much thyroid hormone (hyperthyroidism) or too little (hypothyroidism), can interrupt the menstrual cycle and cause infertility.
Cancer and its treatment. Certain cancers — particularly female reproductive cancers — often severely impair female fertility. Both radiation and chemotherapy may affect a woman's ability to reproduce. Chemotherapy may impair reproductive function and fertility in men and women.
Other medical conditions. Medical conditions associated with delayed puberty or amenorrhea, such as Cushing's disease, sickle cell disease, kidney disease and diabetes, can affect a woman's fertility.
Between 1948 and 1971, a medication called Diethylstilbestrol (DES) was prescribed to prevent miscarriage or premature births. Diethylstilbestrol is no longer prescribed, as medical problems became apparent in the children of the women to whom it was prescribed. Among the medical problems found in the daughters of the women who took DES is cancer in the cervix or vagina. Structural problems in the reproductive organs that can lead to infertility are also present in the daughters of women who took DES.
Fertility also decreases with age. A woman is at her fertile peak in her twenties, and fertility significantly decreases by her thirties. Also, in her mid-thirties, a woman's eggs are not as healthy as they were in her twenties. Chances of conceiving for both men and women begin to deteriorate as the aging process takes its toll. Maintaining a healthy lifestyle may prolong fertility rates, but deterioration is inevitable and a natural part of the aging process.
Many of the risk factors for both male and female infertility are the same. They include:
Age. After about age 30, a woman's fertility potential gradually declines. Infertility in older women may be due to a higher rate of chromosomal abnormalities that occur in the eggs as they age or to health problems that may interfere with fertility. Men older than age 40 may be less fertile than are younger men.
Tobacco smoking. A couple's chance of achieving a pregnancy is reduced if either partner smokes tobacco. Smoking also reduces the possible benefit of fertility treatment. Miscarriages are more frequent in women who smoke.
Alcohol use. For women, there's no safe level of alcohol use during conception or pregnancy. Alcohol use increases the risk of birth defects, and it may also — at moderate to heavy levels — make it more difficult to become pregnant. Moderate alcohol use does not appear to decrease male fertility.
Being overweight. Among American women, infertility often is due to a sedentary lifestyle and being overweight. In addition, a man's sperm count may be affected if he is overweight.
Being underweight. Women at risk include those with eating disorders, such as anorexia nervosa or bulimia, and women following a very low calorie or restrictive diet.
Too much exercise. In some studies, exercising more than seven hours a week has been associated with ovulation problems. On the other hand, not enough exercise can contribute to obesity, which also increases infertility.
Treatment of infertility depends on the cause, how long you've been infertile, your age and your partner's age, and many personal preferences. Some causes of infertility can't be corrected.
Approaches that involve the male include treatment for:
General sexual problems. Addressing impotence or premature ejaculation can improve fertility. Treatment for these problems can be done with medication.
Lack of sperm. If a lack of sperm is suspected as the cause of a man's infertility, surgery or hormones to correct the problem is sometimes possible.
Fertility drugs are the main treatment for women who are infertile due to ovulation disorders. These medications regulate or induce ovulation. In general, they work like natural hormones — such as follicle-stimulating hormone (FSH) and luteinizing hormone (LH) — to trigger ovulation. Commonly used fertility drugs include:
Clomiphene citrate (Clomid, Serophene). This drug is taken orally and stimulates ovulation in women who have polycystic ovary syndrome (PCOS) or other ovulatory disorders. It causes the pituitary gland to release more FSH and LH, which stimulate the growth of an ovarian follicle containing an egg.
Human menopausal gonadotropin (Repronex, Menopur). This injected medication is for women who don't ovulate on their own due to the failure of the pituitary gland to stimulate ovulation. Unlike clomiphene, which stimulates the pituitary gland, human menopausal gonadotropin (hMG) and other gonadotropins directly stimulate the ovaries. This drug contains both FSH and LH.
Follicle-stimulating hormone (Bravelle). FSH works by stimulating maturation of egg follicles the ovaries.
Human chorionic gonadotropin (Ovidrel, Pregnyl). Used in combination with clomiphene, hMG and FSH, human chorionic gonadotropin (HCG) stimulates the follicle to release its egg (ovulate).
Gonadotropin-releasing hormone analogs. This treatment is for women with irregular ovulatory cycles or who ovulate prematurely — before the lead follicle is mature enough — during hMG treatment. Gonadotropin-releasing hormone (Gn-RH) analogs suppress pituitary gland activity, which alters hormone production so that a doctor can induce follicle growth with FSH.
Aromatase inhibitors. This class of medications, which includes letrozole (Femara) and anastrozole (Arimidex), is approved for treatment of advanced breast cancer. Doctors sometimes prescribe them for women who don't ovulate on their own and who haven't responded to treatment with clomiphene citrate. These drugs are not approved by the Food and Drug Administration for inducing ovulation, and their effect on early pregnancy isn't yet known.
Metformin (Glucophage). This oral drug is taken to boost ovulation. It's used when insulin resistance is a known or suspected cause of infertility. Insulin resistance may play a role in the development of PCOS.
Bromocriptine (Parlodel). This medication is for women whose ovulation cycles are irregular due to elevated levels of prolactin, the hormone that stimulates milk production in new mothers. Bromocriptine inhibits prolactin production.
Surgical procedures that may be used to investigate fertility problems and assist with fertility are listed below.
If your fallopian tubes have become blocked or scarred, perhaps as a result of pelvic inflammatory disease (PID), you may need to have surgery to repair the tubes. Surgery can be used to break up the scar tissue in your fallopian tubes, making it easier for eggs to pass along them.
The success of the surgery will depend on how damaged your fallopian tubes are. One study found 69% of women with the least damaged tubes had a live birth after surgery. Other estimates for live births in women following surgery are 20–50%.
Possible complications from tubal surgery include an ectopic pregnancy (when the fertilized egg implants outside of your womb). Between 8–23% of women may experience an ectopic pregnancy after having surgery on their fallopian tubes.
A laparoscopy involves having a small cut (incision) made in your abdomen. A thin, flexible microscope with a light on the end, called a laparoscope, is then passed through the incision. This type of procedure can be used to look at your internal organs, take samples, and perform small operations.
Laparoscopic surgery is often used for women who have endometriosis (when parts of the womb lining start growing outside of the womb), to destroy, or remove, cysts (fluid-filled sacs). It may also be used to remove submucosal fibroids (small growths in the womb).
In women with PCOS, laparoscopic ovarian drilling can be used if ovulation medication has not worked. This involves using either heat or a laser to destroy part of the ovary.
The epididymis is a coil-like structure in the testicles that helps to store and transport sperm. Sometimes the epididymis becomes blocked, preventing sperm from being ejaculated normally. If this is causing infertility, surgery to correct the blockage can be performed.
An important step in becoming pregnant is ensuring that you are healthy, which you can do by making simple lifestyle changes.
Make sure that you eat a nutritious, balanced diet. It should contain at least five portions of fruit and vegetables a day, carbohydrates such as wholemeal bread and pasta, and lean meat, fish, and pulses for protein. Green, leafy vegetables are high in folic acid, which can help to prevent birth defects.
Women who are underweight or overweight ovulate (release an egg) less regularly, or sometimes not at all, compared to women of a healthy weight.
Therefore ensuring that you maintain a healthy weight will make it much easier to conceive. You can use the healthy weight calculator to find out if you are the right weight for your height.
Women should aim for a body mass index (BMI) of 19–25 for the best chance of getting pregnant. A BMI of less than 19 may mean that you are ovulating less frequently. If your BMI is over 29, your doctor may recommend that you lose weight.
Men with a BMI of over 29 may have reduced fertility, and your doctor may recommend that you lose weight. Regular exercise and eating a healthy diet can help you to maintain a suitable weight.
The Department of Health recommends that women should take a daily supplement of 0.4mg of folic acid while they are trying to conceive. If you become pregnant, you should continue taking this until week 12 of the pregnancy. Folic acid helps to protect the unborn baby from problems such as spina bifida (when the baby's spine does not develop properly).
It is very important to stop smoking if you are planning to get pregnant. Smoking is linked to babies with a low birth weight and increased complications during the pregnancy. This advice applies to both women and men because second-hand smoke is bad for unborn babies and young children.
The Department of Health (DH) recommends that women should not drink alcohol while they are trying to conceive. Studies have shown that alcohol can seriously damage a baby's development.
If you decide to drink during pregnancy, you must limit your intake to one to two units of alcohol, once or twice a week, and you must avoid getting drunk.
Men should not drink more than the DH's recommendation of three to four units of alcohol a day. Drinking more than this can reduce your sperm quality. One unit of alcohol is approximately half a pint of normal strength lager, a small glass of wine or a 25ml measure of spirits.
Don't use drugs. Drugs such as marijuana or cocaine can affect fertility, and can seriously damage the development of your baby if you fall pregnant. You should also avoid using some prescription medicines if you are trying to get pregnant. Ask your doctor for further advice.
Make sure that you are up-to-date with your cervical screening tests (smear tests). You need to have one every three to five years depending on your age.
You should also visit your local sexual health clinic to make sure that you do not have any sexually transmitted infections (STIs). Infections such as chlamydia may not have any symptoms but can cause infertility if they are left untreated.
Speak to your doctor if you are planning a pregnancy. They may recommend that you have some additional tests, such as a test for rubella (German measles). You still need to be tested for this even if you have previously had the vaccination, because it can cause serious birth defects in unborn babies.
You may also be tested for the varicella-zoster virus unless you have a definite history of chickenpox or shingles.
If there is a history of genetic conditions in your family, such as cystic fibrosis (a condition that makes the internal bodily secretions thick and sticky) or Down's syndrome (a condition that affects a person's physical appearance and their ability to learn and develop mentally), you should ask your doctor about genetic testing.