Infertility

Infertility is a condition where you can’t

get pregnant after one year of trying to
conceive.

Causes of infertility can include

ovulatory disorders, endometriosis, low
sperm count or low testosterone. The
risk of infertility increases as you age.
Many treatment options are available for
people with infertility

What is infertility?
Infertility is a condition of your
reproductive system that causes people
to be unable to get pregnant (conceive).
Infertility can affect anyone and has
many causes. Getting pregnant involves
several steps:
 1. Your brain must produce
reproductive hormones that control
ovarian function.
2. An egg must mature in
your ovary.
3. Your ovary must release an egg
(ovulation).
4. Your fallopian tube must pick up
the egg.
5. Sperm must travel up
your vagina and through
the uterus to your fallopian tube.
6. The sperm fertilizes the egg to
create an embryo.
7. The embryo travels through your
fallopian tube to the uterus where it
implants.
A pregnancy can’t occur if anything in
this process doesn’t happen.
If you’re younger than 35, your
healthcare provider may diagnose
infertility after one year (12 months) of
trying to conceive. Trying to conceive is
defined as having regular, unprotected
sex. If you’re 35 or older, your provider
may diagnose infertility after six months
of regular, unprotected sex.
Infertility is more common than you
might think. Fortunately, there are many
treatment options available for people
who wish to begin or expand their
family.
What are the types of infertility?
Types of infertility include:
 Primary infertility: women never
been pregnant and can’t conceive
after one year (or six months if you’re
 35 or older) of regular, unprotected
sexual intercourse.
 Secondary infertility: You can’t get
pregnant again after having at least
one successful pregnancy.
 Unexplained infertility: Fertility
testing hasn’t found a reason that a
person or couple is unable to get
pregnant.
How common is infertility?
Infertility affects men and people
assigned male at birth and women and
people assigned female at birth equally.
Infertility is very com.
mon. In the United States, 1 in 5 women
between 15 and 49 years old struggle
with primary infertility and about 1 in 20
women struggle with secondary
infertility. Approximately 48 million
couples live with infertility around the
world.
signs of infertility:
The main sign of infertility is being
unable to get pregnant after six months
or one year of regular, unprotected sex.
You may not have any other symptoms.
But some people may show physical
symptoms such as:
 Pelvic or abdominal pain.
 Irregular vaginal bleeding, irregular
periods or no periods.
 Penile disorders or issues with
ejaculation.

causes infertility:
While causes of infertility vary, studies
show that:
  33% of infertility involves the partner
with a uterus and ovaries.
 33% of infertility involves the partner
with a penis and testicles.
 33% of infertility involves both
partners or is unexplained.
Twenty-five percent of infertile couples
have more than one factor that
contributes to their infertility.
Infertility causes
Some causes of infertility affect just one
partner, while others affect both
partners. Risk factors for infertility
include:
 Age, particularly being in your late
30s or 40s. For men, age begins
affecting fertility closer to 50.
 Eating disorders, including anorexia
nervosa and bulimia.
  Excessive alcohol consumption.
 Exposure to environmental toxins,
such as chemicals, lead and
pesticides.
 Over-exercising.
 Radiation therapy or chemotherapy.
 Sexually transmitted
infections (STIs).
 Smoking and using tobacco
products. (This behavior plays a role
in about 13% to 15% of infertility
cases.)
 Substance abuse.
 Having obesity or being underweight.
 Abnormalities of the hormone-
producing centers of your brain
(hypothalamus or pituitary).
 Chronic conditions and diseases.
Infertility causes for women and
people assigned female at birth
Ovulation disorders are the most
common cause of infertility in people
with ovaries. Ovulation is the process in
which your ovary releases an egg to
meet sperm for fertilization.
These factors can contribute to female
infertility:
 Endometriosis.
 Structural abnormalities of your
vagina, uterus or fallopian tubes.
 Autoimmune conditions like celiac
disease or lupus.
 Kidney disease.
 Pelvic inflammatory disease (PID).
 Hypothalamic and pituitary gland
disorders.
 Polycystic ovary syndrome (PCOS).
 Primary ovarian insufficiency or poor
egg quality.
 Sickle cell anemia.
  Uterine fibroids or uterine polyps.
 Thyroid disease.
 Prior surgical sterilization (tubal
ligation or salpingectomy).
 Genetic or chromosomal disorders.
 Sexual dysfunction.
 Surgical or congenital absence of
your ovaries.
 Infrequent or absent menstrual
periods.
Infertility causes for men
The most common cause of male
infertility involves problems with the
shape, movement (motility) or amount
(low sperm count) of sperm.
Other causes of male infertility include:
 Enlarged veins (varicocele) in your
scrotum, the sac that holds your
testicles.
 Genetic disorders, such as cystic
fibrosis.
 Chromosomal disorders, such as
Klinefelter syndrome.
 High heat exposure to your testicles
from tight clothing, frequent use of
hot tubs and saunas, and holding
laptops or heating pads on or near
your testes.
 Injury to your scrotum or testicles.
 Low testosterone (hypogonadism).
 Misuse of anabolic steroids.
 Sexual dysfunction, such as erectile
dysfunction,
anejaculation, premature
ejaculation or retrograde ejaculation.
 Undescended testicles.
 Previous chemotherapy or radiation
therapy.
 Surgical or congenital absence of
testes.
  Prior surgical sterilization
(vasectomy).
DIAGNOSIS AND TESTS
How is female infertility diagnosed?
First, your healthcare provider will get
your full medical and sexual history.
Fertility for people with a uterus involves
ovulating healthy eggs.
This means your brain has to send
hormonal signals to your ovary to
release an egg to travel from your ovary,
through your fallopian tube and to your
uterine lining.
Fertility testing involves detecting an
issue with any of these processes.
These tests can also help diagnose or
rule out problems:
 Pelvic exam: Your provider will
perform a pelvic exam to check for
structural problems or signs of
disease.
 Blood test: A blood test can check
hormone levels to see if hormonal
imbalance is a factor or if you’re
ovulating.
 Transvaginal ultrasound: Your
provider inserts an ultrasound wand
into your vagina to look for issues
with your reproductive system.
 Hysteroscopy: Your provider inserts
a thin, lighted tube (hysteroscope)
into your vagina to examine your
uterus.
 Saline sonohysterogram
(SIS): Your provider fills your uterus
with saline (sterilized salt water) and
conducts a transvaginal ultrasound.
  Sono hysterosalpingogram
(HSG): Your provider fills your
fallopian tubes with saline and air
bubbles during an SIS procedure to
check for tubal blockages.
 X-ray hysterosalpingogram
(HSG): X-rays capture an injectable
dye as it travels through
your fallopian tubes. This test looks
for blockages.
 Laparoscopy: Your provider inserts
a laparoscope (thin tube with a
camera) into a small abdominal
incision. It helps identify problems
like endometriosis, uterine fibroids
and scar tissue.
How is male infertility diagnosed?
Diagnosing infertility in people with a
penis typically involves making sure a
person ejaculates healthy sperm. Most
fertility tests look for problems with
sperm.
These tests can help diagnose or rule
out problems:
 Semen analysis: This test checks
for low sperm count and poor sperm
mobility. Some people need a needle
biopsy to remove sperm from their
testicles for testing.
 Blood test: A blood test can check
thyroid and other hormone levels.
Genetic blood tests look for
chromosomal abnormalities.
 Scrotal ultrasound: An ultrasound
of your scrotum identifies varicoceles
or other testicular problems.
MANAGEMENT AND TREATMENT
Treatment for infertility depends mostly
on the cause and your goals. Your age,
how long you’ve been trying to conceive
and your personal preferences are
factors in deciding on a treatment.
Sometimes, one person needs
treatment, but other times, treatment
involves both partners.
In most cases, people and couples with
infertility have a high chance of
pregnancy.
Things like medication, surgery or
assisted reproductive technology (ART)
can help.
Often, lifestyle changes or improving
the frequency and timing of intercourse
can improve your chances of
pregnancy.
Treatment can also include a
combination of methods.
Infertility treatment for women
Treatments for infertility in women and
people assigned female at birth include:
 Lifestyle modification: Gaining or
losing weight, stopping smoking or
using drugs, and improving other
health conditions can improve your
chance of pregnancy.
 Medications: Fertility drugs
stimulate your ovaries to ovulate
more eggs, which increases your
chance of getting pregnant.
 Surgery: Surgery can open blocked
fallopian tubes and remove polyps,
fibroids or scar tissue.
Infertility treatment for men
Treatments for infertility if you have
a penis or testes include:
 Medications: Medications can
raise testosterone or other hormone
 levels. There are also drugs
for erectile dysfunction to help you
maintain an erection during sex.
 Surgery: Some men need surgery to
open blockages in the tubes that
carry sperm or to repair structural
problems. Varicocele surgery can
make sperm healthier and improve
the odds of conception.
What are common fertility
treatments?
Some couples need more help
conceiving using assisted reproductive
technology (ART).
ART is any fertility treatment that
involves a healthcare provider handling
the sperm or egg.
To increase pregnancy odds, you can
take medications to stimulate ovulation
before trying one of these options:
 In vitro fertilization (IVF): IVF
involves retrieving eggs from your
ovary, then placing them with sperm
in a lab dish. The sperm fertilizes the
eggs. A provider transfers one to
three of the fertilized eggs (embryos)
into your uterus.
 Intracytoplasmic sperm injection
(ICSI): This procedure may be
performed during the IVF process.
An embryologist injects a single
sperm directly into each egg. Then, a
provider transfers one to three of the
embryos into your uterus.
 Intrauterine insemination (IUI): A
healthcare provider uses a long, thin
tube to place sperm directly into your
 uterus. IUI is sometimes called
artificial insemination.
 Assisted hatching: A process that
involves opening the outer layer of
an embryo to make it easier for it to
implant in your uterine lining.
 Third-party ART: Couples may use
donor eggs, donor sperm or donor
embryos. Some couples need
a gestational carrier or surrogate.
What are complications of treatment?
Complications of infertility treatment
include:
 Higher chance of multiples (twins,
triplets or more): Producing multiple
eggs and transferring more than one
embryo increases your risk of
becoming pregnant with more than
one fetus. Complications such as
miscarriage, premature birth, low
 birth weight, neonatal death, and
long-term health complications are
more common in people pregnant
with multiple fetuses.
 Ovarian hyperstimulation
syndrome (OHSS): A condition that
causes painful and swollen ovaries
as a result of fertility medications. It
can become serious and require
immediate medical attention.
 Ectopic pregnancy: IVF has an
increased risk of ectopic pregnancy.
 Failed cycles: A failed cycle is when
you go through infertility treatment
and it doesn’t end in pregnancy.
Can infertility be cured?
Yes, but it depends on the cause. In
85% to 90% of cases, lifestyle
modification, medication, ART or
surgery can treat infertility and allow a
person to conceive.
PREVENTION
How can I prevent infertility?
You can take these steps to protect your
fertility, especially while trying to
conceive:
 Eat a well-balanced diet and
maintain a weight that’s healthy for
you.
 Don’t smoke, misuse drugs or drink
alcohol.
 Get treated for STIs.
 Limit exposure to environmental
toxins.
 Stay physically active, but don’t
overdo exercise.
 Don’t delay conception until an
advanced age.
  Undergo fertility preservation
procedures (freezing eggs or sperm).
OUTLOOK / PROGNOSIS
What can I expect if I have infertility?
Approximately 9 out of 10 couples get
pregnant after undergoing fertility
treatments. Success rates vary
depending on the cause of infertility, the
couple’s ages and other factors.
Infertility has emotional, physical,
financial and psychological side effects.
Don’t forget to practice self-care and be
patient with yourself and your partner
throughout the process. Infertility isn’t
easy, so surround yourself with
supportive people or consider joining an
online support group. Sometimes,
sharing your feelings with people who
understand what you’re going through
can be helpful.
LIVING WITH
Does insurance cover infertility
treatment?
Health insurance policies vary, so you
should always check with your
insurance provider. Most insurers cover
medically necessary procedures, such
as surgeries to treat endometriosis and
uterine fibroids. Some policies cover
fertility procedures like IUI, but may not
cover ovulation-stimulating medications
or IVF.