Health Topics A-Z

What Is Infertility?

Infertility is defined as the inability for a couple to become pregnant after a year of steady, unprotected intercourse. The male partner, the female partner, or both may have a fertility problem. A person who is infertile has a reduced ability to have a child. It usually doesn't mean a person is sterile — that is, physically unable to ever have a child.

For many couples, infertility is a crisis. It often comes with feelings of guilt or inadequacy. But a diagnosis of infertility is not necessarily a verdict of sterility. Fifteen percent of all couples are infertile but only 1%-2% are sterile. Half of couples that seek help can eventually bear a child, either on their own or with medical assistance.

Men and women are equally likely to have a fertility problem. In about one in five infertile couples, both partners have contributing problems, and in about 15% no cause is found after all tests have been done (unexplained infertility).

What Causes It?
In men, the most common reasons for infertility are sperm disorders.
These problems include:

• Low sperm count. This means there are too few or no spermatozoa in the ejaculate.
• Low sperm motility. This means that the sperm don't swim as well as they should.
• Malformation of the sperm.
• Blocked sperm ducts.

Another common problem is a temporary drop in sperm production. This happens when the testicles have been injured, as can happen when they have been too hot for too long or when the man has been exposed to chemicals or medications which affect sperm production.

Spending a long time in a hot tub, for example, or wearing underwear that holds the testicles too close to the body can increase the testicular temperatures and impair sperm production. Sometimes there is a physical reason. In the relatively common condition called varicocele, veins around the vas deferens (the duct that carries sperm from testicle to urethra) becomes dilated — similar to a varicose vein in the leg. The pooling of blood in these veins keeps the temperature inside the scrotum too high. Certain lifestyles, like increased alcohol intake and smoking, can also have a negative effect on his sperm count.

The #1 reason of infertility in women is anovulation, the lack of ovulation (release of eggs from the ovary). and the major cause of anovulation is a condition called 'polycystic ovarian diseases, or PCOS.

Another reason for female infertility includes the inability of the fallopian tubes to carry eggs from the ovary to the uterus, usually due to scar tissue or a condition called endometriosis.

Rarely, in the uterus, fibroid growths, endometriosis, tumors, cervical problems, or irregular uterine shape can keep the egg from implanting in the uterus. Fertilization may not happen if the cervical mucus damages sperm or impedes their progress.

Age is a major factor of female infertility. In women, fertility declines with age, and even more so after the age of 35 years. Conception after age 45 is rare. Being overweight or underweight can also play a role. Men 40 and over often have decreased fertility.

Evidence suggests that couples trying to get pregnant should see their doctor for a periconception visit as soon as they start trying to conceive. This is especially important for couples with medical issues. During the periconception visit, they can explore whether there are any problems which should be treated to improve fertility and increase chances getting pregnant and having a healthy baby.

Women trying to conceive should add a supplement of at least 600 mcg Folic Acid either alone or as part of prenatal vitamins to decrease the risk of fetal malformations and decrease the risk of a miscarriage. The folic acid supplement should be started at least 1-2 months prior to conception to maximize its efficacy.