According to the American Society for Reproductive Medicine, infertility is typically defined as the inability to achieve pregnancy after one year of unprotected intercourse. Because age can have a significant impact on fertility, women who are 35 years or older should begin the evaluation process as early as after six months of unprotected intercourse rather than a year. Other reasons for seeking a fertility evaluation may include:
- Irregular menstrual cycles (less than every 25 days or more than 35 days), which may suggest that a woman is not ovulating
- Previous pelvic surgery or infection(s), which may suggest fallopian tube disease
- Painful periods, which may suggest endometriosis
- Recurrent Pregnancy Loss (though not considered infertility)
- If you or your partner have a known reason that may complicate the ability to conceive
We at the University of Cincinnati Center for Reproductive Health understand that not being able to conceive on your own in a timely fashion can be stressful. You may experience feelings of anxiety, frustration, guilt and insecurity. These feelings are perfectly normal and our expert staff understands what you are going through. However, we feel that after your initial visit and evaluation, your mind will be eased upon learning that fertility treatments vary for every patient and couple—offering more hope for a successful pregnancy than ever before.
- Conception – How it Works
- Fertility Factors
- Emotional Support
For conception to occur, the following steps must occur:
- A woman must first release an egg (ovulate) which enters into a fallopian tube.
- Sperm must enter the cervix and travel through the uterus and into the fallopian tube
- Fertilization takes place in the fallopian tube within 24 hours of ovulation
- The fertilized egg, or embryo, travels through the fallopian tube down to the uterus, where it implants in the uterine lining and develops.
This is a complex process and infertility results when a problem develops in any part of the process. One out of seven couples has trouble conceiving. The first step in overcoming infertility is an accurate diagnosis of the possible causes of your infertility. Up to 90 percent of the time the cause of infertility can be identified. Up to 40 percent of the time, the cause is solely attributable to the female, 40 percent is solely attributable to the male, 10 percent of infertility issues are a combination of both male and female factors and 10 percent may have trouble conceiving for unexplained reasons.
Age is a major factor in female fertility. As a woman approaches her mid-30s, her fertility begins to decline. This decline in fertility is because there are fewer eggs in the ovaries and the quality of the eggs diminish as a woman gets older. Not only does age affect a woman’s ability to get pregnant and carry the pregnancy to term, age can also affect the pregnancy itself by increasing the risk of genetic or chromosomal defects to the embryo.
Age, however, is not as much of a factor for a male as reduction in fertility generally does not occur until his mid 50s. Men are able to produce sperm throughout their lifetime, though problems can affect sperm quantity and quality regardless of a man’s age. See Male Factor Fertility.
There are several factors that contribute to female infertility. These include ovulation, tubal and cervical-uterine issues.
Problems with ovulation are a common cause of infertility, accounting for approximately 25 percent of all female infertility cases. In order to conceive, a woman must ovulate (release an egg from the ovary into the fallopian tube). Ovulation is connected to a woman’s menstrual cycle, or period, which takes place every 28-34 days depending on the individual. Women who experience a period more than 35 days, or not at all, are probably ovulating infrequently or not ovulating at all.
The causes of ovulatory problems can include:
- Thyroid conditions
- High prolactin levels (which can cause a milky breast discharge in some women)
- Polycystic Ovary Syndrome (PCOS) which is also associated with excessive facial and body hair growth (hirsuitism), acne and obesity (in 50 percent of those with this disorder)
Ovulation can be determined through charting, over-the-counter ovulation predictor kits and through additional testing by your physician.
If a woman is not ovulating or ovulating irregularly, her physician may prescribe fertility medications to stimulate ovulation.
Open (patent) and functioning fallopian tubes are necessary for conception to occur. There are risk factors that can affect tubal function and account for 35 percent of female infertility including:
- Previous pelvic Infections
- Previous pelvic-abdominal surgery
The test that is typically performed to assess tubal patency, or open fallopian tubes, is referred to as a Hysterosalpingogram (HSG). An HSG is an X-ray picture of the pelvis. A thin tube-like instrument is passed into the cervix and then an X-ray dye is injected into the uterus. As the dye enters the uterus and fallopian tubes, an assessment can be done to look at the uterine and fallopian tube anatomy. This is the preferred test for tubal abnormalities.
If the tubes are found to be blocked, scarred or damaged, laparoscopy or another surgical procedure can sometimes correct this problem.
The cervix is located in the lower part of the uterus. Conditions of the cervix can affect fertility but are rarely the sole cause of infertility. The following might contribute to cervical health and are important to inform your physician.
- Abnormal pap smear(s)
- Prior cervical biopsies
- Cervical surgery- Cone biopsy
- “Freezing” and/or laser treatment of the cervix
- Your mother took DES (diethylstilbestrol) while she was pregnant
Cervical problems are generally treated with antibiotics, fertility medications or by IUI.
The uterus (womb) is where the fertilized egg implants and develops. Uterine abnormalities can account for 20 percent of female infertility and can include:
- Uterine scar tissue (Asherman’s Syndrome)
- Polyps (bunched-up pieces of the endometrial lining)
- Abnormally shaped uterine cavity
Problems within your uterus may interfere with implantation of the embryo or may increase the incidence of miscarriage. The test(s) typically performed to assess the uterine cavity include a hysterosalpingogram or Sonohysterogram (SHG or SIS). Similar to the HSG, a thin tube-like instrument is passed into the cervix. Small amounts of saline are injected into the uterus under ultrasound guidance to assess the uterine cavity. This the preferred test for uterine abnormalities.
Surgery may be required to further evaluate and possibly correct uterine cavity abnormalities.
The male partner is either the sole (40 percent) or a contributing cause (10 percent) of infertile couples. Evaluation for the male is a sperm analysis. This can determine the volume (amount), motility (movement) and morphology (shape) of the sperm.
The cause of abnormal sperm can be:
- Varicocele (dilated or varicose veins in the scrotum)
- Duct obstruction
Additional testing including blood, semen cultures and a comprehensive examination with our urologist can help identify the cause.
Treatment for male factor infertility may include:
- Surgical correction of a varicocele (dilated or varicose veins in the scrotum) or duct obstruction
- Hormonal medications to improve sperm production
- Antibiotic therapy for infection
For approximately 10 percent of infertile couples, no identifiable abnormality can be found in spite of all testing. Fortunately, unexplained infertility can be treated with prescribed fertility medications and IUI or IVF.
Miscarriage is one of the most devastating experiences that can happen to a woman. Approximately two out of every 10 pregnancies may result in a miscarriage. Therefore, after having one miscarriage, most women go on to have a healthy pregnancy.
Women are considered to have recurrent pregnancy loss when they have two or three miscarriages in a row. Only about 1 percent of women will have three consecutive miscarriages or more. In about two out of three cases, we are able to determine the cause of recurrent pregnancy loss.
The causes of recurrent pregnancy loss include:
- Genetic-chromosomal defects
- Uterine abnormalities
- Incompetent cervix
- Hormonal defects
- Autoimmune disorders
- Clotting disorders
The Center for Reproductive Health understands that not being able to conceive on your own and undergoing fertility treatments can be stressful. Our experienced and compassionate staff understands what you are going through and is here to assist you by providing you the emotional support and resources that you might need along the way. We understand that each patient and couple reacts to stress differently.
With each step of the process there are physical, emotional and financial stressors that can become magnified should there be any setbacks or disappointments. Oftentimes, feelings of anxiety, frustration, guilt and, sometimes, insecurity can be experienced. These feelings are perfectly normal and commonly felt by patients and couples struggling with infertility or undergoing fertility treatment. Sharing your feelings with someone including your partner, a family member or a friend can help to ease emotional stress. Fertility problems can strain even the best relationships. Be sure to:
- Not assign blame or lash out in anger against your partner.
- Listen to your partner and share your feelings; communication is very important.
- Set goals as a couple regarding how far you are willing to go with your treatment plan and to discuss your financial and emotional limits associated with treatment.
In some situations, we may recommend that you seek the support of a dedicated counselor or therapist that specializes in fertility care. We also encourage all of our patients and couples dealing with fertility issues to join local support groups. These support groups can help keep you from feeling alone as you draw from the experiences of others.
RESOLVE and The American Fertility Association are nonprofit national organizations that offer group support.
If you’ve been through a long period of treatment, consider taking a break to think things over. Just a month off can help relieve some of the pressure you may be feeling. You might also use this time to re-evaluate your goals or agree on a date to stop treatment. Deciding on a time to stop can be very difficult. But many patients and couples find that setting a deadline may help to regain a sense of control. It can also give you a fresh outlook on other alternatives including adoption.
No matter what kind of support you need, the University of Cincinnati Center for Reproductive Health is here for you and will provide you with the emotional support and any resources that you might need.