Infertility: Answers to Frequently Asked Questions

by Food and Drug Administration (FDA)

Heather Pansera and her husband, Anthony, started trying to have a baby as soon as they got married in 2000. In 2001, they settled into a new house in Canton, Ohio, with plenty of room to raise a family. One year passed, and Heather, 32, didn't think much about it. Another year passed and she panicked.

"We were a couple for five years by the time we got married, so we decided to let nature take its course," she says. "It never crossed our minds that getting pregnant would be so difficult."

It seemed like everyone else was having babies, says Anthony, 39. "I have three brothers and three sisters, and they all had kids. You're happy for other people, but you want to experience it too."

An evaluation by a fertility specialist revealed no clear-cut reason for their inability to conceive naturally. What ultimately worked was a combination of a drug to induce ovulation and intrauterine insemination, a procedure in which a catheter was used to deliver Anthony's sperm directly into Heather's uterus around the time of ovulation.

The first five attempts with intrauterine insemination failed, and Heather and Anthony felt crushed each time. They finally got good news after the sixth try.

In February 2004, they found out that Heather was pregnant and due to have a baby in October. Looking back on it, Heather wishes that they had sought medical help sooner and had known more about infertility. "At the time, I felt like I was the only one with the problem," she says. But the Panseras' experience is not uncommon. According to the American Society for Reproductive Medicine (ASRM), 6 million Americans, roughly 10 percent of the population of reproductive age, face infertility.

Here are answers to frequently asked questions about infertility.

Q. What is infertility?

A. Infertility is a disease or condition of the reproductive system that interferes with the ability to conceive. It's typically defined as not being able to get pregnant after having regular unprotected sex for one year. "Regular" is considered every few days when a woman is ovulating — the time of the month when one or more eggs are released from the ovaries. Couples may want to seek medical treatment sooner than the one-year mark if the woman is over 35 or if there is a history of irregular menstrual cycles or diseases of the reproductive system.

Infertility also includes the inability to carry a pregnancy to term, as in the case of someone who's had multiple miscarriages, says Diane Clapp, director of medical information at RESOLVE, a nonprofit advocacy organization for men and women facing infertility. "Some people think that infertility is all in the head and can be fixed with relaxation or a vacation," says Clapp, who is a registered nurse. "But infertility is a medical disease that most people can be treated for." About two-thirds of people who are treated for infertility will become pregnant, according to RESOLVE.

Q. How is conception achieved?

A. Many people don't give much thought to the details of conception. But conceiving a baby is the result of a chain of events. One missed step anywhere along the way can throw everything off. First, an egg must be released during ovulation. A man's sperm must be able to reach the egg and fertilize it. The fertilized egg then must travel through the woman's fallopian tube to the uterus and be successfully implanted there. For the embryo to develop, the woman must be producing an adequate amount of hormones. For example, human chorionic gonadotropin (HCG) is a hormone that helps maintain a pregnancy. After a fertilized egg is implanted in the uterus, HCG is produced by the developing placenta, the structure that supplies nutrients to the baby.

Sometimes a couple will succeed in conceiving after identifying when the woman ovulates and having sexual intercourse around that time. Using ovulation test kits and basal thermometers can help determine more precisely when ovulation occurs. Basal thermometers can indicate a rise in body temperature, which occurs when a woman ovulates. But infertility is more than just bad timing. It can involve disorders that prevent conception or implantation from taking place.

Q. What are the primary causes of infertility?

A. For men, the primary cause of infertility is a sperm disorder. A man may have no sperm or low sperm, or there could be a problem with how the sperm is moving.

For women, the primary cause of infertility is an ovulation disorder. Normally, a woman ovulates every month, usually around the middle of the menstrual cycle, which averages 28 days. Experts say that women with an ovulation disorder may not ovulate at all or they may ovulate irregularly.

Other common causes of infertility in women are a blockage of the fallopian tubes, which prevents an egg from traveling to the uterus, and hormonal defects that make the uterine lining unprepared for egg implantation or that keep a pregnancy from being maintained.

Q. What are the main risk factors for infertility?

A. A woman's fertility starts to decrease in her early 30s and takes a big drop after age 35. According to the ASRM, a healthy 30-year-old woman has about a 20 percent chance each month of getting pregnant. By age 40, that chance is only about 5 percent.

Experts say the main reason for the drop is that women are born with all the eggs they will ever have, and the supply of eggs goes down with age. "The quality of the eggs also goes down, which increases the likelihood of miscarriage in older women," says Adelina Emmi, M.D., associate professor of reproductive endocrinology and infertility at the Medical College of Georgia. "You may hear about celebrities having twins at 50, but you don't always know the details, like whether donor eggs were used."

And though men produce sperm most of their lives and don't experience the sudden drop in fertility that women do, a man's fertility may decrease gradually over time. "As men age, their fertility declines later and less dramatically than it does in women," Emmi says. "There is also evidence that the risk of gene defects in sperm goes up with age."

The risk of infertility also goes up when either partner has had diseases or surgery that could damage the reproductive organs. For example, a major complication of sexually transmitted diseases for women is pelvic inflammatory disease (PID). This infection can lead to infertility because it causes scarring in the uterus and fallopian tubes. Men may have reproductive abnormalities due to prostate surgery or a disorder of the testes resulting in abnormal sperm production.

"This is an area of medicine where getting a good patient history really counts," Emmi says. "We can pick up all kinds of things that people may not realize affect their fertility — from chronic conditions like prediabetic states and thyroid disorder, which can interfere with ovulation, to blood pressure medication, which can lower a man's sperm count."

Lifestyle risk factors that can impair fertility in men and women include smoking, alcohol and drug use, and sexually transmitted diseases. In women, being overweight or underweight can interfere with the production of estrogen, a female hormone that regulates the menstrual cycle and ovulation. According to the ASRM, too much body fat causes a woman to produce too much estrogen. Too little body fat causes a woman to produce too little estrogen.

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