Infertility is the inability to conceive a child or carry a pregnancy to term. Infertility is diagnosed if a couple fails to conceive a child after a year of unprotected intercourse. Then a fertility evaluation should be performed to determine the cause. This guideline may change based on age, medical history, or other problems that may contribute to infertility.
Infertility is not an uncommon problem in the US. According to the Centers for Disease Control and Prevention (CDC), about 6% of married American women between the ages of 15 and 44 are unable to conceive after a year of trying.
Potential Causes of Infertility
Some people believe that infertility is only a woman’s problem. However, both male and female factors can lead to infertility. According to the CDC, in 35% of couples with infertility, male factor infertility is part of the problem. Both female and male infertility may be caused by several factors.
- Age is often considered the most important factor in female fertility. Women are most fertile in their 20s. Fertility declines after that and after age 35, it starts declining at a greater rate.
- Ovulation disorders
- Disorders which affect the release of eggs from the ovaries during the menstrual cycle. These disorders are often caused by hormonal issues like polycystic ovary syndrome (PCOS), hyperthyroidism, or hypothyroidism. Other things that can affect ovulation include diet, overexercising, and BMI.
- Uterine or cervical abnormalities
- Abnormalities in the shape of the uterus or cervix can prevent a fertilized egg from implanting in the uterus. Benign tumors in the uterine wall, called fibroids, may block the fallopian tubes as well.
- Blocked fallopian tubes
- Blockages in the fallopian tubes prevent the egg from reaching the uterus for fertilization. Fallopian tubes may be blocked by inflammation due to pelvic inflammatory disease (PID), adhesions, or endometriosis.
- A disorder in which endometrial tissue (the tissue that makes up the uterine lining) grows outside of the uterus. This can cause scarring and adhesions that can affect the function of the ovaries, fallopian tubes, and uterus.
- Primary ovarian insufficiency
- This is a condition in which the ovaries stop working normally before a woman is 40. Ovarian follicles stop developing eggs, therefore there is no ovulation. This may also be referred to as premature menopause.
- Cancer or cancer treatment
- Reproductive cancers can lead to female infertility. Certain cancer treatments like chemotherapy or radiation can also cause fertility issues.
- Age is a factor in male fertility, but most men remain fertile longer than women. The quality and quantity of sperm usually start declining in a man’s 50s.
- Low sperm count
- The number of sperm in the semen is lower than normal.
- Poor sperm motility
- The sperm do not move or swim properly
- Problems with sperm delivery
- Ejaculatory disorders
- Blockages in the testicles
- Genetic diseases
- Damage or injury to the reproductive organs
- Reproductive cancer or cancer treatments
If you are under 35, your doctor will advise you to try to conceive with unprotected sex for a year before having a fertility evaluation. If you are over 35, then many doctors recommend shortening that time span to six months. Women who are over 40 are usually urged to see a fertility specialist as soon as they decide to try to get pregnant.
Your OB/GYN or fertility specialist can tell you about what should be included in your fertility evaluation given your specific circumstances. Usually, the evaluation consists of getting a medical history from both you and your partner as well as a physical examination. Other tests to check ovarian reserve, sperm count and motility, or reproductive anatomy may also be performed.
Many cases of infertility are managed by treating the underlying cause. This type of treatment includes drug therapy or surgical repair of the damaged reproductive organs. If the cause is unknown or other treatments don’t work, fertility treatments may be an option. These options include ovulation induction, intrauterine insemination (IUI), and in vitro fertilization (IVF) among others. You OB/GYN may provide these treatments, or they may refer you to a reproductive endocrinologist, which is a doctor that specializes in fertility treatments.
Request an Appointment
The physicians, nurses, and medical staff at Raleigh OB/GYN have been dedicated to providing quality care to our patients since 1974. We offer a comprehensive list of gynecological and obstetric services to the women of the Raleigh, NC area. If you have questions or concerns about a reproductive health issue like infertility, call our office at (919) 876-8225 to make an appointment.