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What is infertility?
In general, infertility is defined as not being able to get pregnant (conceive) after one year of unprotected sex. Women who do not have regular menstrual cycles, or are older than 35 years and have not conceived during a 6-month period of trying, should consider making an appointment with a reproductive endocrinologist—an infertility specialist. These doctors may also be able to help women with recurrent pregnancy loss—2 or more spontaneous miscarriages.
Is infertility a common problem?
Yes, about 11% of married women 15–44 years of age have difficulty getting pregnant or carrying a pregnancy to term, (impaired fecundity).
Is infertility just a woman's problem?
No, infertility is not always a woman’s problem. Both men and women contribute to infertility.
Many couples struggle with infertility and seek help to become pregnant; however, it is often thought of as only a women’s condition. A study analyzed data and found that 7.5% of all sexually experienced men younger than age 45 reported seeing a fertility doctor during their lifetime. Of men who sought help, 18% were diagnosed with a male-related infertility problem, including sperm or semen problems and varicocele.

What causes infertility in men?
Infertility in men can be caused by different factors and is typically evaluated by a semen analysis. A specialist will evaluate the number of sperm (concentration), motility (movement), and morphology (shape). A slightly abnormal semen analysis does not mean that a man is necessarily infertile. Instead, a semen analysis helps determine if and how male factors are contributing to infertility.
Conditions that can contribute to abnormal semen analyses include:

  • »Varicoceles, a condition in which the veins on a man’s testicles are large and cause them to overheat. The heat may affect the number or shape of the sperm.
  • »Medical conditions or exposures such as diabetes, cystic fibrosis, trauma, infection, testicular failure, or treatment with chemotherapy or radiation.
  • »Unhealthy habits such as heavy alcohol use, testosterone supplementation, smoking, anabolic steroid use, and illicit drug use.
  • »Environmental toxins including exposure to pesticides and lead.
What things increase a woman's risk of infertility?
Female fertility is known to decline with:

  • »Age. Many women are waiting until their 30s and 40s to have children. In fact, about 20% of women now have their first child after age 35, and this leads to age becoming a growing cause of fertility problems. About one-third of couples in which the woman is older than 35 years have fertility problems. Aging not only decreases a woman’s chances of having a baby but also increases her chances of miscarriage and of having a child with a genetic abnormality.
  • »Smoking.
  • »Excessive alcohol use.
  • »Extreme weight gain or loss.
  • »Excessive physical or emotional stress that results in amenorrhea (absent periods).
When is a woman’s most fertile time?
A woman’s most fertile time is during ovulation. Ovulation typically occurs within day 11 through day 21 of a woman’s cycle.
Counting from the first day of a woman’s last period, day 1 is the first day a woman starts bleeding, and the 11th day is most likely the earliest day a woman will ovulate. The 21st day is most likely the last. A woman’s period comes between the 28th and 32nd day of the cycle. This pattern may differ slightly with each woman depending on a variety of factors.

How do doctors treat infertility?
Infertility can be treated with medicine, surgery, intra-uterine insemination, or assisted reproductive technology. Many times these treatments are combined. Doctors recommend specific treatments for infertility based on:

  • »The factors contributing to the infertility.
  • »The duration of the infertility.
  • »The age of the female.
  • »The couple’s treatment preference after counseling about success rates, risks, and benefits of each treatment option.
What is intrauterine insemination (IUI)?
Intrauterine insemination (IUI) is an infertility treatment that is often called artificial insemination. In this procedure, specially prepared sperm are inserted into the woman’s uterus. Sometimes the woman is also treated with medicines that stimulate ovulation before IUI. IUI is often used to treat:

  • »Mild male factor infertility.
  • »Couples with unexplained infertility.
What is assisted reproductive technology (ART)?
Assisted reproductive technology (ART) includes all fertility treatments in which both eggs and sperm are handled outside of the body. In general, ART procedures involve surgically removing eggs from a woman’s ovaries, combining them with sperm in the laboratory, and returning them to the woman’s body or donating them to another woman. The main type of ART is in vitro fertilization (IVF).
What are the different types of assisted reproductive technology (ART)?
Common methods of ART include:

  • »In vitro fertilization (IVF), meaning fertilization outside of the body. IVF is the most effective and the most common form of ART.
  • »Zygote intrafallopian transfer (ZIFT) or tubal embryo transfer. This is similar to IVF. Fertilization occurs in the laboratory. Then the very young embryo is transferred to the fallopian tube instead of the uterus.
  • »Gamete intrafallopian transfer (GIFT), involves transferring eggs and sperm into the woman’s fallopian tube. Fertilization occurs in the woman’s body. Few practices offer GIFT as an option.
  • »Intracytoplasmic sperm injection (ICSI) is often used for couples with male factor infertility. Sometimes it is also used for older couples or for those with failed IVF attempts. In ICSI, a single sperm is injected into a mature egg as opposed to “conventional” fertilization where the egg and sperm are placed in a petri dish together and the sperm fertilizes an egg on its own.

ART procedures sometimes involve the use of donor eggs (eggs from another woman), donor sperm, or previously frozen embryos. Donor eggs are sometimes used for women who cannot produce eggs. Also, donor eggs or donor sperm are sometimes used when the woman or man has a genetic disease that can be passed on to the baby. An infertile woman or couple may also use donor embryos. These are embryos that were either created by couples in infertility treatment or were created from donor sperm and donor eggs. The donated embryo is transferred to the uterus. The child will not be genetically related to either parent.

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