Infertility means you cannot make a baby (conceive).A.D.A.M.

Causes, incidence, and risk factors

A wide range of physical and emotional factors can cause infertility. Infertility may be due to problems in the woman, man, or both.

FEMALE INFERTILITY:

Female infertility may occur when:

• A fertilized egg or embryo does not survive once it sticks to the lining of the womb (uterus)
• The fertilized egg does not attach to the lining of the uterus
• The eggs cannot move from the ovaries to the womb
• The ovaries have problems producing eggs

Female infertility may be caused by:

• Autoimmune disorders, such as antiphospholipid syndrome (APS)
• Cancer or tumor
• Clotting disorders
• Diabetes
• Growths (such as fibroids or polyps) in the uterus and cervix
• Birth defects that affect the reproductive tract
• Excessive exercising
• Eating disorders or poor nutrition
• Use of certain medications, including chemotherapy drugs
• Drinking too much alcohol
• Obesity
• Older age
• Ovarian cysts and polycystic ovary syndrome (PCOS)
• Pelvic infection or pelvic inflammatory disease (PID)
• Scarring from sexually transmitted infection, previous abdominal surgery, or endometriosis
• Smoking
• Surgery to prevent pregnancy (tubal ligation) or failure of tubal ligation reversal (reanastomisis) 
• Thyroid disease
• Too little or too much of certain hormones

MALE INFERTILITY:

Male infertility may be due to:

• A decrease in sperm count
• Sperm being blocked from being released
• Sperm that do not work properly

Male infertility can be caused by:

• Being in high heat for prolonged periods
• Birth defects
• Cancer treatments, including chemotherapy and radiation
• Environmental pollutants
• Heavy use of alcohol, marijuana, or cocaine
• Impotence
• Infection
• Obesity
• Older age
• Retrograde ejaculation
• Scarring from sexually transmitted infections, injury, or surgery
• Smoking
• Too little or too much hormones
• Use of certain drugs, such as cimetidine, spironolactone, and nitrofurantoin
• Vasectomy, or failure of vasectomy reversal

In healthy couples under age 30 who have sex regularly, the chance of getting pregnant is about 25 - 30% per month.

A woman's peak fertility occurs in her early 20s. After age 35 (and especially 40), the chance that a woman can get pregnant drops considerably. The age when fertility starts to decline is different from woman to woman.

Signs and tests

When you should get treated for infertility depends on your age. Doctors often suggest that women under 30 should try to get pregnant on their own for 1 year before getting tested.

Infertility testing involves a complete medical history and physical examination of both partners.

Blood and imaging tests will be done. In women, this may include:

• Blood tests to check hormone levels, including progesterone and follicle stimulating hormone
• Taking body temperature first thing in the morning to check if the ovaries are releasing eggs
• FSH and clomid challenge test
• Hysterosalpingography (HSG)
• Pelvic ultrasound
• Laparoscopy
• Luteinizing hormone urine test (ovulation prediction)
• Thyroid function tests

Tests in men may include:

• Sperm testing
• Examination of the testes and penis
• Ultrasound of the male genitals (sometimes done)
• Blood tests to check hormone levels
• Testicular biopsy (rarely done)

Treatment

Treatment depends on the cause of infertility. It may involve:

• Education and counseling
• Fertility treatments such as intrauterine insemination (IUI) and in vitro fertilization (IVF)
• Medicines to treat infections and clotting disorders
• Medicines that help the woman grow and release eggs from the ovaries

You can increase your chances of becoming pregnant each month by having sex at least every 3 days before and during ovulation. It is especially important to do so before ovulation occurs. Sperm can live inside a woman's body for at least 3 days. However, a woman's egg can only be fertilized by the sperm for a few hours after it is released. 

Ovulation occurs about 2 weeks before the next menstrual cycle (period) starts. If a woman gets her period every 28 days, the couple should have sex at least every 3 days between the 10th and 18th day after the period starts.

If you are under- or overweight, getting to a healthier weight may increase your chance of getting pregnant.

Support Groups

Sharing with others who have similar fertility challenges can help you not feel alone. Ask your health care provider to recommend local groups. Or check the internet for resources.

Expectations (prognosis)

As many as 1 in 5 couples diagnosed with infertility eventually become pregnant without treatment.

More than half of couples with infertility become pregnant after treatment, not including advanced techniques such as in vitro fertiliziation (IVF).

Calling your health care provider

Call for an appointment with your health care provider if you are unable to get pregnant.

Prevention

Preventing sexually transmitted infections (STIs), such as gonorrhea and chlamydia, may reduce your risk of infertility.

Maintaining a healthy diet, weight, and lifestyle may increase your chance of getting pregnant and having a healthy pregnancy.

References

1. American Society for Reproductive Medicine. Diagnostic evaluation of the infertile female: a committee opinion. Fertil Steril. 2012;98:302-307. [PubMed: 22698637]
2. American Society for Reproductive Medicine. Diagnostic evaluation of the infertile male: a committee opinion. Fertil Steril. 2012;98:294-301. [PubMed: 22698639]
3. Bulun SE. Physiology and pathology of the female reproductive axis. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 17.
4. Lobo RA. Infertility: etiology, diagnostic evaluation,management, prognosis. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, PA: Elsevier Mosby; 2012: chap 41.

Review Date: 2/8/2013.

Reviewed by: Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.