Infertility

Causes and Risks:
Primary infertility is the term used to describe a couple that has never been able to conceive a pregnancy , after a minimum of one year of attempting to do so through unprotected intercourse. Secondary infertility is the term used to describe couples who have previously been pregnant at least once, but have not been able to achieve another pregnancy.

Causes of infertility include a wide range of physical, as well as emotional factors. Approximately 30 to 40% of all infertility is due to a "male" factor (such as retrograde ejaculation , impotence , hormone deficiency, environmental pollutants, scarring from sexually-transmitted disease, or decreased sperm count due to heavy marijuana use or prescription drugs such as cimetidine, spironolactone, and nitrofurantoin).

A "female" factor (for example, scarring from sexually-transmitted disease, ovulation dysfunction, poor nutrition, hormone imbalance, cysts or cancer of the ovaries or uterus, pelvic infection or tumor , or transport system abnormality from the cervix through the Fallopian tubes) is responsible for 40 to 50% of infertility in couples. The remaining 10 to 30% may be caused by contributing factors by both partners, or no cause can be adequately identified.

It is estimated that 10 to 20% of couples will be unable to conceive after one year of attempting to become pregnant. It is important that pregnancy be attempted for an extended period (at least one year); the chances for pregnancy occurring in young healthy couples, having intercourse regularly, is only 25 to 30% per month.

Increased risk for infertility is associated with:



Prevention:
Because infertility is frequently caused by sexually-transmitted diseases, practicing safer sex behaviors may minimize the risk of future infertility. Gonorrhea and chlamydia are the two most frequent causes of STD-related infertility. These diseases are often initially asymptomatic until PID or salpingitis develops. These inflammatory processes cause scarring of the Fallopian tubes and subsequent decreased fertility, absolute infertility or and increased incidence of ectopic pregnancy .

Mumps immunization has been well demonstrated to prevent mumps and its male complication orchitis . Immunization prevents mumps-related sterility.

Some forms of birth control carry a higher risk for future infertility (such as the IUD - intrauterine device). However, IUD are not recommended for women who have not previously had a child therefore women selecting the IUD may be willing to accept the very slight risk of infertility associated with their use. Careful consideration of this risk, weighed with the potential benefits, should all be reviewed and discussed with both partners and the health care provider.

Symptoms:

  • inability to become pregnant
  • a range of emotional reactions by either or both members of the couple related to childlessness (In general, reactions are greater among childless couples. Having a single child blunts the depth of emotion problems).



Signs and Tests:
A complete history and physical examination of both partners is essential.

Tests may include:

  • semen analysis to evaluate ejaculate; collected after 2 to 3 days of complete abstinence to determine volume and viscosity of semen and sperm count , motility, swimming speed, and shape.
  • measuring basal body temperature--taking the woman's temperature each morning before arising in an effort to note the 0.4 to 1.0 degree Fahrenheit temperature increase associated with presumptive ovulation.
  • monitoring cervical mucus changes throughout the menstrual cycle to note the wet, stretchy and slippery mucus associated with the ovulatory phase.
  • postcoital test (PCT)--to evaluate sperm-cervical mucus interaction through analysis of cervical mucus collected 2 to 8 hours after the couple has intercourse.
  • measuring serum progesterone (blood test)
  • endometrial biopsy
  • testicular biopsy (rarely done)
  • measuring urinary luteinizing hormone by using kits commercially available for home use to predict ovulation and assist with timing of intercourse.
  • progestin challenge--with sporadic or absent ovulation
  • serum hormonal levels (blood tests) for either or both partners
  • hysterosalpingography (HSG)--X-ray procedure done with contrast dye that enables evaluation of potential transport from the cervix through the uterus and Fallopian tubes.
  • laparoscopy to allow direct visualization.
  • pelvic exam (women) to determine if there are cysts or damage to the endometrium.



Treatment:
Treatment depends on the cause of infertility for any given couple. It may range from simple education and counseling, to the use of medications that treat infections or promote ovulation, to highly sophisticated medical procedures such as in-vitro fertilization.

It is important for the couple and provider to recognize and discuss the emotional impact of the condition upon the couple, both as individuals and jointly as a couple. As new treatments are announced, couples may either experience new hope or only have to deal with old wounds being reopened. Support groups for infertile couples may be an important source of strength and comfort. RESOLVE, a national organization, provides both informal support and serves as a referral base for professional counseling specific to infertility issues. See infertility - support group .

Prognosis:
A probable cause can be determined for about 85 to 90% of infertile couples. Appropriate therapy (not including advanced techniques such as in-vitro fertilization) allows pregnancy to occur in 50 to 60% of previously infertile couples. Without any treatment intervention 15 to 20% of couples previously diagnosed as infertile will eventually become pregnant .

Complications:
Although infertility itself does not cause physical illness, the psychological impact of infertility upon individuals or couples affected by it may be severe. Marital problems, including divorce, as well as individual depression and anxiety are commonly encountered.

Call Your Healthcare Provider:
Call for an appointment with your health care provider if you are unable to achieve a desired pregnancy .


Pelvic laparoscopy is a surgical procedure used to view the interior of the lower abdomen without major surgery. Small optical instruments can be inserted through the abdominal wall to directly visualize the interior of the abdomen. Some surgeries can be done using laparoscopic techniques. Recovery from this type of surgery, unlike open surgery, often takes only a day and the patient usually returns home the next morning.



This is an illustration of the female reproductive system. Both internal and external views are shown here.



This is an internal view of the male reproductive system.



Gonorrhea is a sexually transmitted disease that causes infection of the genitals. The organisms can spread into the bloodstream (gonococcemia). They frequently lodge in the skin surface, forming a small red infected area. Sometimes a person with severe gonococcemia may have only a few skin lesions.