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You may have
fertility problems if you haven't been able to get pregnant after trying for
at least 1 year. It doesn't necessarily mean you will never get pregnant. Often, couples conceive without help in
their second year of trying. Some don't succeed. But medical treatments do help
Age is an important factor if you are trying to
decide whether to get testing and treatment for fertility problems. A woman is
most fertile in her late 20s. After age 35, fertility decreases and the risk of
miscarriage goes up.
In cases of fertility problems:1
Before you have fertility tests, try
fertility awareness. A woman can learn when she is
likely to ovulate and be fertile by charting her
basal body temperature and using home tests. Some
couples find that they simply have been missing their most fertile days when
trying to conceive.
If you aren't sure when you ovulate, try
Interactive Tool: When Are You Most Fertile?
If these methods don't help, the first step is for both partners to have
some simple tests. A doctor can:
Your family doctor can do these tests. For more complete
testing, you may need to see a fertility specialist.
A wide range
of treatments is available. Depending on what is causing the problem, a couple may
be able to:
If these options aren't possible or don't work for you,
you may want to think about in vitro fertilization (IVF). During an IVF, eggs and
sperm are mixed in a lab so the sperm can fertilize the eggs. Then the doctor
puts one or more fertilized eggs into the woman's uterus. Many couples try IVF
more than once.
Treatment for fertility problems can be stressful,
costly, and hard on your body. Before you start testing, make some decisions
about how far you are willing to go with treatment. You may change your mind later, but it's a good idea
to start with a plan.
Treatments for fertility problems can increase your chances of
getting pregnant. But they also increase your chance of having twins, triplets, or more. Be sure to discuss the risks with
Fertility problems can put a lot of strain on a
couple. It may help to see a counselor with experience in fertility problems. Think
about joining a support group. Talking with other people who are going through the same thing can help you feel less alone.
Learning about fertility problems:
Health Tools help you make wise health decisions or take action to improve your health.
Fertility problems have many causes that involve either the woman's, the man's, or both partners'
reproductive systems. Some causes include:
Rates of infertility and miscarriage increase with age. A
woman's fertility peaks in her late 20s. It gradually begins to decline in her
early 30s. A more pronounced drop in fertility and increase in miscarriage risk
begins around her mid-30s. This is primarily due to the
aging egg supply. Male fertility also decreases with age. But it is a more
gradual decline than in women.
Fertility problems don't cause physical symptoms.
Most healthy young couples trying to have a child are successful after 1 year of trying. But about 10 to 15 out of every 100 couples have trouble getting pregnant.1
Just because you haven't been able to get pregnant after 1 year doesn't mean you can't get pregnant. Many couples later go on to get pregnant, even without treatment.
But your doctor may suggest testing and treatment if you haven't been able to get pregnant after 1 year of having sex 2 or 3 times a week without using birth control. For women over 35, some doctors will offer testing and
treatment after 6 months of trying to become pregnant.
If a clear cause can be found and if there is a promising treatment for that cause, pregnancy is more likely. When a cause can't be found and fertility tests are normal, treatment is less likely to work.
A couple's chances of getting pregnant are greatest within
their first 3 years of trying. After 3 years of sex without birth control,
pregnancy is considered unlikely without treatment.1
Some couples who have tried treatment without
success become pregnant later without more treatment.
Before deciding to move forward with testing and treatment, be sure to think about these issues:
Things that increase your risk of having fertility problems include:
Consult with your doctor if you:
Before seeking medical help with conception,
you can increase your chances of becoming pregnant by practicing
fertility awareness. This means charting your
basal body temperature and using home tests to let you know when you are
likely to ovulate and be fertile. For more information, see Home Treatment.
initial fertility questions and testing, you can see:
For complete fertility testing, see an
obstetrician/gynecologist with special training
and experience in fertility problems. This doctor may be called a
reproductive endocrinologist or fertility specialist.
When looking for a specialist, ask what percentage of a doctor's practice is
fertility treatment. Also ask if he or she has training in reproductive
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Testing for fertility problems usually starts with simple tests for both
partners. In addition to an interview and physical exams, these first
If your test results show no cause of
infertility, your doctor may recommend checking
fallopian tube function. Depending on your age and
other risk factors, you may then be offered further testing. Or you may begin
superovulation (to produce more eggs),
intrauterine insemination (which puts sperm into the uterus with a tube), or both.
For more information, see the topic Infertility Tests.
Testing can be stressful, costly, and sometimes painful. You may need only a few tests. Or you may need many tests over months and years.
Some fertility problems are more easily
treated than others. In general, as a woman ages, especially after age 35, her
chances of getting pregnant go down. But her risk of
miscarriage goes up.
are 35 or older, your doctor may recommend that you skip some of the steps
younger couples usually take. That's because your chances of having a baby decrease
with each passing year.
It's important to understand that even if you are
able to get pregnant, no treatment can guarantee a healthy baby. On the other
hand, scientists in this field have made many advances that have helped
millions of couples have babies.
Before you and your partner start
treatment, talk about how far you want to go with treatment. For
example, you may want to try medicine but don't want to have surgery. You may change your mind during your treatment, but it's good to start with
an idea of what you want your limits to be.
Treatment for fertility can also cost a lot. And insurance often doesn't cover these expenses. If cost is a
concern for you, ask how much the medicines and procedures cost. Then find out if your
insurance covers any costs. Talk with your partner about what you can afford.
Thinking about this ahead of time may help keep you from becoming emotionally and financially drained from trying a series of treatments you hadn't planned for.
Treatments for fertility problems in women depend on what may be keeping the woman from getting pregnant. Sometimes the cause isn't known.
Your doctor might recommend
that you try insemination first. The sperm are collected and then concentrated
to increase the number of healthy sperm for insemination.
Many couples who have problems getting pregnant arrive at a
common point: They must decide whether they want to try assisted reproductive technology (ART).
To learn more, see Other Treatment.
If you haven't already thought about
adoption, this might be a time to think about it. Some
couples decide at this point to spend their resources on adoption instead of
IVF. Other couples see IVF as the best option.
Fertility treatment clinics aren't
widely available in some parts of the country, especially in rural areas. You
may need to travel for treatment.
When you review clinic success rates, be aware that clinics
treating more severe fertility problems may have lower success rates. So
it's possible for a clinic with a lower success rate to have greater overall
expertise than clinics with higher success rates.
The success rate of a clinic is influenced by many things, including the doctors' skills and experience and the cause or
causes of your fertility problem.
When you review
treatment success rates, remember that live birth rates are always lower than
ovulation and pregnancy rates. Miscarriages are common among all women. But they are
more likely in women with risk factors such as older age or a poorly controlled
chronic health condition.
Some fertility problems are related to lifestyle or other health
conditions. To help protect your fertility:
If you have been diagnosed with cancer and hope to have
children in the future, talk to your doctor about
preventing cancer treatment–related infertility.
To decrease your risk of
fertility problems and increase your chances of becoming
pregnant, use the following guidelines.
Women who are trying to get pregnant should avoid
using alcohol and medicines, including
nonsteroidal anti-inflammatory drugs (NSAIDs) such as
ibuprofen and aspirin.
Medicine or hormone treatments are
often the first steps in
fertility treatment. They are also used for in vitro
fertilization and other
assisted reproductive technologies.
If you have irregular or
no ovulation, using medicine or hormones to stimulate ovulation will increase
your chances of pregnancy. But these treatments increase your risk of multiple
pregnancy. And that poses health risks to both you and your fetuses. When
thinking about a fertility treatment:
Other rare complications—such as
ovarian hyperstimulation syndrome—can be caused by
hormone shots used to stimulate ovulation. These shots may be used in assisted reproductive
technology such as IVF.
In very rare
cases, male fertility problems are caused by hormonal imbalances. Men are then
treated with medicine or hormones that help the hypothalamus and
pituitary gland start normal sperm production.
Ask your doctor questions about medicines you are considering. For example, are there
long-term effects? How long will the treatment last? How often you must be tested
while taking the medicine? Are there any side effects that will affect your
For some people, a structural problem can be treated
surgically. Treatment can increase the chances of natural conception.
When considering surgery, ask your doctor
questions about the procedure. For example, how
many times has the surgeon done the procedure? What are your chances of
treatment success? How long will it take to recover?
In cases of severely blocked fallopian tubes, your doctor may advise you to skip surgery and have in vitro fertilization (IVF). IVF is also often recommended first for women over 34 (regardless of the type of blockage). This is because tubal surgery and natural conception may use up precious time if in vitro fertilization might be used later.
Insemination and assisted reproductive technology (ART)
can improve the odds of pregnancy. They introduce the sperm to the egg in the
woman's reproductive tract (insemination) or in the lab (ART).
Insemination flushes the sperm through a
thin, flexible tube directly into a woman's
vagina, cervix, uterus, or fallopian tube. This puts sperm
closer to the egg. And it can overcome fertility barriers such as low sperm count and
Insemination can be used with donor sperm. It can be combined with
other fertility treatments, such as clomiphene or hormone shots.
ART is used to remove eggs from a woman's ovaries (or use donor eggs) and
fertilize them with the man's sperm (or donor sperm) outside the body. One or more fertilized eggs are
then transferred to the woman's uterus or fallopian tubes.
To compare ultrasound and laparoscopy for
egg collection procedures, see
Infertility: Using Ultrasound in ART.
ART procedures are expensive and complex. Most of the time they are used only after other treatment has failed.
Before deciding on ART treatment,
consider the possible
emotional and social, financial, religious, and
ethical and legal questions that may come up
for you and your partner.
In vitro fertilization (IVF) is the most common form of ART.
than one embryo is put in the uterus. This increases your chances that one will
develop into a baby. Because of this, IVF increases your chance of having more
than one baby at a time.
Side effects of IVF can include bloating, weight gain, and nausea. And you risk
having serious side effects such as liver and kidney problems. The embryos may
not grow into babies, so the IVF may need to be repeated.
If you have several
miscarriages or unsuccessful IVF attempts, talk to
your doctor about genetic testing.
insemination doesn't work, your doctor may recommend ICSI (say
"ICK-see"). In a lab, the doctor injects one sperm into an egg. If fertilization
occurs, the doctor puts the embryo into the woman's uterus, just as in vitro
Your doctor may also recommend ICSI when the man has had a vasectomy or has retrograde ejaculation. In retrograde
ejaculation, the semen is ejaculated into the bladder instead of out through the
penis. In these cases, sperm can be taken from the
testicles so that they can be injected into an
Another less common treatment is gamete or zygote intrafallopian transfer (GIFT or
Success rates with IVF are as good as with GIFT and ZIFT or better. And IVF is less expensive. It is also less risky,
because it isn't a surgical procedure.
These treatments include:
It is important to
talk with your doctor before you use any complementary or alternative
The InterNational Council on Infertility Information Dissemination
(INCIID—pronounced "inside") is a nonprofit organization that helps individuals
and couples explore their family-building options. INCIID provides current
information and immediate support regarding the diagnosis, treatment, and
prevention of infertility and pregnancy loss and offers guidance to those
considering adoption or child-free lifestyles.
In accordance with U.S. federal law, the CDC annually publishes
pregnancy success rates for assisted reproductive technology (ART) clinics.
This report includes a comprehensive listing of fertility clinics, help with
interpreting success rates, frequently asked questions about ART, and a
glossary of terms related to infertility treatment.
The American Fertility Association is a national
nonprofit organization that helps women and men facing decisions related to
family building and reproductive health—from prevention and treatment of
infertility to social and psychological concerns. The mission of AFA is to
serve as a lifetime resource for men and women who need reproductive
information and support and to forward the causes of adoption and reproductive
health through advocacy, education, awareness building, and research
This organization provides literature and information on
The National Institute of Child Health and Human
Development (NICHD) is part of the U.S. National Institutes of Health. The
NICHD conducts and supports research related to the health of children, adults,
and families. NICHD has information on its Web site about many health topics.
And you can send specific requests to information specialists.
RESOLVE is a nonprofit organization that provides
support and information to people who are experiencing infertility. Its goal is
to increase awareness of infertility issues through public education and
advocacy. RESOLVE supports family-building through a variety of methods,
including medical treatment, adoption, surrogacy, and the choice of child-free
RESOLVE provides helpful information on handling financial
costs and insurance coverage for infertility treatment.
CitationsFritz MA, Speroff L (2011). Female infertility. In
Clinical Gynecologic Endocrinology and Infertility, 8th
ed., pp. 1137–1190. Philadelphia: Lippincott Williams and Wilkins.Lobo RA (2007). Infertility: Etiology, diagnostic evaluation, management, prognosis. In VL Katz et al., eds., Comprehensive Gynecology, 5th ed., pp. 1001–1037. Philadelphia: Mosby.Fritz MA, Speroff L (2011). Male infertility. In
Clinical Gynecologic Endocrinology and Infertility, 8th
ed., pp. 1249–1292. Philadelphia: Lippincott Williams and Wilkins.Fritz MA, Speroff L (2011). Assisted reproductive technologies. In
Clinical Gynecologic Endocrinology and Infertility, 8th
ed., pp. 1331–1382. Philadelphia: Lippincott Williams and Wilkins.Manheimer E, et al. (2008). Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: Systematic review and meta-analysis. BMJ, 336(7643): 545–549.Other Works ConsultedAmerican College of Obstetricians and Gynecologists
(2008). Medical management of ectopic pregnancy. ACOG
Practice Bulletin No. 94. Obstetrics and Gynecology,
111(6): 1479–1485.American Society for Reproductive Medicine (2004). Patient's Fact Sheet: Cancer and Fertility Preservation. Birmingham, AL: Society for Reproductive Medicine.American Society for Reproductive Medicine Practice Committee (2006). Multiple pregnancy associated with infertility therapy. Fertility and Sterility, 86(Suppl 4): S106–S110.El-Chaar D, et al. (2009). Risk of birth defects increased in pregnancies conceived by assisted human reproduction. Fertility and Sterility, 92(5): 1557–1561.Kumar A, et al. (2007). Infertility. In AH DeCherney et al., eds., Current Diagnosis and Treatment Obstetrics and Gynecology, 10th ed., pp. 917–925. New York: McGraw-Hill.
December 7, 2011
Sarah Marshall, MD - Family Medicine & Femi Olatunbosun, MB, FRCSC - Obstetrics and Gynecology
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