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| |    What Is Infertility? by Marjorie Greenfield, M.D. reviewed by Marjorie Greenfield, M.D. The term "infertility" brings a sick feeling to the hearts of thousands of couples who desperately want children. In reality, most people who are diagnosed as infertile actually are more likely to be subfertile (that is, although it's not as easy as it is for some couples, they are capable of conceiving); this distinction, of course, may be of little comfort when trying to have a baby. What follows is some basic information for couples who are wondering why it is taking them so long to get pregnant. Background: statistics of fertility and infertility When trying to conceive, a couple with no fertility problem has about a 30 percent chance of getting pregnant each month. So even very fertile people can take a while to have a baby, just as a matter of chance. A couple is considered infertile if no pregnancy occurs after they have had unprotected intercourse for one year. Using this definition, infertility is a reality for about 10 to 15 percent of couples. But if these couples continue to try to conceive for another year, about half of them will be successful, even without fertility treatment. Most couples who meet this definition of infertile have a factor that diminishes their chances of getting pregnant in any given menstrual cycle, rather than one that absolutely prevents conception. Maybe the odds are only 10 percent or even just 5 percent per month, but if they try long enough, their number may come up--even if it is a long shot. Statistically, some couples who have only a 5 percent chance of conceiving will get pregnant the first time they try, and they won't even know they had diminished fertility until they try to have another baby and run into difficulty getting pregnant. Therefore, it's important to keep in mind that how long it takes a couple to conceive is somewhat a matter of luck as well as odds. When is it necessary to see a doctor? Since half of the couples who are not pregnant in the first year will conceive in the following year, "trying" from one to three years (depending on how urgent it feels) is reasonable for couples in their 20s. Fertility is affected by age, particularly the woman's. For women over 35, many specialists recommend getting professional help after six months, and for women over 40, by 3 months of trying to conceive. For these couples, there is more likely to be a factor that is causing diminished fertility, and there is more time pressure, especially if they want to have more than one child. Female fertility starts dropping around the mid- to late thirties and decreases rapidly after 40. Although some older women conceive easily, about a third of women who try to conceive for the first time after 35, and fully half of the women who wait until after age 40, will not become pregnant after a year of trying. What causes infertility? Overall, male factors account for about 35 percent of infertility, female factors 35 percent. A combination of both male and female factors contribute to 20 percent of infertility cases, and 10 percent go unexplained even after all the tests are done. It may seem like a coincidence that both male and female factors affect so many couples. Keep in mind, however, that fertility problems are usually relative, so a mild male factor or an ovulation disturbance may diminish the chance per cycle of becoming pregnant, but over time the couple would likely be successful. On the other hand, both factors added together can significantly decrease the chance per cycle of conceiving so that they don't become pregnant by 12 months and are considered infertile. Principles of fertility treatment The purpose of fertility treatment is to help a couple improve their odds of getting pregnant in any given cycle. The best a couple can hope for is an average chance--30 to 40 percent--of conceiving in any given month. But the good news is that fertility treatment has been shown statistically to increase the likelihood that a pair will conceive sooner than they would have without treatment. For example, if a woman normally only releases an egg a few times each year, fertility medications may help make her ovulations more frequent and more predictable, thereby upping her odds of getting pregnant each month. The fertility work-up The evaluation of a couple who sees a doctor for infertility includes tests for male and female problems. These tests look for many different factors: what the sperm look like, how they move, and if the count is high enough; whether the woman is ovulating regularly and if her hormones are sufficient to sustain a pregnancy until it makes its own hormones; how the sperm survive in the cervix as they make their way to the uterus; whether the fallopian tubes allow the sperm and the egg to meet; whether some other condition like endometriosis may be interfering with conception. While the tests eventually may focus on one partner or the other, it's best if both members of the couple go to the first appointment together. Otherwise, the problem often can be missed if only one person goes through the whole evaluation. Often fertility tests include treatments to aid conception, so it's not wise to see a fertility specialist until you actually are ready to conceive. Plus, there are times when a couple can receive worrisome tests results, only to end up getting pregnant that cycle. It's important to keep in mind that even though fertility evaluation is an inexact science and test results may seem depressing, the information they supply can be crucial in directing couples to a successful therapy. There's no question that treatments like ovulation induction and IVF clearly help many couples with all sorts of causes for their diminished fertility--but the first step is to get evaluated.
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