Infertility is defined as the inability to become pregnant after one year of unprotected, regular intercourse. The time is shortened to less than six months in women aged 35 and over. Approximately 11% of couples will experience infertility at some time in their reproductive lives.

Infertility in the female is usually caused by failed ovulation, tubal disease, cervical disorders, endometriosis, hormonal disorders, or uterine disorders. Male factor is implicated in up to 47% of infertile couples. In many cases, the cause of infertility can be determined, and this is termed "unexplained infertility".

Ovulatory Disorders

Irregular (or absent) ovulation has several causes including hormonal imbalances of the hypothalamic-pituitary-adrenal axis or thyroid, excess body weight, stress, ovarian diseases such as a tumor or cyst, a shortened menstrual cycle, extreme weight loss as is seen in eating disorders, alcohol abuse, or excessive exercise.

Tubal Disease

The mature eggs must travel through the Fallopian tubes to the distal end where they are fertilized. The tubes may by damaged from a previous infection, such as Chlamydia or gonorrhea, birth defects, previous surgeries on or around the tubes, endometriosis and other conditions.

Uterine Disease

The uterus must be healthy to support the implantation of the embryo and growth of the fetus. Fibroids are a type of non-cancerous growth that can occur inside the uterus, thus preventing proper fetal development. Adhesions (scar tissue) can form in or "around" the uterus as a result of previous surgery. The uterus may also have an abnormal shape or be positioned improperly. Many of these conditions can be treated surgically.

If the uterus cannot be repaired, a surrogate mother may be enlisted. A surrogate receives the couples embryos, which were created by in vitro fertilization, and carries the fetus to term and delivers the baby. The surrogate may be a friend or family member or she may be located through a surrogacy service and charge a fee. Surrogacy laws vary widely between states.

Endometriosis

Endometriosis is a major cause of infertility and it can cause damage throughout the body. Endometriosis attaches to the ovaries, tubes, etc., grows and divides thus causing obstruction. It will sometimes penetrate the organ it is attached to.

Cervical Factor

The sperm must be ejaculated into the vagina and travel through the cervix into the uterus. There must be sufficient cervical mucous to nourish the sperm and provide a transport media. In rare cases, a woman's body is allergic to her partners sperm and her body produces antibodies to destroy it. Fortunately, cervical factor infertility is readily treated using intrauterine insemination (IUI). In IUI, the specially prepared sperm are placed directly into the uterus thus avoiding the cervix.

Polycystic Ovarian Disease

Polycystic Ovarian Disease (PCOS) is very common in infertile women. The condition is characterized by increased male hormones (androgens), male characteristics such as excess hair growth, ovaries with numerous "old" follicles. PLEASE READ THE WEB PAGE ON PCOS.

Genetic

Some genetic problems can also cause infertility. Women become less fertile as they age, especially after age 30. Aneuploidy is when there is an abnormal number of chromosome pairs such as an extra chromosome 21, which causes Down's Syndrome. The male or female may have a translocation which is when a part of one chromosome switches places with another.

Fortunately, with today's technologies, approximately 85 % of infertile couples, who seek the care of a specialist, will conceive. It is very important that a specialist be seen early, especially if the female is in her thirties. Interestingly, most couples become pregnant with procedures such as IUI and don't require assisted reproductive technologies, such as in vitro fertilization.

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Robert B. McWilliams, MD Reproductive Endocrinology and Gynecology

Infertility