Infertility



Infertility (in-fer-TIL-i-tee) means that a couple has difficulty conceiving a child after approximately a year of trying. The man, woman, or both may have problems with their reproductive system that causes them to be infertile.

KEYWORDS

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Artificial Insemination

Assisted reproductive technology

Gynecology

In vitro fertilization

Reproductive medicine

What Is Infertility?

Infertility is defined as the failure to become pregnant after about a year of trying many times without using contraception * . Infertility problems increase as a person gets older, and they are becoming more widespread as many women are waiting to have babies until they are in their thirties and forties. Currently, fertility problems affect at least 6.1 million couples in the United States. For people who cannot imagine their lives without children and are not considering adoption, the condition may be heartbreaking.

Doctors can find no medical cause for up to 20 percent of infertility cases. In 15 to 20 percent of infertility cases, both the man and the woman have fertility problems. The rest of the time, infertility is caused by problems with either the male or the female reproductive system. Some doctors believe that smoking, drinking a lot of alcohol, poor eating habits, stress, excess weight, and generally poor health can make the physical problems causing infertility even worse.

Male factor infertility

Roughly 35 to 40 percent of infertile couples are unable to conceive because of a problem with the male reproductive system. Infertility can result when a man does not produce enough sperm * , or when the sperm have too short a life span, they do not move properly, or they cannot penetrate the egg to fertilize it. These problems can be caused by many factors, including abnormalities of reproductive organs, a varicose vein * in the scrotum * , inflammation * in the male genitals, and sexually transmitted diseases, such as chlamydial (kla-MID-e-al) infections, gonorrhea (gon-o-REE-a), and syphilis (SIF-i-lis). Some men have trouble ejaculating (discharging sperm), which also can cause infertility. In rare cases, the immune system * of the man or woman may produce antibodies * that kill sperm.

* contraception (kon-tra-SEP-shun) is the deliberate prevention of conception or impregnation.

* sperm are the tiny, tadpole-like cells in the fluid males produce in their testicles (TES-ti-kulz) that can unite with a female's egg to result eventually in the birth of a child.

* varicose vein (VAR-i-kose VAYN) is an abnormally swollen or dilated vein.

* scrotum (SKRO-tum) is the pouch on a male body that contains the testes (TES-teez) and their accessory organs.

* inflammation (in-fla-MAY-shun) is the body's response to infection or irritation.

* immune system is the body system that fights disease.

* antibodies (AN-te-bod-eez) are proteins produced by the immune system to fight specific infections. In certain disorders, antibodies attack some of the body's own proteins and cells.

* hormone is a chemical that is produced by different glands in the body. A hormone is like the body's ambassador: it is created in one place but is sent through the body to have specific regulatory effects in different places.

Infertility in women

Another 35 to 40 percent of couples are infertile because of a problem with the female reproductive tract. Problems can occur in any part of the system:

  • Ovaries: The ovaries (O-va-reez) are a pair of organs where egg cells develop and mature. About 25 percent of female infertility is caused by the failure of a mature egg to leave the ovary (a process called ovulation).
  • Hormones: Problems with hormone * production can prevent pregnancy.
  • Fallopian tubes: A woman has two fallopian (fa-LO-pe-an) tubes (one associated with each ovary), which carry eggs from the ovaries to the uterus (YOO-ter-us). Infertility can occur when one or both of the fallopian tubes are blocked, scarred, or collapsed.
  • Pelvic inflammatory disease (PID): Infertility also is common in women with PID, which is an infection of the female reproductive organs (especially the fallopian tubes).
  • Uterus: The uterus is the muscular organ in which a fertilized egg develops into a fetus (FEE-tus; developing baby). If the uterus contains scar tissue or a piece of tissue dividing it in half, the fertilized egg might not be able to implant and grow.
  • Endometriosis: Women also can have infertility problems because of conditions such as endometriosis (en-do-me-tree-O-sis), which occurs when pieces of the lining of the uterus grow outside of the uterus.
  • Fibroids: Fibroids (FY-broidz) are noncancerous tumors * that also can cause infertility.
  • Cervix: The cervix (SER-viks) is the opening between the uterus and the vagina. Infertility can occur if the cervix does not produce enough mucus * to allow sperm to pass into the uterus.
  • Vaginal infections: The vagina (va-JY-na) is the tubular canal that runs from the cervix to the outside of the body. Certain vaginal infections that spread to the uterus and fallopian tubes can cause infertility.

How Is Infertility Diagnosed?

The first step in treating infertility is finding out the cause. Both the man and the woman require a complete physical examination to determine if a physical disorder is causing infertility.

The first test for male infertility is an analysis of the sperm for shape, movement, and number. The first test for a woman is to find out if she is ovulating. Home ovulation * kits are available for this purpose, as are body temperature charts (the body temperature fluctuates during the menstrual cycle * ). Tests of a woman's blood and urine also help doctors to determine if a woman is having normal menstrual cycles. An x-ray of the uterus and fallopian tubes can reveal any blockage that might prevent the egg from being fertilized. In some cases, the doctor may look inside the body with a laparoscope * , which is a viewing tube that is inserted into the abdomen * through a small incision.

* tumors (TOO-morz) usually refer to abnormal growths of body tissue that have no known cause or physiologic purpose, Tumors may or may not be cancerous.

* mucus (MU-kus) is a kind of body slime. It is thick and slippery, and it lines the inside of many parts of the body.

* ovulation (ov-yoo-LAY-shun) is the release of a mature egg from the ovary.

* menstrual cycle (MEN-stroo-al SY-kul) culminates in menstruation (men-stroo-AY-shun), the discharging through the vagina of blood, secretions, and tissue debris from the uterus that recurs at approximately monthly intervals in females of breeding age.

* laparoscope (LAP-a-ro-skope) is a fiber-optic instrument inserted into an incision in the abdominal wall to perform a visual examination.

* abdomen (AB-do-men), commonly called the belly, is the portion of the body between the thorax (THOR-aks) and the pelvis.

How Is Infertility Treated?

Difficulty conceiving a baby may not be a permanent condition, and many couples with fertility problems eventually have a child without medical intervention. However, some couples need medical help to become pregnant, and the treatment depends on the cause of infertility. If a hormone deficiency causes infertility, treatment may involve taking hormones prescribed by a doctor. If there is damage or an abnormality in the female organs, they sometimes can be repaired surgically. For other couples, treatment can range from taking fertility drugs to using assisted reproductive technology (ART). Many treatments for infertility exist; only a few are described in the following.

Artificial insemination

Artificial insemination (in-sem-i-NAY-shun) is the introduction of a man's sperm into the opening of a woman's uterus with a tube called a catheter (CATH-e-ter). Before insemination, antibodies and unhealthy sperm are removed from the semen (SEE-men), the fluid containing sperm. The sperm used in artificial insemination ideally comes from the woman's male partner. However, in cases where the man is infertile or carries a genetic disorder, sperm from a donor may be used.

Fertility drugs

Fertility drugs can be used to treat problems with ovulation. A number of different medications have been developed that help to stimulate the maturation and release of ova (eggs).

In vitro fertilization (IVF)

"In vitro" literally means "in glass" (as in a test tube) and therefore refers to a procedure performed outside the body. In vitro fertilization (IVF) occurs when eggs are removed from the woman and mixed with sperm in the laboratory. Fertilized eggs, or embryos, then are placed in the woman's uterus. This procedure bypasses the fallopian tubes.

Before IVF, women usually take fertility drugs in order to produce multiple eggs. Eggs are taken from a woman's ovaries using a needle inserted through the vagina. The male partner provides a sperm sample, which is mixed with the eggs in a dish in the laboratory. After several days, if the eggs have been fertilized and have developed into embryos, two to five embryos (usually) are placed into the uterus (not all are expected to develop into fetuses). About two weeks later, the woman takes a pregnancy test to see if the procedure was successful.

Coping with Infertility: Jim and Sarah's Story

Jim and Sarah Albertson are among the 10 to 20 percent of the reproductive-aged population in the United States who have difficulty having a baby. Even though pregnancy is possible in more than half of couples pursuing fertility treatment, it does not seem possible for them.

Jim and Sarah began trying to have a baby on their honeymoon, when they were both 34. Five years later, they still have no children. Sarah has had surgery to remove fibroids, and she has taken hormones and fertility pills. Jim has done everything possible to increase his sperm count. They have tried artificial insemination. It seems their whole lives revolve around trying to get pregnant, but nothing is working.

Multiple Births

One of the major problems facing couples undergoing fertility treatment is that of multiple births. Fertility drugs may result in multiple births, because they can stimu late release of multiple eggs. For examlfle, as many as 10 percent of women who become pregnant with the help of the drug Clomid (KLO-mid), or clomiphene citrate (KLO-mi-feen SY-trayt), have twins, and 1 in 400 women have triplets.

Assisted reproductive technologie such as in vitro fertilization usually plac two to five eggs inside the woman's reproductive tract, because not all are expected to survive—but sometimes thiey all do. In the 1990s, several women whc underwent fertility treatment had as mafny as eight babies at once.

The more embryos that develop at one time in the uterus, the more likely tlhey are to be born prematurely, to be small, and to have serious health problems such as cerebral palsy (se-REE-bral PAWL-zee) and brain damage. Because of such health problems, and because of ethic, II and financial issues associated with multiple births, fertility treatment can bi controversial.

A couple with a fertility problem discu their treatment options with a doctor. © 1989 Custom Medical Stock Photo.
A couple with a fertility problem discu their treatment options with a doctor.
© 1989 Custom Medical Stock Photo.

As Jim and Sarah watch one friend after another have a baby, their own home begins to feel empty. They try not to blame each other, but it is hard not to. Even though their health plan does not cover in vitro fertilization, they decided to spend their own money to try to get pregnant that way. Three tries and $30,000 later, they still have no baby. With the help of marital counseling and the support of other couples with the same problem, Jim and Sarah are learning to accept that they may not have biological children.

See also
Chlamydial Infections
Endometriosis
Gonorrhea
Menstrual Disorders
Pelvic Inflammatory Disease (PID)
Pregnancy, Complications of
Prematurity
Sexually Transmitted Diseases
Syphilis
Varicose Veins

Resources

Books

Cooper, Susan, and Ellen Sarasohn Glazer. Choosing Assisted Reproduction: Social, Emotional and Ethical Considerations.
Indianapolis, IN: Perspectives Press, 1999.

Turiel, Judith Steinberg. Beyond Second Opinions: Making Choices about Fertility Treatment. Berkeley, CA: University of California Press, 1998.

Organizations

American Society for Reproductive Medicine, 1209 Montgomery Highway, Birmingham, AL 35216-2809.
Telephone 205-978-5000
http://www.asrm.org

InterNational Council on Infertility Information Dissemination, Inc. (INCIID), P.O. Box 6836, Arlington, VA 22206.
Telephone 703-379-9178
http://www.inciid.org

RESOLVE, The National Infertility Association, 1310 Broadway, Somerville, MA 02144.
Telephone 617-623-0744
http://www.resolve.org



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