Infertility Defined

Infertility is the inability to become pregnant after a defined period of time of unprotected sexual intercourse. For women ages 35 years and younger, the defined time period is considered to be approximately one year. Women over 35 years of age are advised to seek evaluation and treatment after a six month period, as fertility declines markedly after 37 years of age. The incidence of infertility increases as the women age.

Twenty to twenty five percent of fertile patients will conceive during one month of unprotected intercourse. Sixty percent will conceive after six months, and 85 percent will conceive after one year. These conception rates are averages and will vary between patients.

Infertility is divided into two categories. Primary infertility refers to a patient who has had no prior pregnancies. Secondary infertility refers to a patient who has had prior pregnancies. Primary infertility occurs in about 15% of couples.

Infertility is a complex disease and is often due to numerous factors. A woman who suspects she is infertile must have a thorough evaluation by a specialist. The first office visit may consist of a history and physical. The doctor will ask questions regarding frequency of intercourse, regularity of periods, general health, etc. Patients will also be asked about any pelvic infections, endometriosis, fibroids, polycystic ovary syndrome, surgeries, ectopic pregnancies, or social habits (such as smoking) that may negatively affect fertility.

It is very important that the male partner be evaluated during the initial work up. A history of genital infections, trauma, or environmental exposure to toxins, can reduce male fertility. Disorders of the endocrine system (hypothalmus, pituitary), structural dysfunction (such as obstruction of the vas deferens), or numerous other conditions can cause male infertility. In addition, the male may experience sexual dysfunction and/or retrograde ejaculation. Because fertility depends on the ability to produce sperm, a semen analysis is conducted. The analysis looks at the amount and concentration of sperm and the presence of infection or blood.

Common Causes of Infertility

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