General Information on Infertility
There are many factors that play a role in both male and female reproductive health. This section provides a high level overview of some of the main causes of infertility.
- Overview of Infertility
- Age and Fertility
- Problems with Ovulation
- Damage to Fallopian Tubes
- Male Factor
- More Resources
Infertility is defined as the inability to conceive after 12 months of unprotected intercourse. For women aged 35 and older, inability to conceive after 6 months is generally considered infertility. Repeated pregnancy loss (2 or more spontaneous pregnancy losses) can also be considered infertility. Recent estimates indicate infertility affects 10-15 percent of the population in their childbearing years.
If you experience recurrent pregnancy loss, or if you have not been able to become pregnant within a year (six months if the woman’s age is over 35, 2-3 months if over 40), then you may benefit from assessment and treatment by a reproductive endocrinologist—a doctor with a special interest, training and expertise in the area of infertility.
Thanks to developments during the past decade, the majority of couples who seek medical attention for infertility are able to conceive. Treatments include medications, minor laboratory or office procedures, surgical procedures and assisted reproductive technologies (ART), depending on the individual situation. Your doctor can determine which treatment options are best for you.
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Age and Fertility
Age affects fertility of both men and women. Although men who are in advanced years may father children, fertility rates drop for men beginning at about age 40. For women, the chance of conceiving each month is 25 to 30 percent in her 20s and early 30s. That figure is reduced to 10 percent or less by the by the time a woman is 40 years old.
Women are born with a fixed number of eggs. From about 400,000 eggs at birth, the number decreases even during early childhood, bringing the number closer to 300,000 eggs by the time a woman reaches puberty. Over the next 35 to 40 years of reproductive life, only 400 to 500 eggs will ovulate and at menopause only a few hundred will remain. In particular, there is an acceleration of egg follicle loss during the last 10 to 15 years before menopause. Ovarian function ends when a woman's follicles and eggs are depleted and when the production of estrogen and progesterone ceases. In addition to age, other factors including smoking, genetics, exposure to radiation and prior ovarian surgery may contribute to a more rapid loss of eggs
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Ovulation problems can cause infertility. Irregular menstrual cycles or lack of ovulation can make it difficult to conceive. Polycystic ovary syndrome (PCOS), thyroid disease and other hormonal disorders can affect ovulation and lead to infertility. Being overweight or underweight can also cause problems with ovulation and fertility. Women with these symptoms should consider seeking a fertility assessment early in the process of trying to get pregnant.
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Damaged or Blocked Fallopian Tubes
Fertilization of the egg by the sperm occurs in the fallopian tube 12 to 24 hours after ovulation. The resulting embryo moves through the fallopian tube to the uterus, where it implants and continues to develop. If the fallopian tubes are blocked or damaged, this can result in infertility or ectopic pregnancy (pregnancy outside the uterus). Endometriosis, surgery in the pelvis or sexually transmitted infections (like gonorrhea or chlamydia) can cause damage to the tubes. If you are concerned about the health of your fallopian tubes, please discuss this with your doctor early in the process of trying to get pregnant.
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Thirty to 40 percent of all cases of infertility are related to problems with sperm production. In another third of cases, infertility is due to a combination of male and female problems. If there is a problem with the quality of the sperm, measured by the amount (volume), movement (motility) and shape (morphology) of the sperm, it can result in infertility. Problems with fertility can also result when the male partner is not able to release (ejaculate) sperm.
Several medical problems can affect a man’s ability to make normal amounts or normal quality sperm or cause trouble with ejaculation. Weight and lifestyle choices can also impact male fertility. Smoking and recreational drugs have been shown to affect sperm quality, and overweight men are more likely to have problems with their sperm. Development of immature sperm to mature sperm takes 72 days. Therefore, factors such as fever, medications, medical problems, cigarette smoking or heavy alcohol use may impact the semen analysis for nearly two and a half months afterward.
Men with previous problems with the testicles or specific medical problems known to affect fertility should be assessed early in the process of trying to get pregnant. The semen analysis is the initial test to determine if there is male infertility. Additional semen tests or consultation with an urologist may also be required.
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There are many more factors to consider when trying to determine the cause and treatment for infertility.
An excellent resource for more in-depth information about infertility and infertility testing is the American Society for Reproductive Medicine's overview booklet titled "Infertility: An Overview."
You may also find our sections on Frequently Asked Questions and Infertility Resources to be helpful.
* PAMF's website has numerous links to outside Internet pages, however, we do not sponsor or endorse any of these sites, nor does PAMF make any guarantee, warranty or representation regarding the accuracy of the information contained on them. Visit PAMF Privacy & Content Policy for more information.
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