Definition

Infertility is not being able to conceive after a year of trying. This means having regular, unprotected sex. About one-third of cases are caused by male factors. An equal number are caused by female factors. In the remaining cases, the cause is unknown or is due to problems with both partners.

Causes

Successful conception involves many steps:

• An egg is released from the woman’s ovaries (ovulation).
• The egg travels to the fallopian tubes. Here, the man’s sperm can fertilize it.
• If the egg is fertilized (conception), it moves down the fallopian tubes to the uterus.
• It implants itself into the wall of the uterus. It then begins its 40 weeks of fetal growth.

Most cases of infertility are due to problems with ovulation or problems with fallopian tubes.

Risk Factors

Infertility is more common in women who are older than 35 years old.

These factors increase your chance of developing infertility:

• Very high or very low levels of body fat (resulting in lack of ovulation), obesity
• Excessive exercise (causing to severe a loss of body fat)
• Chronic diseases, such as:
  • Diabetes
  • Lupus
  • Arthritis
  • Hypertension
  • Asthma
• Smoking
• Caffeine consumption
• Alcohol intake
• Occupational exposure to:
  • High temperatures
  • Toxic substances
  • Chemicals
  • Pesticides
  • Radiation
  • Constant stress
• History of:
  • Pelvic inflammatory disease
  • Endometriosis
  • Polycystic ovaries
  • Ectopic pregnancy
  • Kidney failure
  • Cirrhosis
  • Pituitary tumors
  • Anorexia nervosa
  • Autoimmune hypothyroidism
  • Uterine fibroids
  • Pelvic surgery (including uterine surgery)
  • Ulcerative colitis
  • Crohn disease
  • Epilepsy
  • Cushing’s disease
  • Sickle cell anemia
  • HIV infection
  • Kidney disease
  • Appendicitis with complications (ruptured appendix)
• Medications, including
  • Acetaminophen
  • Ibuprofen
  • Pain medications
  • Antibiotics
  • Antidepressants

Symptoms

After one year of trying to conceive, you and your partner should seek help.

Diagnosis

During the first visit, you will both be evaluated. You will be asked about symptoms and medical history. Your doctor will look for physical problems that might cause infertility.

The following tests may be done to see if you are ovulating:

• Basal body temperature—rises at ovulation and remains elevated during the second half of your cycle and throughout pregnancy; you take your temperature every day and record it on a chart
• Blood test—to measure hormone levels
• Endometrial biopsy —to see if ovulation is causing changes in the lining of the uterus

The following may be done to check if your uterus and fallopian tubes are normal:

• Hysterosalpingography (HSG)—an x-ray of the uterus and fallopian tubes
• Transvaginal ultrasound—a device inserted into the vagina to take an image of the pelvic organs
• Hysteroscopy—a thin device inserted through the cervix to look inside the uterus
• Laparoscopy —a small device with a camera is inserted into incisions in the abdomen, allowing the doctor to examine the fallopian tubes, ovaries, and uterus

Treatment

Treatment depends on what is causing the condition. Treatments can be costly and lengthy. They often are not covered by insurance.

Prevention

Not all causes of infertility can be prevented. The following steps may help:

• If you smoke, talk to your doctor about ways to quit.
• Limit or avoid caffeine and alcohol.
• Maintain a healthy body weight.
• Protect yourself from sexually transmitted diseases (STDs) by using condoms. Minimize the number of sexual partners you have.
• Try stress management techniques.

American Society for Reproductive Medicine http://www.asrm.org

Women’s Health Matters http://www.womenshealthmatters.ca

Female Infertility Best Practice Policy Committee of the American Urological Association; Practice Committee of the American Society for Reproductive Medicine. A practice committee report: optimal evaluation of the infertile female. American Society for Reproductive Medicine. 2000;86:S264-S267.

Infertility. American College of Obstetricians and Gynecologists website. Available at:
http://www.acog.org/~/media/For%20Patients/faq137.pdf?dmc=1&ts=20130211T1206240241
Published April 2013. Accessed October 30, 2014.

6/5/2009 DynaMed’s Systematic Literature Surveillance
http://www.ebscohost.com/dynamed:
Luttjeboer FY, Verhoeve HR, van Dessel HJ, et al. The value of medical history taking as risk indicator for tuboperitoneal pathology: a systematic review. BJOG. 2009;116:612-625.