What is infertility?
In general, infertility is defined as not being able to get pregnant (conceive) after one year of unprotected sex. Women who do not have regular menstrual cycles, or are older than 35 years and have not conceived during a 6-month period of trying, should consider making an appointment with a reproductive endocrinologist—an infertility specialist. These doctors may also be able to help women with recurrent pregnancy loss—2 or more spontaneous miscarriages.
How is infertility diagnosed?
Health care providers evaluate men and women differently to diagnose infertility.
Evaluating Female Fertility
In evaluating a woman’s fertility, a health care provider will ask specific questions about her health history. These include: Prior pregnancies, prior miscarriages, the regularity of her menstrual period, the presence of pelvic pain, whether she has abnormal vaginal bleeding or discharge, whether she has a history of pelvic infection or previous pelvic surgery.
A health care provider may also carry out the following laboratory tests and evaluations: A blood test around day 23 of the woman’s menstrual cycle can measure the amount of a hormone called progesterone. This test can tell if ovulation has occurred and if the ovaries are producing a normal amount of this hormone.
Evaluating Male Fertility
The evaluation of a man’s fertility includes looking for signs of hormone deficiency, such as increased body fat, decreased muscle mass, and decreased facial and body hair. The evaluation also includes questions about the man’s health history, including: Past injury to the testicles or penis, recent high fevers, childhood diseases,such as mumps, a physical examination of the testes and penis allows for identification of problems, such as: Infection, signaled by discharge or prostate swelling, hernia, malformed tubes that transport sperm, hormone deficiency as indicated by small testes, presence of a mass in the testicles, varicocele.
A health care provider may also ask a man to provide a sample of semen to assess the health and quality of his sperm. To give a semen sample, the man is requested to refrain from ejaculation for around 48 hours before the test. He then provides a sample by masturbating into a cup or by having intercourse using a special condom (without contraceptive) that collects semen without affecting the sperm. A man may need to provide a semen sample on more than one occasion because sperm production can vary over time depending on the man’s activities and stress level.
Other tests may include:
Measurement of hormones in the blood, including testosterone and follicle-stimulating hormone, Biopsy of the testicle. A health care provider uses a needle to extract sperm from the testicle, Genetic testing. In cases where no or very few sperm are found in the semen a health care provider may do genetic testing before starting fertility treatments.
Treatment for women
Although a woman may need just one or two therapies to restore fertility, it’s possible that several different types of treatment may be needed before she’s able to conceive.
Stimulating ovulation with fertility drugs. Fertility drugs are the main treatment for women who are infertile due to ovulation disorders. These medications regulate or induce ovulation.
Intrauterine insemination (IUI). During IUI, healthy sperm that have been collected and concentrated are placed directly in the uterus around the time the woman’s ovary releases one or more eggs to be fertilized.
Surgery to restore fertility. Uterine problems such as endometrial polyps, a uterine septum or intrauterine scar tissue can be treated with hysteroscopic surgery.
Treatment for men
Approaches that involve the male include treatment for general sexual problems or lack of healthy sperm. Treatment may include:
Treating infections. Antibiotic treatment may cure an infection of the reproductive tract, but doesn’t always restore fertility.
Treatments for sexual intercourse problems. Medication or counseling can help improve fertility in conditions such as erectile dysfunction or premature ejaculation.
Hormone treatments and medications. Your doctor may recommend hormone replacement or medication in cases where infertility is caused by high or low levels of certain hormones or problems with the way the body uses hormones.
Surgery. For example, a varicocele can often be surgically corrected or an obstructed vas deferens repaired. In cases where no sperm are present in the ejaculate, sperm may often be retrieved directly from the testicles.
Assisted reproductive technology (ART). ART treatments involve obtaining sperm through normal ejaculation, surgical extraction or from donor individuals, depending on your specific case and wishes. The sperm is then inserted into the female genital tract, or used to perform in vitro fertilization or intracytoplasmic sperm injection.