Infertility

About 15% of couples in the United States are unable to get pregnant when they want to, making them infertile. Infertility may be caused by a variety of conditions involving either the male or female. About 40% of the time the cause is a male factor, 60% of the time a female factor or both, and may be caused by more than one factor. Some of the common female causes on infertility include an ovulation, endometriosis, abnormal anatomy, or damage to the reproductive origins from prior surgery or infection. Occasionally the cause of infertility cannot be found. Regardless of the cause, there are several treatment options in most cases.

Lifestyle has an important role in infertility. You may be asked to decrease the frequency of sex, gain or lose weight, and to stop smoking. Medical treatment, such as ovulation induction with pills or shots, or surgical treatment such as laparoscopy or microsurgery, may be needed. If so, you should be aware of what is involved as some treatments require a great deal of effort from both partners and can be quite expensive. You should also ask about success rates of any treatment, especially in vitro procedures using assisted reproductive technologies, and be aware that some clinics define success as a pregnancy while others define success as a live birth. Specific treatments may also be combined to increase success.

Induction of ovulation generally uses the medication clomiphene citrate. It is a pill given by mouth the first part of the menstrual cycle that causes stimulation of the ovary to release eggs. Several treatment cycles may be needed and the dosage adjusted. If ovulation does not occur after several treatment cycles with clomiphene other medications may be given by injection. Most women who take ovulation induction drugs respond to treatment with half becoming pregnant within six cycles. Higher doses of medication also increase the possibility of multiple births and over stimulation of the ovaries which may cause large cysts to form.

Surgery may be performed to open or repair the fallopian tubes and to remove fibroid tumors, endometriosis, or scar tissue.

Assisted reproductive technologies include treatments that involve a laboratory using sperm, eggs, or early embryos to help infertile couples have a child. Among such treatments are insemination, in vitro fertilization, gamete intrafallopian tube transfer, and intracytoplasmic sperm injection. A specially trained physician, reproductive endocrinologist, usually directs such procedures and more information can be obtained upon referral or ask your doctor.