Infertility
What is
infertility?
Is
infertility a woman’s problem?
What
causes infertility in men?
What causes infertility in women?
How is
infertility tested?
What is the treatment for infertility?
What
is in vitro fertilization (IVF)?
What are the other assisted reproductive
technologies?
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What is infertility?
Infertility is
defined as the inability to conceive a child despite trying for one year.
The condition affects about 5.3 million Americans, or 9 percent of the
reproductive age population, according to the American Society for
Reproductive Medicine.
Is infertility a
woman’s problem?
It is a myth that
infertility is always a "woman's problem." Of the 80 percent of cases with
a diagnosed cause, about half are based at least partially on male
problems (referred to as male factors)--usually that the man produces no
sperm, a condition called azoospermia, or that he produces too few sperm,
called oligospermia.
What causes infertility
in men?
Lifestyle can
influence the number and quality of a man's sperm. Alcohol and
drugs--including marijuana, nicotine, and certain medications--can
temporarily reduce sperm quality. Also, environmental toxins, including
pesticides and lead, may be to blame for some cases of infertility.
The causes of sperm
production problems can exist from birth or develop later as a result of
severe medical illnesses, including mumps and some sexually transmitted
diseases, or from a severe testicle injury, tumor, or other problem.
Inability to ejaculate normally can prevent conception, too, and can be
caused by many factors, including diabetes, surgery of the prostate gland
or urethra, blood pressure medication, or impotence.
What causes
infertility in women?
The other half of
explained infertility cases are linked to female problems (called female
factors), most commonly ovulation disorders. Without ovulation, eggs are
not available for fertilization. Problems with ovulation are signaled by
irregular menstrual periods or a lack of periods altogether (called
amenorrhea). Simple lifestyle factors--including stress, diet, or athletic
training--can affect a woman's hormonal balance. Much less often, a
hormonal imbalance can result from a serious medical problem such as a
pituitary gland tumor.
Other problems can
also lead to female infertility. If the fallopian tubes are blocked at one
or both ends, the egg can't travel through the tubes into the uterus. Such
blockage may result from pelvic inflammatory disease, surgery for an
ectopic pregnancy (when the embryo implants in the fallopian tube rather
than in the uterus), or other problems, including endometriosis (the
abnormal presence of uterine lining cells in other pelvic organs).
A medical evaluation
may determine whether a couple's infertility is due to these or other
causes. If a medical and sexual history doesn't reveal an obvious problem,
like improperly timed intercourse or absence of ovulation, specific tests
may be needed.
How is infertility tested?
For the woman, the
first step in testing is to determine if she is ovulating each month. This
can be done by charting changes in morning body temperature, by using an
FDA-approved home ovulation test kit (which is available over the
counter), or by examining cervical mucus, which undergoes a series of
hormone-induced changes throughout the menstrual cycle.
Checks of ovulation
can also be done in the physician's office with simple blood tests for
hormone levels or ultrasound tests of the ovaries. If the woman is
ovulating, further testing will need to be done.
Common female tests
include:
Hysterosalpingogram:
An x-ray of the fallopian tubes and uterus after they are injected with
dye, to show if the tubes are open and to show the shape of the uterus.
Laparoscopy: An examination of the tubes and other female organs for
disease, using a miniature light-transmitting tube called a laparoscope.
The tube is inserted into the abdomen through a one-inch incision below
the navel, usually while the woman is under general anesthesia.
Endometrial biopsy:
An examination of a small shred of uterine lining to see if the monthly
changes in the lining are normal.
What is the
treatment for infertility?
Depending on what
the tests turn up, different treatments are recommended. Eighty to 90
percent of infertility cases are treated with drugs or surgery.
Therapy with the
fertility drug Clomid or with a more potent hormone stimulator--Pergonal,
Metrodin, Humegon, or Fertinex--is often recommended for women with
ovulation problems. The benefits of each drug and the side effects, which
can be minor or serious but rare, should be discussed with the doctor.
Multiple births occur in 10 to 20 percent of births resulting from
fertility drug use.
Other drugs, used
under very limited circumstances, include Parlodel (bromocriptine mesylate),
for women with elevated levels of a hormone called prolactin, and a
hormone pump that releases gonadotropins necessary for ovulation.
If drugs aren't the
answer, surgery may be. Because major surgery is involved, operations to
repair damage to the woman's ovaries, fallopian tubes, or uterus are
recommended only if there is a good chance of restoring fertility.
What is in vitro
fertilization (IVF) ?
New, more complex
assisted reproductive technologies, or ART, procedures, including in vitro
fertilization (IVF), have been available since the birth 18 years ago of
Louise Brown, the world's first "test tube baby." IVF makes it possible to
combine sperm and eggs in a laboratory for a baby that is genetically
related to one or both partners. IVF is often used when a woman's
fallopian tubes are blocked. First, medication is given to stimulate the
ovaries to produce multiple eggs. Once mature, the eggs are suctioned from
the ovaries (1) and placed in a laboratory culture dish with the man's
sperm for fertilization (2). The dish is then placed in an incubator (3).
About two days later, three to five embryos are transferred to the woman's
uterus (4). If the woman does not become pregnant, she may try again in
the next cycle.
What are the other assisted reproductive technologies?
Gamete
intrafallopian transfer, or GIFT: Similar to IVF, but used when the woman
has at least one normal fallopian tube. Three to five eggs are placed in
the fallopian tube, along with the man's sperm, for fertilization inside
the woman's body.
Zygote
intrafallopian transfer, or ZIFT (also called tubal embryo transfer): A
hybrid of IVF and GIFT. The eggs retrieved from the woman's ovaries are
fertilized in the lab and replaced in the fallopian tubes rather than the
uterus.
Donor egg IVF: For
women who, for example, have impaired ovaries or carry a genetic disease
that can be transferred to the offspring. Eggs are donated by another
healthy woman and fertilized in the lab with the male partner's sperm
before being transferred to the female partner's uterus.
Frozen embryos:
Excess embryos are frozen, to be thawed in the future if the woman doesn't
get pregnant on the first cycle or wants another baby in the future.
from
The Office On Women's Health - US Department of Health and Human Services
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