About 10% of couples in the United States are affected by infertility. Both men and women can be infertile. According to the Centers for Disease Control, 1/3 of the time the diagnosis is due to female infertility, 1/3 of the time it is linked to male infertility, and the remaining cases of infertility are due to a combination of factors from both partners. For approximately 20% of couples, the cause cannot be determined.
Q. What goes into a fertility evaluation? A. A standard fertility evaluation includes physical exams and
medical and sexual histories of both partners. Men undergo a semen analysis
that evaluates sperm count and sperm movement. "We look at the percent that
are moving and how they are moving--are the sperm sluggish? Are they
wandering?" says Robert G. Brzyski, M.D., Ph.D., associate professor of
obstetrics and gynecology at the University of Texas Health Science Center at
San Antonio. "Often, it's not possible to identify a specific reason for a
sperm disorder," he says. "But there is new recognition that very low
sperm or no sperm may be related to genetics--an abnormality of the Y
For women, doctors first check to see whether ovulation is occurring. This
can be determined and monitored through blood tests that detect hormones,
ultrasound examinations of the ovaries, or an ovulation home test kit. "An
irregular menstrual pattern would make us suspicious of an ovulation problem,
but it's also possible for a woman with regular periods to have an ovulation
disorder," Brzyski says.
Women are born with a finite number of eggs. Thus, as the reproductive years progress, the number and quality of the eggs diminish. The chances of having a baby decrease by 3% to 5% per year after the age of 30. This reduction in fertility is noted to a much greater extent after age 40.
What Causes Female Infertility?
Female infertility can be also be caused by a number of factors, including the following:
Damage to fallopian tubes. Damage to the fallopian tubes (which carry the eggs from the ovaries to the uterus) can prevent contact between the egg and sperm. Pelvic infections, endometriosis, and pelvic surgeries may lead to scar formation and fallopian tube damage.
Hormonal causes. Some women have problems with ovulation. Synchronized hormonal changes leading to the release of an egg from the ovary and the thickening of the endometrium (lining of the uterus) in preparation for the fertilized egg do not occur. These problems may be detected using basal body temperature charts, ovulation predictor kits, and blood tests to detect hormone levels.
Cervical causes. A small group of women may have a cervical condition in which the sperm cannot pass through the cervical canal. Whether due to abnormal mucus production or a prior cervical surgical procedure, this problem may be treated with intrauterine inseminations.
Uterine causes. Abnormal anatomy of the uterus; the presence of polyps and fibroids.
Unexplained infertility. The cause of infertility in approximately 20% of couples will not be determined using the currently available methods of investigation.
How Is the Cause of Infertility Determined?
If male infertility is suspected, a semen analysis is performed. This test will evaluate the number and health of his sperm. A blood test can also be performed to check his level of testosterone and other male hormones.
If female infertility is suspected, your doctor may order several tests, including:
A blood test to check hormone levels
An endometrial biopsy to check the lining of the uterus
Two diagnostic tests that may be helpful in detecting scar tissue and tubal obstruction are hysterosalpingography and laparoscopy.
Hysterosalpingography (HSG). This procedure involves either ultrasound or X-rays taken of the reproductive organs. Either dye or saline and air are injected into the cervix and travel up through the fallopian tubes. This enables the ultrasound or X-ray to reveal if the fallopian tubes are open or blocked.
Laparoscopy. In this procedure, a laparoscope (a slender tube fitted with a fiberoptic camera) is inserted into the abdomen through a small incision near the belly button. The laparoscope enables the doctor to view the outside of the uterus, ovaries, and fallopian tubes to detect abnormal growths, as in endometriosis. The doctor can also check to see if the fallopian tubes are open at the same time.