What is Fertility problems?

Fertility problems

What is infertility?

If you and your partner have been diagnosed as having fertility problems, it means you've been trying to get pregnant for at least a year without success. It doesn't mean you'll never be able to have a baby. There are no guarantees, but there are treatments that can help.

If you've been trying to get pregnant for at least a year, your doctor will be able to suggest some tests to find out what the problem is. Women over 35 will probably be able to get help sooner. You can get help whether or not you've had a child before.

Source:
Institute for Clinical Systems Improvement.
Diagnosis and management of basic infertility.
May 2004. Available at http://www.icsi.org (accessed on 16 June 2008).

Being unable to have a baby can be upsetting and demoralizing but there are treatments that can help.

Being unable to have a baby is hard to cope with. Tests and treatments for infertility can be a strain, both physically and emotionally. It may help you and your partner to talk to a special counselor.

See How infertility can make you feel.

Key points about infertility

Infertility is very common. In the United States, about 1 in 5 couples seek medical help to have a baby.

Source:
Institute for Clinical Systems Improvement.
Diagnosis and management of basic infertility.
May 2004. Available at http://www.icsi.org (accessed on 16 June 2008).

¹
The most common causes in women are ovulation problems and damaged or blocked tubes.
The most common causes in men are a low sperm count and poor-quality sperm.
In up to one-third of infertile couples, doctors cannot find a reason for the infertility.
To improve your chances of getting pregnant, your doctor may advise you to have sex every two or three days.
If you're a woman age 35 or older and you're having problems getting pregnant, don't wait more than a year before you seek help. Many treatments don't work so well when a woman is older.

How you get pregnant

It's useful to know a little about how a pregnancy normally begins. This can help you understand what can go wrong.

To get pregnant:

The woman has to produce an egg
The man has to produce healthy sperm
The egg has to travel from the woman's ovary into her fallopian tube
The sperm have to swim up through the vagina and womb into the fallopian tube, toward the egg
The egg has to be fertilized by the man's sperm
The fertilized egg has to travel down the fallopian tube and embed (plant itself) in the woman's womb.

To find out more, see:

Nearly 90 percent of couples trying to get pregnant are successful within one year. And 95 percent get pregnant within two years.

Source:
Cahill DJ, Wardle PG.
Management of infertility.
BMJ. 2002; 325: 28-32.

How egg and sperm join together

When a man

ejaculation
When a man ejaculates, his penis suddenly releases semen, the white or transparent fluid that carries sperm.

ejaculates inside a woman, one of his sperm may fertilize the egg. Here is what happens:

Source:
Meniru GI.
Fertilization, implantation and early development.
In: Cambridge guide to infertility management and assisted reproduction. Cambridge University Press, Cambridge, UK; 2001.

The man's semen (containing sperm) gets pushed up into the vagina
About 1 percent of sperm (that's about 400,000) swim up to the cervix, the neck of the womb. The rest die or fall out of the vagina
If a woman is in her fertile period, the mucus is thin and watery, helping the sperm swim up to the fallopian tubes
If there is an egg inside one of the tubes, the sperm try to push through the egg wall
The first one through will fertilize the egg
The

genes
Your genes are the parts of your cells that contain instructions for how your body works. Genes are housed on chromosomes, structures that sit in the nucleus at the middle of each of your cells. You have 23 pairs of chromosomes in your normal cells, each of which has thousands of genes. You get one set of chromosomes, and all of the genes that are on them, from each of your parents.

genes from the egg and sperm combine inside a single cell.

After fertilization

The fertilized egg moves down the fallopian tube to the womb. This takes several days.
It starts growing and embeds in the lining of the womb, called the endometrium.
Now it's called an embryo. It forms the placenta to get food from its mother.
The placenta makes a hormone to make the lining of the womb thicken. The hormone also prevents the woman from having her period.

When to have sex

A woman is most likely to get pregnant (most fertile) from four or five days before she ovulates until up to a few hours afterward. This is the likeliest time that the sperm will fertilize an egg.

Many couples who are trying to have a baby concentrate on having sex around this time. There are various ways you can work this out. Some women use special hormone kits from the pharmacist. Other women take their temperature or check the fluid in their vagina. This fluid tends to be thin and stretchy when she is fertile.

Still, it's easy to miss the most fertile time of the month. The length of a woman's menstrual cycle can vary and some women ovulate earlier in their cycle than others. So it's very difficult to be precise, even if you are using hormone kits. Having sex by the calendar can also be stressful and disappointing.

For these reasons, doctors usually advise couples not to try to have sex at certain times of the month, but instead to have sex every two or three days, every week. That way, you're less likely to miss the time that you are ovulating.

Talk with your doctor about when to have sex and whether to use a kit.

What can go wrong

There are many reasons why a couple may find it hard to get pregnant. Either or both partners may have a problem that doctors can identify with tests.

In 2 out of 10 infertile couples, the man has a problem.
In about 4 out of 10, the woman does.
In a further 3 or 4 out of 10, both partners have a problem.

Sometimes, doctors can't work out why you're finding it hard to get pregnant. This is called unexplained infertility.

Problems getting pregnant: the woman

Here are the most common problems that stop a woman from getting pregnant:

Source:
Illions EH, Valley MT, Kaunitz AM.
Infertility: a clinical guide for the internist.
Medical Clinics of North America. 1998; 82: 271-295.

⁴

Problems getting pregnant: the man

Here are the most common reasons why men have fertility problems:

Source:
Wong WY, Thomas CM, Merkus JM, et al
Male factor subfertility: possible causes and the impact of nutritional factors.
Fertility and Sterility. 2000; 73: 435-442.

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Why us?

Things that lower your chances of getting pregnant are called risk factors. Here are the main risk factors for infertility:

Sources for the information on this page:

Institute for Clinical Systems Improvement.Diagnosis and management of basic infertility.May 2004. Available at http://www.icsi.org (accessed on 16 June 2008).

Cahill DJ, Wardle PG.Management of infertility.BMJ. 2002; 325: 28-32.

Meniru GI.Fertilization, implantation and early development.In: Cambridge guide to infertility management and assisted reproduction. Cambridge University Press, Cambridge, UK; 2001.

Illions EH, Valley MT, Kaunitz AM.Infertility: a clinical guide for the internist.Medical Clinics of North America. 1998; 82: 271-295.

Wong WY, Thomas CM, Merkus JM, et alMale factor subfertility: possible causes and the impact of nutritional factors.Fertility and Sterility. 2000; 73: 435-442.

This information was last updated on Mar 06, 2009

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment.
© BMJ Publishing Group Limited 2009. All rights reserved.

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