Frequently Asked Questions About Infertility


What is Infertility?

Infertility is a disease or condition of the reproductive system often diagnosed after a couple has had one year of unprotected, well-timed intercourse, or if the woman has suffered from multiple miscarriages and the woman is under 35 years of age. If the woman is over 35 years old, it is diagnosed after 6 months of unprotected, well-timed intercourse.

Who gets it?

Infertility is a medical problem. Approximately 30% of infertility is due to a female factor and 30% is due to a male factor. In the balance of the cases, infertility results from problems in both partners or the cause of the infertility cannot be explained.

What are the risk factors?

• Weight
• Age
• Sexually Transmitted Diseases (STDs)
• Tubal Disease
• Endometriosis
• DES Exposure
• Smoking
• Alcohol

What are the signs and symptoms?

Often there are no signs or symptoms associated with an infertility problem. Listening to your body and getting regular checkups will help to detect a problem. Early detection and treatment of a problem are often critical in achieving successful pregnancy outcomes later.

How is infertility treated?

Medical technology now offers more answers and treatment options to men and women trying to conceive a child. From hormonal treatments, ovulation induction and Intrauterine insemination to more advanced technologies like in vitro fertilization, ICSI to surrogacy, egg/sperm donation and even embryo donation. For more information on treatment of infertility visit theFamily Building Options section of our site.

What medications are used?

There are a variety of medications used to treat infertility. It is important to understand the medications and what their purpose is and to speak with your physician about the medications that will be used in your specific treatment plan. Read more about Fertility Medications.

What is artificial insemination?

Artificial insemination is now more commonly referred to as IUI (intrauterine insemination). It is a procedure used for couples with unexplained infertility, minimal male factor infertility, and women with cervical mucus problems. The procedure uses the husband's or donor's sperm, washing and treating the sperm, and then injecting it into the woman during the time of ovulation.Read more about IUI.

What is In Vitro or IVF?

In vitro fertilization (IVF) gets its name from the fact that fertilization occurs outside of the woman's body, in a lab dish instead of a woman's fallopian tubes. Typically, a woman will use ovulation stimulating drugs to produce an excess number of eggs. These eggs are surgically removed from the woman and fertilized in dish with sperm. If fertilization takes place, the physician transfers the embryo(s) into the women's uterus. Read more about IVF.

How can I find an infertility specialist?

Visit RESOLVE’s Professional Service Directory to find an infertility specialist in your area or visit www.sart.org.

Can my OB/GYN treat me?

In many cases the difficulty experienced in becoming pregnant can be resolved by a gynecologist without a referral to a specialist. Often the problem comes down to timing intercourse with ovulation, which may be assessed using one of the over-the-counter urine LH test kits (ovulation predictor tests). Your OB/GYN can also conduct a basic infertility evaluation. If a problem is found during your evaluation and for more complex fertility issues, it is advised to see a specialist. This section of the Baby Annie website is from the RESOLVE.ORG website.

How do I Know if I Have an Infertility Problem?

Is infertility a "woman's" problem? Infertility is a medical problem. Approximately 30% of infertility is due to female factor and 30% is due to male factor. In the balance of the cases, infertility results from problems in both partners or the cause of the infertility is "unexplained".

At what time of the month is a woman most fertile?

The day you start your menstrual period is "Day 1." Around "Day 14" you may ovulate and release an egg. The egg is viable for 24 hours; this is your most fertile time. However, not all women ovulate on "Day 14." Some ovulate earlier and some later. Some women do not ovulate at all. Your ovulation pattern can vary month to month. Even if you are getting your period, that does not mean you are ovulating.

How can a woman tell when she ovulates?

One way of determining when you ovulate is to take your basal body temperature every morning and record it on a chart. Three or four months should be adequate to share with your doctor. You can also buy an ovulation predictor kit.

How often should we have intercourse?

Sperm can live for approximately 48 hours in the woman's reproductive tract. It is important to have sexual intercourse at this time. It is a good idea to have intercourse every other day around the time you ovulate. (Day 10, 12, 14, and 16.) Remember that every woman ovulates at a different time. To increase your chances of becoming pregnant, do not douche or use lubricants immediately before or after intercourse.

How long should we try before we see a doctor?

Most physicians advise you not to be concerned unless you have been trying to conceive for at least one year and are under 35. If you are over 35 and have been trying for 6 months, you should consult a physician. If you are over 30 and have a history of pelvic inflammatory disease, painful periods, miscarriage, irregular cycles, or if you know that your partner has a low sperm count, do not wait one year. Consult your ob/gyn. Many couples have a difficult time admitting there may be a problem. After each menstrual cycle there is hope that "it will work this time." When these hopes are dashed month after month, you should consult your OB/GYN or contact with others through RESOLVE.

How do we find a good infertility specialist?

Many Ob/Gyns and Urologists are specially trained to treat the patient having difficulty conceiving. Doctors who specialize in infertility are board certified in reproductive endocrinology.


Fast Facts About Infertility


Infertility is a disease that results in the abnormal functioning of the male or female reproductive system. The World Health Organization, the American Society for Reproductive Medicine (ASRM), and the American College of Obstetricians and Gynecologists (ACOG) recognize infertility as a disease.
Infertility is defined as the inability to conceive after one year of unprotected intercourse (six months if the woman is over age 35) or the inability to carry a pregnancy to live birth.

    • 7.4 million women, or 11.9% of women, have ever received any infertility services in their lifetime. (2006-2010 National Survey of Family Growth, CDC)
    • 1 in 8 couples (or 12% of married women) have trouble getting pregnant or sustaining a pregnancy. (2006-2010 National Survey of Family Growth, CDC)
    • Approximately one-third of infertility is attributed to the female partner, one-third attributed to the male partner and one-third is caused by a combination of problems in both partners or, is unexplained. (www.asrm.org)
    • A couple ages 29-33 with a normal functioning reproductive system has only a 20-25% chance of conceiving in any given month (National Women’s Health Resource Center). After six months of trying, 60% of couples will conceive without medical assistance. (Infertility As A Covered Benefit, William M. Mercer, 1997)
    • Approximately 44% of women with infertility have sought medical assistance. Of those who seek medical intervention, approximately 65% give birth. (Infertility As A Covered Benefit, William M. Mercer, 1997)
    • Approximately 85-90% of infertility cases are treated with drug therapy or surgical procedures. Fewer than 3% need advanced reproductive technologies like in vitro fertilization (IVF). (www.asrm.org)
    • The most recently available statistics indicate the live birth rate per fresh non-donor embryo transfer is 47.7% if the woman is under 35 years of age and 39.2% if the woman is age 35-37. (Society for Assisted Reproductive Technology, 2013)
    • Fifteen states have either an insurance mandate to offer or an insurance mandate to cover some level of infertility treatment. Eight of those states have an insurance mandate that requires qualified employers to include IVF coverage in their plans offered to their employees: Arkansas, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, New Jersey, and Rhode Island.
    • A study published in the New England Journal of Medicine (August 2002) found that the percentage of high-order pregnancies (those with three or more fetuses) was greater in states that did not require insurance coverage for IVF. The authors of the study noted that mandatory coverage is likely to yield better health outcomes for women and their infants since high-order births are associated with higher-risk pregnancies.
    • The Affordable Care Act (ACA) does not require coverage for infertility treatments. Those states with an infertility mandate that covers IVF may have chosen an Essential Health Benefits (EHB) benchmark plan that includes the IVF mandate. The EHB impacts the individual and small group markets only in each state.

The Emotions of Infertility

Infertility is a major life crisis for 1 in 8 couples. For these women and men fighting the disease of infertility, the infertility experience involves many hidden losses for the individuals, their loved ones and society as a whole, including:

    • Loss of the pregnancy and the birth experience
    • Loss of a genetic legacy and loss of future contributing citizens to the next generation
    • Loss of the parenting experience
    • Loss of a grandparent relationship
    • Low feelings of self-worth
    • Loss of stability in family and personal relationships
    • Loss of work productivity
    • Loss of a sense of spirituality and sense of hope for the future.

Because infertility often involves major personal life issues and decisions, it is often experienced as a private matter and is not ordinarily discussed in public forums. The personal nature of the infertility experience contributes to the failure of the public, politicians, healthcare professionals and the media to recognize infertility as a disease. This causes a lack of sound knowledge and available resources about infertility.


Medical Conditions

Infertility is a disease, and if you have been diagnosed, you are not alone. According to The Center for Disease Control and Prevention, more than 1 in 8 couples of childbearing age have difficulty conceiving or carrying a pregnancy to term.

It is important to see a specialist, such as a Reproductive Endocrinologist or urologist, or in some cases your OB/Gyn for a complete fertility work-up and diagnosis.

Endometriosis

Endometriosis is a disorder of the female reproductive system in which endometrial tissue (the normal lining of the uterus) is found outside the uterine cavity. An estimated three to five million American women of reproductive age suffer from endometriosis.

Luteal Phase Defect

Abnormalities in endometrial development -- luteal phase defect (LPD) - are associated with infertility and early miscarriage. Luteal phase defect occurs when the endometrium is inadequately prepared, either because the secretion of progesterone by the ovary is below normal or because the endometrium isn't responding to the normal stimulation by progesterone. Male Factor
30% of infertility is due a male problem such as structural abnormalities, sperm production disorders, ejaculatory disturbances and immunologic disorders.

Multiple Miscarriage

Miscarriage can leave you with deep- rooted feelings of loss and sorrow. These feelings must be confronted and dealt with, not suppressed, as is often urged by friends and family. It is important to take action and see an infertility specialist if you have experienced 2 or more miscarriages.

Ovulatory Disorders


Approximately 30% of female infertility problems are the result of ovulation disorders. There are many factors that can affect ovulation. In this section we will discuss mainly pituitary causes.

Polycystic Ovary Syndrome (PCOS)


PCOS is a very common hormone disorder in women, a leading cause of infertility, and one of the most underdiagnosed diseases in the United States. PCOS is characterized by a myriad of seemingly unrelated symptoms and may include irregular or absent periods, lack of ovulation, weight gain, acne, excessive facial hair and infertility. Even more serious, women with PCOS may be at higher risk for developing cardiovascular disease, Type 2 Diabetes, and endometrial cancer, especially if PCOS is left untreated.

Poor Responder

The term poor responder has been used to define women who require large doses of stimulation medications and who make less than an optimal number of eggs. There is no uniform definition of poor responders, but many clinics have used a cutoff of less than four mature oocytes at the time of hCG or a peak estradiol of less than 500.

Premature Ovarian Failure


Premature ovarian failure is defined as the cessation of menstrual periods before the age of 40. It occurs in 1 in 1,000 women between the ages of 15 and 29 and 1 in 100 women between the ages of 30 and 39. The average age of onset is 27 years. Premature ovarian failure can be both shocking and devastating as there are relatively few treatment options.

Secondary Infertility


Although many Americans are affected by the painful experience of secondary infertility, it generally remains an unacknowledged and invisible condition. Secondary infertility is defined as the inability to become pregnant, or to carry a pregnancy to term, following the birth of one or more biological children.

Unexplained Infertility


Approximately one in five couples will experience unexplained infertility despite completing a full infertility work-up. The emotional response to hearing, "There is no apparent reason for your infertility" can be difficult, maddening and frustrating. Fortunately, there are many options available for the couple diagnosed with unexplained infertility.

Uterine Factors


Abnormalities of the uterus can have a significant impact on the ability of a woman to conceive and to carry a pregnancy successfully. Some women have an abnormally developed uterus from birth (congenital) while others may develop a uterine problem due to infection or surgery (acquired).

The Hidden Effects of Infertility on Self-Esteem and Relationships


Infertility has a strong impact on self-esteem. Suddenly your life, which may have been well-planned and successful, seems out-of-control. Not only is your physical body not responding as expected but it feels as if your entire life is on hold. Facing the disappointment of not becoming pregnant month after month can lead to depression for both you and your spouse. It’s important to understand the signs of depression.

What can you do?


    • Connect with others - find a RESOLVE Support Group
    • Learn ways to connect with your partner
    • Send information to your family and friends
    • Find a mental health expert in your area