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Infertility

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Definition:

Infertility is the inability to become pregnant after 12 months of unprotected intercourse.

Alternative Names:

Barren; Inability to conceive; Unable to get pregnant

Causes, incidence, and risk factors:

Primary infertility is the term used to describe a couple that has never been able to conceive a pregnancy, after at least 1 year of unprotected intercourse.

Secondary infertility describes couples who have previously been pregnant at least once, but have not been able to achieve another pregnancy.

Causes of infertility include a wide range of physical as well as emotional factors. Approximately 30 - 40% of all infertility is due to a "male" factor such as retrograde ejaculation , impotence , hormone deficiency, environmental pollutants, scarring from sexually transmitted disease, or decreased sperm count . Some factors affecting sperm count are heavy marijuana use or use of prescription drugs such as cimetidine, spironolactone, and nitrofurantoin.

A "female" factor -- scarring from sexually transmitted disease or endometriosis, ovulation dysfunction, poor nutrition, hormone imbalance, ovarian cysts, pelvic infection, tumor, or transport system abnormality from the cervix through the fallopian tubes -- is responsible for 40 - 50% of infertility in couples.

The remaining 10 -30% of infertility cases may be caused by contributing factors from both partners, or no cause can be identified.

It is estimated that 10 - 20% of couples will be unable to conceive after 1 year of trying to become pregnant. It is important that pregnancy be attempted for at least 1 year. The chances for pregnancy occurring in healthy couples who are both under the age of 30 and having intercourse regularly is only 25 - 30% per month. A woman's peak fertility occurs in her early 20s. As a woman ages beyond 35 (and particularly after age 40), the likelihood of getting pregnant drops to less than 10% per month.

In addition to age-related factors, increased risk for infertility is associated with the following:

• Multiple sexual partners (increases risk for sexually transmitted diseases)
• Sexually transmitted diseases
• History of PID (pelvic inflammatory disease)
• History of orchitis or epididymitis in men
• Mumps (men)
• Varicocele (men)
• A past medical history that includes DES exposure (men or women)
• Eating disorders (women)
• Anovulatory menstrual cycles
• Endometriosis
• Defects of the uterus (myomas) or cervical obstruction
• Long-term (chronic) disease such as diabetes

References:

Speroff L, Fitz M. Clinical Gynecologic Endocrinology and Infertility. 7th ed. Lippincott Williams & Wilkins; 2004.

Stenchever A. Comprehensive Gynecology. 4th ed. St. Louis, Mo: Mosby; 2001:1204-1206.

• Review Date: 5/15/2006
• Reviewed By: Melanie N. Smith, M.D., Ph.D., Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA. Review provided by VeriMedHealthcare Network.

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