Infertility - Overview
Alternative Names
Inability to conceive; Unable to get pregnant
Definition of Infertility:
Primary infertility describes couples who have never been able to become pregnant after at least 1 year of unprotected sex (intercourse).
Secondary infertility describes couples who have been pregnant at least once, but have not been able to become pregnant again.
Causes, incidence, and risk factors:
Causes of infertility include a wide range of both physical and emotional factors. A couple's infertility may be due to female factors, male factors, or both:
FEMALE INFERTILITY:
Female infertility may be due to:
- Problems with a fertilized egg or embryo being able to survive once it is attached to the lining of the uterus
- Problems with the eggs being able to attach to the lining of the uterus
- Problems with the eggs being able to move from the ovary to the uterus
- Problems with the ovaries producing eggs
Female infertility may be caused by:
- Autoimmune disorders, such as antiphospholipid syndrome (APS)
- Clotting disorders
- Defects of the uterus and cervix (myomas or fibroids, polyps, birth defects)
- Excessive exercising, eating disorders, or poor nutrition
- Exposure to certain medications or toxins
- Heavy use of alcohol
- Hormone imbalance or deficiencies
- Long-term (chronic) disease, such as diabetes
- Obesity
- Ovarian cysts and polycystic ovary syndrome (PCOS)
- Pelvic infection or pelvic inflammatory disease (PID)
- Scarring from sexually transmitted disease or endometriosis
- Tumor
MALE INFERTILITY:
Male infertility may be due to:
- A decrease in the number of sperm
- Sperm being blocked from being released
- Sperm that do not work properly
Male infertility can be caused by:
- Environmental pollutants
- Exposure to high heat for prolonged periods
- Genetic abnormalities
- Heavy use of alcohol, marijuana, or cocaine
- Hormone deficiency or taking too much of a hormone
- Impotence
- Infections of the testes or epididymis
- Older age
- Previous chemotherapy
- Previous scarring due to infection (including sexually transmitted diseases), trauma, or surgery
- Radiation exposure
- Retrograde ejaculation
- Smoking
- Surgery or trauma
- Use of prescription drugs, such as cimetidine, spironolactone, and nitrofurantoin
In healthy couples both under age 30, having sex regularly, the chance of getting pregnant is only 25 - 30% per month. A woman's peak fertility occurs in her early 20s. As a woman ages beyond 35 (and especially after age 40), the likelihood of getting pregnant drops to less than 10% per month.
When to seek help for infertility depends on your age. For women under age 30, it is generally recommended to try to conceive for at least a year before seeking testing.
- Reviewed last on: 3/17/2009
- Linda Vorvick, MD, Family Physician, Seattle Site Coordinator, Lecturer, Pathophysiology, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, WA; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
References
Jose-Miller AB, Boyden JW, Frey KA. Infertility. Am Fam Physician. 2007;75(6):894-856.
Lobo RA. Infertility: etiology, diagnostic evaluation, management, prognosis. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007: chap 41.
Speroff L, Fitz M, eds. Clinical Gynecologic Endocrinology and Infertility. 7th ed. Philadelphia, Pa; Lippincott Williams & Wilkins; 2005.