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Infertility affects over 10% of
couples at some time during their reproductive lives.
This means that one couple out of every ten will experience
infertility, making it a relatively common condition.
It is defined as the inability to become pregnant
after one year of unprotected intercourse in women under
35. It is much more common as women age and
may require evaluation and treatment prior to the benchmark of one year. Women aged 35 and older should seek care from a fertility specialist after 6 months of regular intercourse without conception.
While infertility was once considered a "female problem, we now know that up to half of all couples have a male infertility component. This makes thorough testing of the male a necessity before beginning any female treatments.
Infertility's prevalence may be increasing although there is debate among specialists. One
fact all authorities agree upon is that women are delaying
marriage and childbearing until later in life, sometimes
until their late thirties.
However, infertility,
caused by reduced
ovarian reserve (aging), no longer means it is impossible
to have a child. Couples can choose in vitro fertilization
using donor eggs and expect high success rates.
Infertility - Male
- The male must produce an adequate
quantity of "good quality" sperm.
- Sperm must be ejaculated
into the female's vagina. Blockages in the vas deferens
can impair this process.
- Sperm must swim from the
vagina, past the cervix, to the end of the fallopian
tubes where fertilization occurs.
- A sperm must attach to an egg
and penetrate the zona pellucida (membrane lining
the egg)
- A sperm must be genetically
capable of fertilizing the egg.
The processes listed below must occur for pregnancy to result. The female's reproductive hormone system involves complex series of relationships controlled primarily by the hypothalamus gland, which is a small endocrine gland located at the base of the brain.
- The female must
recruit sufficient follicles under the influence
of FSH. Sub fertility results when the eggs are "too
old" or loose their capacity to fertilize and
develop.
- The egg(s) must grow until it
is mature and ready for ovulation.
- A surge of luteinizing hormone
causes the egg to be "ovulated" or released
from the follicle. Patients receiving Lupron, Ganirelix Acetate,
or Cetrotide require an injection of hCG or LH to initiate
ovulation.
- During follicular maturation, the body produces various hormones,
such as estrogen and progesterone that cause the endometrium
(lining of the uterus) to thicken and become more
vascular in order to accept the developing embryo.
The endometrium may fail to develop properly sometimes as a result of a "luteal phase defect". Exogenous progesterone will usually correct the defect.
- Once ovulated, the eggs must
travel through the fallopian tubes to
the distal end where fertilization occurs.
The egg must be genetically capable of fertilization
and division.
Tubal factor can be caused by scarring
from previous surgery, endometriosis, infection, congenital
abnormalities, and others.
- The fertilized egg (embryo) travels
to the lining of the uterus
(endometrium) where it implants.
- The placenta must nourish the
fetus.
- The fetus must be healthy
and the mother must be able to carry the baby to term.
Infertility results when there is dysfunction of the processes outlined
above . Fortunately, today's advanced technologies
offer very effective means to treat most conditions causing reduced fertility.
It is estimated that 85% of couples who seek
care from a specialist will conceive.
One misconception is that most infertile
couples
will require IVF.
Studies show that only 8-15% of couples will eventually
require IVF and most become pregnant using procedures
such as IUI.
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