Infertility has been defined as a disease of the reproductive system that affects the male or female almost equally. Approximately 40% of couples with infertility have a female factor such as a problem with ovulation (15-20%), tubal disease (15%), endometriosis (10%), uterine factor (5%), or cervical mucus. Up to 40% of couples will have male factor infertility associated with low or absent sperm count or motility, sperm antibodies, or impaired sperm function. The third group of couples (20-30%) has a combination of male and female factors. The woman’s age is an important factor and affects the chance of success of any therapy except egg or embryo donation.
Couples should seek evaluation after one year of attempting pregnancy if the woman is under 35 and has regular cycles and no history of pelvic problems. If over 35, they should pursue evaluation within six months and move to a Reproductive Endocrinologist for an advanced level of care if pregnancy does not occur with therapy with their OB/GYN. The age of the woman is a strong predictor of pregnancy potential; and after 35, the chance of conceiving drops.
The evaluation of infertility attempts to find specific causes that can be treated. The initial evaluation includes a history, physical exam, blood tests and a semen analysis. An x-ray procedure called a hysterosalpingogram (HSG) will be performed in the woman’s cycle between days 4-12 to evaluate her uterus and tubes.
Success rates depend on the problem being treated, the age of the female and the choice of treatment. Certain lifestyle factors can affect fertility. Smoking and tobacco use of any type can decrease fertility in the male or female. Caffeine should be significantly limited in the female prior to attempting pregnancy. Body weight should be as close to normal for height as possible.