What is infertility?
Healthcare providers consider a couple infertile if they try but fail to get pregnant within one year. When the woman is older than 35, the amount of time trying to conceive drops to six months for an infertility diagnosis. In women over 40, immediate evaluation is warranted. Infertility does not include miscarrying or being unable to carry a baby to childbirth.
What causes infertility?
Causes of infertility vary:
- 1 in 3 infertile women have a problem with the female reproductive system.
- 1 in 3 infertile men have a problem with the male reproductive system.
- 1 in 3 couples have a problem that affects both of them or an undetermined issue.
How common is infertility?
An estimated 1 in 10 women between the ages of 15 and 44 have trouble conceiving.
Women who have pregnancy problems may lose the baby:
What are the types of infertility?
Types of infertility include:
Symptoms and Causes
What are risk factors for infertility in all genders?
These factors increase the risk of infertility in all genders:
- Age (over age 35 for women or over 40 for men).
- Eating disorders, including anorexia nervosa and bulimia.
- Excessive alcohol use.
- Exposure to environmental toxins, such as lead and pesticides.
- Over exercising.
- Radiation therapy or other cancer treatments.
- Sexually transmitted diseases (STDs).
- Substance abuse.
- Weight problems (obesity or underweight).
What are risk factors for female infertility?
These factors can contribute to female infertility:
- Abnormal menstruation.
- Blocked fallopian tubes.
- Celiac disease.
- Kidney disease.
- Past ectopic (tubal) pregnancy.
- Pelvic inflammatory disease.
- Pituitary gland disorders, such as Cushing’s syndrome.
- Polycystic ovary syndrome (PCOS), ovarian cysts and primary ovarian insufficiency.
- Sickle cell anemia.
- Uterine problems, including endometriosis, uterine fibroids and uterine polyps.
- Thyroid disease.
What are risk factors for male infertility?
These factors can cause male infertility:
- Enlarged veins (varicocele) in the scrotum, the sac that holds the testicles.
- Genetic disorders, such as cystic fibrosis.
- High heat exposure to testicles from tight clothing or frequent use of hot tubs and saunas.
- Injury to the scrotum or testicles.
- Low sperm count or low testosterone (hypogonadism).
- Misuse of anabolic steroids.
- Premature ejaculation or retrograde ejaculation (semen flows back into the bladder).
- Testicular cancer and treatments.
- Undescended testicles.
Diagnosis and Tests
How is female infertility diagnosed?
Your healthcare provider may ask you to record signs of ovulation, such as basal body temperature and cervical mucus. You may also use a home ovulation kit.
These tests can also help diagnose or rule out a female fertility problem:
- Pelvic exam: Your provider will perform a pelvic exam, including a Pap smear to check for structural problems or signs of disease.
- Blood test: A blood test can check hormone levels, including thyroid hormones.
- Transvaginal ultrasound: Your doctor inserts an ultrasound wand into the vagina to look for problems with the reproductive system.
- Hysteroscopy: Your provider inserts a thin, lighted tube (hysteroscope) into the vagina to examine the uterus.
- Saline sonohysterogram (SIS): Your provider fills the uterus with saline (sterilized salt water) and conducts a transvaginal ultrasound. A full uterus makes it easier to see inside the uterus.
- Hysterosalpingogram (HSG): X-rays capture an injectable dye as it travels through the fallopian tubes. This test looks for blockages.
- Laparoscopy: Your provider inserts a laparoscope (thin tube with a camera) into a small abdominal incision. Female pelvic laparoscopy helps identify problems like endometriosis, uterine fibroids and scar tissue.
How is male infertility diagnosed?
These tests can help diagnose or rule out a male fertility problem:
- Semen analysis: This test checks for problems with sperm, such as low sperm count and poor mobility. Some men need a needle biopsy to remove sperm from the testicles and test it. For most men, this is the only test that will be needed in the workup of infertility.
- Blood test: A blood test can check testosterone, thyroid and other hormone levels. Genetic blood tests look for chromosomal abnormalities.
- Scrotal ultrasound: An ultrasound of the scrotum identifies varicoceles or other testicular problems.
Management and Treatment
When should you seek help for infertility?
Women under the age of 35 who aren’t pregnant after one year of trying should see a healthcare provider. You should seek help sooner (after six months of trying) if you’re older than 35. A woman’s chances of getting pregnant decrease with age. A 30-year-old woman is half as fertile as a 20-year-old woman.
Regardless of gender, you should seek help early if you have a risk factor that affects fertility.
How is female infertility treated?
Treatments for infertility include:
- Medications: Fertility drugs change hormone levels to stimulate ovulation.
- Surgery: Surgery can open blocked fallopian tubes and remove uterine fibroids and polyps. Surgical treatment of endometriosis doubles a woman’s chances of pregnancy.
How is male infertility treated?
Treatments for male infertility include:
- Medications: Medications can raise testosterone or other hormone levels. There are also drugs for erectile dysfunction.
- Surgery: Some men need surgery to open blockages in the tubes that store and carry sperm. Varicocele surgery can make sperm healthier and can improve the odds of conception.
What are fertility treatment options for all genders?
Some couples need more help conceiving. To increase pregnancy odds, a woman may first take medications to stimulate ovulation before trying one of these options:
- Intrauterine insemination (IUI): A healthcare provider uses a long, thin tube to place sperm directly into the uterus.
- In vitro fertilization (IVF): IVF is a type of assisted reproductive technology (ART). It involves harvesting the eggs at the end of the stimulation and placing sperm and eggs together in a lab dish. The sperm fertilize the eggs. A provider transfers one of the fertilized eggs (embryo) into the uterus.
- Intracytoplasmic sperm injection (ICSI): This procedure is similar to IVF. An embryologist (highly specialized lab technician) directly injects a single sperm into each of the harvested eggs and then a provider transfers an embryo into the uterus.
- Third-party ART: Couples may use donor eggs, donor sperm or donor embryos. Some couples need a gestational carrier or surrogate. This person agrees to carry and give birth to your baby.
How can I prevent infertility?
Men and women can take these steps to protect their fertility, especially while trying to conceive:
- Eat a well-balanced diet and maintain a healthy weight.
- Don’t smoke, misuse drugs or drink excessively.
- Get treated for STDs.
- Limit exposure to toxins.
- Stay physically active, but don’t overdo exercise.
Outlook / Prognosis
What is the prognosis (outlook) for people who have infertility?
Approximately 9 out of 10 couples get pregnant after undergoing fertility treatments. Success rates vary depending on the cause of infertility, the couple’s ages and other factors. In general:
- Each IUI attempt has a 20% success rate.
- An estimated 1 in 2 women under the age of 35 conceive with ART. That number drops to 1 in 30 women (3%) for women in their early to mid-40s.
Does insurance cover infertility treatment?
Health insurance policies vary, so you should always check with your provider. Most insurers cover medically necessary procedures, such as surgeries to treat endometriosis and uterine fibroids. Some policies cover fertility procedures like IUI but may not cover ovulation-stimulating medications.
According to The National Infertility Association (Resolve), 19 states have laws requiring employers to cover certain fertility treatments. Each state law is different. You can visit the National Infertility Association’s website to see what protections, if any, your state offers.
What questions should I ask my doctor?
You may want to ask your healthcare provider:
- What’s causing our infertility?
- Should my partner and I both get tested for fertility problems?
- If my partner or I are older, how soon should we get tested for fertility problems?
- What is the best treatment for us?
- What is the treatment success rate?
- What are the treatment side effects or risks?
- Should I look out for signs of complications?
A note from Cleveland Clinic
Infertility poses many challenges. It can affect your relationships and emotional health. Infertility treatments can also be costly and strain your finances. Your healthcare provider can determine the cause of infertility. This first step helps determine the best treatment to help you succeed in expanding your family. Most couples eventually get pregnant, but some turn to adoption. Your provider can review options with you.