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Infertility is defined as inability to conceive after one year of unprotected intercourse. The combined male and female fertility potentials must reach a critical threshold for a pregnancy to occur. Couples who have trouble conceiving generally have multiple problems. To some extent, male and female fertility potentials can compensate for one another. When one partner's fertility potential is diminished, there is less latitude for the other partner's fertility potential.
Infertility is generally not associated with any symptoms. Major factors contributing to infertility may go undetected if both partners are not tested. By seeing a specialist early, the couple may save themselves a lot of frustration and valuable time and expenses in the long run.
The length of time a couple may wait before seeing a specialist depends on several factors. One determining factor is their emotional states. If the couple suspects a particular problem, then there is no reason to wait. Certainly, the woman's age is a very important factor, since fertility declines at age 25. This decline becomes more significant after age 35.
First, the doctor will determine:
- If sperm is present,
- Whether or not the fallopian tubes are open, and
- If ovulation can occur.
 If these three criteria are met, then the couple is considered not sterile, but just infertile. The doctor will then assess factors that can make a couple infertile, i.e., diminish their fertility potential. These include ovulation dysfunction, damaged tubes, sperm anomalies, poor cervical mucus, abnormalities of the uterus and uterine lining, presence of endometriosis, fibroid tumors, scars and adhesions. Likewise, infections, antibodies that fight sperm and other health problems can diminish  fertility potential. The male partner may also need additional evaluation.
Fortunately, there are treatment options available to most patients. Testing may be conducted concurrently along with treatment in order to save time. Treatment begins with simple options, followed by progressively more advanced options. Sometimes, it may require medications, fertility drugs, or even surgery. Less than 5 percent of infertile couples require advanced technologies such as In Vitro Fertilization (IVF), Gamete Intrafallopian Transfer (GIFT) and Zygote Intrafallopian Transfer (ZIFT), Intracytoplasmic Sperm Injection (ICSI) or egg donation.
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"Unexplained infertility" refers to situations where no apparent cause for infertility has been found in spite of thorough evaluation or when treatment of apparent causes has not resulted in a pregnancy. Approximately 5 million Americans are affected by infertility. Ten to 20% of these cases are unexplained.
Before the diagnosis of unexplained infertility can be made, many conditions must be met or problems must have been corrected:
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Fallopian tubes must be open and ovulation must be normal.
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Sperm must be of good quality and the lining of the uterus must be well developed.
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Hormone profiles should be normal.
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There should be no signs of infection or inflammation to prevent a pregnancy.
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Problems with cervical mucus, ovulation and antibodies must be excluded or bypassed.
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There should be no other factor diminishing fertility potential such as endometriosis or pelvis adhesions.
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Couple should be screened for lifestyles and other health conditions.
- Laparoscopy must be normal or detected problems must have been corrected.
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Patients with unexplained infertility can conceptually conceive even without any treatment. Treatment is designed to bypass potential obstacles and to improve the odds of conception. The treatment is conducted in an incremental and progressive fashion.
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 The basic level of treatment consists of the use of clomiphene citrate, a mild fertility drug, with intra uterine insemination (IUI) and progesterone supplementation. This may enhance ovulation, increase the number of sperm in the woman's uterus, obviate few obstacles, and potentially restore the couple's natural fertility. This treatment may be tried for 3 to 6 cycles and if not successful, the couple may move on to the next step.
- The next level of treatment is superovulation through the use of gonadotropins and IUI. Gonadotropins are potent fertility drugs designed to produce and release multiple eggs. Unlike clomiphene, gonadotropins cause enhancement of oocyte quality, cervical mucus, and the uterine lining.
- Couples who fail to conceive with these treatments can proceed with Assisted Reproductive Technologies (ART). These consist of In Vitro Fertilization (IVF), Gamete Intrafallopian Transfer (GIFT), Zygote Intrafallopian Transfer (ZIFT), Intracytoplasmic Sperm Injection (ICSI), blastocyst transfer, egg donation, gestational carrier or other ART procedures. These advanced techniques all include superovulation, egg collection, sperm processing and gamete or embryo transfer.
ICSI consists of injection of a single sperm inside the egg and transfer of embryos into the uterus. ICSI was primarily developed for the treatment of male infertility but it is now used for previous IVF failure as well.
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Continue to Male Infertility & Donor Sperm Insemination >>
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