Infertility is a condition of the reproductive system that impairs the conception of children. It affects approximately 6.1 million individuals throughout the United States. Infertility is usually diagnosed when a couple has been trying to get pregnant unsuccessfully for at least 1 year, and after 6 months if the woman is 35 years or older. You have difficulties getting pregnant (this applies to about 80% of all couples, and usually there is a combination of these problems) because:
- He does not have enough sperm
- You have problems with ovulation and your eggs
- Your fallopian tubes are not open
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- READ THIS: How to get pregnant faster
Getting pregnant is not always easy. The process of fertilization depends on many factors:
- Healthy sperm by the man
- Enough sperm by the man
- Healthy eggs produced by the woman
- Healthy and unblocked fallopian tubes that allow the sperm to reach the egg
- The sperm's ability to fertilize the egg when they join
- The ability of the fertilized egg (embryo) to become implanted in the woman's uterus
- The ability of the lining of the uterus to allow implantation
- Sufficient embryo quality
- A healthy embryo
- A healthy hormonal environment of the woman.
About one in 7 couples (15%) are affected by infertility. Healthy couples in their 20’s have a one in four chance of getting pregnant each month. About 40% to 50% of couples get pregnant within 4-5 months and 85% get pregnant within 12 months.
Read up on Causes of Infertility HERE
Up to 90% of infertility cases are treated with conventional therapies, such as drug treatment or surgical repair of reproductive organs. Less than 5% get treated with IVF in-vitro fertilization.
Before you get treated you need to get tested so you can find out the right treatment. Infertility testing: 5 Steps in 5 Weeks
One of the most important factors when you have difficulties getting pregnant is the mother's age. During infertility workup, over 80% of infertile couples have one or more of these three problems:
- Male Factors (sperm problems: Not enough, not moving, bad shapes
- Ovulation Problems (PCOS or age related issues, Good eggs versus Bad eggs)
- Pelvic factors (infections, endometriosis, scar tissue)
Infertility is usually a responsibility of both partners, one-third of infertility cases are related to the man's problems, one-third to the woman's and in one-third of cases both are responsible. In about fifteen percent of infertility cases no cause is found (unexplained Infertility).
The most common male infertility factors are if he has too few (oligospermia) or no sperm (azoospermia), and malformed sperm cells. Rarely, infertility in men can be caused by a genetic disease. The first test done when a couple has difficulties getting pregnant is a SpermCount. 35% of infertility cases are due to male factors such as an abnormal sperm count (for example, oligospermia or not enough sperm, increased semen viscosity, decreased sperm motility, or decreased semen volume) which makes this test the first and easiest to do.
The #1 factor in women's infertility is an ovulation disorder, either there is no ovulation (anovulation) or the eggs are of not good enough quality. Other causes of female infertility include blocked fallopian tubes, which can occur when a woman has had pelvic inflammatory disease (PID) or endometriosis. A woman's age is a major factor because the number and quality of the eggs decline as a woman gets older starting at age 30. Other reasons for female infertility include a problem with the fallopian tube (endometriosis, scarring, or other problems), and cervical issues.
About 25% of cases of infertility are due to ovulation problems such as anovulation and polycystic ovary syndrome (PCOS);
30% of infertility cases are caused by pelvic factors such as endometriosis, adhesions, or tubal disease.
Less than 5% of infertility is caused by abnormal cervical mucus penetration, antisperm antibodies, or corpus luteum defects (CLP).
In about 10-15% of couples, no specific reason for infertility can be found on initial evaluation. This is called (unexplained infertility). But on further evaluation and treatment, occasionally factors such as poor sperm penetration or abnormal-appearing oocytes (eggs) are discovered.
Timing of Testing
The American Society of Reproductive Medicine recommends that women under 35 begin testing after trying to conceive (TTC) unsuccessfully for 12 months, and women over 35 should begin testing after trying to conceive for 6 months without success.
How are the Causes of Infertility Diagnosed?
Before getting treated you must find out the cause of the problem and what is is you are treating.
LEARN MORE: Attend the BabyMed Fertility University course - Fertility 101
Step 1: The doctor will usually start asking you some questions
- Menstrual history - How regular are your menstrual cycles and could they indicate a problem?
- Medical history - Are there any medical issues in either the woman or the man that could explain the infertility?
- Sexual technique and timing - Are you having enough sex at the appropriate time?
- Lifestyle issues - Certain lifestyle issues both in women and men such as smoking, drinking alcohol, too much stress or caffeine consumption may affect your fertility and your ability to get pregnant.
- Medications - Are there any drugs or medications that you are taking which may affect your ability to conceive?
The next step is a physical examination of both partners to determine their general state of health and to evaluate physical disorders that may be causing infertility.
If no cause can be determined at this point, more specific tests may be recommended.
Step 2: He gets tested
The initial male fertility testing includes a sperm count and semen analysis.
Step 3: She gets tested
The initial tests in women focus on whether and when she ovulates. These tests may include:
- Cycle day 3 ovarian function blood test
- Hysterosalpingogram (X-ray or sonogram) and laparoscopy to assess the fallopian tube patency.
After the above tests, there is usually enough information about the reason for the infertility and how to treat it.
Male Infertility Treatment
Approximately 85 to 90 percent of infertility cases are treated with conventional therapies, such as drug treatment or surgical repair of reproductive organs. Assisted reproductive technologies, such as in vitro fertilization, account for the remaining infertility treatments. Some people find it helpful to hear stories and talk with others. You can visit the pregnancy forums of APA or Shared Journey - another site where you can find, read and share stories.
In-vitro Fertilization (IVF)
For infertile couples in which the woman has blocked or absent fallopian tubes, or the man has a low sperm count, in vitro fertilization (IVF) offers the chance of biological parenthood to couples.
In IVF, eggs are surgically removed from the ovary and mixed with sperm outside the body in a Petri dish ("in vitro" is Latin for "in glass"). After about 40 hours, the eggs are examined to see if they have become fertilized by the sperm and are dividing into cells. These fertilized eggs (embryos) are then placed in the women's uterus, by-passing the fallopian tubes.
IVF has received a great deal of media attention since it was first introduced in 1978, but it actually accounts for less than five percent of all infertility treatment in the United States.
Is in-vitro fertilization expensive?
The average cost of an IVF cycle in the United States is well over $10,000. Like other extremely delicate medical procedures, IVF involves highly trained professionals with sophisticated laboratories and equipment, and the cycle may need to be repeated to be successful. While IVF and other assisted reproductive technologies are costly, they account for only three hundredths of one percent (0.03%) of U.S. health care costs.
Does in vitro fertilization work?
Yes, IVF is very successful for those who are selected well. IVF was introduced in the United States in 1981, and as a result hundred of thousand babies conceived by IVF have been born. In 2012 alone over 60,000 IVF babies were delivered in the US. IVF currently accounts for about 98% of ART procedures, with GIFT, ZIFT and combination procedures making up the remainder. The average live birth rate for IVF in 1998 was 29.1% per retrieval; a little better than the 20% chance in any one month that a reproductively healthy couple has of achieving a pregnancy and carrying it to term.
Do insurance plans cover infertility treatment?
The degree of services covered depends on where you live and the type of insurance plan you have. Fifteen states currently have laws that require insurers to either cover or offer to cover some form of infertility diagnosis and treatment. Those states are Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas and West Virginia. HOWEVER, the laws vary greatly in their scope of what is and is not required to be covered. For more information about the specific laws for each of those states, please call your state's Insurance Commissioner's office. To learn about pending insurance legislation in your state, please contact your State Representatives.
Whether or not you live in a state with an infertility insurance law, you may want to consult with your employer's director of human resources to determine the exact coverage your plan provides.
The desire to have children and be a parent is one of the most fundamental aspects of being human. People should not be denied insurance coverage for medically appropriate treatment to fulfill this goal.
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