Infertility affects approximately 6.1 million individuals throughout the United States, and is usually diagnosed when a couple has been trying to get pregnant unsuccessfully for at least 1 year, or after 6 months if the woman is 35 years or older. 80% of all couples have difficulties getting pregnant.
Typically, there is a combination of the following issues:
- Low sperm count
- Ovulation and egg insufficiency
- Fallopian tubes are not open
Getting pregnant isn't always easy. The process of fertilization depends on several factors:
- Healthy sperm and a sufficient amount
- Healthy eggs
- 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 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 40-50% of couples get pregnant within 4-5 months and 85% get pregnant within 12 months.
Up to 90% of infertility cases are treated with conventional therapies, such as drug treatment or surgical repair of reproductive organs. Less than 5% are treated with IVF in-vitro fertilization. However, before you get treated you need to get tested so you can find out the right treatment for you.
During an infertility workup, over 80% of infertile couples have one or more of these issues:
- 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 the 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 15% of infertility cases, no cause is found (unexplained infertility).
The most common male infertility factors are if the man 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 sperm count. 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 number one 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.
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 being treated, you must find out the cause of the problem:
Step 1: Medical and Reproductive History Assesment:
- 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 85-90% of infertility cases are treated with conventional therapies, such as drug treatment or surgical repair of reproductive organs. Assisted reproductive technologies (ART), such as in vitro fertilization, account for the remaining infertility treatments.
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.
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, bypassing the fallopian tubes.
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.
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, hundreds of thousands of 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.
Do insurance plans cover infertility treatment?
The degree of services covered depends on where you live and the type of insurance plan you have. Currently, only 15 states have laws that require insurers to either cover or offer to cover some form of infertility diagnosis and treatment. 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, call your state's Insurance Commissioner's office.
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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