What is Infertility?

What is infertility

Infertility is a condition of the reproductive system that prevents the conception of children. It affects approximately 10-15% of couples throughout the United States. The diagnosis of infertility is usually given to couples who have been attempting to conceive for at least 1 year without success.

Conception and pregnancy are complicated processes that depend upon a number of factors, including:

  • the production of healthy sperm by the man
  • healthy eggs produced by the woman
  • unblocked fallopian tubes that allow the sperm to reach the egg
  • the sperm’s ability to fertilize the egg when they meet
  • the ability of the fertilized egg (embryo) to become implanted in the woman’s uterus
  • sufficient embryo quality

Finally, for the pregnancy to progress to full term the embryo must be healthy and the woman’s hormonal environment adequate for its development.  If just one of these factors is impaired, infertility can be the result.

Is infertility primarily a woman’s problem?

It is a common assumption that infertility is primarily related to the woman. In reality, only one-third of infertility cases are related to the woman alone. Statistically, one-third of infertility problems are related to men and the remaining one-third is a combination of fertility factors involving both partners or unknown causes. Unknown causes account for approximately twenty percent of infertility cases.

What causes infertility in men?

The most common causes of male infertility are azoospermia (no sperm cells are produced) and oligospermia (few sperm cells are produced).  Sometimes, sperm cells are malformed or they die before they can reach the egg. In rare cases, infertility in men is caused by a genetic disease such as cystic fibrosis or a chromosomal abnormality.

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What causes infertility in women?

The most common cause of female infertility is ovulation disorders.  Problems with ovulation affect about 25% of all infertility situations.  Other causes of female infertility include blocked fallopian tubes, which can happen when a woman has had pelvic inflammatory disease or endometriosisCongenital anomalies (birth defects) involving the structure of the uterus, and uterine fibroids which are associated with repeated miscarriages; and aging, since the ability for ovaries to produce eggs tends to decline with age, especially after the age of 35.

When should someone get tested for infertility?

The American Society of Reproductive Medicine recommends that women under 35 begin testing after trying to conceive unsuccessfully for 12 months. The recommendation for women over 35 is to begin testing after trying to conceive unsuccessfully for 6 months. Some couples or individuals find that they are more relaxed when trying to conceive if they believe that everything is normal.

How early can you get tested?

Couples may request that their health care provider conduct an exam to determine if everything is healthy and working correctly. It is also possible to use over-the-counter screening tests using testing kits to evaluate key aspects of fertility for both men and women.

How is infertility diagnosed?

As already noted, couples are generally advised to seek medical help if they are unable to achieve pregnancy after a year of unprotected intercourse.  The doctor will conduct a physical examination of both partners to determine their general state of health and to search for physical disorders that may be contributing to infertility. The doctor will usually interview both partners about their sexual habits in order to determine whether intercourse is taking place properly for conception.

If no cause can be determined at this point, more specific tests may be recommended. For women, these include an analysis of body temperature and ovulation, x-ray of the fallopian tubes and uterus, and laparoscopy. For men, initial tests focus on semen analysis.

How is infertility treated?

Approximately 85-90% 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 treatment options. Some people find it helpful to hear about the experiences of other infertile couples and to communicate with them. The pregnancy forums of APA or Shared Journey are sites where you can read and share stories.

What is in vitro fertilization (IVF)?

In cases of blocked or absent fallopian tubes or low sperm count, in vitro fertilization (IVF) offers couples the opportunity of biological parenthood.

During IVF, eggs are surgically removed from the ovary and mixed with sperm outside the body in a Petri dish. 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 and currently accounts for less than five percent of all infertility treatments in the United States.

Is in vitro fertilization expensive ?

The average cost of an IVF cycle in the United States is $12,400. Like other extremely delicate medical procedures, IVF involves highly trained professionals with sophisticated laboratories and equipment, and the cycle might need to be repeated in order to be successful. While IVF and other assisted reproductive technologies are can be costly, they account for only three hundredths of one percent (0.03%) of U.S. health care costs.

Does in vitro fertilization work?

IVF was introduced in the United States in 1981. According to Society of Assisted Reproductive Technology (SART), who tracks ART success rates in the U.S., IVF currently accounts for more than 99% of ART procedures, with GIFT, ZIFT and combination procedures making up the remainder. The average live birth rate for IVF in 2008 was 34% of all cycles. The results are slightly better than the 20% chance that a reproductively healthy couple has of achieving a pregnancy in a given month and carrying it to term.

Do insurance plans cover infertility treatment?

The services covered by insurance will depend on where you live and the type of insurance plan. Fifteen states currently have laws that require insurers to cover or offer to cover at least a portion 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 existing laws vary greatly in their scope of what might be covered. For more information about specific laws in each of those states, you may contact your state’s Insurance Commissioner’s office. To learn about pending insurance legislation in your state, you may contact your State Representative.

Whether or not you live in a state with an infertility insurance law, you can choose to consult with your employer’s Human Resources Department to determine the exact coverage your plan provides. Another resource for determining coverage is, “Infertility Insurance Advisor: An Insurance Counseling Program for Infertile Couples.” This booklet is available for a small fee from RESOLVE, an infertility patient advocacy and information organization.

Because the desire to have children and be a parent is fundamental to being human, people should not be denied insurance coverage for medically appropriate treatment for problems of infertility.

For More Information on Infertility:

Last Updated: 09/2014

Compiled using information from the following sources:

Society for Assisted Reproductive Technology (SART), http://www.sart.org

RESOLVE: The National Infertility Association, http://www.resolve.org

NCSL, National Conference of State Legislature, http://www.ncsl.org