What is Infertility?

Infertility
Infertility affects approximately 6.1 million individuals.

Infertility is a condition of the reproductive system that prevents theconception of children. It affects approximately 6.1 million individualsthroughout the United States. The diagnosis of infertility is usually givento couples who have been attempting to conceive for at least 1 year withoutsuccess.

Conception and pregnancy are complicated processes that depend upon a numberof factors, including: 1) the production of healthy sperm by the man, 2)healthy eggs produced by the woman; 3) unblocked fallopian tubes that allowthe sperm to reach the egg; 4) the sperm’s ability to fertilize the eggwhen they meet; 5) the ability of the fertilized egg (embryo) to becomeimplanted in the woman’s uterus; and, 6) sufficient embryo quality.

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

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Is infertility primarily a woman’s problem?

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

What causes infertility in men?

The most common causes of male infertility are azoospermia (nosperm cells are produced) and oligospermia (few sperm cells are produced).Sometimes, sperm cells are malformed or they die before they can reach theegg. In rare cases, infertility in men is caused by a genetic disease suchas 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, whichcan happen when a woman has had pelvic inflammatory disease or endometriosis;Congenital anomalies (birth defects) involving the structure ofthe uterus, and uterine fibroids which are associated with repeated miscarriages;and aging, since the ability for ovaries to produce eggs tends to declinewith age, especially after the age of 35.

When should someone get tested for infertility?

The American Society of Reproductive Medicine recommends that women under35 begin testing after trying to conceive unsuccessfully for 12 months.The recommendation for women over 35 is to begin testing after trying toconceive unsuccessfully for 6 months. Some couples or individuals find thatthey are more relaxed when trying to conceive if they believe that everythingis normal.

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How early can you get tested?

Couples may request that their health care provider conduct an exam todetermine if everything is healthy and working correctly. It is also possibleto use over-the-counter screening tests using testing kits like Fertellto 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 ifthey are unable to achieve pregnancy after a year of unprotected intercourse.The doctor will conduct a physical examination of both partners to determinetheir general state of health and to search for physical disorders thatmay be contributing to infertility. The doctor will usually interview bothpartners about their sexual habits in order to determine whether intercourseis taking place properly for conception.

If no cause can be determined at this point, more specific testsmay be recommended. For women, these include an analysis of body temperatureand 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 to 90 percent of infertility cases are treated with conventionaltherapies such as drug treatment or surgical repair of reproductive organs.Assisted reproductive technologies such as in vitro fertilization accountfor the remaining infertility treatment options. Some people find it helpfulto hear about the experiences of other infertile couples and to communicatewith them. The pregnancyforums of APA or Shared Journeyare 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, invitro fertilization (IVF) offers couples the opportunity of biologicalparenthood.

During IVF, eggs are surgically removed from the ovary and mixed withsperm 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 fertilizedby 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 introducedin 1978 and currently accounts for less than five percent of all infertilitytreatments in the United States.

Is in vitro fertilization expensive ?

The average cost of an IVF cycle in the United States is $12,400. Likeother extremely delicate medical procedures, IVF involves highly trainedprofessionals with sophisticated laboratories and equipment, and the cyclemight need to be repeated in order to be successful. While IVF and otherassisted reproductive technologies are can be costly, they account for onlythree 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 Societyof Assisted Reproductive Technology (SART), who tracks ART success ratesin the U.S., IVF currently accounts for more than 99% of ART procedures,with GIFT, ZIFT and combinationprocedures making up the remainder. The average live birth rate for IVFin 2008 was 34% of all cycles. The results are slightly better than the20% chance that a reproductively healthy couple has of achieving a pregnancyin 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 thetype of insurance plan. Fifteen states currently have laws that requireinsurers to cover or offer to cover at least a portion of infertility diagnosisand 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 lawsvary greatly in their scope of what might be covered. For more informationabout specific laws in each of those states, you may contact your state’sInsurance Commissioner’s office. To learn about pending insurance legislationin 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 Departmentto determine the exact coverage your plan provides. Another resource fordetermining coverage is, “Infertility Insurance Advisor: An Insurance CounselingProgram for Infertile Couples.” This booklet is available for a small feefrom RESOLVE, an infertility patientadvocacy and information organization.

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

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Last Updated: 02/2012

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