Infertility
Key points
- Infertility is the inability to achieve a pregnancy after 12 months of unprotected intercourse.
- Primary infertility is the term used to describe a couple that has never been able to conceive a pregnancy, after at least 1 year of unprotected intercourse.
- A complete history and physical examination of both partners is essential.
- Treatment depends on the cause of infertility for any given couple.
Alternative names
Barren; Inability to conceive; Unable to get pregnant
Definition
Infertility is the inability to achieve a pregnancy after 12 months of unprotected intercourse.
Causes, incidence, and risk factors
Primary infertility is the term used to describe a couple that has never been able to conceive a pregnancy, after at least 1 year of unprotected intercourse. The term secondary infertility describes couples who have previously been pregnant at least once, but have not been able to achieve another pregnancy.
Causes of infertility include a wide range of physical as well as emotional factors. Approximately 30% to 40% of all infertility is due to a "male" factor, such as retrograde ejaculation, impotence, hormone deficiency, environmental pollutants, scarring from sexually transmitted disease, or decreased sperm count. Some factors affecting sperm count are heavy marijuana use or use of prescription drugs such as cimetidine, spironolactone, and nitrofurantoin.
A "female" factor - scarring from sexually transmitted disease or endometriosis, ovulation dysfunction, poor nutrition, hormone imbalance, ovarian cysts, pelvic infection, tumor, or transport system abnormality from the cervix through the fallopian tubes - is responsible for 40% to 50% of infertility in couples. The remaining 10% to 30% may be caused by contributing factors from both partners, or by no cause that can be identified.
It is estimated that 10% to 20% of couples will be unable to conceive after 1 year of attempting to become pregnant. It is important that pregnancy be attempted for an extended period (at least 1 year). The chances for pregnancy occurring in healthy couples who are both under the age of 30 and having intercourse regularly is only 25% to 30% per month. A woman's peak fertility occurs in her early 20s. As a woman ages beyond 35 (and particularly after age 40), the likelihood of conceiving diminishes to less than 10% per month.
In addition to age-related factors, increased risk for infertility is associated with having:
- Multiple sexual partners, increasing the risk for STDs
- A sexually transmitted disease
- A past history of PID (pelvic inflammatory disease) - after a single episode, 10% to15% of women may become infertile
- A past history of orchitis or epididymitis in men
- Mumps (men)
- A varicocele (men)
- A past medical history that includes DES exposure (men or women)
- Eating disorders (women)
Written and revised by
Gerald Hurowitz, M.D.
Our doctors write and review articles for accuracy and keep them up to date.
health.am provides general information, not medical advice. Always consult a qualified health professional about your own health.