Infertility Information

Frequently Asked Questions

• What is infertility?
  
• What causes infertility?
  
• How is infertility diagnosed?
  
• How is infertility treated?
  
• What is in vitro fertilization?
  
• Does in vitro fertilization work?
  
• How long should we try before consulting a doctor?
  
• Infertility Diagnosis List (general list of the most common diagnoses)
  
• What impact does infertility have on psychological well being?
  
• How do I know if I could benefit from psychological counseling?
  
• How can psychological treatment help me/us cope with infertility?
  
• How do depression and anxiety play a role in infertility?
  
• Infertility Myths & Facts

What is infertility?

Infertility is a disease of the reproductive system that impairs one of the body's most basic functions: the conception of children. Conception is a complicated process that depends upon many factors: on the production of healthy sperm by the man and healthy eggs 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; and sufficient embryo quality.
Finally, for the pregnancy to continue to full term, the embryo must be healthy and the woman's hormonal environment adequate for its development. When just one of these factors is impaired, infertility can result. Infertility is often diagnosed after a couple has had one year of unprotected, well-timed intercourse, or if the woman has suffered from multiple miscarriages.

What causes infertility?

In rough terms, about one-third of infertility cases can be attributed to male factors, and about one-third to factors that affect women. For the remaining one-third of infertile couples, infertility is caused by a combination of problems in both partners or, in about 20 percent of cases, is unexplained.
The most common male infertility factors include 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.
The most common female infertility factor is an ovulation disorder. Other causes of female infertility include blocked fallopian tubes, which can occur when a woman has had pelvic inflammatory disease or endometriosis (a sometimes painful condition causing adhesions and cysts). Congenital anomalies (birth defects) involving the structure of the uterus and uterine fibroids are associated with repeated miscarriages.

How is infertility diagnosed?

Couples are generally advised to seek medical help if they are unable to achieve pregnancy after a year of unprotected intercourse, if the woman is under the age of 35. For couples where the woman is 35 years of age or older, they should seek medical help if they are unable to conceive after 6 months of unprotected intercourse. Anyone who thinks they may have a medical condition that may be impacting their fertility, such as endometriosis for example, should seek medical advice immediately. The doctor will conduct a physical examination of both partners to determine their general state of health and to evaluate physical disorders that may be causing infertility. Usually both partners are interviewed 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?

Most infertility cases -- 85 to 90 percent -- are treated with conventional therapies, such as drug treatment or surgical repair of reproductive organs. Medical technology now offers more answers and treatment options to men and women trying to conceive a child. From hormonal treatments, ovulation induction and intrauterine insemination to more advanced technologies like in vitro fertilization, ICSI to surrogacy, egg/sperm donation and even embryo donation.

What is in vitro fertilization?

In infertile couples where women have blocked or absent fallopian tubes, or where men have low sperm counts, in vitro fertilization (IVF) offers a chance at parenthood to couples who until recently would have had no hope of having a "biologically related" child.

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, thus bypassing 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.

Does in vitro fertilization work?

Yes. IVF was introduced in the United States in 1981. Since 1985, when we began counting, through the end of 2006, almost 500,000 babies have been born in the United States as a result of reported Assisted Reproductive Technology procedures (IVF, GIFT, ZIFT, and combination procedures). IVF currently accounts for more than 99% of ART procedures with GIFT, ZIFT and combination procedures making up the remainder. The average live delivery rate for IVF in 2005 was 31.6 percent per retrieval--a little better than the 20 per cent chance in any given month that a reproductively healthy couple has of achieving a pregnancy and carrying it to term. It is important to note that patient characteristics vary among clinics and physicians, so it is important to be sure that you are comparing apples to apples when deciding which clinic will give you the best odds of achieving pregnancy with IVF.

How long should we try before consulting a doctor?

Most physicians advise you not to be concerned unless you have been trying to conceive for at least one year and are under 35. If you are over 35 and have been trying for 6 months, you should consult a physician. If you are over 30 and have a history of pelvic inflammatory disease, painful periods, miscarriage, irregular cycles, or if you know that your partner has a low sperm count, do not wait one year.

Infertility Diagnosis List - it is important to see a specialist, or a Reproductive Endocrinologist for a complete fertility work-up and diagnosis.

Endometriosis - Endometriosis is a disorder of the female reproductive system in which endometrial tissue (the normal lining of the uterus) is found outside the uterine cavity. An estimated three to five million American women of reproductive age suffer from endometriosis.

Multiple Miscarriage - Miscarriage can leave you with deep- rooted feelings of loss and sorrow. These feelings must be confronted and dealt with, not suppressed, as is often urged by friends and family. It is important to take action and see an infertility specialist if you have experienced 2 or more miscarriages.

Male Factor - 40% of infertility is due a male problem such as structural abnormalities, sperm production disorders, ejaculatory disturbances and immunologic disorders.
Implantation Issues - IVF is such a highly structured procedure, yet when the embryo is implanted in the uterus, there is much left to chance.

Ovulatory Disorders - Approximately 40% of female infertility problems are the result of ovulation disorders. There are many factors that can affect ovulation. In this section we will discuss mainly pituitary causes.

Polycystic Ovarian Syndrome - PCOS is a very common hormone disorder in women, a leading cause of infertility, and one of the most under diagnosed diseases in the United States. PCOS is characterized by a myriad of seemingly unrelated symptoms and may include irregular or absent periods, lack of ovulation, weight gain, acne, excessive facial hair and infertility. Even more serious, women with PCOS may be at higher risk for developing cardiovascular disease, Type 2 Diabetes, and endometrial cancer, especially if PCOS is left untreated.

Luteal Phase Defect - Abnormalities in endometrial development -- luteal phase defect (LPD) - are associated with infertility and early miscarriage. Luteal phase defect occurs when the endometrium is inadequately prepared, either because the secretion of progesterone by the ovary is below normal or because the endometrium isn't responding to the normal stimulation by progesterone.

Premature Ovarian Failure - Premature ovarian failure is defined as the cessation of menstrual periods before the age of 40. It occurs in 1 in 1,000 women between the ages of 15 and 29 and 1 in 100 women between the ages of 30 and 39. The average age of onset is 27 years. Premature ovarian failure can be both shocking and devastating as there are relatively few treatment options.

Uterine Factors - Abnormalities of the uterus can have a significant impact on the ability of a woman to conceive and to carry a pregnancy successfully. Some women have an abnormally developed uterus from birth (congenital) while others may develop a uterine problem due to infection or surgery (acquired).

Poor Responder - The term poor responder has been used to define women who require large doses of stimulation medications and who make less than an optimal number of eggs. There is no uniform definition of poor responders, but many clinics have used a cutoff of less than four mature oocytes at the time of hCG or a peak estradiol of less than 500.

Unexplained Infertility - Approximately one in five couples will experience unexplained infertility despite completing a full infertility work-up. The emotional response to hearing, "There is no apparent reason for your infertility" can be difficult, maddening and frustrating. Fortunately, there are many options available for the couple diagnosed with unexplained infertility.

Secondary Infertility - Although over three million Americans are affected by the painful experience of secondary infertility, it generally remains an unacknowledged and invisible condition. Secondary infertility is defined as the inability to become pregnant, or to carry a pregnancy to term, following the birth of one or more biological children.

What impact does infertility have on psychological well being?

Infertility often creates one of the most distressing life crises that a couple has ever experienced together. The long term inability to conceive a child can evoke significant feelings of loss. Coping with the multitude of medical decisions and the uncertainties that infertility brings can create great emotional upheaval for most couples. If you find yourself feeling anxious, depressed, out of control, or isolated, you are not alone.

How do I know if I could benefit from psychological counseling?

Everyone has feelings and emotional ups and downs as they pursue infertility treatment. Feeling overwhelmed at times is a perfectly normal response. However, if you experience any of the following symptoms over a prolonged period of time, you may benefit a great deal from working with a mental health professional:

• loss of interest in usual activities
  
• depression that doesn't lift
  
• strained interpersonal relationships (with partner, family, friends and/or colleagues)
  
• difficulty thinking of anything other than your infertility
  
• high levels of anxiety
  
• diminished ability to accomplish tasks
  
• difficulty with concentration
  
• change in your sleep patterns (difficulty falling asleep or staying asleep, early morning awakening, sleeping more than usual for you)
  
• change in your appetite or weight (increase or decrease)
  
• increased use of drugs or alcohol
  
• thoughts about death or suicide
  
• social isolation
  
• persistent feelings of pessimism, guilt, or worthlessness
  
• persistent feelings of bitterness or anger
  In addition, there are certain points during infertility treatment when discussion with a mental health professional of various options and exploration of your feelings about these options can help facilitate clarification of your thinking and help with your decision making. For example, consultation with a mental health professional may be helpful to you and your partner if you are:
  
• at a treatment crossroad
  
• deciding between alternative treatment possibilities
  
• exploring other family building options
  
• considering third party assistance (gamete donation, surrogacy)
  
• having difficulty communicating or if you have different ideas about what direction to take

How can psychological treatment help me/us cope with infertility?

Mental health professionals with experience in infertility treatment can help a great deal. Their primary goal is to help individuals and couples learn how to cope with the physical and emotional changes associated with infertility, as well as with the medical treatments that can be painful and intrusive. For some, the focus may be on how to deal with a partner's response. For others, it may be on how to choose the right medical treatment or how to begin exploring other family building options. For still others, it may be on how to control stress, anxiety, or depression. By teaching patients problem- solving strategies in a supportive environment, mental health professionals help people work through their grief, fear, and other emotions so that they can find resolution of their infertility. A good therapist can help you sort out feelings, strengthen already present coping skills and develop new ones, and communicate with others more clearly. For many, the life crisis of infertility eventually proves to be an opportunity for life-enhancing personal growth.

How do depression and anxiety play a role in infertility?

Research demonstrates the following:

• Infertile women are significantly more depressed than fertile women
  
• Infertile women have equivalent levels of anxiety and depression as women with cancer, heart disease or HIV+ status
  
• Depression can correlate with poorer outcome in IVF treatment and can interfere with conception

Infertility Myths and Facts

Myth: Infertility is a women's problem.

Fact: This is untrue. It surprises most people to learn that infertility is a female problem in 35% of the cases, a male problem in 35% of the cases, a combined problem of the couple in 20% of cases, and unexplained in 10% of cases. It is essential that both the man and the woman be evaluated during an infertility work-up.

Myth: It's all in your head! Why don't you relax or take a vacation. Then you'll get pregnant!

Fact: Infertility is a disease or condition of the reproductive system. While relaxing may help you with your overall quality of life, the stress and deep emotions you feel are the result of infertility, not the cause of it. Improved medical techniques have made it easier to diagnose infertility problems.

Myth: Don't worry so much -- it just takes time. You'll get pregnant if you're just patient.

Fact: Infertility is a medical problem that may be treated. At least 50% of those who complete an infertility evaluation will respond to treatment with a successful pregnancy. Some infertility problems respond with higher or lower success rates. Those who do not seek help have a "spontaneous cure rate" of about 5% after a year of infertility.

Myth: If you adopt a baby you'll get pregnant!

Fact: This is one of the most painful myths for couples to hear. First it suggests that adoption is only a means to an end, not a happy and successful end in itself. Second, it is simply not true. Studies reveal that the rate for achieving pregnancy after adopting is the same as for those who do not adopt.

Myth: Why don't you just forget it and adopt? After all, there are so many babies out there who need homes!

Fact: For many, adoption is a happy resolution to infertility. However, most people explore medical treatment for infertility prior to considering adoption. In addition, traditional adoption options have changed, and adoption can be more costly and time-consuming than expected. It is, however, still possible to adopt the healthy baby of your dreams. There are also many older children and children with special needs available for adoption.

Myth: Maybe you two are doing something wrong!

Fact: Infertility is a medical condition, not a sexual disorder.

Myth: My partner might leave me because of our infertility.

Fact: The majority of couples do survive the infertility crisis, learning in the process new ways of relating to each other, which deepens their relationship in years to follow.

Myth: Perhaps this is God's way of telling you that you two aren't meant to be parents!

Fact: It is particularly difficult to hear this when you are struggling with infertility. You know what loving parents you would be, and it is painful to have to explain to others that you have a medical problem.

Myth: Infertility is nature's way of controlling population.

Fact: Zero population growth is a goal pursued in a time of world overpopulation, but it still allows for couples to replace themselves with two children. Individuals or couples can certainly elect the option to be childfree or to raise a single child. Infertility, for those who desire children, denies them the opportunity to choose.

Myth: I shouldn't take a month off from infertility treatment for any reason... I just know that this next month will be THE one!

Fact: It is important periodically to reassess your treatment and parenting goals. Continuity in treatment is important, but sometimes a break can provide needed rest and renewal for the next steps.

Myth: I'll be labeled a 'trouble maker' if I ask too many questions.

Fact: The physician/patient team is important. You need to be informed about what treatments are available. What is right for one couple may not be right for another, either physically, financially, or emotionally. Don't be afraid to ask questions of your doctor.
A second opinion can be helpful. If needed, discuss this option with your physician.

Myth: I know I'll never be able to stop treatment until I have a pregnancy.

Fact: Pregnancy is not the only pathway to parenthood. You may begin to think more about parenthood than about pregnancy. You may long for your life to get back to normal. You may consider childfree living or begin to think of other ways to build a family.

Myth: I've lost interest in my job, hobbies, and my friends because of infertility. No one understands! My life will never be the same!

Fact: Infertility is a life crisis -- it has a rippling effect on all areas of your life. It is normal to feel a sense of failure that can affect your self-esteem and self-image. You will move through this crisis. It is a process, and it may mean letting go of initial dreams. Throughout this process, stay informed about the wide range of options and connect with others facing similar experiences.