Defining Infertility

At least 7 million people in the United States struggle with infertility and this number continues to grow. Infertility has often been thought of as a female problem. However, once a couple has been evaluated and diagnosed, 40% is due to a male factor, 40% due to a female factor, and 20% is a multifactorial problem involving both partners. For this reason, infertility should be viewed as a problem that affects a couple, rather than any one individual. The evaluation, diagnosis and treatment of infertility, therefore, require the commitment of both partners.

The definition of infertility can vary. As a general guideline, infertility can be defined as the inability of a couple to achieve a pregnancy after one year of unprotected sexual relations when the female is less than 35 years old. For a woman over 35 years of age, infertility should be investigated after attempting to achieve a pregnancy for six months. The age of the female is perhaps the single most important variable that determines the reproductive potential of a couple. If a patient has a history of irregular menstrual cycles, known endometriosis, sexually transmitted diseases or possible male factor, earlier evaluation is essential.

Causes of infertility

At least 90% of couples that are unable to conceive, when properly evaluated, can be diagnosed with a cause for their infertility. Since approximately 20% of infertile couples will have multiple impediments to conception, a thorough evaluation involves the male and the female.

Male Factor Infertility

Female Factor Infertility

Evaluation

To properly diagnosis infertility necessitates an evaluation of both the female and the male. Initially, a couple has a consultation which includes a history and physical examination. Based upon this evaluation, further testing can be arranged. Depending upon a couple's history, additional tests may include:

• Hormone testing
• Ultrasound
• Hysterosalpingogram
• Semen analysis
• Surgery (i.e. laparoscopy)