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Infertility is often defined as not being able to get pregnant after one year of steady, unprotected intercourse if a woman is under the age of 35; or six months if she is over 35. Infertility affects both men and women equally. In approximately 1 in 5 infertile couples, both partners have contributing problems, and in about 15 percent of couples, no cause is found, called "unexplained infertility."
A visit to a gynecologist specializing in infertility or a board certified reproductive endocrinologist (RE) is recommended if pregnancy has not occurred after one year, or if the woman is older than 35, has irregular periods, has experienced multiple miscarriages, or has any medical problems that could make it difficult to get pregnant.
Causes of Female Infertility
Age is the most important factor influencing the chance of becoming pregnant. In women, fertility declines with age. The decrease with age is almost entirely due to declining number and quality of the eggs in the ovary as a woman ages. There is nothing that can be done to halt or reverse this process. The decline in egg quality that comes with increasing age is also responsible for higher rates of miscarriage and fetal abnormalities.
After taking the patient’s history and doing a physical exam, the doctor will perform one or more of the following tests to determine if the ovary is producing an egg and if that egg can travel to the uterus.
- Ovulation Testing. Ovulation can be evaluated through blood tests that detect hormones, ultrasound of the ovaries, or an ovulation home test kit. An irregular menstrual pattern may indicate an ovulation problem, however it's also possible for a woman with regular periods to have an ovulation disorder.
- Fallopian Tube Testing. To make sure that one or both tubes are not blocked, the doctor may perform a hysterosalpingogram, a hysterosonography and/or a laparoscopy.
- Hormone Testing. Certain hormones in the blood stream can affect fertility by causing ovulation problems. Testing includes drawing bloods for thyroid function, prolactin, DHEA, and testosterone.
- Ovarian Reserve Tests. Ovarian reserve test is a blood test that gives an estimate of how many eggs a woman has in her body and how good they might be. The hormone levels are measured during the first days of a menstrual cycle and sometimes before and after taking fertility drugs. Up to 20 percent of women who seek infertility care have an abnormal ovarian reserve test.
A variety of conditions can lead to male infertility, including problems with sperm production, blockages of the vessels that deliver sperm, hormonal disorders, and problems within the testicle itself. A man’s health history and lifestyle can also affect his fertility. It is important that both partners receive a fertility workup if a couple is having difficulty conceiving.