Infertility

Definition

Primary infertility describes couples who have never been able to become pregnant after at least 1 year of unprotected sex (intercourse).

Secondary infertility describes couples who have been pregnant at least once, but have not been able to become pregnant again.

Alternative Names

Inability to conceive; Unable to get pregnant

Causes, incidence, and risk factors

Causes of infertility include a wide range of both physical and emotional factors. A couple's infertility may be due to female factors, male factors, or both:

FEMALE INFERTILITY:

Female infertility may be due to:

• Problems with a fertilized egg or embryo being able to survive once it is attached to the lining of the uterus
• Problems with the eggs being able to attach to the lining of the uterus
• Problems with the eggs being able to move from the ovary to the uterus
• Problems with the ovaries producing eggs

Female infertility may be caused by:

• Autoimmune disorders, such as antiphospholipid syndrome (APS)
• Clotting disorders
• Defects of the uterus and cervix (myomas or fibroids, polyps, birth defects)
• Excessive exercising, eating disorders, or poor nutrition
• Exposure to certain medications or toxins
• Heavy use of alcohol
• Hormone imbalance or deficiencies
• Long-term (chronic) disease, such as diabetes
• Obesity
• Ovarian cysts and polycystic ovary syndrome (PCOS)
• Pelvic infection or pelvic inflammatory disease (PID)
• Scarring from sexually transmitted disease or endometriosis
• Tumor

MALE INFERTILITY:

Male infertility may be due to:

• A decrease in the number of sperm
• Sperm being blocked from being released
• Sperm that do not work properly

Male infertility can be caused by:

• Environmental pollutants
• Exposure to high heat for prolonged periods
• Genetic abnormalities
• Heavy use of alcohol, marijuana, or cocaine
• Hormone deficiency or taking too much of a hormone
• Impotence
• Infections of the testes or epididymis
• Older age
• Previous chemotherapy
• Previous scarring due to infection (including sexually transmitted diseases), trauma, or surgery
• Radiation exposure
• Retrograde ejaculation
• Smoking
• Surgery or trauma
• Use of prescription drugs, such as cimetidine, spironolactone, and nitrofurantoin

In healthy couples both under age 30, having sex regularly, the chance of getting pregnant is only 25 - 30% per month. A woman's peak fertility occurs in her early 20s. As a woman ages beyond 35 (and especially after age 40), the likelihood of getting pregnant drops to less than 10% per month.

When to seek help for infertility depends on your age. For women under age 30, it is generally recommended to try to conceive for at least a year before seeking testing.