What is Infertility?
Most people will have the strong desire to conceive a child at some
point during their lifetime. Understanding what defines normal fertility
is crucial to helping a person, or couple, know when it is time to seek
help. Most couples (approximately 85%) will achieve pregnancy within
one year of trying, with the greatest likelihood of conception occurring
during the earlier months. Only an additional 7% of couples will
conceive in the second year.
As a result, infertility has come to be defined as the inability to conceive within 12 months.
This diagnosis is therefore shared by 15% of couples attempting to
conceive. We generally recommend seeking the help of a reproductive
endocrinologist if conception has not occurred within 12 months.
However, there are various scenarios where one may be advised to seek
help earlier. These include:
- Infrequent menstrual periods: When a woman has
regular menstrual periods, defined as regular cycles occurring every 21
to 35 days, this almost always indicates that she ovulates regularly.
Ovulation of the egg occurs approximately 2 weeks before the start of
the next period. If a woman has cycles at intervals of greater than 35
days, it may indicate that she is not ovulating an egg predictably, or
even at all. Ovulation of the egg is essential for pregnancy. Therefore,
we recommend an evaluation if menstrual cycles are infrequent or
irregular in a couple attempting pregnancy.
- Female age of 35 years or older: For unclear
reasons, egg numbers decrease at a rapid rate as women age. Furthermore,
as aging occurs, egg quality, or the likelihood of an egg being
genetically normal, decreases. Therefore we recommend a fertility
evaluation if a couple has been attempting pregnancy for 6 months or
more when the woman is 35 years of age or older.
- A history of pelvic infections or sexually transmitted diseases:
Sexually transmitted infections, such as chlamydia or gonorrhea, can
cause inflammation and permanent scarring of the fallopian tubes. The
presence of open tubes is essential for natural conception, as sperm
must traverse the tubes in order to reach and fertilize the ovulated
egg. We recommend immediate evaluation for a couple attempting pregnancy
when the woman has a prior history of pelvic infection. As part of the
fertility evaluation, we will perform an HSG, a test designed to
evaluate if the fallopian tubes are open.
- Known uterine fibroids or endometrial polyps:
Uterine abnormalities, such as fibroids that indent the endometrial
cavity and endometrial polyps, can impair how the endometrium (the
lining of the uterus) and embryo interact to lower implantation and
pregnancy rates. These abnormalities can also cause irregular bleeding
between menstrual cycles. Evaluation should be pursued by 6 months of
attempted pregnancy in women with a known history of these abnormalities
or a history of bleeding between menstrual cycles. The main approach to
correcting or removing these uterine abnormalities is by hysteroscopy, a
surgical method by which a narrow scope with a camera is placed within
the uterine cavity. Instruments can be introduced through the
hysteroscope, allowing the surgeon to remove or correct any anatomic
abnormalities.
- Known male factor semen abnormalities: If a male
partner has a history of infertility with a prior partner, or if there
are abnormalities on his semen analysis, then we advise earlier
fertility evaluation, ideally within 6 months of attempting pregnancy.
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