Definition Infertility is defined as the inability of a couple to become pregnant after 1 year of unprotected sex.
What is going on in the body? About 10% of all couples in Australia are unable to become pregnant. In some cases, a couple may have never been able to have children. In other cases, couples may have trouble getting pregnant after having one or more children. At present it is possible to find the cause of infertility in 80% of couples.
Certain events must take place in a woman's body for pregnancy to occur. These are:
ovulation, which is the release of an egg from the ovary. This usually occurs about 14 days before a women's next period.
the uniting of the egg and a man's sperm.
the attachment of a "fertilised" egg to the lining of the uterus.
The inability to become pregnant may be due to problems in either partner. It is thought that about 30% of the time, a couple cannot get pregnant due mainly to female factors. Thirty percent (30%) are due to male factors. The remaining cases are a combination of both female and male factors.
What are the signs and symptoms of the condition? Affected couples are unable to become pregnant. This may result in emotional and psychological distress. In some cases, the definition of infertility includes couples that become pregnant, but the pregnancies do not produce living children. This may occur with repeated miscarriages, for example.
What are the causes and risks of the condition? There are many female factors that can make a couple unable to become pregnant. These may include:
an infection of the female pelvic organs, usually due to a sexually transmitted disease (STD).
exposure to the drug diethylstilbestrol (DES) before birth.
eating disorders, such as anorexia. In this condition, people have an intense fear of gaining weight and may starve themselves to maintain an abnormally low weight.
Reducing the spread of STDs can help prevent some cases. Having fewer sexual partners and practicing "safer sex," such as using condoms, can reduce STDs. Many cases cannot be prevented.
not delaying a family until after age 35
How is the condition diagnosed? For female factors, a history and physical examination of the woman is the first step. This may be done by specialists or a family doctor. Testing on the woman may include:
ovulation testing, which tries to detect the presence of egg release from the ovary.
a postcoital test, which is done after sex partly to check for problems with the female secretions.
obtaining a biopsy, or tissue sample, of the lining of the uterus.
hormone testing.
special x-ray tests.
pelvic laparoscopy. This is a procedure that uses a special tube with a camera on the end of it. The tube is inserted through a small cut in the abdomen. In this way, the tube can be used to see the pelvic organs directly.
swabs of the cervix (Pap smear) to detect infections.
What are the long-term effects of the condition? The long-term effects of not being able to get pregnant are mostly psychological. The stress of testing and procedures may mount. Emotions can become strained and sex may become less spontaneous. The process of evaluating and treating this condition is also expensive. The reason a couple cannot get pregnant is found in 85% of couples. However, some couples may never be able to have children, despite full treatment. Adoption may be an option.
What are the risks to others? This is not a contagious condition. Others are not at risk.
What are the treatments for the condition? Treatment of this condition will depend on the cause. Without treatment, 15% to 20% of affected couples will eventually become pregnant. Treatment for female factors may include:
education about the best time to get pregnant.
antibiotics for infections.
surgery to treat certain problems, such as endometriosis.
drugs to cause ovulation, such as clomiphene and gonadotrophins (FSH).
artificial fertilisation techniques. There are many different methods available depending on the female problem. Some techniques can be used even if the cause is not found.
Women age 35 or over should not delay treatment, as they have less time left before they will be unable to bear children.
What are the side effects of the treatments? Side effects of drugs to cause ovulation include:
ovarian hyperstimulation syndrome, which is associated with enlarged ovaries and fluid shifts in the body. This can rarely be life threatening.
Antibiotics all have possible side effects. These include allergic reactions, stomach upset, and others. Specific side effects depend on the drugs used. Surgery carries a risk of bleeding, infection, and reactions to pain medication.
What happens after treatment for the condition? Between 80% to 85% of treated couples get pregnant within a year of diagnosis. If pregnancy has not occurred, artificial fertilisation methods may be an option. Support services are available to assist with psychological issues.
How is the condition monitored? Should a pregnancy occur after treatment, early pregnancy testing and x-ray tests will show if it is a healthy pregnancy. If treatment is unsuccessful, a specialist can be consulted.
Author: Eva Martin, MD Reviewer: eknowhow Medical Review Panel Editor: Dr John Hearne Last Updated: 12/06/2005 Contributors Potential conflict of interest information for reviewers available on request
