Primary infertility is the term used to describe a couple that has not conceived a pregnancy after at least 1 year of unprotected sex.
Secondary infertility describes a couple who has been pregnant at least once, but has not been able to achieve another pregnancy.
Causes of infertility include a wide range of physical and emotional factors. Approximately 30 – 40% of all infertility is due to the man. Male problems like retrograde ejaculation, impotence, environmental pollutants, scarring from sexually transmitted disease, or low sperm count are common factors. Factors affecting sperm count are heavy marijuana use or use of prescription drugs like cimetidine, spironolactone, and nitrofurantoin.
Females account for 40-50% of infertility in couples. Female factors include scarring from a sexually transmitted disease or endometriosis, ovulation dysfunction, poor nutrition, hormone imbalance, ovarian cysts, pelvic infection, tumor, or transport system abnormality from the cervix through the fallopian tubes.
The remaining 10 -30% of infertility cases may be caused by contributing factors from both partners, or no cause can be identified.
It is estimated that 10 – 20% of couples will be unable to conceive after 1 year of trying to become pregnant. It is important that pregnancy be attempted for at least 1 year. The chances for pregnancy occurring in healthy couples who are both under the age of 30 and having intercourse regularly is only 25 – 30% per month. A woman’s peak fertility occurs in her early 20s. As a woman ages beyond 35 (and particularly after age 40), the likelihood of getting pregnant drops to less than 10% per month.
In addition to age-related factors, increased risk for infertility is associated with the following:
- Multiple sexual partners (increases risk for sexually transmitted diseases)
- Sexually transmitted diseases
- History of PID (pelvic inflammatory disease)
- History of orchitis or epididymitis in men
- Mumps (men)
- Varicocele (men)
- A past medical history that includes DES exposure (men or women)
- Eating disorders (women)
- Anovulatory menstrual cycles
- Endometriosis
- Defects of the uterus (myomas) or cervical obstruction
- Long-term (chronic) disease such as diabetes
Treatment
Treatment depends on the cause of infertility. It may involve simple education and counseling, medicines to treat infections or promote ovulation, or highly sophisticated medical procedures such as in vitro fertilization. It is important for the couple to recognize and discuss the emotional impact that infertility has on them as individuals and together and to seek medical advice from their health care provider.
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