HR Info
The Facts—and the Fiction—About Infertility
By Carol Ann Friedman, RN, IBCLC, and Program Director of Mothers at Work^®

One out of every 10 couples in the U.S. is infertile. Surprised? You’re not alone. It’s widely assumed that infertility is rare—and that’s just the beginning of the misconceptions surrounding this subject. For example, many people believe that infertility is due most often to a problem with the female partner’s reproductive system. Actually, this is true in only about 35 percent of all infertility cases. Just as frequently—35 percent of the time—the problem is related to the male partner. And in roughly 20 percent of all cases, it’s a combined problem of both partners. (In the remaining cases, a specific cause is never determined.)

Another common misconception is that infertility can be the result of something the couple “does wrong” when trying to conceive. True infertility is a medical condition, not a sexual disorder. There are three basic types of infertility:

	Primary infertility -- meaning the couple has never achieved pregnancy.
	Secondary infertility -- meaning there has been a previous pregnancy and the couple is having difficulty conceiving a second time.
	Sterility -- meaning there is no chance for pregnancy.

In the strictest terms, sterility is different from infertility, which generally represents a reduced potential for pregnancy. Most couples who are having problems achieving pregnancy (and in which the woman is under age 42 or so) are infertile, not sterile. While infertility can be a difficult and emotional experience, the good news is that at least half of the couples who seek professional treatment will become pregnant within a year. The chances of becoming pregnant after one year are rather low.

The Causes of Infertility

In general, infertility in women is due to one of the following:

1. The cervix is unable to nurture and transport sperm into the upper female reproductive tract.
2. The normal process of ovulation is somehow hampered.
3. Abnormalities of the uterus interfere with the implantation of the embryo and/or maintenance of pregnancy.
4. There are problems with the pelvis and/or structures within the pelvic cavity (such as the fallopian tubes).

Age also is a significant factor related to infertility. A woman’s fertility naturally diminishes with age. (All women are born with all of the eggs they will ever have. Over time, this supply of eggs is depleted.) As a result, women over the age of 35 have only about two-thirds the rate of pregnancy compared to women aged 20 to 25.

In men, the causes of infertility essentially are related to sperm quality. The main factors affecting sperm quality are: count (total number of sperm); concentration (number of sperm cells per milliliter); motility (ability of the sperm to “swim”); and morphology (the size and shape of the sperm).

Infertility Treatment Options

Couples who are having trouble conceiving should consult a fertility specialist to determine whether the problem is infertility or sterility. In addition to conducting a thorough examination of the couple (including blood a work-up and a number of other tests), the specialist will be able to review the treatment options (if applicable) and develop a course of action. Treatment options may include:

	Fertility medications (a wide variety are available)
	Surgery (generally used to correct a “structural” problem in men and women alike)
	Artificial insemination (more properly known as intrauterine insemination or IUI)
	Assisted reproductive technology (a procedure in which the eggs are surgically removed, combined with sperm, and returned to the body; in vitro fertilization is the most widely used of these procedures)
	Micromanipulation techniques (used to achieve or improve fertilization and implantation)
	Third-party solutions (a donor supplies eggs, sperm, or an embryo or acts as a surrogate)

When to Seek Help

For younger couples, it is appropriate to see a physician for an infertility work-up after 12 months of trying to get pregnant. But if the female partner is older than 35, the couple might want to consider seeking assistance sooner—after six months, for example. For women 40 and older, it’s completely appropriate to see a fertility specialist after just three to six months of trying to conceive. A significant percentage of women over the age of 40 need professional help to conceive.

Where to Seek Help

Naturally, you should consult your own physician or OB/GYN. If they do not have the facilities to conduct infertility tests, you might be referred to a fertility specialist (usually an OB/GYN with advanced education, research and professional skills in reproductive endocrinology) or to an actual board-certified reproductive endocrinologist.

If your feel that your OB/GYN or physician isn’t being responsive enough to your needs, you might consider finding additional assistance on your own. One good place to begin this process is LifeCare. Our specialists offer a wide range of educational information and referrals to such organizations as:

	RESOLVE, the National Infertility Association—established in 1974 and dedicated to providing education, advocacy, and support for women and men facing infertility. www.resolve.org.  Telephone: (888) 623-0744
	American Infertility Association (AIA)—founded in 1999 to serve as a lifetime resource for men and women needing reproductive information and support and to forward the causes of adoption and reproductive health. www.americaninfertility.org. Telephone: (888) 917-3777
	The InterNational Council on Infertility Information Dissemination (INCIID)—provides comprehensive, consumer-targeted infertility information that covers cutting-edge technologies and treatments; also offers parenting information and information to accommodate those who are considering adoption or exploring the possibility of living childfree.  www.inciid.org.  Telephone: (703) 379-9178

For many couples who cannot conceive but who still want children, adoption is also a viable solution. LifeCare also provides counseling, education and referral services to help families explore and understand adoption.