Who experiences infertility?
Infertility affects approximately 15% of the population. It is one of the most difficult challenges a couple or individual will ever have to go through. There are many causes whose incidence varies across populations.
Approximately 35% of infertility cases are attributable to the female partner alone, 20% to the male partner, and 35% to both the male and female partners. A complete fertility evaluation will assess both partners. The infertility workup will take many factors into account, prioritizing the least invasive means of diagnosing the most common causes of infertility.
The odds of getting pregnant — fecundability
Fecundability is probability that a woman will conceive during any one menstrual cycle and, in the general fertile population, is approximately 20% per month. After one year of trying to conceive, the monthly pregnancy rate decreases to just 1-3% per month without treatment. After two years of trying, the lifetime pregnancy rate drops to 1% without treatment.
Maternal age also plays a major role in fecundability. By the age of 40, fecundability rates decline precipitously to approximately 5% per month as a result of egg and ovarian aging.
When should you see a fertility specialist?
Patients are often told they should only see a specialist after they have tried and failed to conceive for a year. This is appropriate advice for healthy, ovulating women under 35 years old without any risk factors. But it certainly does not apply to everyone.
You should see a specialist as soon as possible if:
- You are a woman 35 and older and have been trying to get pregnant for six months
- You are a woman 40 or older and have been trying to get pregnant for three-to-four months
- You have irregular periods (cycles shorter than 24 days or longer than 35 days) and/or know you do not ovulate regularly
- You have had pelvic inflammatory disease, gonorrhea/chlamydia, ruptured appendicitis (or any other pelvic infection), endometriosis, ovarian surgery where part/all of an ovary was removed and you have been trying for six months
- If the male partner has a known sperm problem or history of testicular issues
Female fertility depends on multiple factors: regular development and release of healthy eggs, patent (open) fallopian tubes, normal uterine anatomy and receptive endometrium.
If there are problems with any one of these, fertility issues can result. The most important factor, however, is female age. Fertility decreases over time as ovaries and eggs decline in quality and quantity. This can present a challenge to women trying to conceive naturally or through IVF with their own eggs.
The chance that a woman under 35 will get pregnant in any given month is approximately 20-25%. By the age of 40, the chances decline to approximately 5%. By the time a woman reaches 44, spontaneous pregnancies are rare.
At the same time, miscarriage rates rise exponentially with age. Miscarriage happens in approximately 10% of pregnancies through age 35, 25% between ages 35-39, 34% between 40-44 and over 50% in women 45 years old and older. This is largely due to decreasing egg quality with age, a factor that also contributes to the increased risk of chromosomal anomalies (i.e., Down syndrome).
When patients come to for a fertility workup, we take a full medical history, complete a physical examination and test for a range of possible factors including:
- Ovulatory disorders . Problems with ovulation can be caused by hormonal imbalances like Polycystic Ovary Syndrome (PCOS), hyperprolactinemia and thyroid disease as well as excessive exercise or being over- or underweight.
- Tubal blockage. Blocked fallopian tubes can be caused by a history of STDs (i.e., gonorrhea or chlamydia) as well as other infections (i.e., ruptured appendicitis, pelvic tuberculosis), previous pelvic surgery, and endometriosis.
- Uterine Issues. Benign growths such as fibroids or endometrial polyps can interfere with implantation, as can intrauterine adhesions from prior uterine surgeries.
- Endometriosis. Endometriosis, or the growth of endometrial tissue (cells that usually grow inside the uterus) in locations outside the uterus can cause infertility by blocking the tubes, damaging ovarian tissue, and by production of various inflammatory factors that are thought to be generally detrimental to eggs and embryos.
- Premature ovarian insufficiency. Occasionally women experience early egg loss because of genetic disorders, cancer treatment, autoimmune disease or other undetermined causes.
- Environmental exposures. Cigarette smoking in particular has been shown to contribute to infertility. It has also been associated with poorer outcomes in women undergoing IVF cycles.
In approximately 10-15% of patients, despite extensive testing, no definitive cause for infertility will be identified, and these patients will be said to have unexplained infertility, which can be treated. Many of these cases may be due to a combination of factors which, by themselves, are not significant (i.e., borderline findings on semen analysis, mild hormonal imbalances) or which are undetectable using current technology.
Male infertility is a significant contributor to couples’ fertility issues. It is the sole factor in approximately 20% of infertility cases and is a contributing factor in approximately 35%. There are many different etiologies of male fertility, including:
- Abnormal sperm production and function. Genetic defects, congenital absence of germ cells (which become sperm), history of undescended testicle(s), infections (i.e., mumps, gonorrhea/chlamydia) and other factors can contribute to deficiencies in sperm counts and/or quality.
- Abnormal sperm delivery. Blockage can occur at multiple points in sperm transport system. Epididymal cysts, absence of the vas deferens (most commonly seen in patients carrying cystic fibrosis mutations), retrograde ejaculation, and sexual function issues like erectile dysfunction and painful intercourse can all contribute.
- Physical illness. Diseases such as obesity, diabetes, high blood pressure and cancer, as well as the medications used to treat these conditions can cause sperm dysfunction.
- Lifestyle. Tobacco, illicit drug use, and alcohol can adversely affect sperm function
- Environmental exposure/toxins. Excessive heat exposure (through hot tubs, saunas, biking), pesticides and other chemicals or radiation can all cause sperm damage.
- Age. More and more data support advancing male age as a factor in infertility. Although less significant and distinct than the female “biological clock,” increasing male age, as early as 40 years old, affects male fertility and associated reproductive risks.
Read about male fertility treatment options.
Schedule a Consultation
Take the first step toward parenthood and schedule a consultation with one of our highly trained fertility specialists. Drs. Koopersmith and Landay are available to answer any question you may have and help you achieve your dream of having a healthy baby. Follow this link to fill out a short contact form and we will be in touch with you shortly to schedule a consultation. We look forward seeing you soon.