General Infertility: Infertility Causes, Testing and Treatment
Definition of infertility: 12 months or more of unprotected intercourse without pregnancy
- Primary infertility: Infertility without any previous pregnancy.
- Secondary infertility: Fertility problems occurring in a couple that has conceived on their own and had a child in the past.
- Sterility: When there is no chance for a pregnancy. This is different from infertility which generally represents a reduced potential for pregnancy.
Most childless couples with a female age under about 45 that are having problems getting pregnant are considered to be infertile but not sterile.
When to see a fertility specialist?
- In general, it is appropriate to see a doctor for medical assistance after 12 months of trying to get pregnant on your own.
- Many couples will start the infertility workup process with their general gynecologist, while others prefer to go straight to a fertility specialist. Either option is appropriate.
- It is advised to see a specialist sooner if the female partner is over 35 years old.
It is prudent to seek medical help for fertility issues without waiting for a year of trying on your own if you have a condition that is a known risk factor for fertility problems, such as irregular menstrual cycles, endometriosis, previous tubal pregnancy, PCOS - polycystic ovary syndrome, previous pelvic inflammatory disease (PID), etc.
The appropriate amount of time to try on your own can be longer, or shorter than one year. For example, if you are only 25 years old and feel that you want to give it more time to occur naturally - you might try on your own for another 6 months before seeing a doctor for help.
However, it is recommended by the American Society for Reproductive Medicine (ASRM) to seek medical help after only 6 months of trying if the female age is 35 or older.
In 2008, ASRM published a revised definition of infertility that says:
"Infertility is a disease, defined by the failure to achieve a successful pregnancy after 12 months or more of regular unprotected intercourse. Earlier evaluation and treatment may be justified based on medical history and physical findings and is warranted after 6 months for women over age 35 years."
- For couples with a female partner age 40 or older, it is appropriate to see a fertility specialist if not pregnant by 3-4 months of trying to conceive.
- A high percentage of women over 40 will have age-related issues (egg quality) and will need medical help to get pregnant.
- If the female partner is 42 or older, it is recommended to see a specialist right away if wanting to have a baby.
You do not need to have sex all the time in order to get pregnant. If you like it that way, then no problem - it doesn't reduce a couple's fertility potential either. The best fertility advice in terms of frequency of intercourse is - every day or every other day "around ovulation".
- Ovulation is usually on day 14 - if the menstrual cycle length (from day 1 to day 1) is 28 days, or on day 16 if periods are 30 days apart.
- In other words, ovulation usually occurs 14 days before the next period comes.
The egg only lives about 12-24 hours, while the sperm (if normal) will live in the female's reproductive tract for up to 2-5 days - while maintaining the ability to fertilize an egg.
- Therefore, the best fertility advice would be to have sex on the day of ovulation, or the day before ovulation (or both).
- Having sex more than about 24 hours after ovulation should be fun and all that, but it isn't likely to increase the planetary population.
Causes of problems getting pregnant
The cause of infertility is investigated by performing fertility tests in a basic infertility evaluation. The tests can be completed during one menstrual cycle (one month).
What causes infertility? The most common causes are:
- Ovulation problems
- Tubal infertility
- Sperm problems
- Unexplained infertility
- Fertility and female age issues
- Egg quantity and quality problems