General Information Infertility is perceived as a problem across virtually all cultures and societies and affects an estimated 10%-15% of couples of reproductive age. In recent years, the number of couples seeking treatment for infertility has dramatically increased due to factors such as postponement of childbearing in women, development of newer and more successful techniques for infertility treatment, and increasing awareness of available services. 1.What is infertility? Infertility means not being able to get pregnant after one year of trying or six months, if a woman is 35 years of age or older. Women who can get pregnant but are unable to stay pregnant may also be infertile. Pregnancy is the result of a process that has many steps. To get pregnant: A woman’s body must release an egg from one of her ovaries (ovulation). The egg must go through a fallopian tube toward the uterus (womb). A man's sperm must join with (fertilize) the egg along the way. The fertilized egg must attach to the inside of the uterus (implantation). Infertility can happen if there are problems with any of these steps. 2.Is infertility permanent? Infertility may be temporary and it may be due to many different problems. More than one problem may be present in a couple. Many of these problems can be corrected. Both the man and woman should be tested. In 15 to 20% of all couples who are infertile, both the man and the woman have problems that cause the infertility. In 35 to 40 %, problems occur in the man. In another 35 to 40%, problems occur in the woman. The remaining cases have no known cause. 3.How is infertility diagnosed? Couples are generally advised to seek medical help if they are unable to achieve pregnancy after a year of unprotected intercourse. The doctor will conduct a physical examination of both partners to determine their general state of health and to evaluate physical disorders that may be causing infertility. Usually both partners are interviewed about their sexual habits in order to determine whether intercourse is taking place properly for conception. If no cause can be determined at this point, more specific tests may be recommended. For women, these include an analysis of body temperature and ovulation, x-ray of the fallopian tubes and uterus, and laparoscopy. For men, initial tests focus on semen analysis. 4.What are the causes of infertility? Infertility in the Man A man may be infertile because he does not have enough sperm, because the sperm does not move or function properly, or because he has blocked passageways. Disease, fevers or infections, and congenital abnormalities can contribute to these problems in men. Infertility in the Woman A woman may be infertile because some parts of her reproductive system are not functioning properly due to disease, infections, problems with hormone production or congenital abnormalities. These factors may interfere with reproduction in a number of ways: ovulation may not occur, the uterus may not be properly prepared to receive the developing embryo, the tubes may be blocked, diseased, or bound by scar tissue, or there may not be adequate cervical mucus for the sperm's survival. Other causes In both the male and female, poor general health may contribute to the causes of infertility. Obesity, poor eating habits, too much stress, smoking or alcohol can make infertility problems worse. Another possible cause may be the development of antibodies to sperm, either in the male or female. Such antibodies may attack and impair sperm and thus prevent conception. 5.What increases a man's risk of infertility? The number and quality of a man's sperm can be affected by his overall health and lifestyle. Some things that may reduce sperm number and/or quality include alcohol; drugs; environmental toxins, including pesticides and lead; smoking cigarettes; health problems; medicines; radiation treatment and chemotherapy for cancer; and age. 6.What things increase a woman's risk of infertility? Many things can affect a woman's ability to have a baby. These include age, stress, poor diet, athletic training, being overweight or underweight, tobacco smoking, alcohol, sexually transmitted diseases, health problems that cause hormonal changes. 7.What are the treatments for infertility? In some cases, patients may simply need more information on the timing of intercourse most favorable to conception. In other cases, drugs may be prescribed to treat an underlying disease, infection or hormone deficiency found in the man or the woman. In the last ten years, there have been tremendous advances with other types of treatment for more difficult infertility problems, including: Sperm Washing: In some cases, the husband's semen may be enhanced by treating the sperm in such a way that removes unhealthy sperm cells, antisperm antibodies and seminal fluid which may be irritating or rejected by the uterus. The healthy sperm are then placed directly into the uterus during an insemination procedure at a simple office visit. Microsurgery and Laparoscopic Surgery: Using these new techniques, some types of infertility may be permanently cured. These procedures are especially useful to correct conditions which cause the fallopian tubes to be blocked, displaced or scarred. The use of a surgical microscope to magnify the small tubes and tissues has greatly increased the success of this type of reconstructive procedure. In appropriate cases, this can be done through laparoscopic surgery, requiring no overnight hospitalization. In Vitro Fertilization and Embryo Transfer (& other ART): Many couples may benefit from "test tube baby" procedures. In these procedures (In Vitro Fertilization, Intra-cytoplasmic Sperm Injection, Assisted Hatching, Blastocyst Culture), eggs are removed from the woman and mixed in the laboratory with the man's sperm. They are later transferred back into the woman in the hopes of achieving a pregnancy. Such treatments are performed in the office setting. No hospitalization is required.