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Understanding Infertility

Infertility is defined as the inability to become pregnant after a year of unprotected intercourse.

The male partner, the female partner, or both may have a fertility problem. A person who is infertile has a reduced ability to have a child. It usually doesn’t mean a person is sterile — that is, physically unable ever to have a child.

For many couples, infertility is a crisis. Fertility problems often come with feelings of guilt or inadequacy. But a diagnosis of infertility is not necessarily a verdict of sterility. Up to 15% of all couples are infertile, but only 1% to 2% are sterile. Half of couples who seek help can eventually bear a child, either on their own or with medical assistance.

Men and women are equally likely to have a fertility problem. In about 1 in 5 infertile couples, both partners have contributing factors, and in about 15% of couples, no cause is found after all tests have been done. This is called “unexplained infertility.”

What causes infertility fertility in men?

In men, the most common reasons for infertility are sperm disorders. These problems include:

  • Low sperm count
  • Low sperm motility (movement)
  • Malformation of the sperm
  • Blocked sperm ducts

Another common problem is a temporary drop in sperm production. This happens when the testicles have been injured, such as when the testicles have been too hot for too long or the man has been exposed to chemicals or medications that affect sperm production.

Spending a long time in a hot tub, for example, or wearing underwear that holds the testicles too close to the body can increase the testicular temperatures and impair sperm production. Sometimes there is a physical reason. In the relatively common condition called varicocele, veins around the vas deferens (the duct that carries sperm from testicle to urethra) becomes dilated — similar to a varicose vein in the leg. The pooling of blood in these veins keeps the temperature inside the scrotum too high.

Certain lifestyles, like increased alcohol intake and smoking, can also have a negative effect on sperm count. Men who are 40 or older often have decreased fertility.

What causes infertility in women?

The primary reason for infertility in women is anovulation, or lack of ovulation (release of eggs from the ovary). The major cause of anovulation is a condition called polycystic ovary disease, or PCOS.

Another reason for female infertility is the inability of the fallopian tubes to carry eggs from the ovary to the uterus, usually due to scar tissue that may have resulted from prior infection or from a condition called endometriosis.

Rarely, the reason may be uterine in nature. Fibroid growths, endometriosis, tumors, cervical problems, or irregular uterine shape can keep the egg from implanting in the uterus. Fertilization may not happen if the cervical mucus damages sperm or impedes their progress.

Age is a major factor of female infertility. In women, fertility declines with age, and even more so after the age of 35. Conception after age 45 is rare. Being overweight or underweight can also play a role in conception difficulty.

Dr. Levi has published many review articles, textbook chapters, scientific abstracts, and research studies in peer review journals. He has also been the recipient of numerous honors and awards.

Dr. Levi lectures at residency training programs, national conferences, obstetrics and gynecology societies, and regional and community forums on a variety of infertility topics that include recurrent miscarriage and advanced reproductive techniques such as IVF, ICSI, and PGS.

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