Infertility
Difficulty conceiving despite regular, unprotected intercourse
Quick Facts
- Type: Reproductive health condition
- Definition: No pregnancy after 1 year of trying
- Affects: Both partners; causes can be male or female
- When to seek care sooner: Age over 35, irregular cycles, known issues
Overview
Infertility is usually defined as not achieving pregnancy after a year of regular, unprotected intercourse, or after six months if the woman is over 35. It is common and affects many couples, and it can involve factors in the female partner, the male partner, both partners, or sometimes no clear cause is found.
Infertility is a medical condition, not a personal failing, and it is often treatable. Many couples go on to conceive with lifestyle changes, treatment of an underlying problem, medications, or assisted reproductive techniques. A thorough evaluation of both partners is the starting point for finding the cause and the best path forward.
Symptoms
The main sign of infertility is simply difficulty getting pregnant. Sometimes there are clues to an underlying cause:
- Irregular, absent, or unusually heavy or painful menstrual periods
- Symptoms of hormone changes, such as excess hair growth, acne, or changes in sex drive
- Pelvic pain, which can occur with conditions such as endometriosis
- In men, problems with sexual function, small or swollen testicles, or other changes
Often, however, there are no outward symptoms, and the difficulty conceiving is the only sign.
Causes
Infertility can stem from female factors, male factors, or both:
- Ovulation problems: Conditions such as polycystic ovary syndrome or other hormone imbalances that disrupt the release of eggs.
- Structural issues: Blocked or damaged fallopian tubes, fibroids, or endometriosis.
- Sperm problems: Low sperm count, poor movement, or abnormal shape.
- Age: Fertility declines with age, particularly for women after the mid-30s.
- Other factors: Certain medical conditions, infections, treatments such as chemotherapy, and lifestyle factors.
In some couples, no specific cause is identified, which is called unexplained infertility.
Risk Factors
- Older age, especially for women over 35
- Being significantly overweight or underweight
- Smoking, heavy alcohol use, or drug use
- A history of sexually transmitted infections or pelvic inflammatory disease
- Hormone disorders or conditions such as endometriosis
- Previous cancer treatment
Diagnosis
Evaluation looks at both partners:
- History and exam: Reviewing menstrual cycles, sexual and medical history, and lifestyle for both partners.
- Ovulation and hormone testing: Blood tests and tracking to confirm ovulation and check hormone levels.
- Semen analysis: Assessing sperm count, movement, and shape.
- Imaging and procedures: Ultrasound and tests to check the uterus and fallopian tubes.
Treatment
Treatment depends on the cause and the couple's circumstances.
- Lifestyle changes: Reaching a healthy weight, stopping smoking, and limiting alcohol can improve fertility.
- Medications: Drugs that stimulate ovulation in women, or treatments to address hormone problems.
- Surgery: Correcting structural problems such as blocked tubes, fibroids, or endometriosis.
- Assisted reproduction: Techniques such as intrauterine insemination (IUI) or in vitro fertilization (IVF).
- Male factor treatment: Addressing sperm problems or underlying conditions.
A fertility specialist can help choose the most appropriate approach.
Improving Your Chances
- Maintain a weight that is healthy for you
- Avoid smoking, recreational drugs, and excess alcohol
- Have regular intercourse, especially around the time of ovulation
- Manage chronic conditions and take folic acid if planning pregnancy
- Seek care promptly if you have irregular cycles or are over 35
When to See a Doctor
Consider seeing a doctor if you have been trying to conceive for a year without success, or after six months if the woman is over 35. Seek advice sooner if there are known concerns, such as irregular or absent periods, very painful periods, a history of pelvic infections or pelvic surgery, or known male fertility issues. Early evaluation can save time and broaden your options.
Frequently Asked Questions
When is a couple considered infertile?
Infertility is usually defined as not conceiving after a year of regular, unprotected intercourse, or after six months if the woman is over 35. Reaching this point is a reason to seek evaluation, not a sign that pregnancy is impossible.
Is infertility a female problem?
No. Infertility can involve female factors, male factors, both, or sometimes no clear cause. Roughly speaking, problems are found in the male partner in a substantial share of cases, which is why both partners are evaluated.
Can infertility be treated?
Often, yes. Depending on the cause, treatment may include lifestyle changes, medications to support ovulation, surgery to correct structural problems, or assisted reproduction such as IUI or IVF. Many couples conceive with appropriate care.
Does age affect fertility?
Yes. Fertility declines with age, especially for women after the mid-30s, and the chance of conceiving each cycle decreases. This is why women over 35 are advised to seek evaluation after six months of trying rather than a year.
What can I do to improve my chances of conceiving?
Maintaining a healthy weight, not smoking, limiting alcohol, managing chronic conditions, and having regular intercourse around ovulation can all help. Seeking timely medical advice if you have irregular cycles or are over 35 is also important.
References
- Office on Women's Health, U.S. Department of Health and Human Services. Infertility.
- Mayo Clinic. Infertility — Symptoms and causes.
- MedlinePlus, U.S. National Library of Medicine. Infertility.
- American Society for Reproductive Medicine (ASRM). Infertility: An Overview.