Infertility: Causes and treatments

April 05, 2012 By Anthony Luciano, M.D.

Reproducing is such a natural part of being human, it's hard to understand how the process can get derailed.

But there are a number of factors that contribute to successful fertilization, and when one or more of these malfunction – as occurs in about 10 percent of U.S. couples – couples will have difficulty getting or staying pregnant, according to the Centers for Disease Control and Prevention.

Infertility is defined as not being able to get pregnant after one year of trying (after six months of trying if a woman is 35 or older). Women who can get pregnant but are unable to stay pregnant may also be considered infertile.

In about one-third of cases, infertility is due to problems involving the woman; in about one-third due to problems involving the man; and in the remaining one-third due to problems both partners are having, or other reasons.

Infertility can have many causes. The most common among women is ovulation problems, including polycystic ovarian syndrome caused by a hormone imbalance. In men, the most common causes include varicocele, in which the veins surrounding the testicles are too large, causing the testicles to heat. Heat adversely affects the number or shape of the sperm. Additional factors, such as hormonal imbalance, infections or poor health can also cause male infertility by affecting the number, shape or movement of sperm, and may require therapy.

While some conditions can't be controlled and require medical and/or surgical treatments, there are infertility risk factors that men and women can control, such as smoking, poor nutrition, obesity and environmental toxins. The use of alcohol, tobacco or drugs are among the most common risk factors affecting women's and men's fertility.

While infertility can be a frustrating and sometimes heartbreaking problem for couples, they need not despair, since most causes of infertility can be successfully treated, and in most cases will not require expensive and intrusive therapies. Infertility treatment depends on several factors, including infertility causes, how long you've been infertile, age and others. Some of the most common treatments include:

• Medication and/or surgical therapy for men to treat varicocele or general sexual problems like impotence or premature ejaculation.
• Hormones or surgery to correct quality and quantity of sperm.
• Medications for women – used alone or in combination -- to stimulate ovulation. These include clomiphene citrate (Clomid); human menopausal gonadotropin or hMG (Repronex, Pergonal); follicle-stimulating hormone or FSH (Gonal-F, Follistim); and others.
• Surgery to restore normal function of fallopian tubes damaged by infections, endometriosis or previous surgery.
• When these treatments fail or are not indicated, couples can usually be successfully treated with assisted reproductive technology, including in-vitro fertilization and embryo transfer (IVF-ET). With IVF, after hormonal treatment to mature several eggs in the ovary, eggs are collected and fertilized with the husband's sperm in the laboratory (in vitro) to produce viable embryos. Three to five days after eggs collection, one or two embryos are then transferred into the uterus (ET).

It's important to remember that some treatments can have side effects, including increasing your chances of having more than one baby at a time. You and your infertility specialist should be very careful to avoid multiple pregnancies, which may occur in 3 percent to 5 percent of treated couples. In some cases fertility treatments might not be covered by medical insurance.
If you're having trouble getting pregnant, see a fertility specialist, who can diagnose any problems and discuss treatment options that meet your needs and personal preferences.

Anthony A. Luciano, M.D., heads the Center for Fertility and Women's Health at The Hospital of Central Connecticut.