Frequently Asked Questions About Infertility

Infertility is the result of a disease (an interruption, cessation, or disorder of body functions, systems, or organs) of the male or female reproductive tract which prevents the conception of a child or the ability to carry a pregnancy to delivery. The duration of unprotected intercourse with failure to conceive should be about 12 months before an infertility evaluation is undertaken, unless medical history, age, or physical findings dictate earlier evaluation and treatment.

If you've been trying to get pregnant for more than a year, you may have infertility.

Infertility is a disease of the reproductive system that impairs one of the body's most basic functions: the conception of children. Conception is a complicated process that depends upon many factors. 

• on the production of healthy sperm by the man and healthy eggs by the woman;
• unblocked fallopian tubes that allow the sperm to reach the egg;
• the sperm's ability to fertilize the egg when they meet;
• the ability of the fertilized egg (embryo) to become implanted in the woman's uterus;
• and sufficient embryo quality.

Finally, for the pregnancy to continue to full term, the embryo must be healthy and the woman's hormonal environment adequate for its development.

When just one of these factors is impaired, infertility can result.

Infertility affects 10%-15% of couples. This makes it one of the most common diseases for people between the ages of 20 and 45. In addition, the longer a woman tries to get pregnant without conceiving, the lower are her chances to get pregnant without medical treatment. Most (85%) couples with normal fertility will conceive within a year of trying. If a couple doesn’t conceive in the first year, their chance of conceiving gets lower each month. This happens more quickly as the woman gets older.

Infertility is the inability to conceive after 12 months of unprotected intercourse. This means that a couple is not able to become pregnant after a year of trying. However, for women aged 35 and older, the inability to conceive after 6 months is generally considered infertility.

No one can be blamed for infertility any more than anyone is to blame for diabetes or leukemia. In rough terms, about one-third of infertility cases can be attributed to male factors and about one-third to factors that affect women. For the remaining one-third of infertile couples, infertility is caused by a combination of problems in both partners or, in about 20 percent of cases, is unexplained.

A woman's age can have a big effect on her ability to have a baby, especially as she enters her 30s and 40s. For a healthy woman in her 20s or early 30s, the chances of conceiving each month is 25%-30%. But by the time a woman is 40 years old, the chances are 10% or less.

The most common female infertility factor is an ovulation disorder. Other causes of female infertility include blocked fallopian tubes, which can occur when a woman has had pelvic inflammatory disease or endometriosis (a sometimes painful condition causing adhesions and cysts). Congenital anomalies (birth defects) involving the structure of the uterus and uterine fibroids are associated with repeated miscarriages.

The most common male infertility factors include azoospermia (no sperm cells are produced) and oligospermia (few sperm cells are produced). Sometimes, sperm cells are malformed or they die before they can reach the egg. In rare cases, infertility in men is caused by a genetic disease such as cystic fibrosis or a chromosomal abnormality.

Going to see a fertility specialist may help a couple figure out why they're not conceiving. Women see a reproductive endocrinologist and men see a urologist who specializes in fertility. In some (10% or more) cases, though, there may not be an obvious reason why a couple can't conceive. This is known as unexplained infertility. Fertility treatments can often help these couples with unexplained infertility.

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.

Most infertility cases -- 85 to 90 percent -- are treated with conventional therapies, such as drug treatment or surgical repair of reproductive organs. Some patients are encouraged to seek In Vitro Fertilization (IVF) treatment.

The degree of services covered depends on where you live and the type of insurance plan you have.  Several states currently have laws that require insurers to either cover or offer to cover some form of infertility diagnosis and treatment.  HOWEVER, the laws vary greatly in their scope of what is and is not required to be covered. For more information about the specific laws for each of those states, please call your state's Insurance Commissioner's office or to learn about pending insurance legislation in your state, please contact your State Representatives.

Whether or not you live in a state with an infertility insurance law, you may want to consult with your employer's director of human resources to determine the exact coverage your plan provides. Another good source of assistance is RESOLVE, an infertility patient advocacy and information organization.

The desire to have children and be parents is one of the most fundamental aspects of being human. People should not be denied insurance coverage for medically appropriate treatment to fulfill this goal.

Infertility often creates one of the most distressing life crises a couple has faced. The long-term inability to conceive a child can evoke significant feelings of loss. Coping with the multitude of medical decisions and the uncertainties that infertility brings can create great emotional upheaval for most couples. Many couples experience anxiety, depression, and feelings of being out of control or isolated. For more information, view the FAQs About the Psychological Component of Infertility.