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\nIn general, infertility is defined as not being able to get pregnant (conceive) after one year (or longer) of unprotected sex. Because fertility in women is known to decline steadily with age, some providers evaluate and treat women aged 35 years or older after 6 months of unprotected sex. While these definitions of infertility are used for data collection and monitoring, they are not intended to guide recommendations about the provision of fertility care services. Individuals and couples who are unable to conceive a child should consider making an appointment with a reproductive endocrinologist\u2014a doctor who specializes in managing infertility. Reproductive endocrinologists may also be able to help women with recurrent pregnancy loss, defined as having two or more spontaneous miscarriages.
\nPregnancy is the result of a process that has many steps. To get pregnant:
\nInfertility may result from a problem with any or several of these steps.
\nImpaired fecundity is a condition related to infertility and refers to women who have difficulty getting pregnant or carrying a pregnancy to term.
\nYes. In the United States, among married women aged 15 to 49 years with no prior births, about 1 in 5 (19%) are unable to get pregnant after one year of trying (infertility). Also, about 1 in 4 (26%) women in this group have difficulty getting pregnant or carrying a pregnancy to term (impaired fecundity).
\nInfertility and impaired fecundity are less common among women with one or more prior births. In this group, about 6% of married women aged 15 to 49 years are unable to get pregnant after one year of trying and 14% have difficulty getting pregnant or carrying a pregnancy to term.
\nNo, infertility is not always a woman\u2019s problem. Both men and women can contribute to infertility.
\n\n Infertility in men can be caused by different factors and is typically evaluated by a semen analysis. When a semen analysis is performed, the number of sperm (concentration), motility (movement), and morphology (shape) are assessed by a specialist. A slightly abnormal semen analysis does not mean that a man is necessarily infertile. Instead, a semen analysis helps determine if and how male factors are contributing to infertility.
\nDisruption of testicular or ejaculatory function
\nHormonal disorders
\nGenetic disorders
\n\n Women need functioning ovaries, fallopian, and a uterus to get pregnant. Conditions affecting any one of these organs can contribute to female infertility. Some of these conditions are listed below and can be evaluated using several different tests.
\nDisruption of ovarian function (presence or absence of ovulation and effects of ovarian \u201cage\u201d)
\nA woman\u2019s menstrual cycle is, on average, 28 days long. Day 1 is defined as the first day of \u201cfull flow.\u201d Regular predictable periods that occur every 21 to 35 days likely reflect ovulation. A woman with irregular periods is likely not ovulating.
\nOvulation can be predicted by using an ovulation predictor kit and can be confirmed by a blood test to check the woman\u2019s progesterone level on day 21 of her menstrual cycle. Although several tests exist to evaluate a woman\u2019s ovarian function, no single test is a perfect predictor of fertility. The most commonly used markers of ovarian function include follicle-stimulating hormone (FSH) value on day 3 to 5 of the menstrual cycle, anti-m\u00fcllerian hormone value (AMH), and antral follicle count (AFC) using a transvaginal ultrasound.
\nDisruption in ovarian function may be caused by several conditions and warrants an evaluation by a doctor.
\nWhen a woman doesn\u2019t ovulate during a menstrual cycle, it\u2019s called anovulation. Potential causes of anovulation include the following
\nFallopian tube obstruction (whether fallopian tubes are open, blocked, or swollen)
\nRisk factors for blocked fallopian tubes (tubal occlusion) can include a history of pelvic infection, ruptured appendix, gonorrhea, chlamydia, endometriosis, or prior abdominal surgery.
\nFallopian tubes may be evaluated by hysterosalpingogram or by chromopertubation.
\nPhysical characteristics of the uterus
\nDepending on a woman\u2019s symptoms, the uterus may be evaluated by transvaginal ultrasound to look for fibroids or other problems, including intrauterine adhesions, endometrial polyps, adenomyosis, and congenital anomalies of the uterus. A sonohystogram or hysteroscopy may also be performed to further evaluate the uterine environment.
\nFemale fertility is known to decline with
\nA woman\u2019s chances of having a baby decrease rapidly every year after the age of 30. Most experts suggest women younger than age 35 with no apparent health or fertility problems and regular menstrual cycles should try to conceive for at least one year before seeing a doctor. However, for women aged 35 years or older, couples should see a health care provider after 6 months of trying unsuccessfully. Women over 40 years may consider seeking more immediate evaluation and treatment.
\nSome health problems also increase the risk of infertility. So, couples with the following signs or symptoms should not delay seeing their health care provider when they are trying to become pregnant:
\nFor women:
\nFor men:
\nIt is a good idea for any woman and her partner to talk to a health care provider before trying to get pregnant. They can help you get your body ready for a healthy baby, and can also answer questions on fertility and give tips on conceiving. Learn more at the CDC\u2019s Preconception Health web site.
\nDoctors will begin by collecting medical and sexual history from both partners. The initial evaluation usually includes a semen analysis, a tubal evaluation, and ovarian reserve testing.
\nInfertility can be treated with medicine, surgery, intrauterine insemination, or assisted reproductive technology.
\nOften, medication and intrauterine insemination are used at the same time. Doctors recommend specific treatments for infertility on the basis of:
\nMale infertility may be treated with medical, surgical, or assisted reproductive therapies depending on the underlying cause. Medical and surgical therapies are usually managed by a urologist who specializes in infertility. A reproductive endocrinologist may offer intrauterine inseminations (IUIs) or in vitro fertilization (IVF) to help overcome male factor infertility.
\nSome common medicines used to treat infertility in women include:
\n*Note: Use of trade names and commercial sources is for identification only and does not imply endorsement by the US. Department of Health and Human Services.
\nMany fertility drugs increase a woman\u2019s chance of having twins, triplets, or other multiples. Women who are pregnant with multiple fetuses may have more problems during pregnancy. Multiple fetuses have a higher risk of being born prematurely (too early). Premature babies are at a higher risk of health and developmental problems.
\nIntrauterine insemination (IUI) is an infertility treatment that is often called artificial insemination. In this procedure, specially prepared sperm are inserted into the woman\u2019s uterus. Sometimes the woman is also treated with medicines that stimulate ovulation before IUI.
\nIUI is often used to treat:
\nAssisted Reproductive Technology (ART) includes all fertility treatments in which either eggs or embryos are handled outside of the body. In general, ART procedures involve removing mature eggs from a woman\u2019s ovaries using a needle, combining the eggs with sperm in the laboratory, and returning the embryos to the woman\u2019s body or donating them to another woman. The main type of ART is in vitro fertilization (IVF).
\nSuccess rates vary and depend on many factors, including the clinic performing the procedure, the infertility diagnosis, and the age of the woman undergoing the procedure. This last factor\u2014the woman\u2019s age\u2014is especially important.
\nCDC publishes ART success rates for all fertility clinics in the United States. In addition, CDC created an IVF Success Estimator \u2013 a tool to estimate the chance of having a live birth using IVF based on the experiences of women and couples with similar characteristics.
\nART can be expensive and time-consuming, but it has allowed many couples to have children that otherwise would not have been conceived. The most common complication of ART is a multiple pregnancy. This is a problem that can be prevented or minimized by limiting the number of embryos that are transferred back to the uterus. For example, transfer of a single embryo, rather than multiple embryos, greatly reduces the chances of a multiple pregnancy and its risks such as preterm birth.
\nART procedures sometimes involve the use of donor eggs (eggs from another woman), donor sperm, or donated embryos. Donor eggs are sometimes used for women who cannot produce eggs. Also, donor eggs or donor sperm are sometimes used when the woman or man has a genetic disease that can be passed on to the baby. An infertile couple may also use donated embryos that were created by other couples in infertility treatment and were not used. When donated embryos are used the child will not be genetically related to either parent. Donor eggs, sperm, or donated embryos may also be used by same-sex couples.
\nWomen with ovaries but no uterus may be able to use a gestational carrier. This may also be an option for women who shouldn\u2019t become pregnant because of a serious health problem. In this case, a woman uses her own egg and it is fertilized by her partner\u2019s sperm. Then, the embryo is placed inside the carrier\u2019s uterus.
\nPreimplantation genetic testing is a procedure used to identify genetic disorders or chromosomal abnormalities in embryos created during an IVF cycle. One or more cells are biopsied from each embryo and sent for testing. These procedures used to be referred to as preimplantation genetic screening and preimplantation genetic diagnosis.
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