What is female infertility?

Infertility means that you haven't been able to get pregnant after trying for at least 1 year (or 6 months if you're over 35). It doesn't mean you'll never get pregnant.

Your chances of getting pregnant are higher when you are younger. You are most able to get pregnant (fertile) in your late 20s. Then, in your mid-30s, you become less fertile. This is because your eggs get older.

Trouble getting pregnant can be caused by a problem with the reproductive organs. Talk with your doctor about testing and treatment. Testing will likely start with hormone and semen testing.

There is a wide range of treatment options. They include medicines, surgery, insemination, and in vitro fertilization (IVF).

If you aren't able to get pregnant after a year of trying (or 6 months, if you're over 35), your doctor may suggest testing and treatment. But some people who have tried treatment without success become pregnant later without more treatment.

The main symptom of infertility is being unable to get pregnant after 6 to 12 months of trying, depending on your age.

A wide range of treatments may be used for infertility. Depending on the cause, they include:

• Medicine that helps with releasing an egg (ovulating).
• A procedure that puts sperm directly inside the uterus (insemination).
• Surgery for a problem caused by endometriosis or blocked fallopian tubes.
• A procedure to concentrate sperm count for insemination.

You may also consider in vitro fertilization (IVF). During IVF, eggs and sperm are mixed in a lab to fertilize the eggs. Then the doctor puts one or more fertilized eggs into the uterus.

Treatment for fertility problems can be stressful and costly. Before you start, think about how far you're willing to go with treatment. You may change your mind later, but it's a good idea to start with a plan.

Weight loss may help improve ovulation in people with PCOS who are overweight. The medicines clomiphene and letrozole can also be used to help with ovulation. If that doesn't work, other medicines may help. If weight loss and medicines don’t work, surgery or IVF may sometimes be an option.

Sometimes infertility is related to lifestyle or other health conditions. To help protect your fertility:

• Avoid using tobacco (cigarettes) and marijuana.
• Avoid exposure to harmful chemicals.
• Avoid excessive alcohol use.
• Limit sex partners and use condoms to reduce the risk of getting a sexually transmitted infection (STI). Untreated STIs can damage the reproductive system and cause infertility. If you think you may have an STI, get treatment right away to reduce the risk of damage.
• Stay at a body weight that's close to the ideal for your height. It will reduce the chance of hormone imbalances.

If you have been diagnosed with cancer and hope to have children in the future, talk to your doctor about your options to help preserve fertility.

To check for fertility problems, a doctor can:

• Do a physical exam.
• Ask questions about your past health. This may help your doctor find clues, such as a history of miscarriages or pelvic inflammatory disease.
• Ask about your lifestyle habits. This includes how often you exercise and whether you drink alcohol or use drugs.
• Do tests that check semen quality. Other tests can measure hormone levels. Hormone imbalances can be a sign of ovulation problems or sperm problems that can be treated.

If your test results show no cause of infertility, your doctor may recommend checking the uterus, fallopian tubes, and ovaries.

Before you have fertility tests, it may help to try fertility awareness. Chart basal body temperature and use home tests to learn when you are likely to ovulate and be fertile. Some people find that they have been missing the most fertile days when trying to conceive.

Medicine or hormone treatments are often the first steps in fertility treatment. They're also used for in vitro fertilization (IVF) and other assisted reproductive technologies. Medicines include:

• Clomiphene and letrozole. These stimulate the release of hormones that help with ovulation.
• Gonadotropins. These hormone shots stimulate the ovaries to produce mature eggs.
• Treatment for polycystic ovary syndrome (PCOS). If you're not ovulating because of PCOS, your doctor might recommend a drug such as metformin along with clomiphene.
• Gonadotropin-releasing hormone (GnRH). It increases production of hormones needed to produce eggs and sperm.
• Bromocriptine and cabergoline. These lower prolactin levels. High prolactin levels can prevent ovulation and sperm production.
• GnRH analogue. This is used for IVF.

For your first fertility questions and testing, you can see:

• A family medicine physician.
• An internist.
• A nurse practitioner (NP).

For complete fertility testing, see an obstetrician/gynecologist with special training and experience in fertility problems. This doctor may be called a reproductive endocrinologist or fertility specialist. When looking for a specialist, ask what percentage of a doctor's practice is fertility treatment. Also ask if the doctor has training in reproductive endocrinology.

• Take a multivitamin with folic acid. This helps to prevent birth defects if you do become pregnant.
• Get regular exercise. But do not overdo it. Excessive exercise can cause eggs to release less often or sperm count to lower.
• Avoid excessive alcohol and caffeine use.
• Avoid smoking, marijuana, and illegal drugs.
• Stay at a healthy weight. This will increase your chances of getting pregnant. Being overweight or weighing too little can affect fertility.
• Talk to your doctor about all medicines you are taking or may take. This includes over-the-counter and prescribed medicines and herbal remedies. Some medicines interfere with pregnancy.
• Write down when your period starts and stops for a few months. Bring that information to your doctor. Your doctor can help you figure out when you ovulate and are most likely to get pregnant if you have sex. Or you may prefer to use a home ovulation test.
• If you know when you will ovulate, try to have sex once a day for the 4 days before ovulation and on the day of ovulation.
• If you don't know when you will ovulate, have sex 2 or 3 times each week.
• Don't use lubricants during sex. They may affect how well sperm can travel to meet an egg.

For some people with infertility, a structural problem can be treated with surgery. Treatment can increase the chances of natural conception.

When thinking about surgery, ask your doctor questions about the procedure. For example, how many times has the surgeon done it? What are the chances that the treatment will be a success? How long will it take to recover?

Surgery may include:

• Fallopian tube procedures. One example is sterilization reversal.
• Laparoscopic surgery. This may help treat endometriosis.
• Myomectomy. This may help treat uterine fibroids.
• Laparoscopic ovarian drilling. This may be used when weight loss and medicine haven't stimulated ovulation in people who have polycystic ovary syndrome (PCOS).
• Varicocele repair. This is used to cut or bypass an enlarged vein in the scrotum.
• Vasectomy reversal. This reconnects the tubes (vas deferens) that were cut during a vasectomy.

Things that increase your risk for infertility include:

• Age. Eggs and sperm can decrease in number or quality with age.
• Birth defects. Some people were born with problems in their reproductive systems.
• Moderate or severe endometriosis.
• Past exposure to very high levels of environmental toxins, certain drugs, or high doses of radiation. This includes cancer chemotherapy or radiation.
• Past infection with a sexually transmitted infection (STI) that has since damaged the reproductive system. This includes gonorrhea or chlamydia.
• Polycystic ovary syndrome. This is a hormone imbalance that can affect ovulation. This can make it harder to get pregnant.

When you have infertility, you may feel alone, confused, or scared. Talking with others about your feelings can help. Here are some places you may find support.

• Family and friends. They can help you cope by giving you comfort and encouragement.
• Counseling. Professional counseling can help you understand and deal with your infertility, and the emotions that may come with it.
• Your doctor. Find a doctor you trust and feel comfortable with. Be open and honest about your fears and concerns.
• Spiritual or religious groups. These groups can provide comfort. And they may be able to help you find counseling or other social support services.
• Support groups. In a support group, you can talk to others who have had similar experiences. Your doctor may be able to tell you about groups in your community. You may also be able to find support in online groups, forums, or discussion boards.

Complementary medicine may help you stay well and cope with infertility. Complementary medicine for fertility includes:

• Acupuncture.
• Dietary changes.
• Relaxation techniques.
• Mind-body medicine.

Talk with your doctor about any complementary health practice that you would like to try or are already using. Your doctor can help you manage your health better if they know about all of your health practices.

Infertility (fertility problems) affects the reproductive system. It means not being able to get pregnant. You may have fertility problems if you haven't been able to get pregnant after trying for at least 1 year (or 6 months if you're over 35). It doesn't always mean you'll never get pregnant. Some people conceive without help in their second year of trying. Some don't succeed. But medical treatments do help many people.

Age is an important factor in deciding whether to get testing and treatment for fertility problems. Female fertility is highest in the late 20s. After age 35, fertility decreases and the risk of miscarriage goes up. Most people should give themselves a year of trying to get pregnant before they will need medical help. But if you're older than 35, consider getting help after 6 months of trying.

Infertility may be caused by:

• Problems with the eggs or releasing an egg (ovulating).
• Problems with the uterus or the fallopian tubes. This may result from things like endometriosis or pelvic inflammatory disease.
• Problems with the sperm. These problems may include how sperm is made, how it functions, or how it moves.
• An unknown issue. Sometimes the cause of infertility is not known.

Rates of infertility and miscarriage increase with age. Female fertility peaks in the late 20s. It slowly starts to decline in the early 30s. A larger drop in fertility and increase in miscarriage risk begins around the mid-30s. This is mainly because of the aging egg supply. Male fertility also decreases with age. But it's a more gradual decline.