Infertility is the inability of a man and a woman to conceive a child through sexual intercourse. There are many possible reasons for the problem, which can involve the man, the woman, or both partners. Various treatments are available that enable a woman to become pregnant; the correct one will depend on the specific cause of the infertility.
Infertility treatment is aimed at enabling a woman to have a baby by treating the man, the woman, or both partners. During normal conception of a child, the man's sperm will travel to the woman's fallopian tubes, where, if conditions are right, it will encounter an egg that has been released from the ovary. The sperm will fertilize the egg, which will enter the uterus where it implants and begins to divide, forming what's called an embryo. The embryo will develop during pregnancy into a baby.
Infertility treatment attempts to correct or compensate for any abnormalities in this process that prevent the fertilization of an egg or development of an embryo.
It's important for a couple contemplating infertility treatment to examine their own ideas and feelings about the process and consider ethical objections before the woman becomes pregnant from such treatment.
About 90% of women who are trying to get pregnant and use no birth control will do so within one year. If after one year of having frequent sexual intercourse with no contraception a couple has not conceived, they should seek the advice of a physician. Tests can be performed to look for possible infertility problems.
Low sperm count treatments
The most common cause of male infertility is failure to produce enough healthy sperm. For fertilization to happen, the number of sperm cells in the man's semen (the fluid ejected during sexual intercourse) must be sufficient, and the sperm cells must have the right shape, appearance, and activity (motility).
Defects in the sperm can be caused by an infection resulting from a sexually transmitted disease, a blockage caused by a varicose vein in the scrotum (varicocele), an endocrine imbalance, or problems with other male reproductive organs (such as the testicles, prostate gland, or seminal vesicles).
If a low sperm count is the problem, it's possible to restore fertility by:
- treating underlying infections
- timing sex to coincide with the time the woman is ovulating, which means that the egg is released from the ovary and is beginning to travel down the fallopian tube (the site of fertilization)
- having sex less often to build up the number of sperm in the semen
- treating any endocrine imbalance with drugs
- having a surgical procedure to remove a varicocele (varicocelectomy)
In some women, infertility is due to blocked fallopian tubes. The egg is released from the ovary, but the sperm is prevented from reaching it because of a physical obstruction in the fallopian tube. If this is the case, surgery may help repair the damage. Microsurgery can sometimes repair the damage to scarred fallopian tubes if it is not too severe. Not all tube damage can be repaired, however, and most tubal problems are more successfully treated with in vitro fertilization.
Fibroid tumors in the uterus also may cause infertility, and they can be surgically treated. Endometriosis,a condition in which parts of the lining of the uterus become imbedded in other internal organs (such as the ovaries or fallopian tubes) may contribute to infertility. It may be necessary to surgically remove the endometrial tissue to improve fertility.
Artificial insemination may be tried if sperm count is low, the man is impotent, or the woman's vagina creates a hostile environment for the sperm. The procedure is not always successful. In this procedure, the semen is collected and placed into the woman's cervix with a small syringe at the time of ovulation. From the cervix, it can travel to the fallopian tube where fertilization takes place. If the partner's sperm count is low, it can be mixed with donor sperm before being transferred into the uterus.
If there is no sperm in the male partner's semen, then artificial insemination can be performed using a donor's sperm obtained from a sperm bank.
Assisted reproductive technologies
Some fertility treatments require removal of the eggs and/or sperm and manipulation of them in certain ways in a laboratory to assist fertilization. These techniques are called assisted reproductive technologies.
IN VITRO FERTILIZATION (IVF). When infertility can't be treated by other means or when the cause is not known, it's still possible to become pregnant through in vitro fertilization (IVF), a costly, complex procedure that achieves pregnancy 20% of the time.
In this procedure, a woman's eggs are removed by withdrawing them with a special needle. Attempts are then made to fertilize the eggs with sperm from her partner or a donor. This fertilization takes place in a petri dish in a laboratory. The fertilized egg (embryo) is then returned to the woman's uterus.
Often, three to six fertilized eggs are returned at the same time into the uterus. Usually one or two of the embryos survive and grow into fetuses, but sometimes three or more fetuses result.
A child born in this method is popularly known as a "test tube baby," but in fact the child actually develops inside the mother. Only the fertilization of the egg takes place in the laboratory.
INTRACYTOPLASMIC SPERM INJECTION (ICSI). In a variation of IVF called intracytoplasmic sperm injection (ICSI), single sperm cells are injected directly into each egg. This may be helpful for men with severe infertility.
GAMETE INTERFALLOPIAN TRANSFER (GIFT). In this technique, sperm and eggs are placed directly into the woman's fallopian tubes to encourage fertilization to occur naturally. This procedure is done with the help of laparoscopy. In laparoscopy, a small tube with a viewing lens at one end is inserted into the abdomen through a small incision. The lens allows the physician to see inside the patient on a video monitor.
ZYGOTE INTRAFALLOPIAN TRANSFER (ZIFT). If infertility is caused by a low sperm count, zygote intrafallopian transfer (ZIFT) can be tried. This technique combines GIFT and IVF. This procedure is also called a "tubal embryo transfer."
In this technique, in vitro fertilization is first performed, so that the actual fertilization takes place and is confirmed in the laboratory. Two days later, instead of placing the embryo in the uterus, the physician performs laparoscopy to place the embryos in the fallopian tube, much like the GIFT procedure.
A woman must have at least one functioning fallopian tube in order to participate in ZIFT.
Couples who are having fertility problems may want to limit or avoid:
- tight-fitting undershorts (men)
- hot tubs, saunas and steam rooms (high temperatures can kill sperm)
Typically, at least half of all couples who are infertile will respond to treatment with a successful pregnancy. For those who cannot become pregnant with treatment or insemination, surrogate parenting or adopting may be a workable option.
Berger, Gary S., et al. The Couple's Guide to Infertility. New York: Doubleday, 1994.
Carlson, Karen J., Stephanie A. Eisenstat, and Terra Ziporyn. The Harvard Guide to Women's Health. Cambridge, MA: Harvard University Press, 1996.
Cunningham, F. Gary, Paul C. Macdonald, et al. Williams Obstetrics. 20th ed. Stamford: Appleton & Lange, 1997.
Ryan, Kenneth J., Ross S. Berkowitz, and Robert L. Barbieri. Kistner's Gynecology. 6th ed. St. Louis: Mosby, 1995.
American Society for Reproductive Medicine. 1209 Montgomery Highway, Birmingham, AL 35216. (205) 978-5000.
Resolve. 1310 Broadway, Somerville, MA 02144-1731. (617) 623-0744. <http://www.resolve.org>.
Carol A. Turkington
Gamete—An egg (ovum) from the female or a mature sperm from the male.
Laparoscopy—A procedure in which a viewing tube is inserted through the abdominal wall to examine a woman's reproductive organs.
Ovulation—The release of an egg from the ovary. Fertilization can occur within a day or two of ovulation.
Zygote—A fertilized egg.