Infertility is the failure of a woman to become pregnant after 1 year of having regular, unprotected sexual intercourse. This is called primary infertility, if a woman has never conceived. If a woman has previously had children but now has not conceived for 1 year, it is known as secondary infertility. Infertility is a problem for one out of every six couples.

How does it occur?
50% of infertility is attributed to female factors. The most common reason for female infertility is the failure to release an egg (ovulate). Failure to ovulate may be caused by:

• a hormone imbalance
• Obesity and weight gain
• Prolonged excessive stress
• a tumor or cyst on the ovary and other ovary disorders
• Extreme exercise, i.e. marathoners
• Weight loss for various reasons, including eating disorders such as anorexia and bulimia
• Abuse of alcohol, drugs, tobacco, coffee, tea, or other products containing caffeine.
• A damaged fallopian tube or uterus can also cause infertility.

These organs may be damaged from:

• a previous infection, such as pelvic inflammatory disease or other sexually transmitted diseases
• a birth defect
• a previous surgery to remove a tubal pregnancy resulting in scar tissue
• Other conditions such as endometriosis, fibroids, or an abnormally-shaped or tipped uterus.

In rare cases, the woman's body destroys the sperm because she is allergic to the sperm. Genetic problems causing infertility are also rare.

There is a natural decline in fertility that comes with aging. This decline occurs more quickly after age 30.

How is the problem diagnosed?
The doctor will give you a thorough physical exam to help investigate and find a treatment for infertility. You may have to give the doctor more information to help determine why pregnancy does not occur. The doctor will ask both you and your partner questions during joint and separate interviews.

Some of the questions usually asked are about previous medical conditions such as illnesses and infections, use of drugs and alcohol, sexual intercourse practices, detailed sexual history (including previous pregnancy, miscarriage, or abortions), genital surgery, circumcision, and normal genital development.

In addition to a complete physical and gynecological exam, the doctor may want to do the following tests:

• urine and blood tests to check for infections and a hormone imbalance
• tests on a sample of cervical mucus and a sample of tissue from the lining of your uterus to determine if ovulation is occurring
• a test of your partner's sperm count to see if the cause of infertility is too few sperm.

The doctor may also instruct you on how to take and chart your body temperature each morning. There is a natural rise in body temperature after ovulation. By looking at your temperature chart, the doctor may determine if and when ovulation is occurring.

A doctor may do the following procedures to check if a blockage in the fallopian tubes or uterus is causing the infertility:

• a laparoscopy (a scope is inserted into your abdomen so the doctor may view the organs)
• an insufflation of the fallopian tubes (carbon dioxide gas is blown into the tubes to help the doctor locate a blockage)
• an x-ray of the uterus and fallopian tubes. (Hysthosdepingogane)

How is it treated?
If the doctor discovers you have a disorder that is causing the infertility, he or she will recommend treating this problem to try to restore your fertility. Treatment may include medication (usually hormones or antibiotics) or surgery. Sometimes a combination of treatments is necessary to correct the problem.

To restore fertility the doctor may suggest the following:

• Take hormones for a hormone imbalance, endometriosis, or short menstrual cycle. (Multiple births may occur if your ovaries are over-stimulated by hormone treatment.)
• Take drugs to stimulate ovulation.
• Keep a record of your daily temperature to track ovulation. This will help predict when you are most fertile or if the drugs you are taking is stimulating egg production.
• Have surgery to remove blockage or scar tissue from the fallopian tubes or uterus.

If you cannot become pregnant because your partner's sperm count is low, artificial insemination is an option. The sperm is collected and then placed in your body during the most fertile time in your menstrual cycle. This has varying success. If your partner's sperm count is still insufficient, you may become pregnant using sperm donated from another man.

In vitro fertilization is another option. In this procedure, the sperm and egg are fertilized outside of the body and put into your body. This procedure is an option if the man's sperm count is low or if your fallopian tubes are blocked or damaged and cannot be corrected with surgery. In vitro fertilization is expensive and success rates are often low.

The period of investigation and treatment for infertility can be stressful for a couple and put unusual strain on their relationship. Counseling may help the couple get through any difficult times.

What can be done to help prevent infertility?
You may not be able to prevent infertility resulting from genetic abnormalities or an illness. However, you can do the following to reduce your risk of developing disorders that might cause infertility:

• Prevent sexually transmitted diseases by using condoms and making sure both you and your partner only have sex with each other.
• Limit your intake of alcohol, coffee, tea, soda, and other foods and beverages containing caffeine.
• Avoid use of recreational drugs (such as marijuana) and overuse of prescription and over-the-counter drugs.
• Avoid exposure to toxic substances such as industrial chemicals, herbicides, and pesticides.
• Maintain good personal hygiene and health practices.

Contact the doctor about any signs of infection or hormonal change, such as:

• unusual discharge from the vagina
• abdominal pain
• fever
• abnormal bleeding
• change in menstrual cycle
• discomfort during intercourse
• sores and itching in the vagina or rectum