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Infertility is defined as the inability to conceive after one year of attempting to achieve pregnancy. Among fertile couples, the chance of becoming pregnant each month is 20 - 25%. Considering the complexity of both the female and male reproductive system, conception can be viewed as nothing less than a miracle. Any change in the complicated sequence of events can disrupt ovulation, conception, or pregnancy.

In about 18% of couples male factor is the exclusive cause and partly or mainly male in 30 - 40% of couples; partly or mainly female in another 40%. In 15% of cases, a definite cause cannot be identified, although effective treatment is available. Some of the most common conditions that can contribute to infertility are described below.

Abnormal ovulation results in irregular or absent menstrual periods. Most of the time, this is caused by a hormonal imbalance due to improper coordination and communication between the part of the brain called the hypothalamus and the pituitary gland. Together these two organs cause the release of hormones in the blood stream. In many cases, abnormal ovulation can be successfully treated with hormonal therapy.

Blocked or damaged fallopian tubes may interfere with the egg and sperm uniting. Blockages may also negatively affect embryo development and implantation in the uterus. They can be caused by previous infection in the pelvis or by abdominal surgery. Treatment of tubal problems or pelvic scarring may require specialized surgery or IVF, depending on each woman's situation.

Every month the lining of the uterus, the endometrium, thickens in preparation for the implantation of an embryo. Sometimes the endometrial cells will migrate from their normal location and attach to the ovaries and other pelvic organs. This is called endometriosis and can cause infertility. The symptoms of endometriosis include heavy painful and long menstrual periods. However there is no correlation between the severity of the symptoms and the extent of the disease. Several forms of treatment are available including medication and surgery.

When the ovaries are not ovulating, cervical mucus helps prevent infection by killing bacteria. However, at the time of ovulation cervical mucus should change to encourage sperm survival. Cervical problems may also be related to the consistency of the cervical mucus or to the cervical anatomy, which will not allow the sperm to enter the uterus.

Fertility levels decrease with age, especially in women. Maximum fertility for women occurs between the ages of 15 and 24. Many couples delay starting a family until they are in their 30's or 40's. About one-third of women who defer pregnancy until their mid-30's will have a problem becoming pregnant, and at least half of all women over 40 will have difficulties. For this reason, women over the age of 35 should wait for no more than 6 months of unprotected sexual intercourse before consulting their doctor.

Problems may be related to inadequate sperm count or abnormalities related to size, shape, and movement of the sperm. Male infertility is sometimes related to the presence of a varicocele, which are varicose veins of the scrotum that affect sperm quality and quantity. Testicular injury, undescended testicles, and hormonal imbalances may also be the cause of male factor infertility. Occasionally, the presence of other diseases such as diabetes, central nervous system problems, and pituitary tumors can affect fertility.

There are a number of diagnostic tools available to help pinpoint the cause of infertility. After a couple has undergone a thorough evaluation of their medical history, the doctor will initiate a series of specific diagnostic investigations based upon his suspicion of the source of infertility for the couple.

Patients and partners should seek fertility treatment if they are under 35 years of age and have had regular intercourse without contraception for one year without success.

Patients and partners over 35 years of age should seek treatment after trying without success for six months.

Patients unable to carry pregnancies to term or have experienced multiple miscarriage may also seek help from Reproductive Endocrinologists.

Key points for a thorough evaluation include:

1. Ruling out reproductive abnormalities in males and females
2. Patent fallopian tubes
3. Ovulation
4. Sperm Quality
5. Ability of the egg and sperm to unite
6. Ability of achieving and maintaining implantation