You may have fertility problems if you haven't been able to get pregnant after trying for at least 1 year. It doesn't necessarily mean you will never get pregnant. Often, couples conceive without help in their second year of trying. Some don't succeed. But medical treatments do help many couples.
Age is an important factor if you are trying to decide whether to get testing and treatment for fertility problems. A woman is most fertile in her late 20s. After age 35, fertility decreases and the risk of miscarriage goes up.
In cases of fertility problems:1
Before you have fertility tests, try fertility awareness. A woman can learn when she is likely to ovulate and be fertile by charting her basal body temperature and using home tests. Some couples find that they simply have been missing their most fertile days when trying to conceive.
If you aren't sure when you ovulate, try this Interactive Tool: When Are You Most Fertile?
If these methods don't help, the first step is for both partners to have some simple tests. A doctor can:
Your family doctor can do these tests. For more complete testing, you may need to see a fertility specialist.
A wide range of treatments is available. Depending on what is causing the problem, a couple may be able to:
If these options aren't possible or don't work for you, you may want to think about in vitro fertilization (IVF). During an IVF, eggs and sperm are mixed in a lab so the sperm can fertilize the eggs. Then the doctor puts one or more fertilized eggs into the woman's uterus. Many couples try IVF more than once.
Treatment for fertility problems can be stressful, costly, and hard on your body. Before you start testing, make some decisions about how far you are willing to go with treatment. You may change your mind later, but it's a good idea to start with a plan.
Treatments for fertility problems can increase your chances of getting pregnant. But they also increase your chance of having twins, triplets, or more. Be sure to discuss the risks with your doctor.
Fertility problems can put a lot of strain on a couple. It may help to see a counsellor with experience in fertility problems. Think about joining a support group. Talking with other people who are going through the same thing can help you feel less alone.
Learning about fertility problems:
Health Tools help you make wise health decisions or take action to improve your health.
|Decision Points focus on key medical care decisions that are important to many health problems.|
|Fertility Problems: Should I Be Tested?|
|Fertility Problems: Should I Have a Tubal Procedure or In Vitro Fertilization?|
|Infertility: Should I Have Treatment?|
|Multiple Pregnancy: Should I Consider a Multifetal Pregnancy Reduction?|
|Interactive tools are designed to help people determine health risks, ideal weight, target heart rate, and more.|
|Interactive Tool: When Are You Most Fertile?|
Fertility problems have many causes that involve either the woman's, the man's, or both partners' reproductive systems. Some causes include:
Rates of infertility and miscarriage increase with age. A woman's fertility peaks in her late 20s. It gradually begins to decline in her early 30s. A more pronounced drop in fertility and increase in miscarriage risk begins around her mid-30s. This is primarily due to the aging egg supply. Male fertility also decreases with age. But it is a more gradual decline than in women.
Fertility problems don't cause physical symptoms.
Most healthy young couples trying to have a child are successful after 1 year of trying. But about 10 to 15 out of every 100 couples have trouble getting pregnant.1
Just because you haven't been able to get pregnant after 1 year doesn't mean you can't get pregnant. Many couples later go on to get pregnant, even without treatment.
But your doctor may suggest testing and treatment if you haven't been able to get pregnant after 1 year of having sex 2 or 3 times a week without using birth control. For women over 35, some doctors will offer testing and treatment after 6 months of trying to become pregnant.
If a clear cause can be found and if there is a promising treatment for that cause, pregnancy is more likely. When a cause can't be found and fertility tests are normal, treatment is less likely to work.
A couple's chances of getting pregnant are greatest within their first 3 years of trying. After 3 years of sex without birth control, pregnancy is considered unlikely without treatment.1
Some couples who have tried treatment without success become pregnant later without more treatment.
Before deciding to move forward with testing and treatment, be sure to think about these issues:
Things that increase your risk of having fertility problems include:
Consult with your doctor if you:
For complete fertility testing, you may be referred to an obstetrician/gynecologist with special training and experience in fertility problems.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Testing for fertility problems usually starts with simple tests for both partners. In addition to an interview and physical examinations, these first tests will:
If your test results show no cause of infertility, your doctor may recommend checking fallopian tube function. Depending on your age and other risk factors, you may then be offered further testing. Or you may begin treatment with superovulation (to produce more eggs), intrauterine insemination (which puts sperm into the uterus with a tube), or both.
For more information, see the topic Infertility Tests.
Testing can be stressful, costly, and sometimes painful. You may need only a few tests. Or you may need many tests over months and years.
Some fertility problems are more easily treated than others. In general, as a woman ages, especially after age 35, her chances of getting pregnant go down. But her risk of miscarriage goes up.
If you are 35 or older, your doctor may recommend that you skip some of the steps younger couples usually take. That's because your chances of having a baby decrease with each passing year.
It's important to understand that even if you are able to get pregnant, no treatment can guarantee a healthy baby. On the other hand, scientists in this field have made many advances that have helped millions of couples have babies.
Before you and your partner start treatment, talk about how far you want to go with treatment. For example, you may want to try medicine but don't want to have surgery. You may change your mind during your treatment, but it's good to start with an idea of what you want your limits to be.
Treatment for fertility can also cost a lot. Provincial health plans and private insurance often don't cover these expenses. If cost is a concern for you, ask how much the medicines and procedures cost. Then find out if your insurance covers any costs. Talk with your partner about what you can afford.
Thinking about this ahead of time may help keep you from becoming emotionally and financially drained from trying a series of treatments you hadn't planned for.
Treatments for fertility problems in women depend on what may be keeping the woman from getting pregnant. Sometimes the cause isn't known.
Your doctor might recommend that you try insemination first. The sperm are collected and then concentrated to increase the number of healthy sperm for insemination.
Many couples who have problems getting pregnant arrive at a common point: They must decide whether they want to try assisted reproductive technology (ART).
To learn more, see Other Treatment.
If you haven't already thought about adoption, this might be a time to think about it. Some couples decide at this point to spend their resources on adoption instead of IVF. Other couples see IVF as the best option.
Fertility treatment clinics aren't widely available in some parts of the country, especially in rural areas. You may need to travel for treatment.
When you review clinic success rates, be aware that clinics treating more severe fertility problems may have lower success rates. So it's possible for a clinic with a lower success rate to have greater overall expertise than clinics with higher success rates.
The success rate of a clinic is influenced by many things, including the doctors' skills and experience and the cause or causes of your fertility problem.
When you review treatment success rates, remember that live birth rates are always lower than ovulation and pregnancy rates. Miscarriages are common among all women. But they are more likely in women with risk factors such as older age or a poorly controlled chronic health condition.
Some fertility problems are related to lifestyle or other health conditions. To help protect your fertility:
If you have been diagnosed with cancer and hope to have children in the future, talk to your doctor about preventing cancer treatment–related infertility.
To decrease your risk of fertility problems and increase your chances of becoming pregnant, use the following guidelines.
Women who are trying to get pregnant should avoid using alcohol and medicines, including non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and ASA.
Medicine or hormone treatments are often the first steps in fertility treatment. They are also used for in vitro fertilization and other assisted reproductive technologies.
If you have irregular or no ovulation, using medicine or hormones to stimulate ovulation will increase your chances of pregnancy. But these treatments increase your risk of multiple pregnancy. And that poses health risks to both you and your fetuses. When thinking about a fertility treatment:
Other rare complications—such as ovarian hyperstimulation syndrome—can be caused by hormone shots used to stimulate ovulation. These shots may be used in assisted reproductive technology such as IVF.
In very rare cases, male fertility problems are caused by hormonal imbalances. Men are then treated with medicine or hormones that help the hypothalamus and pituitary gland start normal sperm production.
Ask your doctor questions about medicines you are considering. For example, are there long-term effects? How long will the treatment last? How often you must be tested while taking the medicine? Are there any side effects that will affect your daily life?
For some people, a structural problem can be treated surgically. Treatment can increase the chances of natural conception.
When considering surgery, ask your doctor questions about the procedure. For example, how many times has the surgeon done the procedure? What are your chances of treatment success? How long will it take to recover?
In cases of severely blocked fallopian tubes, your doctor may advise you to skip surgery and have in vitro fertilization (IVF). IVF is also often recommended first for women over 34 (regardless of the type of blockage). This is because tubal surgery and natural conception may use up precious time if in vitro fertilization might be used later.
Insemination flushes the sperm through a thin, flexible tube directly into a woman's vagina, cervix, uterus, or fallopian tube. This puts sperm closer to the egg. And it can overcome fertility barriers such as low sperm count and cervical mucus.
Insemination can be used with donor sperm. It can be combined with other fertility treatments, such as clomiphene or hormone shots.
ART is used to remove eggs from a woman's ovaries (or use donor eggs) and fertilize them with the man's sperm (or donor sperm) outside the body. One or more fertilized eggs are then transferred to the woman's uterus or fallopian tubes.
To compare ultrasound and laparoscopy for egg collection procedures, see Infertility: Using Ultrasound in ART.
ART procedures are expensive and complex. Most of the time they are used only after other treatment has failed.
In vitro fertilization (IVF) is the most common form of ART.
Usually, more than one embryo is put in the uterus. This increases your chances that one will develop into a baby. Because of this, IVF increases your chance of having more than one baby at a time.
Side effects of IVF can include bloating, weight gain, and nausea. And you risk having serious side effects such as liver and kidney problems. The embryos may not grow into babies, so the IVF may need to be repeated.
If you have several miscarriages or unsuccessful IVF attempts, talk to your doctor about genetic testing.
When insemination doesn't work, your doctor may recommend ICSI (say "ICK-see"). In a lab, the doctor injects one sperm into an egg. If fertilization occurs, the doctor puts the embryo into the woman's uterus, just as in vitro fertilization (IVF).
Your doctor may also recommend ICSI when the man has had a vasectomy or has retrograde ejaculation. In retrograde ejaculation, the semen is ejaculated into the bladder instead of out through the penis. In these cases, sperm can be taken from the testicles so that they can be injected into an egg.
Another less common treatment is gamete or zygote intrafallopian transfer (GIFT or ZIFT).
Success rates with IVF are as good as with GIFT and ZIFT or better. And IVF is less expensive. It is also less risky, because it isn't a surgical procedure.
These treatments include:
It is important to talk with your doctor before you use any complementary or alternative treatments.
|Society of Obstetricians and Gynaecologists of Canada (SOGC)|
|780 Echo Drive|
|Ottawa, ON K1S 5R7|
The mission of SOGC is to promote optimal women's health through leadership, collaboration, education, research, and advocacy in the practice of obstetrics and gynaecology.
|Adoption Council of Canada|
The Adoption Council of Canada provides information about provincial and international adoptions. Information covers myths, frequently asked questions, and family stories.
|Assisted Human Reproduction Canada|
|Phone:||1-866-467-1853 (toll free)|
Assisted Human Reproduction Canada provides information about assisted human reproduction technologies for patients, donor-conceived people, donors, and health professionals.
|Canadian Fertility and Andrology Society|
|Montreal, QC H3B 3W7|
The Canadian Fertility and Andrology Society website provides patient resources, contact information for invitro fertilization (IVF) clinics in Canada, and frequently asked questions about fertility.
|Infertility Awareness Association of Canada|
|2160 Nightingale Avenue|
|Montreal, QC H9S 1E4|
The Infertility Awareness Association of Canada provides information, assistance, and support to people dealing with infertility.
- Fritz MA, Speroff L (2011). Female infertility. In Clinical Gynecologic Endocrinology and Infertility, 8th ed., pp. 1137–1190. Philadelphia: Lippincott Williams and Wilkins.
- Lobo RA (2007). Infertility: Etiology, diagnostic evaluation, management, prognosis. In VL Katz et al., eds., Comprehensive Gynecology, 5th ed., pp. 1001–1037. Philadelphia: Mosby.
- Fritz MA, Speroff L (2011). Male infertility. In Clinical Gynecologic Endocrinology and Infertility, 8th ed., pp. 1249–1292. Philadelphia: Lippincott Williams and Wilkins.
- Fritz MA, Speroff L (2011). Assisted reproductive technologies. In Clinical Gynecologic Endocrinology and Infertility, 8th ed., pp. 1331–1382. Philadelphia: Lippincott Williams and Wilkins.
- Manheimer E, et al. (2008). Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: Systematic review and meta-analysis. BMJ, 336(7643): 545–549.
Other Works Consulted
- American College of Obstetricians and Gynecologists (2008). Medical management of ectopic pregnancy. ACOG Practice Bulletin No. 94. Obstetrics and Gynecology, 111(6): 1479–1485.
- American Society for Reproductive Medicine (2004). Patient's Fact Sheet: Cancer and Fertility Preservation. Birmingham, AL: Society for Reproductive Medicine.
- American Society for Reproductive Medicine Practice Committee (2006). Multiple pregnancy associated with infertility therapy. Fertility and Sterility, 86(Suppl 4): S106–S110.
- El-Chaar D, et al. (2009). Risk of birth defects increased in pregnancies conceived by assisted human reproduction. Fertility and Sterility, 92(5): 1557–1561.
- Kumar A, et al. (2007). Infertility. In AH DeCherney et al., eds., Current Diagnosis and Treatment Obstetrics and Gynecology, 10th ed., pp. 917–925. New York: McGraw-Hill.
|Primary Medical Reviewer||Sarah Marshall, MD - Family Medicine|
|Primary Medical Reviewer||Anne C. Poinier, MD - Internal Medicine|
|Specialist Medical Reviewer||Femi Olatunbosun, MB, FRCSC - Obstetrics and Gynecology|
|Last Revised||January 20, 2012|
Last Revised: January 20, 2012
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