Infertility FAQ's

What is infertility? (#1)

Is infertility a common problem? (#2)

Is infertility just a woman's problem? (#3)

What causes infertility in men? (#4)

What increases a man's risk of infertility? (#5)

What causes infertility in women? (#6)

What things increase a woman's risk of infertility?

(#7)

How does age affect a woman's ability to have

children? (#8)

How long should women try to get pregnant before calling their doctors? (#9)

How will doctors find out if a woman and her partner have fertility problems? (#10)

How do doctors treat infertility? (#11)

What medicines are used to treat infertility in women? (#12)

What is intrauterine insemination (IUI)? (#13)

What is assisted reproductive technology (ART)? (#14)

How often is assisted reproductive technology (ART) successful? (#15)

What are the different types of assisted reproductive technology (ART)? (#16)

What is infertility?

Infertility means not being able to get pregnant after one year of trying. Or, six months, if a woman is

35 years of age or older. Women who can get pregnant but are unable to stay pregnant may also be

infertile.

Pregnancy is the result of a process that has many steps. To get pregnant—

A woman’s body must release an egg from one of her ovaries (http://womenshealth.gov/Glossary

/index.cfm#ovaries) (ovulation).

The egg must go through a fallopian tube (http://womenshealth.gov/Glossary

/index.cfm#fallopian) toward the uterus (http://womenshealth.gov/Glossary/index.cfm#uterus)

(womb).

A man's sperm must join with (fertilize) the egg along the way.

The fertilized egg must attach to the inside of the uterus (implantation).

Infertility can happen if there are problems with any of these steps.

Is infertility a common problem?

Yes. About 10 % of women (6.1 million) in the United States ages 15–44 years have difficulty getting

pregnant or staying pregnant.

Is infertility just a woman's problem?

No, infertility is not always a woman's problem. Both women and men can have problems that cause

infertility. About one-third of infertility cases are caused by women’s problems. Another one third of

fertility problems are due to the man. The other cases are caused by a mixture of male and female

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problems or by unknown problems.

Ovulation problems are often caused by polycystic ovarian syndrome (PCOS). PCOS is a hormone

imbalance problem which can interfere with normal ovulation. PCOS is the most common cause of

female infertility. Primary ovarian insufficiency (POI) is another cause of ovulation problems. POI

occurs when a woman’s ovaries stop working normally before she is 40. POI is not the same as early

menopause.

What causes infertility in men?

Infertility in men is most often caused by—

A problem called varicocele (VAIR-ih-koh-seel). This happens when the veins on a man’s

testicle(s) are too large. This heats the testicles. The heat can affect the number or shape of the

sperm.

Other factors that cause a man to make too few sperm or none at all.

Movement of the sperm. This may be caused by the shape of the sperm. Sometimes injuries or

other damage to the reproductive system block the sperm.

Sometimes a man is born with the problems that affect his sperm. Other times problems start later in

life due to illness or injury. For example, cystic fibrosis often causes infertility in men.

What increases a man's risk of infertility?

A man's sperm can be changed by his overall health and lifestyle. Some things that may reduce the

health or number of sperm include—

Heavy alcohol use

Drugs

Smoking cigarettes

Age

Environmental toxins, including pesticides and lead

Health problems such as mumps, serious conditions like kidney disease, or hormone problems

Medicines

Radiation treatment and chemotherapy for cancer

What causes infertility in women?

Most cases of female infertility are caused by problems with ovulation. Without ovulation, there are

no eggs to be fertilized. Some signs that a woman is not ovulating normally include irregular or absent

menstrual periods.

Men Seek

Infertility Services

Many couples struggle with infertility and seek help to become pregnant; however, it is often thought

of as only a women’s condition. But a CDC study analyzed data from the 2002 National Survey of

Family Growth, and found that 7.5% of all sexually experienced men reported a visit for help with

having a child at some time during their lifetime—this equates to 3.3–4.7 million men. Of men who

sought help, 18.1% were diagnosed with a male-related infertility problem, including sperm or semen

problems (13.7%) and varicocele (5.9%).

Anderson JE, Farr SL, Jamieson DJ, Warner L, and Macaluso M. Infertility services reported by men

in the United States: national survey data. Fertility and Sterility 2009; (6):2466–2470.

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Less common causes of fertility problems in women include—

Blocked fallopian tubes due to pelvic inflammatory disease (http://womenshealth.gov/glossary

/index.cfm#PID) , endometriosis (http://womenshealth.gov/glossary/index.cfm#endometriosis) , or

surgery for an ectopic pregnancy (http://womenshealth.gov/glossary/index.cfm#ectopic)

Physical problems with the uterus

Uterine fibroids (http://womenshealth.gov/Glossary/index.cfm#u_fibroids) , which are

non-cancerous clumps of tissue and muscle on the walls of the uterus

What things increase a woman's risk of infertility?

Many things can change a woman's ability to have a baby. These include—

Age

Smoking

Excess alcohol use

Stress

Poor diet

Athletic training

Being overweight or underweight

Sexually transmitted infections (STIs)

Health problems that cause hormonal changes, such as polycystic ovarian syndrome

(http://womenshealth.gov/glossary/index.cfm#PCOS) and primary ovarian insufficiency

(http://womenshealth.gov/glossary/index.cfm#POI)

How does age affect a woman's ability to have children?

Many women are waiting until their 30s and 40s to have children. In

fact, about 20% of women in the United States now have their first child

after age 35. So age is a growing cause of fertility problems. About

one-third of couples in which the woman is older than 35 years have

fertility problems.

Aging decreases a woman's chances of having a baby in the following

ways—

Her ovaries become less able to release eggs

She has a smaller number of eggs left

Her eggs are not as healthy

She is more likely to have health conditions that can cause fertility

problems

She is more likely to have a miscarriage

How long should women try to get pregnant before calling their doctors?

Most experts suggest at least one year. Women aged 35 years or older should see their doctors after

six months of trying. A woman's chances of having a baby decrease rapidly every year after the age of

30.

Some health problems also increase the risk of infertility. So, women should talk to their doctors if

they have—

CDC - Infertility FAQs - Reproductive Health http://www.cdc.gov/reproductivehealth/infertility/

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Irregular periods or no menstrual periods

Very painful periods

Endometriosis

Pelvic inflammatory disease

More than one miscarriage

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It is a good idea for any woman to talk to a doctor before trying to get pregnant. Doctors can help you

get your body ready for a healthy baby. They can also answer questions on fertility and give tips on

conceiving.

How will doctors find out if a woman and her partner have fertility

problems?

Doctors will do an infertility checkup. This involves a physical exam. The doctor will also ask for both

partners’ health and sexual histories. Sometimes this can find the problem. However, most of the

time, the doctor will need to do more tests.

In men, doctors usually begin by testing the semen. They look at the number, shape, and movement

of the sperm. Sometimes doctors also suggest testing the level of a man's hormones.

In women, the first step is to find out if she is ovulating each month. There are a few ways to do this.

A woman can track her ovulation at home by—

Writing down changes in her morning body temperature for several months

Writing down how her cervical mucus looks for several months

Using a home ovulation test kit (available at drug or grocery stores)

Doctors can also check ovulation with blood tests. Or they can do an ultrasound

(http://womenshealth.gov/Glossary/index.cfm#ultrasound) of the ovaries. If ovulation is normal, there

are other fertility tests available.

Some common tests of fertility in women include—

Hysterosalpingography (HIS-tur-oh-sal-ping-GOGH-ru-fee): This is an X-ray of the

uterus and fallopian tubes. Doctors inject a special dye into the uterus through the vagina. This

dye shows up in the X-ray. Doctors can then watch to see if the dye moves freely through the

uterus and fallopian tubes. This can help them find physical blocks that may be causing

infertility. Blocks in the system can keep the egg from moving from the fallopian tube to the

uterus. A block could also keep the sperm from reaching the egg.

Laparoscopy (lap-uh-ROS-kuh-pee): A minor surgery to see inside the abdomen. The

doctor does this with a small tool with a light called a laparoscope (LAP-uh-roh-skohp). She or

he makes a small cut in the lower abdomen and inserts the laparoscope. With the laparoscope,

the doctor can check the ovaries, fallopian tubes, and uterus for disease and physical problems.

Doctors can usually find scarring and endometriosis (http://www.womenshealth.gov

/faq/endomet.htm) by laparoscopy.

Finding the cause of infertility can be a long and emotional process. It may take time to complete all

the needed tests. So don't worry if the problem is not found right away.

How do doctors treat infertility?

Infertility can be treated with medicine (#12) , surgery, artificial insemination (#13) , or assisted

reproductive technology (#14) . Many times these treatments are combined. In most cases infertility is

treated with drugs or surgery.

Doctors recommend specific treatments for infertility based on—

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Test results

How long the couple has been trying to get pregnant

The age of both the man and woman

The overall health of the partners

Preference of the partners

Doctors often treat infertility in men in the following ways—

Sexual problems: Doctors can help men deal with impotence or premature ejaculation.

Behavioral therapy and/or medicines can be used in these cases.

Too few sperm: Sometimes surgery can correct the cause of the problem. In other cases,

doctors surgically remove sperm directly from the male reproductive tract. Antibiotics can also

be used to clear up infections affecting sperm count.

Sperm movement: Sometimes semen has no sperm because of a block in the man’s system. In

some cases, surgery can correct the problem.

In women, some physical problems can also be corrected with surgery.

A number of fertility medicines are used to treat women with ovulation problems. It is important to

talk with your doctor about the pros and cons of these medicines. You should understand the possible

dangers, benefits, and side effects.

What medicines are used to treat infertility in women?

Some common medicines used to treat infertility in women include—

Clomiphene citrate (Clomid®): This medicine causes ovulation by acting on the pituitary

gland. It is often used in women who have polycystic ovarian syndrome (PCOS)

(http://www.womenshealth.gov/faq/pcos.htm) or other problems with ovulation. This medicine is

taken by mouth.

Human menopausal gonadotropin or hMG (Repronex®, Pergonal®): This medicine

is often used for women who don't ovulate due to problems with their pituitary gland—hMG acts

directly on the ovaries to stimulate ovulation. It is an injected medicine.

Follicle-stimulating hormone or FSH (Gonal-F®, Follistim®): FSH works much like

hMG. It causes the ovaries to begin the process of ovulation. These medicines are usually

injected.

Gonadotropin-releasing hormone (Gn-RH) analog: These medicines are often used for

women who don't ovulate regularly each month. Women who ovulate before the egg is ready can

also use these medicines. Gn-RH analogs act on the pituitary gland to change when the body

ovulates. These medicines are usually injected or given with a nasal spray.

Metformin (Glucophage®): Doctors use this medicine for women who have insulin

resistance and/or PCOS (http://www.womenshealth.gov/faq/pcos.htm) . This drug helps lower

the high levels of male hormones in women with these conditions. This helps the body to ovulate.

Sometimes clomiphene citrate or FSH is combined with metformin. This medicine is usually

taken by mouth.

Bromocriptine (Parlodel®): This medicine is used for women with ovulation problems due

to high levels of prolactin. Prolactin (http://womenshealth.gov/Glossary/index.cfm#prolactin) is a

hormone that causes milk production.

Many fertility drugs increase a woman's chance of having twins, triplets, or other multiples. Women

who are pregnant with multiple fetuses have more problems during pregnancy. Multiple fetuses have

a high risk of being born too early (prematurely). Premature babies (/reproductivehealth

/MaternalInfantHealth/PretermBirth.htm) (http://www.cdc.gov/reproductivehealth/MaternalInfantHealth

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/PBP.htm) are at a higher risk of health and developmental problems.

What is intrauterine insemination (IUI)?

Intrauterine insemination (IUI) is an infertility treatment that is often called artificial

insemination. In this procedure, the woman is injected with specially prepared sperm. Sometimes the

woman is also treated with medicines that stimulate ovulation before IUI.

IUI is often used to treat—

Mild male factor infertility

Women who have problems with their cervical mucus

Couples with unexplained infertility

What is assisted reproductive technology (ART)?

Assisted reproductive technology (ART) (http://www.cdc.gov/ART/index.htm) is a group of different

methods used to help infertile couples. ART works by removing eggs from a woman's body. The eggs

are then mixed with sperm to make embryos. The embryos are then put back in the woman's body.

How often is assisted reproductive technology (ART) successful?

Success rates vary and depend on many factors. Some things that affect the success rate of ART

include—

Age of the partners

Reason for infertility

Clinic

Type of ART

If the egg is fresh or frozen

If the embryo is fresh or frozen

CDC collects success rates on ART for some fertility clinics. According to the 2009 CDC fertility clinic

success rates (http://www.cdc.gov/art/ARTReports.htm) , the average percentage of ART cycles that led

to a live birth were—

41% in women younger than 35 years of age

32% in women aged 35–37 years

22% in women aged 38–40 years

12% in women aged 41–42 years

5% in women aged 43–44 years

ART can be expensive and time-consuming. But it has allowed many couples to have children that

otherwise would not have been conceived. The most common complication of ART is multiple

fetuses. But this is a problem that can be prevented or minimized in several different ways.

What are the different types of assisted reproductive technology (ART)?

Common methods of ART include—

In vitro fertilization (IVF) means fertilization outside of the body. IVF is the most effective

ART. It is often used when a woman's fallopian tubes are blocked or when a man produces too

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few sperm. Doctors treat the woman with a drug that causes the ovaries to produce multiple

eggs. Once mature, the eggs are removed from the woman. They are put in a dish in the lab along

with the man's sperm for fertilization. After 3 to 5 days, healthy embryos are implanted in the

woman's uterus.

Zygote intrafallopian transfer (ZIFT) or Tubal Embryo Transfer is similar to IVF.

Fertilization occurs in the laboratory. Then the very young embryo is transferred to the fallopian

tube instead of the uterus.

Gamete intrafallopian transfer (GIFT) involves transferring eggs and sperm into the

woman's fallopian tube. So fertilization occurs in the woman's body. Few practices offer GIFT as

an option.

Intracytoplasmic sperm injection (ICSI) is often used for couples in which there are

serious problems with the sperm. Sometimes it is also used for older couples or for those with

failed IVF attempts. In ICSI, a single sperm is injected into a mature egg. Then the embryo is

transferred to the uterus or fallopian tube.

ART procedures sometimes involve the use of donor eggs (eggs from another woman), donor sperm,

or previously frozen embryos. Donor eggs are sometimes used for women who can not produce eggs.

Also, donor eggs or donor sperm is sometimes used when the woman or man has a genetic disease

that can be passed on to the baby. An infertile woman or couple may also use donor embryos. These

are embryos that were either created by couples in infertility treatment or were created from donor

sperm and donor eggs. The donated embryo is transferred to the uterus. The child will not be

genetically related to either parent.

Surrogacy

Women with no eggs or unhealthy eggs might also want to consider surrogacy. A surrogate is a

woman who agrees to become pregnant using the man's sperm and her own egg. The child will be

genetically related to the surrogate and the male partner. After birth, the surrogate will give up the

baby for adoption by the parents.

Gestational Carrier

Women with ovaries but no uterus may be able to use a gestational carrier. This may also be an option

for women who shouldn't become pregnant because of a serious health problem. In this case, a

woman uses her own egg. It is fertilized by the man's sperm and the embryo is placed inside the

carrier's uterus. The carrier will not be related to the baby and gives him or her to the parents at

birth.

Recent research by the Centers for Disease Control showed that ART babies are two to four times

more likely to have certain kinds of birth defects. These may include heart and digestive system

problems, and cleft (divided into two pieces) lips or palate. Researchers don’t know why this

happens. The birth defects may not be due to the technology. Other factors, like the age of the

parents, may be involved. More research is needed. The risk is relatively low, but parents should

consider this when making the decision to use ART.

Courtesy of the National Women's Health Information Center (http://www.womenshealth.gov/) .

Related Links

How Do I Know If I Have an Infertility Problem? (http://www.resolve.org/infertilityoverview/what-is-infertility/how-do-i-know-if-i-have-an-infertility-problem.html) (Resolve: The

National Infertility Association)

Infertility (http://www.modimes.org/pnhec/173_14308.asp) (March of Dimes)

CDC - Infertility FAQs - Reproductive Health http://www.cdc.gov/reproductivehealth/infertility/

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Page last reviewed: June 28, 2011

Page last updated: June 28, 2011

Content source: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion

Centers for Disease Control and Prevention 1600 Clifton Rd. Atlanta, GA 30333, USA

800-CDC-INFO (800-232-4636) TTY: (888) 232-6348, New Hours of Operation

8am-8pm ET/Monday-Friday

Closed Holidays - cdcinfo@cdc.gov

Infertility (http://www.nlm.nih.gov/medlineplus/infertility.html) (MedlinePlus)

American Fertility Association (http://www.theafa.org/) The American Fertility Association

(AFA) is a national consumer organization that offers support for men and women dealing with

infertility. Their purpose is to educate the public about reproductive disease, and support

families during struggles with infertility and adoption.

RESOLVE: The National Infertility Association (http://resolve.org/) RESOLVE is a national

consumer organization that offers support for men and women dealing with infertility. Their

purpose is to provide timely, compassionate support and information to people who are

experiencing infertility and to increase awareness of infertility issues through public education

and advocacy.

Fertile Hope (http://www.fertilehope.org/index.cfm) Fertile Hope is a national nonprofit

organization dedicated to providing reproductive information, support, and hope to cancer

patients whose medical treatments present the risk of infertility.

American Society for Reproductive Medicine (http://www.asrm.org/) The American Society for

Reproductive Medicine (ASRM) is a multidisciplinary organization for the advancement of

information, education, advocacy and standards in the field of reproductive medicine.

Society for Assisted Reproductive Technology (http://www.sart.org) The Society for Assisted

Reproductive Technology (SART) promotes and advances the standards for the practice of

assisted reproductive technology to the benefit of patients, members, and society at large.

Tissue Action Plan (http://www.fda.gov/BiologicsBloodVaccines

/GuidanceComplianceRegulatoryInformation/Guidances/Tissue/default.htm) The purpose of the

Tissue Action Plan is to develop the policies, regulations, and guidance documents for regulation

of cellular and tissue-based products.

Human Cell, Tissues and Cellular and Tissue-Based Products (http://www.fda.gov

/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/EstablishmentRegistration

/TissueEstablishmentRegistration/FindaTissueEstablishment/ucm110270.htm) Listing of ART clinics

registered with FDA.

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