Definition:
Primary infertility describes couples who have never been able to become pregnant after at least 1 year of unprotected sex (intercourse). Secondary infertility describes couples who have been pregnant at least once, but have not been able to become pregnant again.
Alternative Names:
Inability to conceive; Unable to get pregnant
Causes, incidence, and risk factors:
Causes of infertility include a wide range of both physical and emotional factors. A couple's infertility may be due to female factors, male factors, or both: FEMALE INFERTILITY: Female infertility may be due to: - Problems with a fertilized egg or embryo being able to survive once it is attached to the lining of the uterus
- Problems with the eggs being able to attach to the lining of the uterus
- Problems with the eggs being able to move from the ovary to the uterus
- Problems with the ovaries producing eggs
Female infertility may be caused by: - Autoimmune disorders, such as antiphospholipid syndrome (APS)
- Clotting disorders
- Defects of the uterus and cervix (myomas or fibroids, polyps, birth defects)
- Excessive exercising, eating disorders, or poor nutrition
- Exposure to certain medications or toxins
- Heavy use of alcohol
- Hormone imbalance or deficiencies
- Long-term (chronic) disease, such as diabetes
- Obesity
- Pelvic infection or pelvic inflammatory disease (PID)
- Scarring from sexually transmitted disease or endometriosis
- Tumor
MALE INFERTILITY: Male infertility may be due to: Male infertility can be caused by: - Environmental pollutants
Exposure to high heat for prolonged periods Heavy use of alcohol, marijuana, or cocaine Hormone deficiency or taking too much of a hormone Infections of the testes or epididymis Older age Previous scarring due to infection (including sexually transmitted diseases), trauma, or surgery Radiation exposure - Smoking
Surgery or trauma Use of prescription drugs, such as cimetidine, spironolactone, and nitrofurantoin
In healthy couples both under age 30, having sex regularly, the chance of getting pregnant is only 25 - 30% per month. A woman's peak fertility occurs in her early 20s. As a woman ages beyond 35 (and especially after age 40), the likelihood of getting pregnant drops to less than 10% per month. When to seek help for infertility depends on your age. For women under age 30, it is generally recommended to try to conceive for at least a year before seeking testing.
References:
Jose-Miller AB, Boyden JW, Frey KA. Infertility. Am Fam Physician. 2007;75(6):894-856. Lobo RA. Infertility: etiology, diagnostic evaluation, management, prognosis. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007: chap 41. Speroff L, Fitz M, eds. Clinical Gynecologic Endocrinology and Infertility. 7th ed. Philadelphia, Pa; Lippincott Williams & Wilkins; 2005.
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