Women in Motion

Susan Blatt, MD

A couple is said to be infertile if they have not conceived after one year of trying to become pregnant. This is a widespread problem and affects about 6 million couples per year in this country. Often infertility is first discovered as a problem in couples who are over the age of 35. In that case, it is appropriate to make a diagnosis in a timely manner, since it becomes much harder to conceive when a woman is in her late 30’s.

The basic tests for fertility include a sperm count for the male. For the female there are tests to determine whether or not she is ovulating and whether the fallopian tubes are open. If the tubes are obstructed or there is another abnormality, there will be laparoscopy during which surgical repairs can be made.

If the cause of infertility does not seem to be due to abnormal or absent sperm, women’s causes must be considered. One cause of female infertility relates to abnormalities with ovulation or egg production. Treatment with medication can often bring about ovulation and result in a normal pregnancy.

Another problem occurring in many infertile women is disease of the fallopian tubes. Normally the egg is fertilized in the fallopian tube and then passes into the uterus and implants in the wall of the uterus. In the past, surgical repair of the tubes resulted in some limited success. Now, more commonly infertility professionals advise in vitro fertilization (IVF) in the case of tubal disease.

Endometriosis is sometimes the cause of infertility. In this condition, tissue that normally makes up the lining of the inside of the uterus is found outside the uterus, in the pelvis or abdomen. It is not clear why this occurs, but endometriosis dramatically lowers the rate of conception. Surgery is sometimes done to clean out the abnormal tissue, but surgery may not improve fertility. In vitro fertilization is usually the best solution for this problem.

In some couples there is no cause found for their infertility. This type of infertility, called unexplained infertility, is more common in women over 35. In these cases, each of the treatments may be tried, with varying success rates.

In vitro fertilization is now very common. Successful pregnancies occur about 35% of the time in women under 35. The success rate is lower in older women. Success of in vitro fertilization is only 10% in women over 40. Multiple births and premature deliveries are common. The cost of the procedure is in the range of $10,000 making it unavailable to many women.

Since the causes of female infertility are rarely understood, it is not clear how to prevent the problem. For women who choose to have their children when young, there will be a higher rate of conception. Infection may be the cause of some cases of infertility, so women should be treated for sexually transmitted infections in a timely and effective manner.