Infertility: Frequently Asked Questions

What is infertility?

For couples hoping to become parents, difficulty conceiving a baby can be frustrating and unexpected. Many couples who struggle with infertility do end up having children, sometimes with medical help. An important early step is understanding possible causes of infertility.

For public health data collection, infertility is defined as not being able to get pregnant (conceive) after 1 year (or longer) of unprotected sex.

Fertility in women is known to decline steadily with age. As a result, some providers evaluate and treat women aged 35 years or older after 6 months of unprotected sex.

These definitions of infertility are not intended to guide recommendations about the provision of fertility care services to individuals or families.

Both men and women can contribute to infertility.

Individuals and couples who are unable to conceive a child should consider making an appointment with a reproductive endocrinologist. This is a health care provider who specializes in managing infertility.

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.
• A man's sperm must join with the egg along the way (fertilize).
• The fertilized egg must go through a fallopian tube toward the uterus.
• The embryo must attach to the inside of the uterus (implantation).

Infertility may result from a problem with any or several of these steps.

Impaired fecundity is a condition related to infertility. It refers to women who have difficulty getting pregnant or carrying a pregnancy to term.

Reproductive endocrinologists may also be able to help women with recurrent pregnancy loss, defined as having two or more spontaneous miscarriages.

Is infertility a common problem?

Yes. In the United States, 1 in 5 (19%) of married women aged 15 to 49 with no prior births are unable to get pregnant after 1 year of trying. About 1 in 4 (26%) of women in this group have difficulty getting pregnant or carrying a pregnancy to term.

What causes infertility in women?

Women need functioning ovaries, fallopian tubes, and a uterus to get pregnant. Conditions affecting any one of these organs can contribute to female infertility.

Disruption of ovarian function

A woman's menstrual cycle is on average 28 days long. Regular, predictable periods that occur every 21 to 35 days likely reflect ovulation. A woman with irregular periods is likely not ovulating. Ovulation can be predicted by using an ovulation test or blood test.

Disruption in ovarian function may be caused by several conditions and calls for an evaluation by a health care provider. No single test is a perfect predictor of fertility, but there are tests for common markers of ovarian function. These include follicle-stimulating hormone (FSH), anti-müllerian hormone (AMH), and antral follicle count (AFC) tests.

Some conditions that may cause issues related to ovarian function include the following:

• Polycystic ovary syndrome (PCOS) is the most common cause of infertility. PCOS is a condition that causes women to not ovulate, or to ovulate irregularly.
• Diminished ovarian reserve (DOR) is a condition where there are fewer eggs remaining in the ovaries than expected at a specific age. This condition can be due to congenital, medical, surgical, or unexplained causes.
• Impaired function of the hypothalamus and pituitary glands can affect ovarian function. If impaired, these glands can cause too much of the hormones that maintain normal ovarian function to be produced.
• Functional hypothalamic amenorrhea (FHA) is a condition that can affect ovarian function. It can be caused by excessive exercise, weight loss, or stress, or by a combination of these factors.
• Primary ovarian insufficiency (POI) is sometimes referred to as premature menopause. It occurs when a woman's ovaries fail before age 40.

Fallopian tube obstruction

Fallopian tubes can be evaluated by various methods, including with a hysterosalpingogram or by chromopertubation.

• Hysterosalpingogram is an X-ray of the uterus and fallopian tubes. These images are used to see if dye moves freely through the fallopian tubes indicating they are open.
• Chromopertubation is similar to a hysterosalpingogram but is done in the operating room at the time of a laparoscopy. This test is used to evaluate if the fallopian tubes are open and to assess if they are dilated.

Risk factors for fallopian tube obstruction include:

• History of pelvic infection
• Ruptured appendix
• Gonorrhea
• Chlamydia
• Endometriosis
• Prior abdominal surgery

Abnormalities of the uterus

The uterus may be evaluated by transvaginal ultrasound to look for various problems. A sonohystogram or hysteroscopy may also be performed to evaluate the uterine environment.

Problems that affect the physical characteristics of the uterus include:

• Intrauterine adhesions
• Endometrial polyps
• Adenomyosis
• Congenital anomalies of the uterus
• Fibroids

What increases a woman's risk of infertility?

Female fertility is known to decline with:

• Age. Fertility declines with age primarily because egg quality declines over time. Older women also have fewer eggs left, and they are more likely to have health conditions that can cause fertility problems. Aging also increases a woman's chances of miscarriage and of having a child with a genetic abnormality.
• Smoking.
• Excessive alcohol use.
• Having overweight, obesity, or low body weight.
• Extreme weight gain or loss.
• Excessive physical or emotional stress that results in amenorrhea (absent periods).

What causes infertility in men?

Infertility in men can be caused by disruption of testicular or ejaculatory function, as well as by hormonal and genetic disorders. It is typically evaluated by a semen analysis, complete medical history, and physical examination. This assessment helps determine if and how male factors are contributing to infertility.

A semen analysis assesses the number (concentration), motility (movement), and morphology (shape) of sperm. The results are then evaluated by a specialist. If semen is found to be slightly abnormal, it does not necessarily mean that a man is infertile.

Disruption of testicular or ejaculatory function

Some conditions that can disrupt testicular or ejaculatory function include the following:

• Varicocele is a condition in which the veins in the testicles are enlarged, which may affect the number or shape of the sperm.
• Trauma to the testes may affect sperm production and result in lower number of sperm.
• Unhealthy habits, such as heavy alcohol use, smoking, anabolic steroid use, and illicit drug use, may decrease sperm production.
• Cancer treatment involving the use of certain types of chemotherapy, radiation, or surgery to remove one or both testicles may affect sperm production or the ability of sperm to fertilize an egg.
• Medical conditions such as diabetes, cystic fibrosis, certain types of autoimmune disorders, and certain types of infections may cause testicular failure.

Hormonal disorders

Improper function of the hypothalamus or pituitary glands are hormonal disorders that can cause infertility. These glands produce hormones that maintain normal testicular function. Too much of these hormones, especially prolactin, can result in infertility. Other conditions that damage or impair the hypothalamus or the pituitary gland may also result in low or no sperm production.

Examples of hormonal disorders include:

• Malignant (cancerous) pituitary tumors
• Congenital adrenal hyperplasia
• Exposure to too much estrogen
• Exposure to too much testosterone
• Cushing's syndrome
• Chronic use of medications called glucocorticoids

Genetic disorders

Genetic conditions can cause no sperm or low numbers of sperm to be produced.

Examples of genetic disorders include:

• Klinefelter's syndrome
• Y-chromosome microdeletion
• Myotonic dystrophy

What increases a man's risk of infertility?

Male fertility is known to decline with:

• Age. Couples in which the male partner is 40 or older are more likely to report difficulty conceiving.
• Having overweight or obesity.
• Smoking.
• Excessive use of alcohol or drug use (such as opioids or marijuana).
• A history of trauma to the testes.
• Exposure to testosterone, radiation, certain medicines, or certain environmental toxins.
• Frequent exposure of the testes to high temperatures.

When should couples trying to get pregnant see a health care provider?

A woman's chances of having a baby decrease rapidly every year after the age of 30.

• Couples with no apparent health or fertility problems, in which the woman is under 35 years old and has regular menstrual cycles, should try to conceive for at least one year before seeing a health care provider.
• Couples with no apparent health or fertility problems, in which the woman is 35 years or older and has regular menstrual cycles, should see a health care provider after 6 months of trying to conceive naturally without success.
• Couples in which the woman is older than 40 should consider seeking more immediate evaluation and treatment.

Couples with the following signs or symptoms should not delay seeing their health care provider when they are trying to become pregnant:

For women:

• Irregular periods or no menstrual periods.
• A history of endometriosis or very painful menstrual periods.
• A history of pelvic inflammatory disease.
• Known or suspected uterine or tubal disease.
• A history of more than one miscarriage.
• Genetic or acquired conditions that can diminish ovarian reserve.

For men:

• A history of testicular trauma.
• Prior hernia surgery.
• Prior use of chemotherapy.
• A history of infertility with another partner.
• Sexual dysfunction.

Health care providers will collect a thorough medical and sexual history from both partners. Initial evaluation can include tests that are appropriate based on the couple’s specific circumstances. These tests may include: a semen analysis, tubal evaluation, and ovarian reserve testing.

It is a good idea for couples to talk to a health care provider before trying to get pregnant. Providers can help you get your body ready for a healthy baby. They can also answer questions on fertility and give tips on conceiving. Learn more about about planning for pregnancy.

How do health care providers treat infertility?

There are a variety of treatment options for infertility. The type of treatment offered depends on the cause of infertility, its duration, and your age. Your health care provider may need to perform preliminary testing to determine the best treatment option for you. A couple's treatment preferences after they have received counseling about success rates, risk factors, and benefits of each option also determine how their infertility is treated.

Treatment options for infertility may include timed intercourse, medications, intrauterine insemination, surgery, or assisted reproductive technology.

Timed intercourse

Timed intercourse—with or without—medication is often the first option for many couples who are trying to conceive. It may be recommended for couples where the male has normal or close to normal sperm count and motility (movement), the female has open (or functioning) fallopian tubes, and the couple is physically able to have intercourse.

With timed intercourse, a couple tracks the woman's ovulation and has intercourse around the time of ovulation. If a woman ovulates normally on her own, she may not need to take medication. Otherwise, she may need to take medication (orally or through injection) to stimulate ovulation.

Medications

There are a variety of medications used to treat infertility in women. Many fertility medications increase a woman's chance of having twins, triplets, or other multiples. Women who are pregnant with multiples may have more problems during pregnancy and are at higher risk of being born prematurely (too early). Premature babies are at a higher risk of health and developmental problems. Your health care provider may talk with you about strategies to reduce the risk of multiple births while using infertility medications.

Intrauterine insemination

Intrauterine insemination (IUI) is an infertility treatment that is sometimes referred to as "artificial insemination." During this procedure, specially prepared sperm are inserted into the woman's uterus. This treatment may be recommended for couples in which the male has close to normal sperm count and motility (movement) and the ability to produce a semen sample in the office (or, under some circumstances, at home) and the woman has open, functioning fallopian tubes.

This treatment may be appropriate for couples:

• Where the woman does not ovulate normally on her own but can be made to ovulate with medication.
• Who experience unexplained infertility.
• With mild male factor infertility (slightly low sperm count or sperm motility).
• And same-sex female couples wishing to conceive with donor sperm.

Surgery

Surgical treatments for fertility are rare because of the success of other treatments, such as Intrauterine insemination (IUI) and In vitro fertilization (IVF). Surgery may be recommended to women with certain diagnoses to increase the likelihood of conceiving. Examples include removing fibroids surgically from the uterus with a procedure called a myomectomy or surgery to treat blocked fallopian tubes. Men may also be offered surgery for specific diagnoses, such as varicoceles.

In vitro fertilization

Assisted reproductive technology (ART) includes all fertility treatments in which either eggs or embryos are handled outside of the body. The main type of ART is in vitro fertilization (IVF). In general, ART procedures involve removing eggs from a woman's ovaries using a needle. These eggs are then combined with sperm in the laboratory to create embryos. The embryos are returned to the woman's body, frozen for future use, or donated to another woman.

A variation of ART, called intracytoplasmic sperm injection (ICSI), is often used for couples with male factor infertility. With ICSI, a single sperm is injected into a mature egg.

Preimplantation genetic testing can be used during ART to identify genetic disorders or chromosomal abnormalities in embryos. One or more cells are biopsied from each embryo and sent for testing.

ART can be expensive and time-consuming. Despite these challenges, ART has helped many couples have children that otherwise would not have been conceived.

Success rates after IVF vary and depend on many factors. They can include the clinic performing the procedure, the infertility diagnosis, and the age of the woman undergoing the procedure. The woman's age is especially important.

CDC publishes ART success rates for all fertility clinics in the United States. In addition, CDC created an IVF Success Estimator to help estimate the chance of having a live birth using IVF based on the experiences of women and couples with similar characteristics.

The most common complication of ART is a multiple pregnancy. This can be prevented or minimized by limiting the number of embryos that are transferred back to the uterus. For example, transfer of a single embryo greatly reduces the chances of a multiple pregnancy. Using a single embryo, rather than multiple embryos, lowers risks such as preterm birth.

What is third-party reproduction?

ART procedures sometimes involve the use of donor eggs, donor sperm, or donated embryos. Donor eggs are sometimes used for women who cannot produce eggs. Donor eggs or donor sperm are sometimes used for other reasons, such as a genetic disease that can be passed on to the baby.

An infertile couple may also use donated embryos that were created by other couples in infertility treatment and were not used. When donated embryos are used, the child will not be genetically related to either parent. Donor eggs, donor sperm, or donated embryos may also be used by same-sex couples.

A gestational carrier (surrogate) carries an embryo that was formed from the egg of another woman with the expectation of returning the infant to its intended parents. Women who have no uterus may be able to use a gestational carrier. Women who cannot become pregnant, or who have a serious health problem and should not become pregnant may also consider this option.