Eleven percent of reproductive-age couples in the United States have trouble conceiving or sustaining a pregnancy. About one-third of these cases are due to female fertility problems, one-third to male fertility problems, and the rest to factors involving both partners or to unexplained causes.
If you've had regular, unprotected sex for more than a year without conceiving (or six months if you're older than 35), see your doctor. About 65 percent of couples that get treatment for a fertility problem are eventually able to have a successful pregnancy, according to Resolve, the national infertility association.
The success rates below are based on averages gathered from large groups of patients. Each couple is unique, so think of the success rate for any treatment as a general snapshot, not a prediction of your chances of having a baby. Read on to learn more about female infertility and available fertility treatments.
Ovulation problems
An ovulation problem occurs when eggs don't mature in the ovaries or when the ovaries fail to release a mature egg. This is sometimes known as premature ovarian failure. Ovulation problems are common in women with infertility.
Possible symptoms: Absent or infrequent periods, unusually light or heavy menstrual bleeding, or lack of such premenstrual symptoms as bloating or breast tenderness.
Possible solutions: Managing body weight if it's too low or too high, taking fertility drugs (with or without artificial insemination), and having in vitro fertilization (IVF).
Success rates: Thirty to 40 percent of women taking clomiphene citrate to induce ovulation become pregnant by the third treatment cycle. When fertility drugs to increase egg production are combined with artificial insemination, the pregnancy rate is between 10 and 20 percent per treatment cycle.
The percentage of IVF treatment cycles resulting in a live birth (in which one or more babies are born) is about:
- 40 percent for women age 34 and under
- 31 percent for women age 35 to 37
- 21 percent for women age 38 to 40
- 11 percent for women age 41 to 42
- 5 percent for women age 43 and over
Endometriosis
Endometriosis is a condition that occurs when tissue normally found in the lining of the uterus (endometrial tissue) grows outside the uterus, usually in the abdomen or pelvis.
Possible symptoms: Some women have no symptoms, while others have painful periods or intercourse, heavy bleeding or unusual spotting, and general pelvic pain.
Possible solutions: Surgery to remove endometrial tissue or open blocked fallopian tubes, fertility drugs (with or without artificial insemination), and IVF.
Success rates: A large study found that 30 percent of women with infertility related to early stage endometriosis conceived naturally within three years after having laparoscopic surgery to remove endometrial tissue.
When women with early stage endometriosis are treated with fertility drugs and artificial insemination, the pregnancy rate is between 9 and 15 percent per treatment cycle. The live birth rate per treatment cycle for women with endometriosis who undergo IVF ranges from 2 to 42 percent, depending on the woman's age.
Poor egg quality
The quality and number of eggs the ovaries produce – naturally or with fertility treatment – declines significantly after age 35.
There are multiple causes of female infertility including structural factors such as adhesions or fibroids, infectious causes such as Chlamydia resulting in PID and tubal blockage, hormonal reasons such as polycystic ovaries and ovulatory problems, genetic factors causing premature menopause or embryo defects, and declining egg quality due to advancing age.
The most likely causes for female infertility are:
Pelvic Inflammatory Disease (PID) - PID is the most common cause of infertility worldwide. It's an infection of the pelvis involving one or more reproductive organs, including the ovaries, the fallopian tubes, the cul-de-sac, the cervix or the uterus. Sometimes PID spreads to the appendix or to the entire pelvic area.
Polycystic ovary syndrome (PCO) - This condition affects 5 million American women and is another major cause of infertility. In PCO, the ovaries produce high amounts of male hormones, especially testosterone. LH levels may be abnormally high while FSH levels are abnormally low; thus, normal follicle grow and ovulation do not produce occur. Instead they form fluid-filled cysts that eventually cover the ovaries. Other hormonal problems may be linked to PCO like elevated testosterone which can contribute to medical problems like obesity, diabetes and Metabolic Syndrome.
Endometriosis - This disease is another common cause of female infertility. Endometriosis refers to a condition in which sections of the uterine lining implant inside the pelvis. These implants eventually form cysts that grow with each menstrual cycle and may eventually create inflammation and scarring that can affect the egg capture by the fallopian tubes . The scars can then block the passage of the egg, the fertilization of the egg, and possibly the implantation of the embryo.
Fibroids - Fibroids, are usually benign growths that may form in the uterine muscle near the fallopian tubes, in the cavity of the uterus or cervix. As a result, the sperm or fertilized egg may not be able to reach the uterus or implant there. Fibroids in the uterus are very common in women over age 35.
Premature Menopause - Some women may experience premature menopause, when their ovaries stop producing estrogen and progesterone and eggs. Often the cause is unknown or may be due to a lower number of eggs a woman has in her life time. If this occurs, donor egg may be the best option for a successful pregnancy. A few cases may be due to genetic conditions in the female.
If you and your partner are struggling to have a baby, you're not alone. Ten to 15 percent of couples in the United States are infertile. Infertility is defined as not being able to get pregnant despite having frequent, unprotected sex for at least a year for most couples.
Infertility may result from an issue with either you or your partner, or a combination of factors that interfere with pregnancy. Fortunately, there are many safe and effective therapies that significantly improve your chances of getting pregnant.
Symptoms
The main symptom of infertility is not getting pregnant. There may be no other obvious symptoms. Sometimes, an infertile woman may have irregular or absent menstrual periods. Rarely, an infertile man may have some signs of hormonal problems, such as changes in hair growth or sexual function.
In general, infertility is defined as not being able to get pregnant (conceive) after one year of unprotected sex. Women who do not have regular menstrual cycles, or are older than 35 years and have not conceived during a 6-month period of trying, should consider making an appointment with a reproductive endocrinologist - an infertility specialist. These doctors may also be able to help women with recurrent pregnancy loss - 2 or more spontaneous miscarriages.
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 (ovulation).
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 (womb).
The fertilized egg 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 and refers to women who have difficulty getting pregnant or carrying a pregnancy to term.
Thinking about getting pregnant? Then it’s time to get acquainted with the big O: ovulation. Just as menstrual cycles are different for every woman, so is ovulation. By learning to recognize the signs of ovulation, you’ll be able to time sex with your partner accordingly to boost the odds of getting pregnant. But even if you’re not trying to conceive right at this moment, having a better understanding of ovulation signs can give you a clearer picture of your menstrual cycle and help you spot any abnormal ovulation symptoms down the line. Read on for all the need-to-know info about ovulation, from how to chart your menstrual cycle to how to spot the signs of impending ovulation.
You probably learned way back in health class that ovulation is the phase in your menstrual cycle when a mature egg is released from the ovary, setting the stage for fertilization. Each woman is born with millions of immature eggs that wait to be released, normally one at a time, every month. During ovulation the egg travels down the fallopian tube, where it may meet up with a sperm and become fertilized. For most healthy women, ovulation generally happens once a month, a few weeks after menstruation begins.
You may have heard that ovulation typically happens on day 15 of your menstrual cycle, but it’s not the same for everyone. If you’re like most women of childbearing age, your menstrual cycle lasts between 28 and 32 days, and ovulation usually hits between days 10 and 19 of that cycle—about 12 to 16 days before your next period. “In healthy women, ovulation occurs 14 days before the onset of your period,” says Donnica L. Moore, MD, president of Sapphire Women's Health Group in Chester, New Jersey. So if your cycle is 35 days, ovulation will happen on day 21 of that cycle. If your cycle is 21 days, ovulation will happen on day seven. The timing of ovulation can vary from cycle to cycle and from woman to woman, adds Shannon M. Clark, MD, associate professor at the University of Texas Medical Branch at Galveston in Galveston, Texas, which is why it’s a good idea to get familiar with your body’s menstrual calendar for at least three months or so, to help you better estimate your own ovulation cycle.
For some women ovulation doesn’t always take place or it can be irregular. In general, if you are pregnant, have gone through menopause, or you take birth control pills consistently and on time, you won’t ovulate. Certain diseases or disorders (such as polycystic ovary syndrome or premature ovarian failure, among other conditions) and certain medications (including some antidepressants, anti-nausea medications and chemotherapy) may cause a woman to stop ovulating for periods of time. Also, other lifestyle factors— stress or being significantly underweight or overweight (measured by body fat percentage)—may affect menstruation and ovulation. If you’re dealing with irregular menstrual cycles or ones that are short (fewer than 21 days) or long (more than 35 days), Clark recommends you get evaluated by a physician to rule out any medical conditions that might be causing those irregular cycles. It’s true tracking ovulation with irregular cycles can be more difficult, but keep in mind that ovulation occurs 14 days before the onset of menstruation, so even with irregular periods, you could still conceive at some point in your cycle.
Most girls get their first period between the ages of 10 and 15, but some get it earlier and some later. The first period is known as menarche (pronounced: MEN-ar-kee).
A girl's monthly cycle is the number of days from the start of her period to the start of the next time she gets her period. You often hear this is a 28-day cycle. But 28 is just an average figure that doctors use. Cycle lengths vary — some are 24 days, some are 34 days. And a girl may notice that her cycles are different lengths each month — especially for the few years after she first starts getting her period.
Early in a girl's cycle, her ovaries start preparing one egg. At the same time, the lining of the uterus becomes thick to prepare a nesting place for a fertilized egg in the event that the girl becomes pregnant.
About 2 weeks before a girl gets her period, the egg is released from the ovary (this is called ovulation). The egg travels through the fallopian tube into the uterus. If the egg isn't fertilized by sperm, it starts to fall apart. Then the lining and egg leave a girl's body as her period and the whole thing starts all over again — that's why we use the word "cycle." The first day a girl's period comes is Day 1 of her cycle.
A girl's body may not follow an exact schedule. It’s common, especially in the first 2 years after a girl starts getting her period, to skip periods or to have irregular periods. Illness, rapid weight change, or stress can also make things more unpredictable. That's because the part of the brain that regulates periods is influenced by events like these. Going on a trip or having a major change in schedule can also make your period come at a different time than expected. All of this is perfectly normal.
It's also normal for the number of days a girl has her period to vary. Sometimes a girl may bleed for 2 days, sometimes it may last a week. That's because the level of hormones the body makes can be different from one cycle to the next, and this affects the amount and length of bleeding.
Irregular or abnormal ovulation accounts for 30% to 40% of all cases of infertility. Having irregular periods, no periods, or abnormal bleeding often indicates that you aren't ovulating, a condition known clinically as anovulation.
Although anovulation can usually be treated with fertility drugs, it is important to be evaluated for other conditions that could interfere with ovulation, such as thyroid conditions or abnormalities of the adrenal or pituitary glands.
Getting Pregnant With Ovulation Problems
Once your doctor has ruled out other medical conditions, he or she may prescribe fertility drugs to stimulate your ovulation.
The drug contained in both Clomid and Serophene (clomiphene) is often a first choice because it's effective and has been prescribed to women for decades. Unlike many infertility drugs, it also has the advantage of being taken orally instead of by injection. It is used to induce ovulation and to correct irregular ovulation by increasing egg recruitment by the ovaries.
PCOS is a problem with hormones that affects women during their childbearing years (ages 15 to 44). Between 2.2 and 26.7 percent of women in this age group have PCOS (1, 2).
Many women have PCOS but don’t know it. In one study, up to 70 percent of women with PCOS hadn’t been diagnosed (2).
PCOS affects a woman’s ovaries, the reproductive organs that produce estrogen and progesterone — hormones that regulate the menstrual cycle. The ovaries also produce a small amount of male hormones called androgens.
The ovaries release eggs to be fertilized by a man’s sperm. The release of an egg each month is called ovulation.
Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) control ovulation. FSH stimulates the ovary to produce a follicle — a sac that contains an egg — and then LH triggers the ovary to release a mature egg.
PCOS is a “syndrome,” or group of symptoms that affects the ovaries and ovulation. Its three main features are:
cysts in the ovaries
high levels of male hormones
irregular or skipped periods
Birth control pills are a kind of medicine with hormones that you take every day to prevent pregnancy. There are many different brands of pills. The pill is safe, affordable, and effective if you always take it on time. Besides preventing pregnancy, the pill has lots of other health benefits, too.
The birth control pill works by stopping sperm from meeting an egg (which is called fertilization).
The hormones in the pill stop ovulation. No ovulation means there’s no egg hanging around for sperm to fertilize, so pregnancy can’t happen.
The pill’s hormones also thicken the mucus on the cervix. Thicker cervical mucus makes it hard for the sperm to swim to an egg — kind of like a sticky security guard.
How do I make the pill work best for me?
Forgetting pills, losing the pack, not refilling your prescription on time — these are the main reasons why people who take the pill get pregnant. It’s good to think about these things ahead of time. Here are some ways to help you remember to take your pills every day:
Use our birth control reminder app or set an alarm on your phone.
Keep your pill pack next to something you use everyday (like your toothbrush or phone charger).
Keep your pills in your bag so they’re always with you.
Friends or family members who take medicine every day can be pill buddies and help each other remember.
Your partner can help remind you.
Do whatever works to help you take your pill on time, all the time.
Want to be extra super duper sure you don’t accidentally get pregnant? Also use a condom every time you have vaginal sex. That way you’ll also be protected against STDs.
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