For conception to take place in the human female, the following events must occur:
Infertility is defined in most cases as the inability to conceive after one year of trying. When infertility occurs, it is because of failure in one of the four steps listed above.
Approximately one‐third of infertility cases are due to "subnormal" fertility in both the male and the female. In the remaining two‐thirds of the cases, approximately half are due to only male factor and half are due to only female factor. The problem must be approached with the investigation of both partners.
Infertility in the male may result if the male has no sperm, not enough sperm, sperm which are improperly formed or inadequately active, or, although he has sperm, the passage from the testicle to the end of the penis is blocked. Other problems may occur with ejaculation, as a result of which the sperm are not deposited in the vagina in the proper way. A number of factors may contribute to the development of these conditions:
A female may be infertile because she does not have eggs, does not release the eggs in a monthly fashion, has a blockage in her reproductive system, or has hormonal problems. Specific conditions which contribute to infertility in the female are:
The workup varies greatly, depending upon the medical history and the ages of the patients involved. The basic workup includes a semen analysis for the male, a blood test or other tests to prove that ovulation is occurring regularly in the female, and an evaluation of whether the woman's fallopian tubes are open so that an egg can get from the ovary to the uterus.
For the male the specific tests required may include:
For the female the specific tests required may include:
In some situations, some testing may be omitted and the couple is advised to proceed directly to assisted reproductive technology procedures.
Treatment will depend upon the diagnosis and on a number of other considerations and needs to be discussed between the couple and their physician.
The basic treatment options for the male include:
The basic treatment options for the female include:
Not everyone who is infertile can be made to be fertile. For some patients, adoption or a decision to live
child‐free are options to consider. All of these options should be carefully discussed with your physician.