Infertility affects approximately 10% of couples at some time during their reproductive lives. This means that one couple out of every ten will experience difficulty conceiving, making infertility a relatively common condition. Infertility is defined as the inability to become pregnant after one year of unprotected intercourse in women under 35. Infertility is much more common as women age and this may require intervention prior to one year's duration in women over 35.

There is debate concerning whether or not the incidence of infertility is increasing. One fact all authorities agree upon is that women are delaying marriage and childbearing until later in life, sometimes until their late thirties. Unfortunately, the biological clock does not correlate with the societal clock and as women age their fertility decreases. Declining fertility, or reduced ovarian reserve, no longer means it is impossible to have a child. Couples can choose in vitro fertilization using donor eggs and expect high success rates.

The "common" causes of infertility are discussed in depth throughout our Web site and a simplistic overview follows. These processes must occur in order for pregnancy and childbirth to occur:

The Infertile Male

• The male must produce an adequate quantity of good quality sperm.
• The sperm must be ejaculated into the female's vagina.
• The sperm must swim from the vagina, past the cervix, to the end of the fallopian tubes where fertilization occurs.
• A sperm must attach to an egg and penetrate the zona pellucida (membrane lining the egg)
• A sperm must be genetically capable of fertilizing the egg.

The Infertile Female

During all of these processes numerous precise, complex hormonal interactions occur.

• The female must recruit sufficient follicles under the influence of hormones that form the hypothalamic-pituitary-adrenal axis.
• The egg(s) must grow until it is mature and ready for ovulation.
• A surge of luteinizing hormone causes the egg to be "ovulated" or released from the follicle.
• During follicular maturation (eggs ripen) the body produces various hormones, such as estrogen and progesterone that cause the endometrium (lining of the uterus) to thicken and become more vascular in order to accept the developing embryo.
• Once ovulated, the eggs must travel unimpeded through the fallopian tubes to the distal end where fertilization occurs. · The egg must be genetically capable of fertilization and division.
• The fertilized egg (embryo) travels to the lining of the uterus (endometrium) where it attaches.
• The placenta must nourish the developing fetus.
• The fetus must be healthy and the mother must be able to carry the baby to term.

Dysfunction of the processes outlined above leads to infertility. Infertility causes are typically divided into eight categories:

• Male Factor
• Ovarian failure or dysfunction
• Cervical Factor
• Tubal Factor
• Hormonal imbalance (luteal phase defect, etc.)
• Endometriosis
• Uterine Factor
• PCOS
• Unexplained Infertility

Fortunately, today's advanced technologies offer very effective means to treat most causes of infertility. In fact, it is estimated that 85% of infertile couples who seek care from a specialist will conceive.

Perhaps the most important step a couple can take is to consult a qualified physician early in their evaluation. One misconception is that most couples who receive care from a specialist will require in vitro fertilization. Estimates are that only 8-10% of couples will require IVF and many more become pregnant though procedures such as IUI.