Fifty percent of pregnancies in the United States are unplanned. Among teenage women, 75 out of 1,000 get pregnant. These statistics make getting pregnant seem like an easy task. Most women spend at least a third of their lives capable of reproducing, but many expend a lot of energy attempting to prevent an unexpected pregnancy.

It really is a misconception that it is easy to get pregnant. During any given menstrual cycle, a woman only has a 20 percent chance of conception, even for those couples who are planning to get pregnant. Many couples encounter challenges when they decide they want to conceive a child. In 2002, 12 percent of women between the ages of 18 and 44 had trouble getting pregnant or carrying a pregnancy to term according to the Centers for Disease Control and Prevention (CDC).

Not being able to get pregnant may be considered a fertility problem, or infertility, after a couple spends at least one year trying to get pregnant without any success. This does not mean that the couple will never get pregnant, but it does mean it may be time to talk to a medical professional about their concerns.

Factors that May Cause Infertility

There are many factors that can affect fertility in women. The most common issues are age and general health status. Once a woman passes the age of 35, the chances of getting pregnant decrease significantly, and the chance of having a miscarriage increases. The frequency of ovulation decreases with age, and the health of her eggs also decline with age. Other health factors that may change fertility status can include stress, poor eating habits, athletic training, being overweight or obese, as well as being underweight, smoking, drinking alcohol, having any sexually transmitted infections, or any other health problems that affect hormones.

Men may also have fertility issues. Some men may not produce any or very few sperm, or the sperm may have abnormalities that do not allow them to make it to the egg. This male infertility can be genetic, or it may be caused by illness. Other factors that can affect the health of the sperm include drinking alcohol, taking drugs, being exposed to toxic chemicals in the environment, smoking, having other health problems, taking medications, receiving treatment for cancer and age.

Things to Think about Before Beginning Fertility Treatments

The scope of fertility treatments covers the spectrum from advice to do nothing (but have a lot of sex) and wait for a pregnancy to costly surgeries and fertility treatments that might not result in a successful pregnancy. Of course, before trying any fertility treatments, it is very important to have both partners examined by a doctor to determine the cause of the infertility, and if it is reversible. Insurance generally does not cover the costs, so it is also important to assess personal finances and consider how much money can be earmarked for fertility treatments.

Fertility Treatments for Women

Ovulation issues are one reason why many couples may have trouble getting pregnant. A first step may be to take medications that can help a woman ovulate. This method is the safest treatment and it is often effective since ensuring a woman ovulates increases the chances of a pregnancy occurring. However, it does not work for everyone; the medication may also have side effects such as overstimulating a woman’s ovaries, or causing hot flashes, irritability, nausea, headaches, tender breasts, blurry vision and, in some rare cases, hair loss may occur. If ovulation issues persist after trying medication, hormone shots are usually the next option. Hormone shots are given in daily series from the start of your period and often cause side effects such as nausea and bloating. Some women may develop cysts as a result of the injections. One other side effect of any fertility drugs is that they can increase the possibility of twins, triplets and additional multiple births.
 
Even if ovulation is not the issue, and the doctor does not know why a couple is unable to conceive, medication and then hormone shots would be tried. However, another alternative is insemination. Insemination is when sperm are inserted directly into the woman’s uterus, which increases the chances of a pregnancy occurring.

Another non-ovulation problem could be that a woman’s fallopian tubes may be damaged or blocked and this can result in the egg not being fertilized because the sperm are not able to reach it. It is possible to have surgery to fix the tubes, in which women who have undergone such surgeries, 20-60 percent were able to conceive and have successful pregnancies. However, the success of the tubal surgery is dependent on which parts of the tubes are blocked. And if the woman is over 34, or if the tubes have endured severe damage, this procedure may be skipped in lieu of trying another procedure.

Some women have endometriosis, which is when the endometrial tissue that usually lines the inside of the uterus grows outside of it instead. It can often be found in the abdomen and will attach to the other reproductive organs or the intestines. These growths can be painful and bleed during a woman’s menstrual cycle. Scar tissue can develop as well, and this scar tissue can prevent the organ from functioning normally, can cause pain and can interfere with conception. Treating endometriosis can be done with medications or with a surgical procedure to remove the scar tissue and growths.

The final options in female fertility treatments are assisted reproductive technology (ART). ART is when eggs are taken out of a woman’s body (they can be fresh or frozen) and they are fertilized with sperm from a man in the laboratory and then the fertilized embryos are placed in the uterus. These eggs and sperm can be from the couple wanting a child, or they can be from donors, if the woman is not ovulating or if the parents have a genetic disease they do not want to pass to the baby. The most common and successful type of ART is in-vitro fertilization (IVF). IVF is used when fallopian tubes are blocked or if the man is not able to produce enough sperm. Women take medications that cause the ovaries to produce more than one egg during an ovulation cycle. These eggs are removed, fertilized with the man’s sperm in the lab, and the embryos are placed in the uterus. The medications come in the form of daily injections and can have uncomfortable side effects such as nausea, water weight gain, along with more serious concerns like liver and kidney problems.

Another method of ART is zygote intrafallopian transfer (ZIFT). It differs from IVF in that the embryo is placed in the fallopian tube instead of the uterus. The third type of ART is gamete intrafallopian transfer (GIFT), during which eggs and sperm are transferred to the fallopian tube so that fertilization can happen inside the woman’s body. GIFT is rarely offered as a choice of ART. The success of ART depends on a variety of factors such as the age of the couple, the cause of infertility, the type of ART being used, if the egg is frozen or not, or if the embryo is frozen or not. ART also increases the chances of having twins and other multiple births. Both ZIFT and GIFT procedures are not commonly done in the United States, and both are more expensive than IVF as they both involve surgery.

Fertility Treatments for Men

Male fertility problems center around their sperm. The sperm may not be healthy, or there may not be enough sperm, or there may be problems with ejaculation. There are behavior therapies that can be tried to rectify these issues, or medications may be used to increase or improve sperm production, and surgery is also an option for a low sperm count. After trying these other methods, the next option a doctor will suggest is usually insemination. Insemination involves collecting sperm from the man and then combining multiple collections together to place into the woman’s uterus to increase the chances of fertilization, thus conceiving. 

If insemination does not work, a doctor may suggest intracytoplasmic sperm injection (ICSI), a method of ART used for male infertility. If a man has gone through a vasectomy, or if the sperm is ejaculated into the bladder instead of out through the penis, or if a couple is of advancing age, or if a couple who did not succeed with IVF, ICSI may be used. During ICSI, one sperm is injected into one egg, and then that fertilized embryo is placed in the fallopian tube or the uterus.

Are Fertility Treatments for You?

While fertility problems can affect both men and women, there are a variety of options available to help both genders overcome their fertility issues. Before getting involved with costly treatments, be sure to talk to your doctor about other health concerns that could also be affecting your ability to conceive.