Infertility is the inability to conceive a child after one year of actively trying to become pregnant or the inability to carry a pregnancy full term. Infertility may be caused by male or female factors. Couples may need an infertility evaluation if you and your partner have not conceived after one year of unprotected, regular intercourse. Certain conditions may warrant seeing a healthcare provider after only six months of trying. These include:
- Female partner over age 35
- Irregular or absent periods
- Two or more miscarriages
- Prior use of an intrauterine device (IUD)
- Endometriosis/painful menstruation
- Breast discharge
- Excessive acne or hirsutism (body hair) in female
- Prior use of the contraceptive and no subsequent menstruation
- Prostate infections
- A history of sexual transmitted disease in either partner
- A history of pelvic/genital infection in either partner
- Previous abdominal surgery in either partner
- Reversal of surgical sterilization in either partner
- Chronic medical condition in either partner( e.g. diabetes, high blood pressure, etc.)
- History of chemotherapy or radiation therapy in either partner
- Pain during intercourse, or other gynecological problems
- Smoking
According to the Physician’s Desk
Reference Guide to Women’s Health and Prescription Drugs 1994, about 10% of the population who is of reproductive-age is affected by infertility.
That adds up to about 6 million American couples. 
Age is the strongest predictor of female infertility:
- Fertility decreases after age 35 for women. Changes in fertility also occur with age in men, but there is no particular age after which a man cannot father a child.
- A women's peak fertility occurs from her late teens through her late 20's.
- Older women are more likely to have health problems that may interfere with fertility, such as an increase risk of miscarriage and chromosomal abnormalities that occur in the eggs.
The first step in diagnosing infertility is for both partners to undergo a physical examination, which may be followed by a blood test to determine hormone levels. Men will be asked for a specimen of ejaculated semen, which will be analyzed for sperm quantity and the presence of infection or blood. The lab will note any abnormalities in the shape and movement of the sperm. The doctor may ask about the following:
- Health history
- Medications
- Sexual habits
- Menstrual cycle
Women will have a gynecologic exam that may be followed by several other procedures or monitoring, including:
- Pelvic exam: An examination of a women's reproductive system, externally and internally, performed to determine if there are cysts, fibroids, or other abnormalities.
- Hysterosalpingogram: An X-ray that evaluates the condition of the uterus and fallopian tubes.
- Laparoscopy: A procedure that examines the pelvic cavity to identify endometriosis, scarring, and blockage, or irregularities of the fallopian tubes and uterus.
- Basal body temperature monitoring: Women may be asked to take their temperature every morning with a special thermometer to note a temperature, which is associated with ovulation.
Treatment of infertility may include restoring or bringing about fertility, intrauterine insemination (IUI), assisted reproductive technology (ART), and fertility medications. Treatment for infertility may depend on several factors, including:
- Age of the female
- Duration of infertility
- Contributing factors
- treatment risks
- Cost of therapy
To restore or bring about fertility, couples may be asked to:
- Have intercourse more often or on a scheduled basis.
- Be treated for sexual problems such as erectile dysfunction, premature ejaculation, or problems with the reproductive organs.
- Help determine when ovulation is occurringby measuring a women's basal body temperature and using home ovulation tests.
IUI
IUI, sometimes called artificial insemination, is a type of fertility treatment where sperm taken from a partner or donor is injected into a women's uterus at the time of ovulation to encourage fertilization. Some women may receive this treatment while also taking fertility medications to simulate ovulation.
ART
ART includes all infertility treatments that involve the handling of both sperm and eggs. in ART procedures, one or more fertilized eggs, or embryos, are transferred to the uterus to increase the chances of pregnancy. This procedure accounts for more than 70,000 babies born in the United States every year. In vitro fertilization (IVF) is a type of ART.
- In IVF, a women receives fertility medications to stimulate the development of several eggs.
- After the eggs are developed, they are surgically removed from the ovaries and fertilized with sperm outside the body, in the lab.
- After fertilization has occurred, the embryos are transferred into the uterus.
- The women may receive additional medication to help maintain her pregnancy.
- If IVF is not successful, other types of ART may be suitable options.