Infertility is a condition of the reproductive system that prevents the conception of children. It affects approximately 10-15% of c...
Infertility is
a condition of the reproductive system that prevents the conception of children. It affects approximately 10-15% of
couples throughout the United States. The diagnosis of
infertility is usually given to couples who have been attempting to
conceive for at least 1 year without success.
Conception and
pregnancy are complicated processes that depend upon a number of factors,
including:
- the production
of healthy sperm by the man
- healthy eggs
produced by the woman
- unblocked
fallopian tubes that allow the sperm to reach the egg
- the sperm’s
ability to fertilize the egg when they meet
- the ability of
the fertilized egg (embryo) to become implanted in the woman’s uterus
- sufficient
embryo quality
Finally, for the pregnancy to
progress to full term the embryo must be healthy and the woman’s hormonal
environment adequate for its development. If just one of these factors is
impaired, infertility can be the result.
Is Infertility Primarily a
Woman’s Problem?
It is a common assumption that
infertility is primarily related to the woman. In reality, only one-third
of infertility cases are related to the woman alone. Statistically,
one-third of infertility problems are related to men and the remaining
one-third is a combination of fertility factors involving both partners
and unknown causes. Unknown causes account for approximately twenty
percent of infertility cases.
What Causes Infertility in
Men?
The most common causes of male
infertility are azoospermia (no sperm cells are
produced) and oligospermia (few sperm cells are produced). Sometimes,
sperm cells are malformed or they die before they can reach the egg. In
rare cases, infertility in men is caused by a genetic disease
such as cystic fibrosis or a chromosomal
abnormality.
For men with low sperm count or
motility issues, clinically proven supplements are available that can
improve sperm parameters.
What Causes Infertility in
Women?
The most common cause of female
infertility is ovulation disorders. Problems with
ovulation affect about 25% of all infertility situations.
Other causes of female infertility include blocked fallopian tubes,
which can happen when a woman has had pelvic inflammatory disease or endometriosis; Congenital
anomalies (birth defects) involving the structure of the uterus,
and uterine fibroids which are associated with repeated miscarriages; and
aging, since the ability for ovaries to produce eggs tends to decline with
age, especially after the age of 35.
When Should Someone Get
Tested For Infertility?
The American Society of Reproductive
Medicine recommends that women under 35 begin testing after trying to conceive
unsuccessfully for 12 months. The recommendation for women over 35 is to
begin testing after trying to conceive unsuccessfully for 6 months. Some
couples or individuals find that they are more relaxed when trying to
conceive if they believe that everything is normal.
How Early Can You Get
Tested?
Couples may request that their health
care provider conduct an exam to determine if everything is healthy and
working correctly. It is also possible to use over-the-counter screening
tests using testing kits to evaluate key aspects of fertility for both men and
women.
How Is Infertility
Diagnosed?
As already noted, couples are
generally advised to seek medical help if they are unable to achieve
pregnancy after a year of unprotected intercourse. The doctor will
conduct a physical examination of both partners to determine their general
state of health and to search for physical disorders that may be
contributing to infertility. The doctor will usually interview
both partners about their sexual habits in order to determine whether
intercourse is taking place properly for conception.
If no cause can be determined at this
point, more specific tests may be recommended. For women, these include an
analysis of body temperature and ovulation, x-ray of the
fallopian tubes and uterus, and laparoscopy. For men, initial tests focus
on semen analysis.
How Is Infertility Treated?
Approximately 85-90% of
infertility cases are treated with conventional therapies such
as drug treatment or surgical repair of reproductive organs. Assisted
reproductive technologies such as in vitro fertilization account for the
remaining infertility treatment options. Some people find it helpful to
hear about the experiences of other infertile couples and to communicate with
them. The pregnancy forums of APA or Shared Journey are
sites where you can read and share stories.
What Is In Vitro
Fertilization (IVF)?
In cases of blocked or absent
fallopian tubes or low sperm count, in vitro fertilization (IVF)
offers couples the opportunity of biological parenthood.
During IVF, eggs are surgically
removed from the ovary and mixed with sperm outside the body in a Petri
dish. After about 40 hours, the eggs are examined to see if they have
become fertilized by the sperm and are dividing into cells. These
fertilized eggs (embryos) are then placed in the women’s uterus,
by-passing the fallopian tubes.
IVF has received a great deal of
media attention since it was first introduced in 1978 and currently
accounts for less than five percent of all infertility treatments in the
United States.
Is In Vitro Fertilization
Expensive?
The average cost of an IVF cycle in
the United States is $12,400. Like other extremely delicate medical
procedures, IVF involves highly trained professionals with sophisticated
laboratories and equipment, and the cycle might need to be repeated in
order to be successful. While IVF and other assisted reproductive
technologies are can be costly, they account for only three hundredths of
one percent (0.03%) of U.S. health care costs.
Does In Vitro Fertilization
Work?
IVF was introduced in the United
States in 1981. According to Society of Assisted Reproductive Technology
(SART), who tracks ART success rates in the U.S., IVF currently accounts
for more than 99% of ART procedures, with GIFT, ZIFT and
combination procedures making up the remainder. The average live birth rate for
IVF in 2008 was 34% of all cycles. The results are slightly better than
the 20% chance that a reproductively healthy couple has of achieving a
pregnancy in a given month and carrying it to term.
Do Insurance Plans Cover
Infertility Treatment?
The services covered by insurance
will depend on where you live and the type of insurance plan. Fifteen
states currently have laws that require insurers to cover or offer to cover
at least a portion of infertility diagnosis and treatment. Those states
are Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana,
Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode
Island, Texas and West Virginia.
However, the existing laws vary
greatly in their scope of what might be covered. For more
information about specific laws in each of those states, you may contact
your state’s Insurance Commissioner’s office. To learn about pending
insurance legislation in your state, you may contact your State
Representative.
Whether or not you live in a state
with an infertility insurance law, you can choose to consult with your
employer’s Human Resources Department to determine the exact coverage your
plan provides. Another resource for determining coverage is, “Infertility
Insurance Advisor: An Insurance Counselling Program for Infertile
Couples.” This booklet is available for a small fee from RESOLVE, an
infertility patient advocacy and information organization.
Because the desire to have children
and be a parent is fundamental to being human, people should not be denied
insurance coverage for medically appropriate treatment for problems of
infertility.
