Who Needs Infertility Assistance?
At least 15% of married couples, a minimum of roughly four and one half million couples will experience some degree of infertility.

What is Infertility?
Infertility is most simply defined as "The inability of a couple to achieve conception after a year of unprotected intercourse, or inability to carry pregnancies to a live birth."

60% Female problem
35% Male problem
25% Problem found in both sexes
Only 3.5% of infertility is unexplained

Of the 95% of couples whose physical basis for non-conception or miscarriage is found more than 50% can be successfully treated with medical or surgical techniques.

What is the Couple's Commitment?
The evaluation and treatment of infertility requires a great commitment of time, energy and resources. Infertility is not merely a physical condition, it is an emotional and social condition as well. Infertility for some couples is the first crisis a couple has to face in their marriage. How common a problem is male factor infertility?

In 60% of all couples experiencing infertility, a male factor is involved.
40% of these couples it is primarily a male factor in an additional
20% of these couples, it is a combination of male and female factors.
This is why when a couple is having trouble conceiving it makes sense
to evaluate the man as well as the woman.

What are the most common causes of male infertility?
Varicoceles or dilated veins in the scrotum, (just as an individual may have varicose veins in their legs.)  These veins are dilated because the blood does not drain properly from them creating extra blood to pool in the scrotum, having a negative effect on the sperm production. Varicoceles is the most common reversible cause of male infertility and can be corrected by minor outpatient surgery.

What is IUI?
Intrauterine insemination (IUI) is a process where processed sperm is placed directly inside the uterus with a small catheter. This process is used frequently when male infertility is present due to abnormalities in the seminal fluid that reduces sperm mobility. The thick semen is processed to separate the moving sperm from the surrounding debris, dead sperm and seminal fluid improving the sperm's ability to move through and into the woman's reproductive tract.

What is Immunologic Infertility in men?
Men can develop an immunologic response, (antibodies) to their own sperm. The causes for this may include testicular trauma, testicular infection, large varicoceles or testicular surgery. Sometimes there are unexplained reasons why this occurs.

These antibodies have a negative effect on fertility at several points along the pathway to fertilization. They make it more difficult for the sperm to make its way into the uterus, to bind with the external membrane of the egg and more difficult for the sperm to fuse with the membrane of the eggs themselves.

What lifestyle changes can be made to improve male infertility?
There are a number of lifestyle factors that can significantly affect male factor fertility.

Quit Smoking.
Stop Taking Recreational Drugs.
Reduce Alcohol.
Avoid Lubricants.
Extreme Exercise.
Avoid High Temperatures.
Take Vitamins E, A, C, B9, and Zinc.

Will smoking effect fertility in men?
Yes. Smoking and its associated toxins cause a 23% decrease in sperm production a 13% decrease in motility and an increased number of abnormal formed sperm.

Does taking "recreational" drugs make men sterile?
The use of recreational drugs should be eliminated if a couple is serious about becoming pregnant. Marijuana and cocaine use causes a decreased average sperm count, motility and normal morphology. Cocaine also decreases the ability of sperm to penetrate cervical mucous, making it difficult for them to enter the uterus. Taking recreational drugs does not make you sterile but it does reduce the likelihood of your partner becoming pregnant.

How does taking anabolic steroids effect fertility?
With use at almost epidemic proportions these male hormones suppress the testes ability to make testosterone. This decrease, reduces the production of sperm in some cases to near zero production. When taken, these steroids cause a persistent depression of the hypothalamus and pituitary that may be irreversible, even when the steroids are stopped.

Does alcohol use reduce a mans fertility?
Moderate alcohol use does not affect male fertility. Excessive alcohol use affects the hormonal axis the hypothalamus and pituitary and is a direct gonadotoxin reducing sperm production. In addition it causes associated liver dysfunction and nutritional deficiencies that are also detrimental for sperm production.

Does exercise have an affect on male fertility?
Avoid Extreme Exercise. Aerobic and resistance training helps to increase testosterone levels, which leads to increased sperm production. Moderate amounts of exercise can only be helpful. However, long distance runners (men who run greater than 100 miles per week) and distance cyclists (men who ride greater than 50 miles per week) have decreased spermatogenesis. These activities should be moderated when a sub-fertile man is attempting conception.

Does temperature have an affect on male fertility?
Avoid high temperature environments that increase the overall scrotal temperature. This can have a negative effect on sperm production. Men should avoid the increased temperatures of saunas and hot tubs.

What if I am interested in having a vasectomy reversal?
In many cases a vasectomy reversal is the best available first option for a couple interested in having a child after the man has undergone a vasectomy. It is the most natural, least invasive and cost effective method of producing a pregnancy. If successful, the man's sperm may be of adequate quantity to allow for natural conception. If this does not occur Intrauterine Insemination or IUI may be an option.

How does fertility effect the sexes?
Human conception is a difficult and complex process, even under the best conditions. Fertility problems affect both men and women. In about 30% of infertility cases, the problem can be found solely in a medical problem of the woman, in another 30%, male factors alone cause the infertility and in another 30% of cases, both partners have conditions which render the couple infertile. In the remaining 10% of cases, no clear cause can be found.

Fertility diagnosis and treatment is lengthy, time consuming and expensive. The process can frequently be eased and shortened by both partners working together with their fertility physicians from the beginning.

In addition to the tests done on a woman, it is often necessary to perform a semen analysis to be sure a husband has sufficient normally functioning sperm for fertilization to occur.

What is the most common cause of infertility in women?
The most common cause of female infertility is an ovulation disorder. Other causes of female infertility include blocked fallopian tubes, polycystic ovary syndrome (PCOS) and endometriosis.

The clock in ticking. How much time does a woman have?
Late thirties or early forties? No, actually a woman's fertility begins to decline in her late twenties. This means that the average number of cycles it takes to get pregnant will increase after the age of about 27. Delayed childbearing has resulted in about 20% of all women in the United States now having their first child after age 35. If you wait until you are 30 the probability of having a baby decreases 3-5 % per year, and even faster after 40.

This is because of a lot of reasons. One is that at birth, a woman has all the eggs she will ever have. As an egg ages, it is more likely to develop a chromosomal abnormality most likely causing a miscarriage if pregnancy is achieved.

A woman in her 20s has only a 12-15% chance of having a miscarriage each time she becomes pregnant. On the other hand, a woman in her 40s faces a 50% risk of miscarriage.

Being in my 40's how long should we try before consulting a doctor?
If a woman is over 40 and the couple has been trying to conceive for over six months without success a basic infertility evaluation is indicated.

Unfortunately, we can not "turn back the clock" on a woman's ovaries but we can use fertility medications to try to increase the chance of pregnancy. These medications increase the number of eggs that develop in a given month, and enhance the chance that at least one of them might be able to be fertilized and develop into a pregnancy. Fertility medications offer some hope the pregnancy rates are generally low there are other surgical options as well.

What effect does dieting have on you ability to become pregnant?
Normal dieting has little effect on your chances to become pregnant. However excessive dieting such as anorexia or bulimia may have a long-lasting effect on the hypothalamus. This is an area of the brain that regulates your menstrual cycles with regular pulses of hormones. If you have anorexia or bulimia you may have noticed that you no longer have regular periods or they may have stopped all together. While you may be glad not to have periods when you were not trying to get pregnant, the absence of your periods can cause other medical problems and has a serious on your ability to get pregnant.

At what age does a woman's fertility start to decline?
Late thirties or early forties? No, actually a woman's fertility begins to decline in her late twenties. This means that the average number of cycles it takes to get pregnant will increase after the age of about 27. All women are different and some will still conceive quite easily at an older age while others will face difficulties with infertility.

At what age does a man's fertility start to decline?
25, 35, how about 50. Less data are available on this, but it appears that male fertility doesn't tend to decline measurably until after the age of 50.

When a couple is infertile, how often is this due solely to the woman?
50 percent of infertility cases are due to the woman. Of these cases, 20 percent are due to infrequent or irregular ovulation. The remaining 80 percent may be caused by an age-related decrease in egg quality, tubal blockage or scarring, endometriosis or a number of other less common disorders.

When a couple is infertile, how often is this due solely to the man?
Thirty percent of infertility cases are due to the man. A man is most likely infertile due to low sperm count, poor sperm motility, abnormally shaped sperm or some combination of all three.

When a couple is infertile, how often is this due to both the man and woman?
Twenty percent of infertility cases are due to fertility problems experienced by both the man and woman.

Why is it that infertility is such a problem today and not for our parents?
While the number of couples experiencing infertility has increased over 35 years ago, today's increasing infertility rates are principally associated with couples trying to have children later in life. This means that a 35-year-old in the 1960's was just as likely to have difficulty in conceiving as a 35-year-old today. In the past, women married and had children at a younger age. Today, more and more women are starting careers and putting off having children until they are in their 30's and 40's, when their fertility has measurably declined.

How common a problem is male factor infertility?
In 60% of all couples experiencing infertility, a male factor is involved. 40% of these couples it is primarily a male factor in addition, 20% of these couples, it is a combination of male and female factors. This is why when a couple is having trouble conceiving it makes sense to evaluate the man as well as the woman.

Do birth control pills help protect your fertility?
Yes, birth control pills can help protect your fertility. Women on birth control pills may be less likely to develop endometriosis or a tubal disease. Cervical mucus is typically "hostile" while taking oral contraceptive pills, which helps keep some infections from reaching the upper genital tract. The progesterone in pills also minimizes the growth of the endometrium (lining of the uterus), which is why many women have fewer menstrual cramps while taking birth control pills. This same effect inhibits or limits the growth of endometriosis cells in the pelvis.

If I use birth control am I saving my eggs for when I want to get pregnant?
No. Many woman think this is true, the fact is that use of birth control pills does not allow women to "save up" their supply of eggs. Women steadily use up their supply of eggs throughout their life. This includes prior to going through puberty, while pregnant and while on birth control pills. The hormonal changes provided by the birth control pill inhibits only the completion of egg maturation and prevention of ovulation.

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