Diagnosis

Even the most fertile human couple does not necessarily conceive the first time sexual intercourse takes place. In fact, the chance of conception in any given month among fertile couples attempting to conceive is about 20%, or one chance in five. To avoid unnecessary testing and treatment, most doctors will not make the diagnosis of infertility until one year of unprotected intercourse has failed to result in pregnancy. Some cases, involving older couples or existing evidence from previous marriages, may be diagnosed sooner and treated more aggressively.

Once it is found that the couple has infertility, examinations, testing and history- taking begin to find the cause(s) of infertility. In about 30% of infertility cases, the problem can be found solely in a medical problem of the woman's; 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.

Women are given a physical and pelvic examination, laboratory tests, and one or more imaging procedures to locate the problem which may be causing infertility. Testing may include exploratory surgery, using laparoscopy. In this technique, a small fiber-optic tool is inserted through a "keyhole" incision to allow the physician to inspect the reproductive system. Advanced ultrasound imaging may also reveal structural or functional problems. One commonly found condition during the infertility evaluation is endometriosis. In this disorder, cells from the endometrium, which normally line the uterus, spread in patches and cysts throughout the female reproductive system. Additionally, some women do not ovulate regularly or at all. Others may produce eggs regularly that are prevented from being fertilized, descending or implanting.

Men are tested for the presence, quantity and quality of their sperm. The most common problem affecting male sperm levels is a varicocele, a tangle of veins surrounding the testicle. Surgical correction of large varicoceles restores fertility in about two-thirds of cases. Other causes of male infertility include insufficient hormone levels (which may be supplemented); blocked tubes which carry sperm (which can sometimes be surgically repaired or bypassed), untreated diabetes or prostate disease and other conditions.

Once the cause of infertility has been determined, a plan can be customized for the patient to fit their unique situation and move them along on the path to conceiving a child. In fact, nearly 90% of infertility cases are treatable with medical therapies such as drug treatment, surgical repair of reproductive organs and assisted reproductive techniques such as in vitro fertilization.