Infertility is defined as the inability of a couple to get pregnant after trying to do so for at least one year. About 20 percent of the couples in the United States have to deal with the problem of infertility. About 40 percent of infertility cases are due to a problem with the sperm of the male. About another 40 percent of the causes of infertility are due to a problem with the female. These causes include ovulation problems, tubal problems, endometriosis and cervical factors. About 20 percent of the infertility cases are due to problems in both the male and female or of unknown cause.

The infertility problems in men can be caused by problems in their sperm. Some men have a low sperm count. The normal sperm count in one milliliter of semen is over 20 million. A man with a sperm count of 5 to 20 million is considered subfertile. A man with a sperm count of less than 5 million is considered infertile. Sperm that do not swim well (sperm motility) and do not have normal structures may also cause problems. Some sperm may be immature or have abnormalities in their head or tail. A semen sample has to contain less than 25 percent of these types of sperm to be considered normal. An abnormal volume of semen can also decrease the chances of successful fertilization.

There are many conditions that can adversely affect your sperm such as having only one testicle, testicles that are smaller than normal, or abnormally large veins (varicocele) in the testicles. There are things that might affect the formation of sperm (spermatogenesis) including exposure to various toxins, alcohol abuse, drug use, anabolic steroid use, diabetes and thyroid or other endocrine diseases. There are treatments that might help with male infertility. Your doctor can improve your sperm motility by injecting small doses of testosterone. You can get rid of varicoceles through surgery. There is also a procedure called artificial insemination that might help. Artificial insemination is a mechanical means of depositing the male's most motile sperm or donor sperm into the uterus of the female.

Ovulatory problems account for most cases of female infertility. If there are ovulatory problems, there may be no eggs to be fertilized. Problems with the thyroid and pituitary glands can be responsible for ovulatory problems since they release hormones that help regulate the menstrual cycle. There are medications that can stimulate fertility such as Clomid and Pergonal. You can check to see that you do not have an ovulatory problem by making sure that an ovum is produced each month, your morning body temperature is slightly higher around the time of ovulation and luteinizing hormones are released just before ovulation.

Pelvic adhesions are fibrous scars that prevent sperm from reaching the egg or interfere with fertilization. These scars can be caused by previous surgeries, abortions, prior births, or pelvic inflammatory disease. Endometriosis can lead to pelvic adhesions. Endometriosis is a disorder in which the uterine tissue is located outside of the uterus. The bleeding from the uterine tissue during the menstrual period can cause irritation within the pelvis, which can lead to scarring. Pelvic adhesions can also block a fallopian tube. This may prevent the ovum and sperm from meeting in the fallopian tube.

A hysterosalpingogram is an x-ray exam that can show if a fallopian tube is blocked. This exam checks to see if dye material can travel through the tube. Some women have become pregnant after this exam because the dye material has helped removed the obstruction in the fallopian tube. A doctor can determine if you have scarring by doing a laparoscopy. This procedure uses a scope that is inserted into the abdomen through an incision near the naval. During the laparoscopy, the doctor can treat pelvic adhesions by cutting them with special instruments. There are also medications that can treat endometriosis. In addition, surgery may be required if there is an obstruction caused by pelvic adhesions.

Problems with the cervix can also cause infertility. The cervix is the opening from the vagina to the uterus. The cervix produces mucus, which helps transport the sperm into the uterus. Occasionally, the mucus is too thick and will prevent the sperm from getting into the uterus. There are some situations where there is a smaller amount of mucus because of an injury that reduces the number of glands in the cervix. Also, if surgery or infection caused scarring of the cervix, the cervical opening may get smaller which makes it more difficult for the sperm to get through. If there is an infection, you can use antibiotics to treat it. If mucus is the problem, you can use artificial insemination to bypass the mucus.

Michael Russell
Your Independent guide to Infertility

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