Infertility occurs when you’re not able to become pregnant after a year of trying or after six months if you’re 35 or older, according to the Mayo Clinic. Infertility can occur in males and females.

The Centers for Disease Control and Prevention (CDC) reports that 12 percent of women in the United States between the ages of 15 and 44 have problems becoming or staying pregnant due to male or female infertility.

What Are the Symptoms of Infertility?

The main indication of infertility is not being able to become pregnant after unprotected intercourse after a year of trying or after six months if you’re 35 or older.

Women may also experience irregular or absent menstrual periods, painful periods, or multiple miscarriages.

Men may also have a history of testicular, prostate, or sexual problems.

What Causes Infertility?

Certain steps in the reproductive process must occur to become pregnant:

1. A woman’s ovary must release an egg. This process is known as ovulation.
2. The egg must then travel through the fallopian tube toward the uterus, or the womb. A man’s sperm must be in the woman’s body during this specific time. It must also meet and join with the egg as it travels through the fallopian tubes. This process is known as fertilization.
3. The fertilized egg must then reach the uterus.
4. At the uterus, the fertilized egg must push its way inside and implant itself. This is called implantation.

Infertility can occur if there’s a problem with any of these steps.

Infertility in Women

Female infertility is most often the result of problems with ovulation. Irregular or absent periods can indicate an issue with ovulation. These problems may occur with hormonal disorders, such as polycystic ovarian syndrome (PCOS) or primary ovarian insufficiency (POI). POI occurs when a woman’s ovaries stop working before age 40.

Other causes of infertility in women include:

• uterine fibroids, which are benign growths that can keep fertilized eggs from implanting properly in the uterine lining
• scar tissue in the pelvis from past surgeries
• scar tissue inside the uterus from instrumentation
• early menopause
• blocked or scarred fallopian tubes due to infection or endometriosis

Endometriosis

Endometriosis is an often painful condition in which the uterine tissue that should line the inside of your uterus begins to grow outside of the uterus. The tissue becomes trapped because it has no place to go. Uterine tissue inside the uterus sheds each month during the menstrual cycle, but the trapped tissue can’t shed. The surrounding body tissues become inflamed, and scar tissue may form inside the fallopian tubes. This can lead to infertility in women.

Infertility in Men

Problems with sperm production and delivery, a low sperm count, and low motility, or ability of sperm to swim and fertilize the egg, can all affect male fertility.

A varicocele is a disorder in which the veins draining a man’s testicles have incompetent or leaky valves. The backflow of blood can enlarge the blood vessels and can raise the temperature of the testicles. This causes a low sperm count or abnormal sperm. Testicles are normally slightly below the core body temperature.

Who Is at Risk for Infertility?

Certain risk factors can make it more difficult for men and women to conceive.

Age

Women older than 30 and men older than 40 years old are at an increased risk of infertility. According to the Centers for Disease Control and Prevention, about 20 percent of women in the United States are now waiting until their 30s or 40s to have children.

Lifestyle Factors

The following lifestyle factors can impair healthy egg and sperm production:

• smoking
• heavy alcohol use
• drug use
• being overweight
• being underweight
• exercising excessively
• stress

In men, exposure to environmental toxins, such as pesticides, and exposure to high temperatures, such as in hot tubs, have also been shown to affect sperm count.

How Is Infertility Diagnosed?

Your doctor will usually start with a physical examination. They’ll want to discuss your medical and sexual history. If no cause is immediately evident, additional tests may also be necessary.

Men

In men, your doctor may ask for a semen analysis. This will look for problems with sperm, including low sperm count or motility issues.

A blood test to examine hormone levels and an ultrasound to look for certain conditions, such as retrograde ejaculation or ejaculatory duct obstruction, may also be necessary. In retrograde ejaculation, semen, which is the white fluid that contains sperm, enters the bladder instead of exiting through the penis. Sometimes, cysts may form on the ejaculatory ducts, which can block semen from exiting the duct and traveling to the penis for ejaculation. This is called ejaculatory duct obstruction.

Women

In women, the first concern is whether there are ovulation problems. Your doctor may ask you to track your ovulation, or they may check your ovulation with a blood test.

If ovulation is normal, your doctor may look for other problems with the ovaries, fallopian tubes, or uterus. They’ll look for these problems using an X-ray, ultrasound, or laparoscopy.

A laparoscopy is a minimally invasive procedure performed under general anesthesia. Your doctor will make a small incision under your navel. They’ll then insert a small camera to look at your fallopian tubes, ovaries, and uterus. This procedure is helpful in finding endometriosis, scarring, and fallopian tube blockages or abnormalities.

Not all tests for men or women may be necessary. However, identifying the cause of an infertility problem can take several months and can be expensive. The Mayo Clinic reports that one-third of cases never have a diagnosed, specific cause of infertility.

What Are the Treatment Options for Infertility?

Fertility Drugs

Fertility drugs help regulate or trigger ovulation, but they can also increase a woman’s chance of having twins or other multiple births.

Laparoscopic Surgery

Laparoscopic, or minimally invasive surgery, can help open or repair damaged or blocked fallopian tubes.

Artificial Insemination

Fertility treatments are often combined with artificial insemination, also known as intrauterine insemination. This involves placing specially prepared sperm into a woman’s uterus. The sperm may come from a male partner or an anonymous sperm donor.

In Vitro Fertilization (IVF)

In vitro fertilization (IVF) is a process in which your doctor retrieves eggs and sperm from a woman and a man, and then combines them in a laboratory, forming embryos. The doctor then places the embryos inside the woman’s uterus. Doctors usually recommend IVF when all other treatments have failed.

What Is the Long-Term Outlook?

If you’re having problems becoming or staying pregnant, remember that you’re not alone. Infertility is a problem that many men and women face. To help you cope, make sure to find support, consider your options, and manage your stress during diagnosis and treatment. If you want to have a child, a growing number of treatment options are available to make this possible.