Infertility

Infertility is a disease of the reproductive system defined by the inability to achieve pregnancy after 12 months of regular unprotected intercourse, or after 6 months for people aged 35 or older. It affects both men and women and can be classified as primary, when there has never been a pregnancy, or secondary, when conception has occurred previously but is now difficult.

Causes vary by gender and individual factors. Female factors include ovulatory disorders such as polycystic ovary syndrome, tubal disease, endometriosis, age-related decline in fertility, and uterine or cervical conditions. Male factors include low sperm concentration or motility, abnormal sperm morphology, genetic or endocrine issues, and certain health or lifestyle factors. In many cases, causes are multifactorial or unexplained, and prognosis depends on the specific diagnosis and age.

Evaluation typically starts with medical histories, physical examinations, and basic tests such as semen analysis. Further assessment may include ovulation evaluation, hormonal testing, imaging with ultrasound, and procedures like hysterosalpingography or laparoscopy in selected cases. When indicated, genetic testing or counsel may be offered. A coordinated evaluation of both partners is common to identify contributing factors.

Treatments are tailored to the underlying cause and may involve lifestyle changes, medications to induce ovulation, and procedures to improve reproductive potential. Medical therapies include agents such as clomiphene or letrozole, while injectable gonadotropins may be used in some cases. Surgical options address tubal or endometriosis-related issues. Assisted reproductive technologies, including intrauterine insemination and in vitro fertilization, are commonly employed. Fertility preservation may be considered for individuals facing treatments that threaten fertility.

Outcomes vary with age, cause, and access to care. Pregnancy rates per cycle generally decline with increasing female age, and infertility can have emotional and financial impacts, underscoring the importance of timely evaluation and informed decision-making.