Infertility is a disease or condition of the reproductive system often diagnosed after a couple has had one year of unprotected, well-timed intercourse, or if the woman has been unable to carry a pregnancy that results in a live birth.
Infertility is a medical problem. Approximately 35% of infertility cases are due to a female factor and 35% are due to a male factor. In many cases, infertility results from problems in both partners or the cause of the infertility cannot be explained.
We advise you not to be concerned unless you have been trying to conceive for at least one year, unless you do not menstruate regularly. If you are over 30 years old, have a history of pelvic inflammatory disease, painful periods, miscarriage, irregular cycles, or if your partner has a known low sperm count, you may want to seek help sooner.
A fertility specialist, or reproductive endocrinologist, is a medical doctor who has been specially trained in the complex issues that can contribute to infertility. In addition to being trained as an Ob/Gyn, a reproductive endocrinologist must complete highly specialized training for treating all aspects of infertility.
Below are the school and training requirements that an Ob/Gyn and Reproductive Endocrinologist must complete.
To Become Board Certified in Ob/Gyn, the doctor must:
- Graduate from college & medical school
- Complete 4-year residency in Ob/Gyn
- Pass written exam in Ob/Gyn
- Complete 2-year practice experience
- Pass oral exam in Ob/Gyn
To Become Board Certified in Endocrinology, the doctor must:
- Complete all requirements for Ob/Gyn board certification (see above)
- Attend 3-year fellowship in reproductive endocrinology
- Pass written exam in reproductive endocrinology
- Pass oral exam in Ob/Gyn
- Complete 2-year practice experience
- Pass 3-hour oral exam in Reproductive Endocrinology & Infertility
There are currently about 1,000 board certified reproductive endocrinologists practicing in the U.S. The most qualified experts have completed +3 year fellowships and passed exams to become board certified in andrology.
The most fertile time of the month is just before or at ovulation. Ovulation usually occurs two weeks before a period starts, so it is necessary to count backwards from the anticipated start of the next period in order to find the most fertile time. Take the number of days in the usual cycle (from the beginning of one period to the beginning of the next) and subtract 14. For example, a woman with a 32 day period would likely ovulate around day 18 (32-14=18), while a woman with a 28 day cycle would ovulate around day 14 (28-14=14).
Because the sperm live longer than the egg does, it is best to have intercourse before ovulation rather than afterwards, so a woman who ovulates on day 14 would have a good chance of conceiving if she has intercourse on either day 12, 13 or 14. For women with monthly menstrual cycles but with slightly irregular intervals (e.g. 27-33 day menstrual cycles), one way to decide on the potential fertile period is by taking the shortest cycle and subtracting 16, then taking the longest cycle and subtracting 12. This would give the fertile time and allow for even more fluctuation in cycle length than usual. For example, the fertile period for a woman whose cycles vary from 27 to 33 days should be sometime between day 11 (27-16=11) and 21 (33-12=21).
Alternatively, women may want to use an ovulation predictor kit, which can be downloaded as an app or purchased over the counter at drug stores. One important fact to note is that, if a woman is using a basal body temperature chart, that the temperature will rise after ovulation, and therefore after the most fertile period. The couple should therefore not wait until the temperature has risen to start to have intercourse, as they will have missed the most fertile time.
There's even ovulation tracker apps! The app analyzes the data that you provide (input your menstrual days and for some apps, even your basal body temperature) to make accurate predictions regarding your ovulation days—your most fertile time. Important to note that for women who do not ovulate regularly or have irregular menstrual cycles, the use of an ovulation tracker app is of little benefit.
Additionally, your body may signal when you are about to ovulate. Many women feel twinges in their lower abdomen (your ovaries are on the right and left sides of your lower abdomen). Other women notice clear, stretchy vaginal discharge just at their fertile time. Your doctor can also request an ultrasound or appropriate blood tests to determine ovulation.
It is a good idea to have intercourse every other day around the time you ovulate (day 10, 12, 14, and 16). Remember, every woman is different, and may not ovulate exactly on day 14. It is preferable to have intercourse every other day rather than every day so that sufficient sperm will be available. To increase your chances of the egg becoming fertilized, do not douche or use lubricants immediately before having intercourse.
Your doctor will likely do the following:
- Blood tests to check [delete] hormone levels in the woman; thyroid, prolactin, and androgen levels
- Complete semen analysis on the male partner
- Diagnostic testing (Hysterosalpingogram (HSG) or FemVue (Sono HSG) to evaluate if the woman's fallopian tubes are patent
- Endometrial biopsy - evaluates the quality of the uterine lining (if appropriate)
- Laparoscopy - out-patient surgery to check for endometriosis or pelvic scarring in the woman
If you have not had these tests done, ask your doctor about them.
The lab will provide instructions to abstain from sex for a certain period of time before the test, and it will give you a sterile container to use for the specimen. After masturbating and ejaculating into the jar, you must take the whole specimen immediately to the lab. You may be asked to produce a specimen at the lab, where they will provide a private room.
There is evidence linking reproductive impairment with exposure to alcohol, tobacco, and caffeine. Alcohol and tobacco use have been demonstrated to affect the reproductive capacities of both men and women, and tobacco is an especially potent reproductive toxin. It is wise to be in the best physical shape possible while you attempt to conceive and, of course, to ensure a healthy pregnancy and baby.
Yes. High temperatures can kill sperm. That is why the scrotum is located outside the body, to keep the sperm cool. It is a good idea to avoid hot tubs, saunas, and steam rooms. Wear loose pants and underwear. And even avoid using "laptops" on your lap as the heat produced can potentially affect spermatogenesis.
Learn as much as you can about infertility.
- Read reliable information from your doctor, reputable web resources, or trusted friends and family.
- We have compiled a list of recommended books.
- RESOLVE has over 60 fact sheets on different topics related to infertility and offer support groups in many areas.
- Visit the ASRM and CDC websites for more information.
Sources: Long Island IVF and RESOLVE.