Infertility

Background

Infertility is a disease of the reproductive system that impairs the ability to conceive children. There are many factors involved in order for conception to occur. A man must produce healthy sperm and the woman must produce healthy eggs. The fallopian tubes must not be blocked in order to allow the sperm to reach the egg. Once the sperm and egg meet, the sperm must be able to fertilize the egg. The fertilized egg must implant successfully in the woman’s uterus for an embryo to develop. Finally, the embryo must be healthy — and the woman’s hormonal environment must be balanced for the embryo to develop. If any of the factors mentioned above are impaired, then infertility can result.

Both women and men can have problems that cause infertility. It is estimated to affect about 7.3 million women and their partners in the United States. One-third of infertility cases are caused by women’s factors. Another third of infertility cases are due to male factors. The other cases are caused by both male and female problems or by unknown problems. Twenty-five percent of couples experiencing infertility have more than one contributing factor.

In women, infertility is used to describe those of normal childbearing age. It does not apply to women who can’t get pregnant because they are near or past menopause. In addition, women who are able to get pregnant but who cannot carry a pregnancy to term (birth) may also be considered infertile.

Causes

Most cases of female infertility are caused by problems with ovulation. Two conditions that can affect ovulation are premature ovarian failure and polycystic ovary syndrome (PCOS). In premature ovarian failure, the ovaries stop functioning before menopause. In women with PCOS, the ovaries may not release an egg regularly or may not release a viable, healthy egg. Even if a healthy egg is released and fertilized, a woman with PCOS may have difficulty with her uterus accepting and implanting the fertilized egg. This can result in infertility.

Other causes of infertility in women may include:

  • Blocked fallopian tubes, which can occur when a woman has had pelvic inflammatory disease or endometriosis (a sometimes painful condition that causes adhesions and cysts)
  • Physical problems with the uterine wall
  • Uterine fibroids

A woman’s risk for infertility can be affected by lifestyle and environmental factors, including:

  • Age
  • Stress
  • Poor diet
  • Being overweight or underweight
  • Smoking, drugs and alcohol
  • Sexually transmitted diseases (STDs)

The most common causes of male infertility are either that no sperm cells are produced or that very few are produced. Sperm cells can also be malformed, or die before they can reach the egg. A genetic disease such as cystic fibrosis or a chromosomal abnormality can also cause male infertility in rare cases.

Male infertility can result from physical problems and lifestyle or environmental factors, such as:

  • Age
  • Stress
  • Exposing the testes to high temperatures, which can affect the ability of sperm to move and fertilize an egg
  • Smoking, drugs and alcohol
  • Exposure to environmental toxins, including pesticides and lead

Symptoms

There are often no signs or symptoms associated with an infertility problem. Couples generally are advised to seek medical help if they are unable to achieve pregnancy after a year of unprotected intercourse.

Diagnosis

If infertility is suspected, the doctor will conduct a physical examination of both partners to determine their health and evaluate if there are any physical disorders that may be causing infertility. Both partners are often interviewed about their sexual history and habits to determine if intercourse is taking place properly for conception.

Women may also receive an analysis of body temperature and ovulation, x-ray of the fallopian tubes and uterus, and laparoscopy. In men, doctors will often begin by testing the semen for the number, shape and movement of the sperm. Doctors may also suggest testing the level of a man’s hormones.

Treatment

Specialty drug list

Medical technology now provides more answers and treatment options to women and men trying to conceive. There are many ways to treat infertility, including medication, surgery, intrauterine insemination / artificial insemination or assisted reproductive technology (ART) such as in vitro fertilization. Often these treatments are combined.

Doctors recommend certain treatments for infertility based on the following:

  • Test results
  • How long the couple has been trying to get pregnant
  • The age of both the man and woman
  • The overall health of the partners
  • Preference of the partners

There are a number of family-building options also available to women and men who want to have a baby and need eggs, sperm or embryos donated by a third party, as well as surrogacy or gestational carrier arrangements. Donors may be known or anonymous. Our pharmacy works with donors and recipients to help ensure confidential, convenient and cost-effective specialty pharmacy care for the following third-party reproduction options:

  • Donor sperm is often recommended for severe male factor infertility or when genetic disease is present. Donor sperm can also be an important option for same-sex couples and single women wanting to have a baby.
  • Women with decreased ovarian reserve and poor egg quality, premature ovarian failure or the presence of genetic disease often use donor eggs to achieve pregnancy.
  • Surrogacy, or traditional surrogacy, allows the egg donor to also carry the pregnancy and deliver the child. In certain situations, a gestational carrier is needed to carry the pregnancy, following insemination with an embryo(s). These options are typically indicated for women with poor egg quality or who are unable to carry a pregnancy to term.

For more information on the more commonly used fertility medications, visit our Medication Center.

Side effects

Common medicines used to treat infertility include clomiphene citrate, human menopausal gonadotropin (hMG), follicle-stimulating hormone (FSH), or gonadotropin-releasing hormone (Gn-RH) analog. Treatment can cause side effects but it is important that a person never changes their dosage or stops taking their medication without talking to their doctor or pharmacist. Common side effects for the different medication options for infertility include:

  • Human menopausal gonadotropin (hMG) — Injection site pain, lower-abdomen tenderness, fluid retention, headache, emotional irritability, breast discomfort and fatigue
  • Follicle-stimulating hormone (FSH) — Injection site pain, abdominal pain, weight gain, breast discomfort, emotional irritability, nausea, vomiting and diarrhea
  • Gonadotropin-releasing hormone(Gn-RH) — An irregular menstrual period (or no menstrual period at all); hot flashes; vaginal burning, itching or dryness; decreased sexual interest and increased acne or oily skin or hair.

References

American Society for Reproductive Medicine.
http://www.sart.org/detail.aspx. Accessed August 9, 2012.

Centers for Disease Control and Prevention. http://www.cdc.gov/reproductivehealth/infertility. Accessed August 9, 2012.

National Institutes of Health. NICHD. Infertility/Fertility. http://www.nichd.nih.gov/health/topics/infertility_fertility.cfm. Accessed August 9, 2012.

The National Infertility Association. http://www.resolve.org. Accessed August 9, 2012.