Understanding Infertility

By Dr. Anitha Nair, Reproductive Endocrinologist, Shady Grove Fertility Centers, Washington, DC

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Eighty five percent of all couples trying to conceive will become pregnant within one year. Approximately 7 million, or 1 in 6 couples, will have difficulty conceiving and may need medical help to identify and treat the possible causes of infertility. The good news is that there are treatments now to help almost everyone.


Infertility is a disease of the reproductive system that inhibits a couple's ability to have a baby. Infertility affects men and women equally without discrimination and for this reason both partners should actively participate in the diagnosis and treatment process .  Infertility is not uncommon and you are not alone.


Forty percent of all infertility cases may be attributed to the woman, 40% to the man, in 10% of cases both partners contribute to the problem, and 10% of the time the cause can not be identified and it is unexplained.

Defining Infertility
The standard definition of infertility is the inability to achieve a pregnancy after one year of unprotected intercourse in couples where the woman is under age 35. Because a woman's fertility declines naturally as she gets older, couples should consider seeking medical help after 6 months of trying when the female partner is over age 35.


The Importance of a Woman's Age
A woman's fertility peaks in her mid-20s, begins to decline around 27 and drops off more steeply after age 35. A woman's fertility is measured by her ability to achieve a pregnancy on a given month. For women, the ability to conceive is tied to the quality of her eggs. As women age, hormonal changes begin to take place. There is a lot going on but of particular interest are the 2 main hormones controlling the development and release of the egg each month. These are FSH (follicle stimulating hormone) LH (lutenizing hormone).


A rising FSH level is linked to a decreasing egg quality. Decreased egg quality means it becomes more difficult for the sperm to fertilize the egg naturally. There may even be chromosomal abnormalities occurring within the egg itself, which is why amniocentesis is recommended for pregnant women over 35.


To illustrate this point, the natural pregnancy rate for women under 30 is 20-30% per month, but by age 40 the likelihood of conception occurring drops to less than 5% per month.


If You Suspect Infertility
If you are over 35 or if you suspect that past medical history may be impacting your fertility, run don't walk to the nearest fertility center. If you are under 35, a good first step is to consult with your primary care doctor or OB/GYN who can do the basic testing and determine a diagnosis. Don't let cost get in the way of scheduling that first appointment because most insurance plans will cover an initial consultation, and what you learn will be invaluable and may even put you on the road to parenthood.

Dr. Anitha Nair

Article written by Dr. Anitha Nair
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