What is Infertility?

In general, infertility is defined as not being able to get pregnant (conceive) after one year (or longer) of unprotected sex. Because fertility in women is known to decline steadily with age, some providers evaluate and treat women aged 35 years or older after 6 months of unprotected sex. Women with infertility should consider making an appointment with a reproductive endocrinologist—a doctor who specializes in managing infertility. Reproductive endocrinologists may also be able to help women with recurrent pregnancy loss, defined as having two or more spontaneous miscarriages.

Pregnancy is the result of a process that has many steps. To get pregnant:

A woman’s body must release an egg from one of her ovariesexternal icon
A man’s sperm must join with the egg along the way (fertilize).
The fertilized egg must go through a fallopianexternal icon toward the uterusexternal icon (womb).
The embryo must attach to the inside of the uterus (implantation).

Infertility may result from a problem with any or several of these steps.

Impaired fecundity is a condition related to infertility and refers to women who have difficulty getting pregnant or carrying a pregnancy to term.

Is infertility just a woman's problem?

No, infertility is not always a woman’s problem. Both men and women can contribute to infertility.

What causes infertility in men?

Infertility in men can be caused by different factors and is typically evaluated by a semen analysis. When a semen analysis is performed, the number of sperm (concentration), motility (movement), and morphology (shape) are assessed by a specialist. A slightly abnormal semen analysis does not mean that a man is necessarily infertile. Instead, a semen analysis helps determine if and how male factors are contributing to infertility.

Disruption of testicular or ejaculatory function

Varicocele, a condition in which the veins within a man’s testicle are enlarged. Although there are often no symptoms, varicoceles may affect the number or shape of the sperm.
Trauma to the testes may affect sperm production and result in lower number of sperm.
Heavy alcohol use, smoking, anabolic steroid use, and illicit drug use.
Cancer treatment involving certain types of chemotherapy, radiation, or surgery to remove one or both testicles.
Medical conditions such as diabetes, cystic fibrosis, certain types of autoimmune disorders, and certain types of infections may cause testicular failure.

Hormonal disorders

Improper function of the hypothalamus or pituitary glands. The hypothalamus and pituitary glands in the brain produce hormones that maintain normal testicular function. Production of too much prolactin, a hormone made by the pituitary gland (often due to the presence of a benign pituitary gland tumor), or other conditions that damage or impair the function of the hypothalamus or the pituitary gland may result in low or no sperm production.
These conditions may include benign and malignant (cancerous) pituitary tumors, congenital adrenal hyperplasia, exposure to too much estrogen, exposure to too much testosterone, Cushing’s syndrome, and chronic use of medications called glucocorticoids.

Genetic disorders

Genetic conditions such as a Klinefelter’s syndrome, Y-chromosome microdeletion, myotonic dystrophy, and other, less common genetic disorders may cause no sperm or low numbers of sperm to be produced.

What increases a man’s risk of infertility?

Age. Although advanced age plays a much more important role in predicting female infertility, couples in which the male partner is 40 years old or older are more likely to report difficulty conceiving.
Being overweight or obese.
Smoking.
Excessive alcohol and drug use (opioids, marijuana).
Exposure to testosterone. This may occur when a doctor prescribes testosterone injections, implants, or topical gel for low testosterone, or when a man takes testosterone or similar medications illicitly for the purposes of increasing their muscle mass.
Exposure to radiation.
Frequent exposure of the testes to high temperatures, such as that which may occur in men confined to a wheelchair, or through frequent sauna or hot tub use.
Exposure to certain medications such as flutamide, cyproterone, bicalutamide, spironolactone, ketoconazole, or cimetidine.
Exposure to environmental toxins including exposure to pesticides, lead, cadmium, or mercury.

What increases a woman's risk of infertility?

Female fertility is known to decline with

About 1 in 5 (22%) couples in which the woman is 30-39 have problems conceiving their first child, compared to about 1 in 8 (13%) couples in which the woman is younger than 30. Fertility declines with age primarily because egg quality declines over time. In addition, older women have fewer eggs left and they are more likely to have health conditions that can cause fertility problems. Aging also increases a woman’s chances of miscarriageexternal iconand of having a child with a genetic abnormality
Smoking.
Excessive alcohol use.
People with overweight or obesity or underweight.
Extreme weight gain or loss.
Excessive physical or emotional stress that results in amenorrhea (absent periods).

What Is Reproduction?

Reproduction is the process by which organisms make more organisms like themselves. But even though the reproductive system is essential to keeping a species alive, unlike other body systems, it's not essential to keeping an individual alive

In the human reproductive process, two kinds of sex cells, or gametes (GAH-meetz), are involved. The male gamete, or sperm, and the female gamete, the egg or ovum, meet in the female's reproductive system. When sperm fertilizes (meets) an egg, this fertilized egg is called a zygote (pronounced: ZYE-goat). The zygote goes through a process of becoming an embryo and developing into a fetus.

The male reproductive system and the female reproductive system both are needed for reproduction.

Humans, like other organisms, pass some characteristics of themselves to the next generation. We do this through our genes, the special carriers of human traits. The genes that parents pass along are what make their children similar to others in their family, but also what make each child unique. These genes come from the male's sperm and the female's egg.

What Is the Female Reproductive System?

The external part of the female reproductive organs is called the vulva, which means covering. Located between the legs, the vulva covers the opening to the vagina and other reproductive organs inside the body.

The fleshy area located just above the top of the vaginal opening is called the mons pubis. Two pairs of skin flaps called the labia (which means lips) surround the vaginal opening. The clitoris, a small sensory organ, is located toward the front of the vulva where the folds of the labia join. Between the labia are openings to the urethra (the canal that carries pee from the bladder to the outside of the body) and vagina. When girls become sexually mature, the outer labia and the mons pubis are covered by pubic hair.

A female's internal reproductive organs are the vagina, uterus, fallopian tubes, and ovaries.

The vagina is a muscular, hollow tube that extends from the vaginal opening to the uterus. Because it has muscular walls, the vagina can expand and contract. This ability to become wider or narrower allows the vagina to accommodate something as slim as a tampon and as wide as a baby. The vagina's muscular walls are lined with mucous membranes, which keep it protected and moist.

The vagina serves three purposes:

It's where the penis is inserted during sexual intercourse.
It's the pathway (the birth canal) through which a baby leaves a woman's body during childbirth.
It's the route through which menstrual blood leaves the body during periods.

A very thin piece of skin-like tissue called the hymen partly covers the opening of the vagina. Hymens are often different from female to female. Most women find their hymens have stretched or torn after their first sexual experience, and the hymen may bleed a little (this usually causes little, if any, pain). Some women who have had sex don't have much of a change in their hymens, though. And some women's hymens have already stretched even before they have sex.

The vagina connects with the uterus, or womb, at the cervix (which means neck). The cervix has strong, thick walls. The opening of the cervix is very small (no wider than a straw), which is why a tampon can never get lost inside a girl's body. During childbirth, the cervix can expand to allow a baby to pass.

The uterus is shaped like an upside-down pear, with a thick lining and muscular walls — in fact, the uterus contains some of the strongest muscles in the female body. These muscles are able to expand and contract to accommodate a growing fetus and then help push the baby out during labor. When a woman isn't pregnant, the uterus is only about 3 inches (7.5 centimeters) long and 2 inches (5 centimeters) wide.

There are two fallopian (pronounced: fuh-LO-pee-un) tubes, each attached to a side of the uterus. Within each tube is a tiny passageway no wider than a sewing needle. At the other end of each fallopian tube is a fringed area that looks like a funnel. This fringed area wraps around the ovary but doesn't completely attach to it. When an egg pops out of an ovary, it enters the fallopian tube. Once the egg is in the fallopian tube, tiny hairs in the tube's lining help push it down the narrow passageway toward the uterus.

The ovaries (pronounced: OH-vuh-reez) are also part of the endocrine system because they produce female sex hormones such as estrogen (pronounced: ESS-truh-jun) and progesterone (pronounced: pro-JESS-tuh-rone).

How Does the Female Reproductive System Work?

The female reproductive system enables a woman to:

Produce eggs (ova)
Have sexual intercourse
Protect and nourish a fertilized egg until it is fully developed
Give birth

Sexual reproduction couldn't happen without the sexual organs called the gonads. Most people think of the gonads as the male testicles. But both sexes have gonads: In females the gonads are the ovaries, which make female gametes (eggs). The male gonads make male gametes (sperm).

When a baby girl is born, her ovaries contain hundreds of thousands of eggs, which remain inactive until puberty begins. At puberty, the pituitary gland (in the central part of the brain) starts making hormones that stimulate the ovaries to make female sex hormones, including estrogen. The secretion of these hormones causes a girl to develop into a sexually mature woman.

Unless the egg is fertilized by a sperm while in the fallopian tube, the egg leaves the body about 2 weeks later through the uterus — this is menstruation. Blood and tissues from the inner lining of the uterus combine to form the menstrual flow, which in most girls lasts from 3 to 5 days. A girl's first period is called menarche (pronounced: MEH-nar-kee).

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