Introduction
Infertility is the inability of a couple to achieve a pregnancy after repeated intercourse without contraception for 1 year.
Infertility affects about one of five couples in the United States. It is becoming increasingly common because people are waiting longer to marry and to have a child. Nevertheless, up to 60% of the couples who have not conceived after a year of trying do conceive eventually, with or without treatment. The goal of treatment is to reduce the time needed to conceive or to provide couples who might not otherwise conceive the opportunity to do so. Before treatment is begun, counseling that provides information about the treatment process (including its duration) and the chances of success is beneficial.
The cause of infertility may be due to problems in the man, the woman, or both. Problems with sperm, ovulation, or the fallopian tubes each account for almost one third of infertility cases. In a small percentage of cases, infertility is caused by problems with mucus in the cervix or by unidentified factors. Thus, the diagnosis of infertility problems requires a thorough assessment of both partners.
Age is a factor, primarily for women. As women age, becoming pregnant becomes more difficult and the risk of complications during pregnancy increases. Also, women, particularly after age 35, have a limited time to resolve infertility problems before menopause.
Even when no cause of infertility can be identified, the couple may still be treated. In such cases, the woman may be given drugs to stimulate several eggs to mature and be released--so-called fertility drugs (see Section 22, Chapter 254). Examples are clomiphene and human gonadotropins. A woman's chances of becoming pregnant are about 10 to 15% with each month of treatment. Alternatively, an artificial insemination technique that selects only the most active sperm may be tried.
While a couple is undergoing treatment for infertility, one or both partners may experience frustration, emotional stress, feelings of inadequacy, and guilt. They may alternate between hope and despair. Feeling isolated and unable to communicate, they may become angry at or resentful toward each other, family members, friends, or the doctor. The emotional stress can lead to fatigue, anxiety, sleep or eating disturbances, and an inability to concentrate. In addition, the financial burden and time commitment involved in diagnosis and treatment can cause marital strife.
These problems can be lessened if both partners are involved in and are given information about the treatment process, regardless of which one has the diagnosed problem. Knowing what the chances of success are, as well as realizing that treatment may not be successful and cannot continue indefinitely, can help a couple cope with the stress. Information about when to end treatment, when to seek a second opinion, and when to consider adoption is also helpful. Counseling and psychologic support, including support groups such as RESOLVE and the American Infertility Association, can help.
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