Infertility
What is Infertility?
Infertility is the inability to become pregnant after 12 months or more of regular unprotected intercourse. For women over 35, doctors typically define infertility as six months of trying without success. This condition affects about 1 in 8 couples in the United States.
Infertility can stem from issues in either partner or a combination of factors. In women, it often involves problems with ovulation, hormone balance, or the reproductive organs. In men, it typically relates to sperm production, sperm quality, or blockages in the reproductive tract. About one third of cases trace back to female factors, one third to male factors, and one third to combined or unexplained causes.
Understanding the root causes of infertility often begins with hormone testing and physical evaluation. Blood tests can reveal imbalances in key reproductive hormones like follicle stimulating hormone and progesterone. Many cases of infertility respond well to treatment once the underlying cause is identified. Early testing helps couples move forward with informed decisions about their reproductive health.
Symptoms
- Inability to conceive after 12 months of trying, or six months if over age 35
- Irregular or absent menstrual periods in women
- Very painful or heavy periods
- Hormonal fluctuations causing skin changes, weight gain, or facial hair growth
- Pain during intercourse
- Low sex drive or erectile dysfunction in men
- Small or firm testicles in men
- Changes in hair growth patterns
Many people with infertility have no obvious symptoms beyond difficulty conceiving. Hormone imbalances and structural issues can exist without causing noticeable problems. This is why testing becomes essential when pregnancy does not occur within the expected timeframe.
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Causes and risk factors
Infertility has many potential causes that differ between men and women. In women, common causes include ovulation disorders related to hormone imbalances, polycystic ovary syndrome, endometriosis, blocked fallopian tubes, and age-related decline in egg quality. Low progesterone during the luteal phase can prevent the uterine lining from supporting a fertilized egg. Abnormal follicle stimulating hormone levels, either too high or too low, disrupt the maturation of eggs needed for conception. Infections like trichomoniasis can also create fertility complications if left untreated.
In men, infertility often results from low sperm production, poor sperm motility, or abnormal sperm shape. Hormonal imbalances, including abnormal follicle stimulating hormone levels, can impair sperm production. Varicoceles, infections, previous surgeries, and exposure to toxins or excessive heat can all affect male fertility. Lifestyle factors like smoking, heavy alcohol use, obesity, stress, and certain medications increase infertility risk in both partners. Age is a significant factor, especially for women over 35 and men over 40.
How it's diagnosed
Diagnosing infertility begins with a medical history review and physical examination for both partners. Doctors ask about menstrual cycles, previous pregnancies, sexual habits, medications, and lifestyle factors. For women, key diagnostic tests include hormone blood tests to measure follicle stimulating hormone, progesterone, luteinizing hormone, thyroid hormones, and other reproductive markers. These tests reveal whether ovulation is occurring normally and if hormone levels support pregnancy.
Rite Aid offers fertility hormone testing through our add-on panels, including FSH and progesterone tests that identify common hormonal causes of infertility. Additional diagnostic tools may include ultrasound imaging to examine reproductive organs, hysterosalpingography to check fallopian tube openness, and semen analysis for male partners. Some cases require specialized testing for infections like trichomoniasis that can affect fertility. Starting with blood work helps identify hormone-related issues before moving to more invasive procedures.
Treatment options
- Lifestyle modifications including maintaining a healthy weight, reducing stress, quitting smoking, and limiting alcohol intake
- Fertility medications like clomiphene citrate or letrozole to stimulate ovulation in women
- Hormone therapy to correct imbalances in progesterone, FSH, or other reproductive hormones
- Treatment of underlying infections with appropriate antibiotics
- Intrauterine insemination, where sperm is placed directly in the uterus during ovulation
- In vitro fertilization for more complex cases, where eggs and sperm are combined in a lab
- Surgery to correct structural problems like blocked tubes, endometriosis, or varicoceles
- Nutritional support with folate, vitamin D, omega-3 fatty acids, and antioxidants
- Timing intercourse around ovulation to increase conception chances
- Addressing thyroid disorders, diabetes, or other chronic conditions affecting fertility
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Frequently asked questions
Most doctors recommend seeking evaluation after 12 months of regular unprotected intercourse without pregnancy. If you are over 35, consider getting tested after six months of trying. Women over 40 should consult a doctor right away. Early testing can identify treatable causes and help you make informed decisions about your fertility options.
Key hormone tests include follicle stimulating hormone, which regulates egg and sperm production, and progesterone, which prepares the uterine lining for pregnancy. Doctors also measure luteinizing hormone, thyroid hormones, prolactin, and testosterone. These tests reveal whether ovulation is occurring and if hormone levels support conception. Rite Aid offers FSH and progesterone testing through our fertility add-on panels.
Yes, infertility affects both sexes in roughly equal proportions. About one third of infertility cases stem from female factors, one third from male factors, and one third from combined or unexplained causes. This is why both partners should undergo evaluation when conception does not occur within the expected timeframe. Male fertility testing typically starts with semen analysis and hormone blood work.
Low progesterone during the luteal phase, the time after ovulation, can prevent pregnancy by not preparing the uterine lining properly. The lining needs adequate progesterone to support implantation of a fertilized egg. Testing progesterone levels helps identify if this hormone deficiency is contributing to infertility. Treatment often includes progesterone supplementation or medications that support natural production.
Follicle stimulating hormone plays different but essential roles in both sexes. In women, FSH stimulates egg maturation in the ovaries each menstrual cycle. In men, it drives sperm production in the testicles. Both low and high FSH levels can signal fertility problems. High FSH often indicates declining ovarian reserve in women or testicular dysfunction in men.
Yes, certain infections can lead to fertility complications if left untreated. Trichomoniasis, a common sexually transmitted infection, can cause inflammation and scarring that affects fertility. Chlamydia and gonorrhea can also damage reproductive organs and create blockages. Testing for these infections is important during fertility evaluations. Most infections respond well to antibiotic treatment when caught early.
Maintaining a healthy weight is one of the most important factors, as both obesity and being underweight affect hormone balance. Quitting smoking, limiting alcohol to moderate amounts, reducing caffeine, and managing stress all support fertility. Regular exercise helps, but avoid excessive training that disrupts menstrual cycles. Eating a nutrient-dense diet with plenty of vegetables, healthy fats, and lean protein provides building blocks for reproductive hormones.
In vitro fertilization becomes an option when other treatments have not succeeded or when specific conditions make natural conception unlikely. These include blocked fallopian tubes, severe male factor infertility, advanced maternal age, or diminished ovarian reserve. Many couples try less invasive options first, like fertility medications or intrauterine insemination. Your doctor will recommend IVF based on your specific diagnosis, age, and how long you have been trying to conceive.
Age significantly impacts fertility, especially for women. Female fertility begins declining in the late 20s and drops more sharply after 35 due to decreasing egg quantity and quality. By age 40, the chance of pregnancy each cycle drops to about 5 percent. Male fertility also declines with age, though more gradually. Sperm quality and quantity decrease after 40, and genetic abnormalities become more common.
Yes, fertility hormone testing is available through blood work at clinical labs. Rite Aid offers FSH and progesterone testing through our add-on fertility panels at Quest Diagnostics locations nationwide. These tests help identify hormonal causes of infertility before pursuing more invasive procedures. Testing should be timed to specific days of your menstrual cycle for accurate results. Your healthcare provider can help interpret results and recommend next steps.