Infertility is defined as not being able to get pregnant or conceive after one year or longer of unprotected sex. As fertility in women is known to decline steadily with age, some doctors evaluate and treat women aged 35 years or older after 6 months of unprotected sex.

There are two types of infertility: primary infertility, where someone who's never conceived a child in the past has difficulty conceiving and secondary infertility, where someone who has had 1 or more pregnancies in the past is having difficulty conceiving again.

Pregnancy is the result of a process that has many steps. To get pregnant, a woman’s body must release an egg, a man’s sperm must join with the egg along the way, the fertilized egg must go to the womb and the embryo must attach to the inside of the uterus. Infertility may result from a problem with any or several of these steps. Therefore, infertility is not always a woman’s problem. Both men and women can contribute to infertility.

How is infertility caused?

Women can be infertile due to problems with ovulation. Ovulation problems can be a result of: polycystic ovary syndrome (PCOS), diminished ovarian reserve, fallopian tube obstruction, physical characteristics of the uterus, endometriosis, stress or menopause. Some health problems increase the risk of infertility. Hence, women with irregular periods or no menstrual periods, a history of pelvic    inflammatory    disease or a history of more than one miscarriage, should not delay seeing a doctor when they are trying to become pregnant.

Men can be infertile due to poor quality semen, hormonal and genetic disorders or disruption of testicular or ejaculatory function through trauma to the testes and medical conditions. Prior hernia surgery, exposure to testosterone, prior use of chemotherapy, a history of infertility with another partner and sexual dysfunction are some of the health problems that increase the risk of infertility for men.

Age, smoking, excessive alcohol and drug use, being overweight or underweight, certain medications, sexually transmitted diseases, environmental toxins and high temperatures can increase infertility in both sexes.  

When to see a doctor. 

Experts suggest women younger than 35 years with no apparent health or fertility problems and regular menstrual cycles should try to conceive for at least one year before seeing a reproductive endocrinologist, a doctor who specializes in managing infertility. However, women aged 35 years or older, should see an endocrinologist after 6 months of trying unsuccessfully. Women over 40 years may consider seeking more immediate evaluation and treatment. 

Doctors know if one is infertile by collecting medical and sexual history from both partners. The initial evaluation usually includes a semen analysis, a tubal evaluation, and ovarian reserve testing.  

Infertility can be treated with medicine, surgery, artificial insemination or assisted reproductive technology such as in vitro fertilization (IVF). Often, medication and artificial insemination are used at the same time. Doctors recommend specific treatments depending on the factors contributing to infertility, the duration of infertility, age and the couple’s treatment preference.  

It is advised for a couple to see a doctor before trying to get pregnant as they can assist in getting your body ready for a healthy baby, can answer questions on fertility and give advice on conceiving. 

Conceiving isn’t always easy. The fertility process is an emotional roller coaster and it is easy to get discouraged. If you and your spouse are having fertility difficulty, you’re not alone. Staying positive is an extremely important part of your fertility journey. Be gentle with yourself knowing that you’re doing the best you can and that even miracles take a little time.