A couple's inability to become pregnant has been a source of personal and marital stress since biblical times. The medical definition of infertility is: the inability of a couple to become pregnant after one year of trying to do so. Depending on the couple's situation, an evaluation may be started before a year has passed. It is estimated that 10-15% of married couples in the U.S. have this problem.

There are many causes of infertility. Statistically, it appears that in approximately 40% of couples there is a female factor responsible and in another 40%, a male cause is found. In about 10% of couples both partners are found to have a cause for the problem and in about 10% no cause can be found at all. Couple is the key word here, infertility is a shared problem and both partners need to be involved for a successful evaluation.

To understand the problem of infertility, one must consider the process. For a couple to become pregnant, four things need to occur:

1) Female egg production with ovulation - There are several hormonal conditions in women which lead to faulty egg production and anovulation (no ovulation). There are medications that can treat many of the causes of this. Clomid and others drugs can help many of these women become pregnant.

2) Normal sperm production - Semen analysis (SA) examines for this. SA looks for evidence of on going infections and at the quality of sperm, as well as quantity. Infections can be treated with antibiotics, but other abnormalities that are found may not be treated as simply or may not be treated at all. A semen donor may be considered at this time.

3) Egg and sperm must reach each other and successfully unite - For this to happen the female must have an open passage. The tubes can be evaluated with an X-ray test to see if they are open. If the tubes are blocked, laparoscopy can be done to see why. This is a day surgery that looks in the abdomen though a tiny incision. It can determine the cause of the blockage and also may allow treatment with a laser at the same time. Endometritis, if found can be treated with medications such as Danazol and infections can be treated with antibiotics. Severe scars once formed frequently must be removed with full open surgery.

4) The fertilized egg must travel down the tube and implant in the womb's lining - The same problem of tubal injury that can block conception can also prevent the fertilized egg from reaching the uterus. This can result in tubal pregnancies. Once the egg finally reaches the uterus the lining must still accept it and help it establish the ability to obtain oxygen and nutrition from the mother's blood. Hormonal problems as well as uterine abnormalities can prevent this and lead to a miscarriage.

This has been a brief overview of some of the causes and treatments of infertility. Unfortunately, even once found, the causes can not always be treated successfully, but this too allows decisions to be made, such as an adoption or the use of I.V.F. (in vitro fertilization). I.V.F. bypasses some of the problems we have not been able to overcome. The egg and sperm are put together in a lab and then the fertilized egg is put into the uterus. This is quite expensive now, but hopefully will be less so in the not too distant future.

Fortunately, while we await advances in technology to give us more answers, further advances in technology to give us more answers, further advances in time will give us more pregnancies.