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Infertility is usually defined as the inability to conceive after having sexual intercourse without using contraception (birth control). Women under age 35 are said to be infertile if they do not conceive after a year of trying and their partner has no infertility or sterility issues. In women age 35 and older, infertility is determined after six months of unsuccessful attempts to become pregnant. Infertility is a diminished capacity to conceive. It is different from sterility which is a complete inability to conceive.

According to the American Society for Reproductive Medicine (ASRM), infertility affects about 6.1 million couples (about 10 percent of the reproductive age population) in the United States. Infertility affects both men and women equally.

There are many risk factors for both female and male infertility, including:

• Age. A woman’s fertility gradually declines after age 35. Less is known about infertility and age in men, although in general fertility declines after age 35. However, many women over 35 successfully conceive and deliver a healthy baby.
  
  
• Smoking and drinking alcohol. Both decrease the chance of conception.
  
  
• Being overweight or underweight. Infertility among American women is often due to being overweight or not getting enough exercise. Having a low body weight also has been associated with increased risk of miscarriage (unplanned ending of a pregnancy before viability of the fetus).

Common causes of female infertility include damage or blockage of the fallopian tubes, often resulting from pelvic inflammatory disease (a bacterial infection of the reproductive organs and the leading cause of ectopic pregnancy), endometriosis, polycystic ovarian syndrome (PCOS) and uterine fibroids among others. Some common causes of male infertility include abnormal sperm production or function and impaired delivery of sperm.

In addition to a physical examination, a physician, typically an obstetrician-gynecologist (ObGyn), will perform several diagnostic tests in the evaluation of infertility. Women may receive a blood test to determine the level of hormones involved in ovulation and a hysterosalpingography, which evaluates the condition of the uterus and fallopian tubes. Men may also receive a blood test to determine their testosterone level as well as a semen analysis (a specimen of ejaculated semen is analyzed for quantity, color and presence of infections or blood).

Treatment for infertility depends on the cause and duration of the problem, the woman and man’s age and the couple’s treatment preferences. Couples seeking to conceive using fertility treatments may face some difficult decisions. For many, religious beliefs play a role in determining whether or not to have fertility treatments.

Fertility treatments may involve the woman or the man or both. They can include medication, surgery or methods of assisted reproductive technology (ART), such as in vitro fertilization ([IVF] a technique in which the woman’s eggs are removed and combined with sperm outside the body to achieve fertilization) or artificial insemination (a technique in which sperm is placed into a woman’s ovarian follicle, uterus, cervix or fallopian tubes by artificial means rather than sexual intercourse).  

When fertilization is successful, there can also be complications. Fertility treatments may result in multiple pregnancy, in which women carry twins, triplets or more babies. They may also result in miscarriage. Carrying multiple fetuses also increases a woman’s risk of delivering prematurely. In an effort to reduce this risk, the ASRM issued guidelines last year to decrease the rate of multiple pregnancies in patients using ART. Among its recommendations, the ASRM is urging for only a limited number of embryos – in some cases only one – to be transferred during IVF procedures.

Couples and women without male partners who want to have a baby and are unable to conceive through fertility treatments may choose adoption (legal act of permanently placing a child with a parent or parents other than the biological parents).