Fertility is the ability to conceive. Conception may take place through sexual intercourse between a man and a woman, or through assisted reproductive technology (ART).

Conception resulting from intercourse occurs after an egg is released from the ovaries during ovulation. It then moves into the fallopian tubes where it is joined by sperm. The fertilized egg (zygote) travels down to the uterus and implants itself into the uterine wall where it normally develops over a 40-week period.  

To maximize chances of conceiving, some women practice natural family planning, which involves using special methods to determine the best times to conceive. Some methods include keeping a fertility calendar to track basal body temperature (when the body is at rest) and monitor cervical mucus changes. This calendar can help women to determine the approximate time of ovulation.

Some women make lifestyles changes to enhance conception, such as taking vitamins and avoiding alcohol and smoking.

When a woman of childbearing age is unable to conceive after a year of having sexual intercourse without using contraception and her partner has no infertility or sterility issues, she is said to be infertile. Some of the most common causes of female infertility include fallopian tube damage or blockage caused by endometriosis or genital infections and ovulation abnormalities caused by polycystic ovarian syndrome (PCOS).

In addition to a physical examination, a physician will perform tests to diagnose infertility, such as a series of blood tests and a hysterosalpingography, which is a radiological study that evaluates the condition of the uterus and fallopian tubes.

Treatment for infertility depends on the cause and duration of the problem and the couple’s treatment preferences. There are a number of treatment options, including ovulation drugs, surgery and ART. Complications of fertility treatments include multiple pregnancy and miscarriage.

Fertility is the ability to conceive through sexual intercourse between a man and a woman, or through methods such as assisted reproductive technology (ART).

Under normal circumstances, a woman’s pituitary gland (endocrine gland about the size of a pea that sits at the base of the brain) sends a signal to the ovaries to prepare an egg for ovulation each month. The pituitary hormones involved in this process are follicle-stimulating hormone (FSH) and luteinizing hormone (LH). After a dominant follicle has developed from increasing FSH stimulation, then usually at midcycle a surge in LH will send a signal to the ovarian follicle to release an egg (ovulate). Ovulation on average occurs around day 14 of the menstrual cycle, although the exact timing varies among women and from month to month.

After the egg is released, it is picked up by the fallopian tube where it remains viable for about 24 hours. For conception to occur, sperm enters the body usually through sexual intercourse. Then, it must travel through the vagina, into the uterus and up into the fallopian tube to unite with the egg. Sperm are viable for up to 72 hours.

If fertilization occurs, the fertilized egg (zygote) travels down to the uterus and implants itself into the uterine wall, which develops into an embryo and then a fetus over a 40-week (approximately nine-month) period.

Though conception may seem straightforward, there are hundreds of variables that may influence the reproductive process. These variables may either prevent conception or result in an unplanned pregnancy.

Some women practice natural family planning, which is a method of determining the best times to conceive. This involves several techniques for determining when ovulation occurs, including:

• Keeping a fertility calendar. Women chart their menstrual cycles on a calendar by noting the days their period begins and ends. In women with a 28-day cycle, ovulation occurs about 14 days after the day the last period began. However, tracking ovulation can be difficult because numerous factors such as stress and illness can impact the timing of ovulation.
  
  
• Using an ovulation monitoring kit (this tests urine for the presence of hormones associated with ovulation). While these kits provide an accurate way to detect the time of ovulation, they can be costly, ranging from $20 to $50 apiece. They may also lead couples to time sex to occur too late after ovulation for conception.
  
  
• Tracking basal body temperature (temperature when the body is at rest). Ovulation may cause a jump in body temperature, usually between 0.5 to 1.6 degrees Fahrenheit (17.5 to 16.9 degrees Celsius). Women are most fertile during the two to three days prior to the temperature rise. Body temperature can be measured using an oral thermometer that can be purchased at a pharmacy. Women using this technique should take their temperature at the same time each morning (before getting out of bed) and identify patterns that emerge over the course of a month. Although this is a simple method, it may be difficult to identify ovulation because the temperature rise may be too subtle to detect or may occur after ovulation has already happened.
  
  
• Monitoring changes in the cervical mucus. Right before ovulation, there is an increase in a clear, slippery vaginal secretion that resembles raw egg whites. After ovulation, it becomes cloudy or sticky, or disappears. Although the change in the secretion is an accurate way to detect ovulation, judging the appearance of the secretion can be difficult.

Some women also consider making lifestyle changes that have been identified as impacting fertility. Among them are:

• Having regular sex. Couples trying to conceive should have sex frequently (at least two or three times a week). Around the time a woman is ovulating, the frequency should increase to once a day.
  
  
• Maintaining a healthy lifestyle. Maintaining a normal weight, exercising regularly and eating a healthy and varied diet can help a woman conceive. They are also important practices during pregnancy. A physician, typically an obstetrician, can help identify lifestyle changes that improve chances of conceiving and a healthy pregnancy.
  
  
• Taking vitamins. Folic acid (vitamin B-9) plays an important role in a baby’s development. Taking a prenatal vitamin or folic acid supplement at least one month before conception through the first trimester of pregnancy can reduce the risk of some birth defects, especially neural tube defects such as spina bifida.
  
  
• Quitting smoking. Women should quit smoking because tobacco changes the cervical mucus, which may prevent sperm from reaching the egg. Quitting smoking may also decrease the risk of miscarriage.
  
  
• Avoiding alcohol. Women should avoid drinking alcohol if they are trying to conceive or are pregnant.
  
  
• Avoiding certain medications. Some medications can make conceiving more difficult. Patients should consult with a physician before taking any medication to determine whether it will impact conception as well as pregnancy.

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).

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor or healthcare professional the following questions about fertility issues:

1. I’m unable to get pregnant. Does this mean I’m infertile?
   
   
2. Can my inability to conceive be caused by my partner?
   
   
3. What are some of the ways I can maximize my chances of conceiving naturally?
   
   
4. How long should I try to conceive before I seek treatment for infertility?
   
   
5. What diagnostic tests will you be performing on me to confirm infertility? Will my partner require testing?
   
   
6. What are some of the treatments that are available for me? Will my partner require treatment?
   
   
7. What is your experience in treating infertility?
   
   
8. Should I take ovulation drugs? Are there side effects with taking these medications?
   
   
9. What are the risks with in vitro fertilization?
   
   
10. What are my options if I’m still unable to get pregnant after receiving fertility treatments?
    
    
11. Do you recommend any lifestyle changes that can improve my chances of getting pregnant? Does my partner need to incorporate these changes as well?
    
    
12. Do you know of any support groups for couples with fertility problems?