For most couples trying to have a baby, getting pregnant takes an average of six months. After having frequent, unprotected (without using birth control) intercourse for one year, about 10-15% of couples in their 20's and early 30's have difficulty getting pregnant.
Difficulty getting pregnant jumps to 40-50%
in women in their late 30's and 40's.
When this happens, the couple most likely has
a problem with infertility.
Women
A woman's most fertile years are from age 16-24, after which fertility begins to decline as age increases and the likelihood of conceiving drops significantly. About 90% of all infertility cases can be traced to specific causes (some listed below) that can be diagnosed and treated. Over two-thirds of infertile couples who seek treatment can have children, therefore, a couple should seek help as soon as they suspect an infertility problem.
Men
As in women, men produce follicle-stimulating hormone (FSH) and luteinizing hormone (LH) in their pituitary glands. The pituitary gland is, in turn, controlled by an area in a man's brain known as the hypothalamus, which sends out a hormone known as GnRH, or gonadotropin-releasing hormone. GnRH “tells” the man's pituitary when to release FSH and LH. A man's LH travels to his testes where it stimulates Leydig Cells to produce testosterone, the male hormone. Then, testosterone, along with FSH, stimulates Germ Cells in the testes to produce sperm. Any disruption in this system may interfere with a man's ability to produce sperm, as well as his ability to successfully engage in sexual intercourse.
Abnormal Sperm Production and Function
Impaired Delivery of Sperm
General health, Lifestyle Issues, and Environmental Exposures
Unexplained infertility
In some couples, no obvious cause for their infertility is found. This is called unexplained infertility and may occur in 5 percent or less of couples after the work-up and evaluation are completed.
Unexplained infertility simply means that we do not know why the couple is not fertile - essentially, it is a confession of medical ignorance. People with unexplained infertility do have a cause for their infertility, but due to limitations of our current testing, we cannot determine the reason.
Although we have made great strides in understanding human reproduction, there is much more to learn. With time, some causes for what we call unexplained infertility will be better understood.
The diagnosis is one of exclusion-that is, one that is made only after all the tests have been performed and their results found to be normal.
Infertility may be labeled as "unexplained" when:
The woman is ovulating regularly, has open fallopian tubes with no evidence of adhesions or endometriosis
The man has normal sperm production sexual intercourse takes place frequently, particularly around the time of ovulation
The couple has been trying to conceive for at least one year
Because unexplained infertility carries no specific diagnosis, the treatment recommended by fertility specialists is empiric. This means that the treatment is done to optimize a couple's chance of successful conception but is not used to treat or overcome a specific problem.
In some instances, couples with unexplained infertility will conceive over time. In fact, fifty percent of couples diagnosed with unexplained infertility, who have never had a child before, will conceive within five-and-a-half years. And, if the couple has had a previous child, fifty percent will conceive within two to three years.