Infertility is defined as trying to get pregnant (with frequent intercourse) for at least a year with no success. Female infertility, male infertility or a combination of the two affects millions of couples. An estimated 10 to 18 percent of couples have trouble getting pregnant or having a successful delivery.
The main symptom of infertility is the inability to get pregnant. A menstrual cycle that’s too long (35 days or more), too short (less than 21 days), irregular or absent can mean that you’re not ovulating. There may be no other outward signs or symptoms.
For pregnancy to occur, every step of the human reproduction process has to happen correctly. The steps in this process are:
- One of the two ovaries releases a mature egg.
- The egg is picked up by the fallopian tube.
- Sperm swim up the cervix, through the uterus and into the fallopian tube to reach the egg for fertilization.
- The fertilized egg travels down the fallopian tube to the uterus.
- The fertilized egg implants and grows in the uterus.
Infertility treatment depends on the cause, your age, how long you’ve been infertile and personal preferences. Because infertility is a complex disorder, treatment involves significant financial, physical, psychological and time commitments.
Fertility drugs generally work like the natural hormones — follicle-stimulating hormone (FSH) and luteinizing hormone (LH) — to trigger ovulation. They’re also used in women who ovulate to try to stimulate a better egg or an extra egg or eggs. Fertility drugs may include:
- Clomiphene citrate. Clomiphene (Clomid) is taken by mouth and stimulates ovulation by causing the pituitary gland to release more FSH and LH, which stimulate the growth of an ovarian follicle containing an egg.
- Gonadotropins. Instead of stimulating the pituitary gland to release more hormones, these injected treatments stimulate the ovary directly to produce multiple eggs. Gonadotropin medications include human menopausal gonadotropin or hMG(Menopur) and FSH (Gonal-F, Follistim AQ, Bravelle).
- Metformin. Metformin (Glucophage, others) is used when insulin resistance is a known or suspected cause of infertility, usually in women with a diagnosis of PCOS. Metformin helps improve insulin resistance, which can improve the likelihood of ovulation.