Frequently Asked Questions
Infertility is a disease of the reproductive system that
impairs one of the body's most basic functions: the conception of children.
Conception is a complicated process that depends upon many factors: on
the production of healthy sperm by the man and healthy eggs by the woman,
unblocked fallopian tubes that
allow the sperm to reach the egg, the sperm's ability to fertilize the
egg when they meet, the ability of the fertilized egg (embryo)
to become implanted in the woman's uterus, and sufficient embryo quality.
Finally, for the pregnancy to continue to full term, the embryo must be
healthy and the woman's hormonal environment adequate for its development.
When just one of these factors is impaired, infertility can result.
In rough terms, about one-third of infertility cases can
be attributed to male factors, and about one-third to female factors.
For the remaining one-third of infertile couples, infertility is caused
by a combination of problems in both partners or, in about 20 percent
of cases, is unexplained.
The most common male infertility factors include azospermia
(no sperm cells are produced) and oligospermia
(few sperm cells are produced). Sometimes, sperm cells are malformed or
they die before they can reach the egg. In rare cases, a genetic disease
such as cystic fibrosis or a chromosomal abnormality causes infertility
The most common female infertility factor is an ovulation
disorder. Other causes of female infertility include blocked fallopian
tubes, which can occur when a woman has had pelvic
inflammatory disease or endometriosis
(a sometimes painful condition causing adhesions and cysts). Congenital
anomalies (birth defects) involving the structure of the uterus and uterine
fibroids can be associated with repeated miscarriages.
Couples are generally advised to seek medical help if they
are unable to achieve pregnancy after a year of unprotected intercourse.
The doctor will ask many questions and conduct a physical examination
of both partners to determine their general state of health and to evaluate
physical disorders that may be causing infertility. Usually both partners
are interviewed about their sexual habits in order to determine whether
intercourse is taking place properly for conception. If no cause can be
determined at this point, more specific tests may be recommended. For
women, these include an analysis of ovulation, x-ray of the fallopian
tubes and uterus, and perhaps a laparoscopy. For men, the initial test
is a semen analysis.
Eighty five to 90 percent of infertility cases are addressed
through conventional therapies, such as drug treatment or surgical repair
of reproductive organs. A recent
government survey reported that only five percent of infertility cases
was treated with in vitro fertilization. However, theres no guarantee
that the woman will become pregnant and most importantly, carry the child
to term. While infertility treatments have helped many couples have children,
success rates differ depending on the type of treatment.
The degree of services covered depends on where you live
and the type of insurance plan you have. Fourteen states currently have
laws that require insurers to either cover or offer to cover some form
of infertility diagnosis and treatment. Those states are Arkansas, California,
Connecticut, Hawaii, Illinois, Maryland, Massachusetts, Montana, New Jersey,
New York, Ohio, Rhode Island, Texas, and West Virginia. While state laws
vary greatly in their scope of coverage, the average couple going through
infertility treatments pays at least half of their expenses out of pocket.
The costs for these procedures and medications vary widely. On the low
end, fertility drugs such as hormone therapy (used to induce ovulation
or sperm development) run from $200 - $300 a month. In vitro fertilization,
on the other hand (in which the egg is fertilized outside the woman) costs
$8,000 to $13,000 per treatment. For more information about state laws,
refer to the State Infertility
Insurance Laws page of the ASRM website.
ASRM believes the desire to have children and be parents
is one of the most fundamental aspects of being human. People should not
be denied insurance coverage for medically appropriate treatment to fulfill
What impact does infertility have on psychological well-being?