Patient education: Infertility in couples (The Basics)

Why are we having trouble getting pregnant? — For some people, pregnancy happens easily, while others have a harder time.

There are different reasons why a couple might have trouble getting pregnant. For example, there could be a problem with 1 or both partners.

When a couple has trouble getting pregnant, doctors often do tests in both partners to try to figure out the cause. But even with tests, doctors sometimes cannot figure out why a couple can't get pregnant.

When should we see a doctor? — Most doctors recommend that a couple begin having tests if they cannot get pregnant after having unprotected sex for 1 year. But if you are worried, talk with your doctor or nurse sooner. They might recommend that you or your partner have tests done sooner if you are age 35 or older, or have medical problems.

What tests are done for male infertility? — When the problem is with the person who is trying to get their partner pregnant, this is called "male infertility." Doctors also sometimes use the term "male factor infertility."

If your doctor suspects that male infertility might be the problem, they will ask you questions about your health and sex history, and do an exam. They will often order a test called a "semen analysis." This test checks how many sperm you make and how healthy they are.

Other tests might include:

●Blood tests – Some blood tests check male hormone levels. Abnormal hormone levels can make it hard to get your partner pregnant. Other blood tests can check if you have a genetic condition that can make it hard to get your partner pregnant.

●Ultrasound – This imaging test creates pictures of the inside of the body and can check for problems with the sex organs (figure 1). For example, there could be a blockage in the "vas deferens," which is the tube that sperm travels through.

●Biopsy – A biopsy might be done if a semen analysis shows that you have no sperm or a very small amount of sperm. During a biopsy, a doctor collects a small tissue sample from inside the testicle. Then, they look at the sample under a microscope to check if sperm are present.

What tests are done for female infertility? — When the problem is with the person who is trying to get pregnant, this is called "female infertility." Doctors also sometimes use the term "female factor infertility."

If your doctor suspects that female infertility might be the problem, they will ask you questions about your health, monthly periods, and sex history. They will also do an exam.

You might have 1 or more of the following tests:

●Blood tests – Blood tests can check female hormone levels. Abnormal hormone levels can make it hard to get pregnant. Blood tests can also be done to check for genetic problems that can make it hard to get pregnant.

●Ovulation tests – Different tests can be used to check if you are ovulating. Ovulation is the time in your monthly cycle when your ovary releases an egg into your fallopian tube (figure 2). If this does not happen, the egg cannot be fertilized, which is how pregnancy happens (figure 3).

●Tests to check the uterus and fallopian tubes – Problems with the fallopian tubes and uterus can make it hard to get pregnant. Tests to look for these problems include:

•Ultrasound, X-ray, or other imaging tests – These tests create pictures of the inside of the body. They can check for an abnormally shaped uterus, blockages in the tubes (which can be related to past infection or surgery), and other problems.

•Tests that look inside the body – These tests are not as simple as imaging tests, because they involve procedures. A doctor can look inside the body using a small tube with a camera on the end. They can put the tube into the vagina, past the cervix, and up into the uterus to look at the inside of the uterus. They can also put the tube through a small opening in the skin in the lower part of the belly to look at the outside of the uterus, fallopian tubes, and ovaries.

What happens after the tests? — Test results might show that 1 or both partners have a problem that can be treated. In that case, treatment will likely be aimed at fixing that problem.

Sometimes, the problem can't be treated. Or the tests might not show what the problem is. In these cases, there are other treatments doctors can do to help couples get pregnant. Talk with your doctor about different treatment options so you can choose the right treatment for you.

What else can we do? — Trying to get pregnant can be stressful. It's normal to feel sad, worried, angry, or guilty. It is important to get help for these feelings. You might find it helpful to talk with a counselor or go to a support group for people who are trying to get pregnant.

If you are interested, your doctor can also talk with you about other options for having children. Options might include adoption or having another person, called a "gestational carrier," carry a pregnancy for you and your partner.

More on this topic

Patient education: Male infertility (The Basics)
Patient education: Female infertility (The Basics)
Patient education: Absent or irregular periods (The Basics)

Patient education: Treatment of male infertility (Beyond the Basics)
Patient education: Ovulation induction with clomiphene or letrozole (Beyond the Basics)
Patient education: Infertility treatment with gonadotropins (Beyond the Basics)
Patient education: In vitro fertilization (IVF) (Beyond the Basics)
Patient education: Absent or irregular periods (Beyond the Basics)