Infertility Articles - Infertility Options provided by JAMA

Having a baby is a happy occasion that many couples look forward to. However, some couples need help to conceive. About 10 percent of Americans of reproductive age have problems with infertility.

A study in the November 17, 1999, issue of The Journal of the American Medical Association (Schieve et al) reports that three factors - the age of the woman, number of embryos transferred, and the ability of the infertility laboratory to identify and select high-quality embryos for transfer - had a strong effect on the success of an in vitro fertilization (IVF, see definition on this page) and the risk for multiple birth (giving birth to more than one child).

Assisted reproductive technology (ART) is a term used for all treatments or procedures that involve manipulation of human eggs and sperm for the purpose of establishing a pregnancy. Couples interested in ART should consult their doctor to discuss all the factors that may affect the rate of success in their particular case.

What is Infertility?

Infertility is a condition of the reproductive system that impairs the ability to conceive children. A variety of complicated factors determine whether a couple can successfully conceive. Approximately a third of infertility cases can be attributed to factors that affect the man, a third to factors that affect the woman, and the remaining third to a combination of problems with both partners or an unexplained source.

Causes of Infertility:

The woman's fallopian tubes may be blocked or damaged, making it difficult for the egg to be fertilized or for an embryo to travel to the uterus.
The male sperm count may be low or there may be problems with sperm function.
The woman's ovaries may not be maturing and passing eggs normally or egg quality and number may have diminished with age; or the woman may have hormonal conditions that adversely affect ovulation.
Disorders of the uterus or vagina that impair fertility.

When to Seek Help:

Generally, couples who have been unsuccessful in conceiving for a year are advised to seek medical help. The doctor will conduct a thorough medical history and physical examination to determine general health and pinpoint any possible causes of infertility.

Advanced Types of Fertility Treatment:

Superovulation and intrauterine insemination (SO-IUI) - Using hormones to stimulate multiple egg ovulation and placing sperm in the uterus at the time of ovulation.
In vitro fertilization (IVF) - Using hormones to stimulate egg ovulation, extracting the eggs, fertilizing the eggs in the laboratory, and then transfering the resulting embryo(s) into the woman's uterus through the cervix.
Gamete intrafallopian transfer (GIFT) - Using an instrument called a laparoscope to place the unfertilized eggs and sperm (gametes) into the women's fallopian tubes through small incisions in her abdomen. Used in 5 percent of procedures.
Zygote intrafallopian transfer (ZIFT) - Fertilizing a woman's eggs in the laboratory and then using a laparoscope to help transfer the fertilized eggs (zygotes) into her fallopian tubes. Used in two percent of procedures.

For More Information:

American College of Obstetricians and Gynecologists
Send business-size self-addressed stamped envelop to:
ACOG Resource Center
Infertility: Causes and Treatments (#AP002)
P.O. Box 96920
Washington, DC 20090-6920
RESOLVE, The National Infertility Association
National HelpLine
(617) 623-0744
(for infertility information, support groups, and referrals)
American Society for Reproductive Medicine
(205) 978-5000

Additional Sources: Centers for Disease Control and Prevention's Reproductive Health Information Source, American Society for Reproductive Medicine

Mi Young Hwang, Writer
Richard Glass, M.D., Editor
Jeff Molter, Director of Science News

( JAMA . 1999; 282:1888)

Published in JAMA : November 17, 1999

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