Infertility means that a couple is unable to become pregnant or stay pregnant after at least a year of trying. Although conceiving a child may seem simple and natural, our bodies’ processes are quite complicated. Getting pregnant depends on many factors, including production of healthy sperm by the man and healthy eggs by the woman, and release of a healthy egg (ovulation) by the woman. It also depends on a healthy lining in the uterus, successful fertilization of the egg, and proper implantation of the fertilized egg in the uterus. If just one of these steps goes wrong, infertility can result. If you’re experiencing infertility problems, you’re not alone. Many couples struggle to get pregnant, and for many reasons. Men and women are equally likely to have problems that cause infertility. Factors Affecting Fertility in Women For a woman, challenges may include hormonal problems, infection, or rare genetic abnormalities. Another factor is endometriosis, a condition in which the tissue lining the uterus develops outside the uterus. This can cause scar tissue to form and affect reproductive organ function. Another common problem is blockage of the fallopian tubes, which prevents the sperm and egg from meeting. Sometimes a woman’s immune system interferes with normal ovulation, fertilization, or implantation of a fertilized egg. Women can also develop antisperm antibodies that attack and destroy sperm or interfere with normal fertilization. Factors Affecting Fertility in Men Factors that affect a man’s fertility include low or absent sperm production, abnormal sperm function, hormonal disorders, and rare genetic abnormalities. Lifestyle is another factor. Recreational drug use, heavy alcohol use, cigarette smoking, and certain medications can affect sperm quality and function. A man may also have antisperm antibodies that attack and destroy sperm. Another common infertility factor is varicocele, the widening of the veins in the scrotum. This condition is usually treatable and reversible with surgery. When to See Your Doctor When a woman is still not pregnant after one year of unprotected intercourse—or after six months in women older than 35—or if there are known problems causing infertility, a medical evaluation of both the man and woman is recommended. Tests and Exams An obstetrician/gynecologist or reproductive endocrinologist will review both partners’ medical and sexual histories to evaluate possible physical causes of infertility and if sexual intercourse has been appropriately timed. The woman may have a complete physical exam, including a Pap test, and her ovulation and hormone function may be evaluated. She may have an ultrasound to show any abnormal conditions, such as ovarian cysts or fibroids (benign tumors in the uterus). A man may undergo a semen analysis to evaluate the sperm count, motility, shape, and quantity, in addition to male hormone testing. Men may be referred to a urologist for further evaluation. Treatment For some couples, the cause of infertility is never found. If the cause is determined, a specialist can work with you to establish the best course of treatment. Treatment for infertility is determined based on your age, overall health, and medical history; extent and cause of the disorder; and your preference. Most infertility cases are treated with conventional therapies, such as medication or surgical repair of reproductive abnormalities. Depending on the cause, there are many options for an infertile couple, including insemination procedures, laboratory fertilization, sperm injections, donor eggs, and more. You’ll work with your doctor to determine the best option for you.