By Lilly Swiersz, M.D.

More than 2 million Americans have problems conceiving a child. As women wait longer to begin their families, the problem is on the rise because a woman’s fertility declines with age, particularly after age 35.

Infertility is defined as having unprotected sex for more than one year without becoming pregnant. This can be a very difficult experience for the couple, leading to feelings of anger, guilt, frustration and jealousy.

Thanks to medical advances in diagnostic tests and treatments, couples with infertility problems have a better chance of conceiving than ever before. More than half of all couples experiencing problems are able to conceive because of these advances.

During the treatment process, the doctor is generally able to detect what is causing the infertility. In more than 80 percent of the cases, the cause is identified.

At least one ovary and one fallopian tube must work properly for a woman to conceive. A man must have at least one productive testis and duct system. A fertility specialist determines where the problem may lie by performing several tests.

For a woman:

• Medical history.

• Physical exam.

• Test of blood hormone levels.

• Test of sperm in the cervical mucus after intercourse.

• Sample of the endometrial lining.

• X-ray of the uterus and fallopian tubes.

• Laparoscopy (outpatient surgical procedure) to evaluate the fallopian tubes, ovaries and pelvis and to look for endometriosis and pelvic scar tissue.

For a man:

• Medical history.

• Physical exam.

• Semen analysis.

• Hormonal testing.

• Antisperm antibody testing.

There are several types of treatments. In most cases, the treatment includes ovulation stimulation in the form of a hormone shot in addition to one of the following:

• Intrauterine Insemination (IUI): Sperm are washed and placed in a sterile medium, then injected directly into the uterus.

• In Vitro Fertilization-Embryo Transfer (IVF-ET): Eggs are taken from the ovary, fertilized with sperm in a lab and grown into early embryos that are then placed into the uterus.

• Gamete Intrafallopian Transfer (GIFT): Combined eggs and sperm (gametes) are placed into a catheter and inserted into the fallopian tube to attempt to initiate pregnancy. Other variations of this treatment involve delivering embryos or zygotes (the stage right before embryo development) to the tubes.

Success rates vary with each type of treatment, and each treatment does carry some risks. Couples should speak with their doctors about these issues.