According to the Centers for Disease Control and Prevention (CDC), more than 7.3 million Americans, or one in eight couples of childbearing age, are infertile. There are several risk factors that can contribute to problems with male and female fertility, including extreme weight gain or loss, age, sexually transmitted infections (STIs), smoking and alcohol use. Infertility is a disease or condition of the reproductive system that affects an estimated 10 to 15 percent of couples trying to conceive in the United States. It occurs in both women and men; in fact, female factors and male factors each account for approximately one-third of all infertility cases. The remaining cases arise from insufficiency in both partners, or the cause of infertility simply cannot be explained.

Early detection and treatment of infertility can help achieve a successful pregnancy outcome. With advances in technology and our personalized approach for each patient, UCRM is able to offer a range of effective treatment options to address both female and male infertility problems. From simple hormonal treatment, ovulation induction and intrauterine insemination (IUI) to the more advanced technologies like in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), or third party reproductive strategies such as surrogacy, donor egg and embryo donation, UCRM is helping more patients realize their hopes and dreams of achieving parenthood.

Infertility

What is infertility?

Infertility is a problem of the reproductive system. It affects the body's ability to reproduce. It could be caused by a problem with the man’s system, the woman’s system, or both. For a pregnancy, the following must happen:

  • The man must make healthy sperm.
  • The woman must make healthy eggs.
  • The fallopian tubes must be open to let the sperm to reach the egg.
  • The sperm must be able to fertilize the egg.
  • The fertilized egg must implant in the uterus.
  • The embryo must be healthy.

Infertility is not just a woman's concern. Half the time, a male problem causes or contributes. Many couples have more than one factor that plays a role.

In a few cases, a cause for infertility can’t be found.

If you think you are not able to get pregnant, see your healthcare provider early. The age of the woman and how long the couple has been trying to get pregnant may affect treatment.

What causes infertility?

Many things can cause infertility. It can be a problem in the female reproductive system, the male reproductive system, or a mix of the two. The following are things that can affect infertility.

Female factors

  • Ovulation problems. The woman doesn’t make enough hormones to develop, mature, and release a healthy egg.
  • Anatomical problems. A problem with the woman’s anatomy can prevent the egg and the sperm from meeting. The most common problem is blocked fallopian tubes. Other problems may include scar tissue in the pelvis from past surgeries or infections.
  • Endometriosis. The tissue that lines the uterus implants outside the uterus in this condition. It usually implants on other reproductive organs or in the belly. Each month, this misplaced tissue reacts to the hormone changes of the menstrual cycle. This means it builds up, breaks down, and bleeds. This can cause scar tissue to form and affect fertility.
  • Birth defects. Certain birth defects can affect fertility. One of the most common problems happens when a female fetus is exposed to DES (diethylstilbestrol) in her mother’s womb. Pregnant women in the 1940s and 1950s took this medicine to prevent pregnancy loss. But it was found to cause problems with the development in the uterus and cervix in the fetus. This would later hurt the ability of the woman to get pregnant.
  • Infection. Pelvic inflammatory disease (PID) is caused by a type of bacteria such as gonorrhea and chlamydia. PID can affect the uterus, fallopian tubes, the ovaries, or all three. It causes scar tissue to grow between organs. This leads to ongoing pelvic pain and raises the risk for an ectopic pregnancy. This is when the fertilized egg implants outside the uterus.
  • Immune system problems. A problem with a woman's immune system can lead to pregnancy loss. Antibodies in a woman's system can fail to recognize a pregnancy. Or there may be an abnormal immune response to the pregnancy. Women can also develop antisperm antibodies, which attack and destroy sperm.

Male factors

  • Low or absent sperm production. Without enough healthy sperm, the chance of fertilization is decreased.
  • Abnormal sperm function. Sperm must be able to swim and penetrate the egg.
  • Varicocele. This is a condition in which varicose veins develop around the testes. It’s a very common cause of infertility in men. It’s usually treatable with surgery.
  • Hormone disorders. Abnormal male hormone or endocrine function can affect sperm production and fertility.
  • Chromosome defects. Certain chromosome defects are linked to male infertility.
  • Birth defects. Abnormalities in a man's reproductive system can happen during fetal development. Some birth defects are due to a man's exposure to DES (diethylstilbestrol) taken by his mother during pregnancy.
  • Immune system problems. A man may have antisperm antibodies, which attack and destroy sperm.

These lifestyle habits can also affect sperm quality and function:

  • Use of recreational drugs such as marijuana or cocaine
  • Heavy alcohol use
  • Smoking
  • Taking certain medicines
  • Too much heat to the genital area, such as using a hot tub

 

What are the symptoms of infertility?

A couple is believed infertile if conception does not happen:

  • After one year of unprotected sex
  • After 6 months in women over age 35
  • If there are known problems causing infertility

How is infertility diagnosed?

To diagnose infertility, both the man and the woman are tested.

Some healthcare providers can do a basic infertility evaluation. But, many causes of infertility are best treated by a board-certified reproductive endocrinologist. This is an OB/GYN who has had education and training in infertility and is certified with the American Board of Obstetrics and Gynecology.

Generally, the healthcare provider will test both partners to find the cause of infertility. The healthcare provider is looking for answers to these questions:

  • Is the female ovulating regularly?
  • Is the male making healthy sperm?
  • Are the female's egg and the male's sperm able to unite and grow normally?
  • Are there any problems with implantation?
  • Is the mother able to maintain the pregnancy?

These tests are often part of the basic workup for infertility.

Both partners

Health and sexual history to look for any physical causes of infertility and find out if they have sex at the right time.

Female

  • Physical exam. You will have a complete physical exam including a Pap test and testing for infection.
  • Ovulation evaluation. You can check to see if you are ovulating by keeping a basal body temperature chart. This is your morning body temperature. Other ovulation prediction methods use urine samples.
  • Hormone testing. Hormone testing may be recommended. Certain hormones increase and decrease at various times in the monthly cycle.
  • Ultrasound. Ultrasound can show the follicles, which are the sacs that contain the developing eggs. It can also show the thickness of the uterine tissues. Your healthcare provider can also check for problems such as ovarian cysts or fibroids.
  • X-rays. A hysterosalpingogram may be advised. For this test, a dye is injected into the cervical opening to see inside the uterus. This lets the radiologist see if the fallopian tubes are open.

Male

  • Semen analysis. A semen sample is taken and tested in the lab. The healthcare provider can:
    • Check the sperm count
    • Test sperm motility
    • Check how many and the shape of sperm
    • Evaluate the ejaculate liquid

Other tests may be done that test the sperm's ability to penetrate the egg, as well as male hormone testing.

Men may be sent to a urologist for further testing.

How is infertility treated?

Your healthcare provider will discuss the best treatment with you based on:

  • How old you are
  • Your overall health and medical history
  • How well you can handle specific medicines, procedures, or therapies
  • How long the condition is expected to last
  • Your opinion or preference

Once a diagnosis is made, you can work with a fertility expert to find the best treatment. Most people with infertility are treated with conventional therapies. This includes treatment with medicine or surgical repair of reproductive abnormalities. Depending on the cause of infertility, there are many choices to offer an infertile couple.

Types of treatments for women may include:

  • Intrauterine insemination. This method uses a small flexible tube called a catheter to place specially washed and prepared sperm directly into the uterus. It may be used for low sperm count or cervical mucus problems. This method is often used along with ovulation medicines.
  • Ovulation medicine. These medicines help regulate the timing of ovulation. They stimulate the growth and release of mature eggs. They can also help correct hormone problems that can affect the lining of the uterus. Ovulation medicines can stimulate more than one egg to be released. This raises the chance of having twins and other multiples. Some of the common medicines include:
    • Clomiphene citrate
    • Human menopausal gonadotropins. Medicines with follicle-stimulating hormone (FSH) and luteinizing hormone (LH)
    • Follicle-stimulating hormone (FSH)
  • Surgery. Surgery may be used to treat or repair a condition such as blocked fallopian tubes or endometriosis. This may be done using laparoscopy. In a laparoscopy, a small telescope inserted into the abdominal or pelvic cavity lets the healthcare provider see internal organs. Some methods to treat infertility can be done using instruments inserted through the laparoscope.
  • Assisted reproductive technology (ART). For some couples, more extensive treatment is needed. With most forms of ART, the sperm and egg are joined in the lab. The fertilized egg is then returned to the woman's uterus where it can implant and grow. While ART procedures are often costly, many are being used with success. These include:
  • In vitro fertilization (IVF). This involves removing a woman's eggs and fertilizing them in the lab with sperm. The embryo is then transferred into the woman's uterus through the cervix. Most couples transfer two embryos. More may be transferred in certain cases. IVF is the most common form of ART. It is often the treatment of choice for a woman with blocked, severely damaged, or absent fallopian tubes. IVF is also used for infertility caused by endometriosis or male factor infertility. IVF is sometimes used to treat couples with long-term unexplained infertility who have not been able to get pregnant with other treatments.
  • Intracytoplasmic sperm injection (ICSI). In this procedure, a single sperm is injected directly into an egg. This method is most commonly used to help with male factor infertility problems.
  • Gamete intrafallopian transfer (GIFT). This involves using a fiber-optic instrument called a laparoscope to guide the transfer of unfertilized eggs and sperm into the woman's fallopian tubes through small incisions in her abdomen. GIFT is only used in women with healthy fallopian tubes.
  • Zygote intrafallopian transfer (ZIFT). This involves fertilizing a woman's eggs in the lab. Then the laparoscope guides the transfer of the fertilized eggs (zygotes) into her fallopian tubes. ZIFT is only used in women with healthy fallopian tubes.
  • Donor eggs. This involves transferring an embryo from a donor to an infertile woman. The donor gives up all parental rights to any resulting children. ART using donor eggs is more common in older women. The chance of a fertilized egg implanting is related to the age of the woman who produced the egg. Egg donors are typically in their 20s or early 30s.
  • Embryo cryopreservation. In this method, the embryos are frozen for transfer at a later date. This is often used when an IVF cycle produces more embryos than can be transferred at one time. The remaining embryos can be transferred in a future cycle if needed.

There is a range of treatment choices available for male factor infertility. Treatment may include:

  • Assisted reproductive technologies (ART). This type of treatment may include:
    • Artificial insemination. This involves placing large numbers of healthy sperm either at the opening of the cervix or directly into the woman’s uterus.
    • IVF, GIFT, and other techniques. These have been used for the treatment of male infertility. As is the case with artificial insemination, IVF and similar techniques offer the chance to prepare sperm in a lab. In the lab, the eggs are exposed to the best concentration of high quality, motile sperm.
    • Microsurgical fertilization (microinjection techniques, such as intracytoplasmic sperm injection, or ICSI). For this treatment, a single sperm is injected into an egg. Fertilization then takes place under the microscope.
  • Medicine therapy. A few infertile men have a hormone problem that can be treated with hormone therapy. Hormone imbalances caused by a problem with the hypothalamus, the pituitary gland, and the testes directly affect the development of sperm. Medicine therapy may include gonadotrophin therapy, antibiotics, or another medicine.
  • Surgery. Surgery for male infertility is done to repair anatomical problems that impede sperm production and maturation or ejaculation. Surgery to remove varicose veins in the scrotum (varicocele) can sometimes improve the quality of sperm.

Key points about infertility

  • Infertility is a problem of the reproductive system. It impairs the body's ability to reproduce. It could be caused by a problem with the man’s system, the woman’s system, or both.
  • Infertility is not just a woman's concern. In about half of infertile couples, the male is the sole cause.
  • The couple are believed infertile if conception does not happen after 1 year of unprotected sex, after 6 months in women over age 35, or if there are known problems causing infertility.
  • Many causes of infertility are best treated by a board-certified reproductive endocrinologist.
  • Depending on the cause of infertility, there are many treatment choices for an infertile couple.
  • Treatment with medicine or surgical repair cure most cases of infertility.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

Infertility Risk Factors for Men and Women

For women. General factors that can affect the ability to ovulate, conceive, or deliver a child successfully include the following:

  • Age. Women in their late 30s and older are generally less fertile than women in their early 20s

  • Endometriosis

  • Chronic diseases (diabetes, lupus, arthritis, hypertension, or asthma)

  • Hormonal imbalance

  • Environmental factors. Cigarette smoking, alcohol consumption, or exposure to workplace hazards or toxins

  • Excessive or very low body fat

  • Abnormal Pap smears that have been treated with cryosurgery or cone biopsy

  • DES taken by mother during pregnancy

  • Sexually transmitted diseases

  • Fallopian tube disease

  • Multiple miscarriages

  • Fibroids

  • Pelvic surgery

  • Abnormalities in the uterus that are present at birth or happen later in life

For men. Infertility is not just a woman's problem. Following is a list of risk factors related to male infertility:

  • History of prostatitis, genital infection, or sexually transmitted diseases

  • Exposure to hazards on the job or toxic substances, such as radiation, radioactivity, welding, and many chemicals, including lead, ethylene dibromine, and vinyl chloride.

  • Cigarette or marijuana smoke

  • Heavy alcohol consumption

  • Exposure of the genitals to high temperatures

  • Hernia repair

  • Undescended testicles

  • Prescription drugs (opioid-like drugs that affect the central nervous system, including many psychotropic drugs)  

  • Mumps after puberty

Marc A. Bernhisel, M.D.

Dr. Marc Bernhisel is happy to be back at the University of Utah again! Dr. Bernhisel graduated from the University of Utah in 1975 with a Bachelor's degree in Biology (cum laude) and attended the University of Utah medical school graduating in 1979 (AOA). He also did residency in Obstetrics and Gynecology was at the University of Utah. He then com... Read More

Douglas T. Carrell, Ph.D., H.C.L.D.

Doug Carrell received his Ph.D. degree in reproductive physiology from the University of Utah in 1995, after receiving a M.S. degree in cellular and developmental biology from Brigham Young University. Dr. Carrell has worked in the area of research and treatment of human infertility for 35 years. Dr. Carrell is the clinical laboratory director of t... Read More

Specialties:

Andrology, In Vitro Fertilization, Reproductive Endocrinology & Infertility

Locations:

Andrology & IVF Laboratories (801) 581-3740

Jessie A. Dorais, M.D.

Patient Rating:

4.8

4.8 out of 5

Jessie Dorais, M.D. as a Clinical Assistant Professor, in the Division of Reproductive Endocrinology and Infertility. Dr. Dorais received a Bachelor of Science degree in Biology from Brigham Young University in 2003, and her M.D. from the University of Illinois, College of Medicine in 2007. She completed her Obstetrics & Gynecology residency ... Read More

James M. Hotaling, M.D., M.S., FECSM

Patient Rating:

4.6

4.6 out of 5

Dr. Hotaling has significant training in both the clinical aspects of male fertility and genetic epidemiology and he is currently the only fellowship trained male infertility/andrology expert in Utah. He completed a 6 year residency in urology at the University of Washington, elected to pursue a year of sub-specialty training in male infertility ... Read More

Erica B. Johnstone, M.D.

Patient Rating:

4.6

4.6 out of 5

Erica B. Johnstone, M.D., M.H.S., is a gynecologist and reproductive endocrinologist in the Division of Reproductive Endocrinology and Infertility. Dr. Johnstone clinical interests include reproductive endocrine disorders and all types of infertility, and she also works with hormonal disorders in children and adolescents. Her research interests in... Read More

Megan Link, M.D.

Megan H. Link, M.D., is a gynecologist and reproductive endocrinologist in the Division of Reproductive Endocrinology and Infertility.  Dr. Link’s clinical interests include endometriosis, fertility preservation, reproductive endocrine disorders and all types of infertility.  Dr. Link received her bachelor’s degree from The College of Idaho and ear... Read More

Specialties:

Reproductive Endocrinology & Infertility

Locations:

A location has not yet been added by this physician.

Andrew K. Moore, M.D.

Patient Rating:

4.6

4.6 out of 5

Dr. Moore is pleased to bring the University of Utah’s world-class reproductive medicine closer to home for Utah Valley and southern Salt Lake county residents. He has office hourse each week in South Jordan and Orem. Dr. Moore's clinical interests include the full breadth of reproductive endocrinology and fertility treatment, as well as speciali... Read More

C. Matthew Peterson, M.D.

Patient Rating:

4.7

4.7 out of 5

Matthew Peterson, M.D., is a Reproductive Endocrinologist in the University of Utah Department of Obstetrics and Gynecology. Dr. Peterson received his undergraduate degree, magna cum laude from Brigham Young University in 1977 and his M.D. from the University of Utah in 1981. His residency training in obstetrics and gynecology was accomplished at M... Read More

Specialties:

OB/Gyn, General, Reproductive Endocrinology & Infertility

Locations:

A location has not yet been added by this physician.

Reproductive Medicine services are available at the Utah Center for Reproductive Medicine as well as multiple locations through out the state of Utah, including Centerville, Orem, South Jordan and Park City. Our reproductive endocrinologists offer a wide range of services including:

  • Infertility counseling
  • Infertility monitoring and treatment
  • IUD insertion and removal
  • Annual gynecological exams
  • Endocrinology
  • Diagnosis and treatment of polycystic ovary syndrome
  • In vitro fertilization
  • Treatment of endometriosis
  • Pediatric and adolescent gynecology services

Our highly trained reproductive endocrinology specialists are experts in both the treatment and research of infertility and our clinic consistently boasts one of the highest success rates in the nation.

Neighborhood Health Center Locations:

Utah Center for Reproductive Medicine 675 Arapeen Drive, Suite 205
Salt Lake City, Utah 84108-1237
Map
University of Utah Health Care
Centerville Health Center
26 South Main
Centerville, Utah 84014
Map
Dixie Regional Medical Center 544 South 300 East
St. George, UT 84770
Map
McKay Dee Hospital 4401 Harrison Blvd.
Ogden, UT 84403
Map
University of Utah Health Care
Redstone Health Center
1743 W. Redstone Center Drive, #115
Park City, Utah 84098
Map
University of Utah Health Care
South Jordan Health Center
5126 W. Daybreak Parkway
South Jordan, 84009
Map
Utah Valley Regional Medical Center
Woman’s and Children’s Clinic
1034 N 500 W
Provo, Utah 84604
  • Healthy Conceptions for Couples Intervention Pilot Study
    Keywords: Infertility, Obesity, polycystic ovarian syndrome, emotionally focused therapy, weight loss
    Status: Recruiting
  • FAZST
    Keywords: Fertility, reproductive medicine, pregnancy outcomes, folic acid and zinc supplementation trial, semen quality, infertility
    Status: Recruiting
  • FIT-PLESE
    Keywords: Overweight, Infertility, BMI, Weight loss, Free, Reproductive medicine
    Status: Recruiting