The ability to bear children has riveted the attention of mankind, ancient and modern. A vast body of mythology and folklore has arisen from this prima concern. Enormous advances within the last two decades have demystified the puzzle of infertility, and have enabled greater numbers of couples to enter into parenthood. 

Approximately 10-15% of all married couples are unable to bear children. The diagnosis of infertility is arrived upon after a couple has not achieved conception after one year of unprotected sexual intercourse. The cause for infertility can be considered to be within one of three areas: 1) the male factor; 2) the female factor; or 3) unknown factor. The modern approach taken by the infertile couple stresses identification of areas to be enhanced medically, to enhance fertility. There is no longer an emphasis on "who's to blame".

Approximately 40% of infertility can be attributed to a female factor and approximately 40% to a male factor. In approximately 15-20% of the cases, no distinct defect can be recognized. A commitment to an infertility evaluation by both members of the couple is important since 35% of the couples will have an etiology of dual origins. 

With respect to the female factor, approximately half of the patients will be anovulatory. That is to say, the patient does not regularly produce eggs from her ovary. Most of the patients respond quickly to low-dose medications such as Clomid. The incidence of twins born to a mother treated with the medication is only slightly greater than the general population. Incidentally, it was on a much stronger medication that women have superovulated and given birth to quadruplets or quintuplets.

Further evaluation of the female patient will include postcoital testing to evaluate the ability of the sperm to survive in the presence of the cervical mucus. Hysterosalpingography, a dye injection test, may be utilized to evaluate the lining of the uterus and the patency of openness of the fallopian tubes. For yet a smaller percentage of patients, they may require a laparoscopy to visualize the female reproductive organs directly. For the male, analysis of the semen is the most important part of the examination.

For the occasional patient who has incurred damage to her genital tract that cannot be repaired surgically, there is now the exciting possibility of in-vitro fertilization, known commonly as "test tube baby" procedures. The success rate for this very complex technique now approaches 20-25% in some centers, providing a newborn to a couple who, ten years ago, would have been declared sterile.

With the discovery of many new and exciting advancements, couples today have a much greater chance of bearing children than their counterparts did 20 years ago.

Yours in health,

Patrick W. Diesfeld, M.D.

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