INFERTILITY

Not all women can get pregnant when they choose. The many causes of infertility can be grouped into several categories:

SPERM PROBLEMS:

No sperm at all: Artificial insemination with frozen anonymous donor sperm is an option.

Very few sperm with little or no swimming ability: A new procedure known as ICSI (intracytoplasmic sperm injection) involves placing the head of the sperm directly into the egg. This only requires one sperm and it doesn't have to be motile.

Low sperm count and/or poor swimming ability: This situation can sometimes be managed by concentrating the sperm in a small volume and placing it directly into the womb (uterus) by artificial insemination.

EGG PROBLEMS:

Most women release one egg (ovulate) each month. Some women infrequently, rarely or never ovulate. Most of these women can take medications to solve the problem.

GETTING TOGETHER PROBLEMS:

If the man has enough sperm and the women is ovulating they need to get together for conception to occur. Interference with this can happen at different levels:

The cervix: The opening of the uterus at the back of the vagina may have an opening that is too tiny (cervical stenosis) or the mucous that enables the sperm to swim may be deficient. There are several ways to cure these problems including artificial insemination with the partner's sperm. A specially prepared specimen can be placed directly in the uterus bypassing the cervical problem.

The Fallopian tubes: These delicate structures enable the sperm to reach the egg and the fertilized egg to reach the uterus. If they are blocked or damaged fertility will be reduced. Surgery can sometimes fix the tubes. In other cases the "test tube" approach (IVF-ET, in vitro fertilization-embryo transfer) can be used.