Definition

Standard medical textbooks define infertility as the "failure to conceive following one year of unprotected sexual intercourse." For young and healthy heterosexual couples having frequent intercourse, about 85% will be pregnant after one year of trying and about 93% will be pregnant after two years of trying to conceive.

While this is the "classic" definition of infertility, the "current" definition is "failure to conceive following one year of unprotected intercourse if under 35 years of age or six months if over 35."

While this definition is useful as a guideline for who should be evaluated for infertility, rigid adherence to the definition can be a disservice to many people desiring to create a family. Some insurance companies and health plan administrators set policies on fertility coverage based on the 'six months to one year' definition even though it does not apply to everyone in every situation. For example, couples with specific infertility risk factors, such as women with a history of pelvic infection or men with a history of undescended testicles should be evaluated as soon as they plan on starting a family. The likelihood of discovering a problem, which would require intervention, is higher in such cases. Other cases include single women or lesbian couples who may need the services of fertility specialists, but may not qualify under their insurance policy's definition of infertility. Valuable fertile time - may be lost, if evaluation and treatment are delayed.

Timely Evaluations.....

Initial infertility evaluations should be individualized, taking into consideration the medical history of the couple and the age of the female partner.

The following are Pacific Fertility Center's guidelines for when to begin medical evaluation for infertility.

• Women less than 35 years of age: Begin after one year of trying
• Women 35-39: Begin after approximately six months of adequately timed intercourse or inseminations.
• Women 40 and over: Begin after three months. We do this because we recognize that female age is one of the most important predictors of subsequent conception. When female age is a factor, moving more aggressively towards completing the evaluation and initiating treatment can help to maximize the chances of pregnancy.

True Infertility

It is important to understand that human reproduction appears to be relatively inefficient. In any one month, it is estimated that of 100 young and healthy heterosexual couples attempting to conceive, about 25 couples will successfully do so and about 75 will fail. True infertility only occurs in a few specific situations:

• Women with blocked fallopian tubes,
• Women that has no uterus or no egg follicles (menopause or premature ovarian failure)
• Men who have no sperm.

Sub-Fertility

Any other diagnoses in couples, besides the three mentioned above, represent some degree of sub-fertility. That is, there is some finite chance, however small, of conception without the assistance of fertility treatments. Fertility treatments in sub-fertile couples should be undertaken when the odds of conception could be improved by treatment.

A diagnostic evaluation may uncover a problem that can be overcome with medical technology. However, there is always some chance that a couple may eventually get pregnant on their own. The role of the fertility specialist in this case is to guide the patient towards timely evaluations and treatment decisions that will significantly improve their chances of becoming parents.

An Efficient Evaluation

This section of our web site is designed to help you understand some of the more common causes of infertility and sub-fertility. This information can assist you as you work with your physician to obtain an efficient evaluation. An evaluation that will not only diagnose your problem, but also improve the development of your treatment plan.