More than 1 million married women ages 15-44 across the United States are infertile. Janet McLaren Bouknight, M.D., offers insight on the symptoms, diagnosis and treatment of infertile couples trying to conceive. 
Infertility affects both men and women, with nearly 15 percent of couples’ being affected, according to the American Congress of Obstetrics and Gynecology. There are many causes that inhibit a couple from getting pregnant, both physical and mental.
Infertility can be grouped into two categories: primary infertility, which refers to couples who have not become pregnant after at least one year of unprotected intercourse; and secondary infertility, which refers to couples who have been pregnant at least once, but are unable to conceive now.
Janet McLaren Bouknight, M.D., director of the University of Alabama at Birmingham In Vitro Fertilization Program, provides answers to questions that many women may have when it comes to infertility and treatment.
Q: When should a woman be concerned with infertility issues?
Bouknight: Many women spend their early reproductive years thinking of and planning when to have children, so when they have trouble getting pregnant, it is usually both unexpected and upsetting. Guidelines recommend that women under the age of 35 years seek medical attention if they have not conceived after a year of trying, and women 35 years and older after six months of unsuccessful attempts. A woman of any age should seek immediate evaluation if she has a gynecologic history that is concerning for fertility issues, such as irregular menstrual cycles or a prior pelvic surgery or pelvic infection that could have caused scarring.
Q: What are the signs of infertility?
Bouknight: Many times, patients do not have any symptoms, which can be frustrating; but painful periods can be a symptom of endometriosis, a pelvic pain condition that also causes infertility. Any surgery on the pelvis (male or female) can result in scarring that impairs fertility.
Q: Who should see a fertility specialist?
Bouknight: Any woman who falls into the categories discussed above should seek a fertility evaluation with her OB/GYN or a fertility specialist. That provider can help identify the reasons for the couple’s infertility and develop a treatment plan to help them conceive.
Q: What should they expect as they begin seeing a fertility specialist?
Bouknight: Patients should expect to initially undergo an evaluation to identify the underlying cause or causes of their infertility. This usually involves a detailed reproductive history, as well as a physical exam.
A female patient should expect lab work to check reproductive hormone levels and an imaging study, ultrasound or exam, to check the health of the uterus, fallopian tubes and ovaries.
A male patient, in addition to a reproductive history, can expect a semen analysis to check the number and health of sperm. Further evaluation of the male partner by a urologist may be needed if the semen analysis is abnormal.
After the specialist determines the underlying cause of infertility, patients and the specialist can discuss the best treatment options available to ultimately conceive a child.
Q: What options are out there for women?
Bouknight: Treatment options depend on why the couple is having trouble conceiving. For some women, the only treatment necessary may be pills to stimulate follicular development to help her grow and release eggs.
A procedure called an intrauterine insemination can be used when the male partner has a low sperm count. It is a brief office procedure about as involved as a Pap smear that can greatly increase the chance of conceiving.
For those with more challenging cases of infertility, the fertility practice at UAB offers the full gamut of infertility services, including:
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In vitro fertilization: A procedure in which the woman uses fertility shots to stimulate eggs to grow for two weeks; the eggs are then removed with a minor surgical procedure and fertilized in the lab
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Intracytoplasmic sperm injection: A technique added to IVF to help with fertilization, used primarily for male factor infertility
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Preimplantation genetic testing: A technique added to IVF in which a few cells are removed from the embryo prior to transfer to test for genetic conditions
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Donor egg and donor sperm services: UAB’s practice has an egg donor program, and works with a number of sperm banks so that these services are available for couples who cannot conceive using their own eggs and/or sperm
Q: How have fertility treatments changed during the past five to 10 years?
Bouknight: Fertility treatment continues to advance, and the medicine practiced today provides patients better chances of being successful and adding to their families. There is a better understanding of which pill medications may help a woman ovulate, and newer protocols help women undergoing IVF maximize their chance of a successful treatment. The biggest change is probably within the IVF lab, where improved lab conditions help take the best care possible of our patients’ embryos.