About 50% of couples who get expert help for their infertility can achieve pregnancy within two years with appropriate treatment of the woman, the man, or both. Males and females each account for 40% of infertility; in the remaining 20%, either both partners are responsible or the cause is unclear.  

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What Are Some Causes Of Infertility
Causes of infertility include a wide range of physical, as well as emotional factors. Approximately 30 to 40% of all infertility is due to a "male" factor (such as retrograde ejaculation, impotence, hormone deficiency, environmental pollutants, scarring from sexually-transmitted disease, or decreased sperm count due to heavy marijuana use or prescription drugs such as cimetidine, spironolactone, and nitrofurantoin).
A "female" factor (for example, scarring from sexually-transmitted disease, ovulation dysfunction, poor nutrition, hormone imbalance, cysts, or cancer of the ovarians or uterus, pelvic infection or tumor, or transport system abnormality from the cervix through the Fallopian tubes) is responsible for 40 to 50% of infertility in couples. The remaining 10 to 30% may be caused by contributing factors by both partners, or no cause can be adequately identified.

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What Factors May Increase Ones Risk Of Infertility
It is estimated that 10 to 20% of couples will be unable to conceive after one year of attempting to become pregnant. It is important that pregnancy be attempted for an extended period (at least one year); the chances for pregnancy occurring in young healthy couples, having intercourse regularly, is only 25 to 30% per month.

Increased risk for infertility is associated with:

• having multiple sexual partners (therefore increasing the risk for STDs)
• having a sexually-transmitted disease
• having a past history of PID (pelvic inflammatory disease) (after single episode 23% of women become infertile)
• age - A woman's age, or more accurately, the age of her eggs, plays a major role in fertility. At age 25, the chance of getting pregnant within the first six months of trying is 75%; at age 40, it is only 22%. This decrease in fertility appears to be due to a higher rate of chromosomal damage that occurs in the eggs as time goes by.
• weight - Although most of a woman's estrogen is manufactured in her ovaries, 30% is produced in fat cells. Because a normal hormonal balance is essential for the process of conception, it is not surprising that extreme weight levels, either high or low, can contribute to infertility.
• having mumps orchitis (men)
• having a past medical history inclusive of DES exposure (men or women)
• having eating disorders (women)
• having anovulatory (with out mensus) menstrual cycles (Marathon runners, dancers, and others who exercise very intensely may find that their menstrual cycle is abnormal and fertility is impaired).
• having a chronic disease (such as diabetes)
• depression - depression is very common in women who are trying to become pregnant. In fact, depression may have a direct effect on hormones that regulate reproduction.
  

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How Do I Find The Right Doctor
Believe it or not, there is a difference between an obstetrician/gynecologist and an infertility specialist. An ob/gyn is a medical doctor who incorporates infertility as just one minor area of his/her general practice. There are many ob/gyn’s that claim to be specialists in infertility, this is misleading due to the fact that only about 500 out of 28,000 ob/gyn practitioners are board certified specialists in infertility, also known as reproductive endocrinologists. While all of these physicians are gynecologists, reproductive endocrinologists’ practices are set up solely to assist in reproduction. Because of this, they have specialized ultrasound equipment, expanded office hours for cycling patients and the necessary surgical and laboratory facilities to accommodate their infertile patients’ daily needs.

The five most important questions to ask your doctor before entering into treatment are:

1. What is your background and training?
2. How many of these procedures do you perform annually?
3. What is your pregnancy rate per procedure?
4. What is you "baby rate" per procedure?
5. Who does more of these procedures annually than you do, and how do their success rates compare to yours? – This is a lie detector test which can be checked against calling your local Resolve chapter and you can requesting current data on physicians in your community who perform various procedures that are of interest to you.

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Tests Before Treatment (The Basic Workup)
It is always hard to wait for something you want right now, but tests are an intricate part of the treatment program of infertility. Your physician will be performing a series of tests in hopes of closing in on your possible problem areas and determining the exact cause of your infertility. With out tests, treatment can not follow.

1. Medical History and Physical Examination
The first step in any infertility work up is a complete medical history and physical examination. Sexual technique and timing, menstrual history, family history of infertility, lifestyle issues, such as drug, alcohol, and caffeine consumption, and a profile of the patient's general medical and emotional health can help the physician decide on appropriate tests. The male partner should also be given a physical examination.

2. Laboratory Tests
Blood and urine tests are taken to evaluate hormone levels. Urine tests can measure preovulatory LH surges. To rule out luteal phase defect, the physician may take tissue samples of the uterus one or two days before a period to determine if the corpus luteum is adequately producing progesterone. If a woman is having abnormal or irregular menstruation, measurements of FSH and LH levels are taken to detect premature menopause (high FSH and LH) or polycystic ovary syndrome (high LH and low FSH). Blood tests for prolactin levels and thyroid function are also measured. Cervical mucus is examined after intercourse at mid-cycle (when ovulation should occur) to determine whether it has the right qualities to promote sperm passage and to see if the sperm are viable and motile. This so-called postcoital test has been in use since 1866. Some experts now believe, however, that abnormal postcoital test results have no effect on pregnancy rates and that they lead to unnecessary fertility procedures. Tissue samples taken from the cervix may be cultured to rule out infection. Tests for hypothyroidism and diabetes should be considered in women with recent ovarian failure that is not caused by genetic abnormalities. Tests will also be performed on the male partner to determine sperm count and viability.

3. Testing for Fallopian Tube and Uterine Abnormalities
Laparoscopy
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Hysterosalpingography
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Ultrasound
Ultrasound is a noninvasive method for evaluating the uterus and ovaries by using sound waves rather than x-rays. Ultrasound carries little risk or discomfort while producing clear images that enable the physician to count any mature follicles present and examine the endometrium. Fibroid tumors and ovarian cysts can be diagnosed as well.

Other tests may include the following:

• Semen analysis to evaluate ejaculate; collected after 2 to 3 days of complete abstinence to determine volume and viscosity of semen and sperm count, motility, swimming speed, and shape.
• Chromosomal Testing - Tests that analyze sex chromosomes may help predict which couples are more apt to fail or succeed using assisted reproductive technologies. One, called fluorescent in situ hybridization, detects sperm abnormalities. Others look at the chromosomes of both the man and woman to detect abnormal patterns.
• Measuring basal body temperature--taking the woman's temperature each morning before arising in an effort to note the 0.4 to 1.0 degree Fahrenheit temperature increase associated with presumptive ovulation.

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Treatment
Treatment depends on the cause of infertility for any given couple. It may range from simple education and counseling, to the use of medications that treat infections or promote ovulation, to highly sophisticated medical procedures such as in-vitro fertilization. 
For more in-depth information use this link:  http://health.excite.com/content/dmk/dmk_article_3961653

Artificial Insemination
Artificial insemination (AI) is a procedure that places the sperm inside the woman's vagina, uterus, or cervix. There are several variations: intracervical insemination places sperm in the cervix (used for cervical mucus problems or vaginal abnormalities); intrauterine insemination (IUI) and intratubal insemination place the sperm higher up and are effective for more severe problems.

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Assisted Reproductive Technologies:
Assisted reproductive technologies (ART) are procedures that retrieve eggs from the ovary and reimplant them. The most common one is in vitro fertilization (IVF). More recent ART procedures include gamete intrafallopian transfer (GIFT), zygote intrafallopian transfer (ZIFT), and intracytoplasmic sperm injection (ICSI).

Assisted Reproductive Technologies: Specific Procedures
In Vitro Fertilization (IVF)

http://www.fertilityinstitute.com/advanced.html

http://infertility.miningco.com/health/infertility/library/weekly/aa042900a.htm

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Expectations And Complications
A probable cause can be determined for about 85 to 90% of infertile couples. Appropriate therapy (not including advanced techniques such as in-vitro fertilization) allows pregnancy to occur in 50 to 60% of previously infertile couples. Without any treatment intervention 15 to 20% of couples previously diagnosed as infertile will eventually become pregnant.

Planning for Treatment Outcomes
There often is no way to predict which couples will eventually conceive; some with multiple problems will overcome great odds, while seemingly fertile couples fail to conceive. Many of the new treatments are remarkable, but a live birth is never guaranteed. The emotional stress of failure can be devastating even on the most loving and affectionate relationships. Even in the absence of failure, the road to pregnancy can be very difficult. Couples must be prepared to make many sacrifices, both financial and emotional, before undergoing this process. A successful pregnancy often depends on repeated attempts. Some couples become addicted to treatment, and continue with fertility procedures until they are emotionally and financially drained. Partners should decide in advance how many and what kind of procedures they believe will be financially and emotionally acceptable and attempt to determine a final limit. They should also explore in advance alternatives such as adoption, childlessness, and donor sperm. Determining all options as early as possible in the process can reduce anxiety during treatments and feelings of hopelessness if they don't work out.

Complications
Although infertility itself does not cause physical illness, the psychological impact of infertility upon individuals or couples affected by it may be severe. Marital problems, including divorce, as well as individual depression and anxiety are commonly encountered.

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