Infertility affects about 6.1 million people in the United States, which is approximately 10% of the reproductive age population. Infertility is very common in males with male factor infertility being present in up to half of all infertile couples.

At birth a women will have 2,000,000 to 4,000,000 oocytes (eggs), which is her lifetime supply. As a woman ages, the number of oocytes deteriorates to 200,000 to 400,000 by the time she begins menses leading to age related infertility. During her lifetime, approximately 300,000 to 400,000 eggs will be ovulated and as she ages the “quality” of her eggs declines.

Conception is a complicated process involving many biological processes in both partners. The male needs to produce healthy sperm that can reach and fertilize an egg (s) and the female needs to recruit and ovulate healthy eggs. Once the pregnancy is established, she must be able to carry the baby to term without miscarriage.

The eggs must travel unimpeded through the fallopian tubes to the distal end where fertilization occurs. The egg must be penetrated by a single “genetically healthy” sperm, which initiates the process of fertilization. After fertilization, a series of cell divisions occurs to form the embryo and after approximately five days the embryo travels to the uterus where it will implant in the endometrium and continue its development. Disruption of any of these processes, or others, may result in infertility. Please see the page on "Infertility-Causes" for more information.

Female Age and Infertility

Advanced female age has become a more prevalent cause of infertility. Egg quality declines measurably in the mid to late thirties and most women will reach perimenopause by age 43.  The ages vary considerably in different women and some will experience premature menopause, which can occur much earlier.

Infertility's incidence has increased over the last several years as more and more women choose to delay childbearing. A higher percentage of women are marrying at older ages, many are delaying childbearing until their careers are established, the divorce rate is high and many couples remarry and desire their own children. It is clear that the biological clock is not in sync with these societal changes as a woman’s greatest fertility occurs in her teens and twenties. The rise in the number of women waiting until later in life to have children increases their chances of infertility and remaining childless. Egg freezing is a process that could dramatically help many women wanting to preserve their fertility.

Female age is perhaps the “biggest enemy” to fertility.  Before the age of 25 years the majority of chromosomes are normal and abnormalities are seen in only 17% of the eggs.  As women age, their menstrual cycles shorten making it more difficult to get pregnant and by the age of 40 approximately 74% of the eggs released are chromosomally abnormal leading to miscarriage and infertility.

Smoking and Infertility

Smoking has been shown to increase infertility and we recommend that all patients stop (including the male). Smoking in women has been shown definitely to cause:

• Decrease in estrogen production
• Acceleration of egg depletion resulting in earlier menopause
• Delay in conception
• Women who smoke cigarettes were three times more likely to experience longer than a year delay in conception
• Increase risk of miscarriages
• Increase abnormalities in sperm motility and shape
• Three fold increase risk of ectopic pregnancy
• Women who are undergoing In vitro fertilization and smoke have a decrease in the eggs available for fertilization and decrease in pregnancy rate.
• Smoking decreases the weight of newborn and leads to premature birth.
• There is an increase incidence of sudden infant death syndrome in smoking households.
• Women should quit smoking at least two months prior to attempting to conceive.