Fetal development timeline

A normal pregnancy lasts nine months (280 days). Each three-month period of pregnancy is called a trimester. During each trimester, the fetus grows and develops.

The actual embryo or fetal age also known as “conceptual age” is the time elapsed from fertilization (the union of an egg and a sperm into a single cell) of the egg near the time of ovulation . However, because most women do not know when ovulation occurred, but do know when their last menstrual period (LMP) began, the time elapsed since the first day of the last normal menstrual period (LNMP), the menstrual age, is used to determine the age of a pregnancy. The menstrual age is also known as the gestational age. Gestational age is conventionally expressed as completed weeks. Therefore, a 36 week, 6 day fetus is considered to be a 36 week fetus ¹⁾.

Pregnancy begins when a man’s sperm fertilizes a woman’s egg. Fertilization takes place in the fallopian tube. Over the next few days, the single cell divides into multiple cells. At the same time, the small cluster of dividing cells moves through the fallopian tube to the lining of the uterus. There it implants and starts to grow. From implantation until the end of the eighth week of pregnancy, it is called an embryo. From the ninth week of pregnancy until birth, it is called a fetus.

Since you don’t always know when fertilization occurred, doctors calculate pregnancy based on the first day of your last menstrual period (LMP). A normal pregnancy lasts about 40 weeks from the first day of your last menstrual period (LMP). Your doctor will count forward 40 weeks from your LMP to estimate the due date. Pregnancy is assumed to start 2 weeks after the first day of the LMP. Therefore, an extra 2 weeks is counted at the beginning of your pregnancy when you are not actually pregnant. Pregnancy “officially” lasts 10 months (40 weeks)—not 9 months—because of these extra weeks. Most births occur between weeks 38 and 42. If you have an ultrasound early in your pregnancy, your doctor may measure the baby to determine your due date instead.

The day your baby is due is called the estimated due date (EDD). Only about 1 in 20 women give birth on their due dates. Still, the estimated due date (EDD) is useful for a number of reasons. It determines your fetus’s gestational age throughout pregnancy so that the fetus’s growth can be tracked. It also provides a timeline for certain tests that you will have throughout your pregnancy.

Your estimated due date (EDD) is calculated from the first day of your last menstrual period (LMP). But when the date of the LMP is uncertain, an ultrasound exam may be done during the first trimester to estimate the due date. If you have had in vitro fertilization, the estimated due date (EDD) is set by the age of the embryo and the date that the embryo is transferred to the uterus.

Figure 1. Fetal development chart

First trimester (week 1–week 12)

Pregnancy begins when a man’s sperm fertilizes a woman’s egg. Since you don’t always know when fertilization occurred, doctors calculate pregnancy based on the first day of your last menstrual period (LMP). Your doctor will count forward 40 weeks from your LMP to estimate the due date. Most births occur between weeks 38 and 42. If you have an ultrasound early in your pregnancy, your doctor may measure the baby to determine your due date instead.

After conception, your baby begins a period of dramatic change known as the embryonic stage. This stage runs from the 5th through the 10th week of pregnancy. During this stage, the baby is called an embryo.

There are numerous changes that occur during the embryonic stage. First, the cells of the embryo called embryonic stem cells multiply and develop. They become the hundreds of different types of cells needed to make a whole human body. Your baby’s major organs and body parts begin to take shape.

The placenta forms during the embryonic stage. The placenta takes nutrients, oxygen, and water from your blood and passes these along to your baby through the umbilical cord. It also removes the baby’s wastes. The placenta will filter out most of the harmful substances that may be present in your body.

The amniotic sac forms during this stage as well. It is filled with amniotic fluid, which surrounds and protects your baby in the uterus.

Below are some of the highlights that occur during the embryonic stage.

• Nervous system. This is one of the first things to develop. It includes the formation of your baby’s brain, spinal cord, and nerves.
• Heart. An S-shaped tube forms on the front of the embryo. This will become your baby’s heart. At first the heart does not beat, but soon it starts beating and pumping an early form of blood.
• Face. Your baby’s facial features begin to take shape. The eyes and ears form on the sides of the head and are linked to the brain. The eyes move forward on the face, and eyelids form to protect the developing eyes. Pieces of tissue grow and join together to create the forehead, nose, cheeks, lips, and jaw. The nasal passages, mouth, and tooth buds form the baby’s first teeth. A tongue with taste buds also forms.
• Arms and legs. At first, your baby’s arms and legs begin as little buds that sprout from the embryo’s sides. As they grow, the arms look like paddles and the legs look like flippers. A ridge appears on the end of each one. They eventually become your baby’s fingers and toes.
• Sexual organs. Cells form to become your baby’s eggs or sperm. Your baby’s penis or vagina is visible at the end of the embryonic period. However, it is still too soon to tell on an ultrasound if your baby is a girl or boy.
• Muscles and movement. Muscles develop and the embryo begins to move. At first it’s only twitching and reacting to touch. Once the nerves and muscles start working together, your baby can start moving on purpose.

By the end of the embryonic stage at week 10, your baby will be about 1 inch long. That’s still too small for you to feel your baby’s movements. You’ll probably feel them starting in the middle of the second trimester.

After the embryonic stage, the fetal stage begins and your baby is called a fetus. This stage runs from the 11th week until birth. Your baby will grow longer and gain weight quicker. Their organs and body parts will continue to develop.

The last 2 to 3 weeks of the first trimester are the beginning of the fetal stage. In those weeks, fingernails and toenails begin to form and the kidneys start working. By the end of the first trimester, your baby has tripled in length to about 3 inches long.

Second trimester (week 13–week 28)

From the moment of conception to the time of delivery, your growing baby goes through several stages of development. The middle part of your pregnancy is called the second trimester. It is made up of weeks 13 or 14 through weeks 26 or 27. The timeframe can vary based on your doctor. During this time, your baby continues to grow and change almost daily. Here is a summary of how your baby develops during the second trimester.

When the second trimester starts, your baby is about 3 inches long. Your doctor might tell you your baby measures a certain length “from crown to rump.” This means your baby is being measured from the top of its head to its bottom (instead of head to toe) because the legs are curled up to the baby’s stomach.

At the beginning of the second trimester, your baby’s head is the biggest part of his or her body. During the next few weeks, the rest of your baby’s body will get longer in order to catch up. By the end of the second trimester, your baby may be 9 inches — or even longer.

Below are other highlights of the second trimester.

• Your baby will start to hear certain sounds, such as your heartbeat, by about the 18th week of pregnancy. Your baby’s hearing will continue to improve and they will be able to hear your voice.
• Your baby’s eyes may open as early as the 20th week. Before this, the eyelids have been sealed shut. However, your baby’s eyes cannot see anything until the third trimester.
• Your baby will have fingerprints and footprints by the end of the second trimester.
• Fine hair and a white waxy substance cover and protect your baby’s skin. The skin is thin, loose, and wrinkled. In the third trimester, some fat will start to fill in under the skin.
• Your baby’s digestive system will start to function. The baby also will begin to produce and release urine, which becomes amniotic fluid.
• By the middle of your second trimester, the baby’s sex should be clear. If you have an ultrasound, you should be able learn your baby’s sex, if you want. Keep in mind your baby has to be in an ideal position for the doctor or technician to see the sex organs.

Things to consider

Your baby is moving almost all the time throughout your pregnancy. However, you won’t start to feel it until about the 20th week. At first, you may notice a fluttering feeling. It can be hard to tell if this is your baby or something else. Soon enough, the movements will become very noticeable. Your partner may be able to feel the baby move as well. You might even be able to see your belly move when your baby “kicks.”

Your baby’s movements are helping them prepare for life outside your body. Muscles grow stronger as your baby learns to kick, suck, and open and close their hands. Your baby also practices making faces, such as frowning, smiling, and squinting.

Third trimester (week 29–week 40)

By the end of the second trimester, all of your baby’s organs and body parts are present and working. The final part of your pregnancy is the third trimester. It is weeks 27 through birth. During this time, your baby is grows and matures.

In the third trimester, your baby’s senses continue to progress. Your baby uses its senses of hearing and touch to learn about its body and your womb. They still can’t see much, though. Their eyes can detect bright light, but it’s too dark to see in the uterus. Your baby hears and knows your voice and may move in response to music. Your baby also starts to practice important movements, including grasping and sucking. They may even start sucking on their thumb.

Other highlights of the third trimester:

• By the end of the third trimester, your baby has eyelashes and eyebrows. They may have a full head of hair or be bald. Nails have grown to the tips of the fingers and toes.
• The white waxy substance and fine hair that covered and protected your baby’s skin has begun to fall off. You may see some of the leftover hair after your baby is born. Most of this usually is gone within the first few weeks of life.
• Most babies move to a head-down position in the uterus toward the end, with the head on the mother’s pubic bone.
• The lungs are the last major organ to finish developing. When fully mature, they produce a chemical that affects the hormones in your body. Doctors are not sure why labor starts, but this chemical may be one of the causes.

Will my baby be big enough to survive if they are born before my due date?

Your due date is an estimate. Only 5 percent of babies are born on their actual due dates. Your baby is “full-term” (not premature) if they are born during or after week 37. If this is your first pregnancy, your baby is likely to be born after your due date.

If your baby is born earlier, near the beginning of the third trimester, they are likely to survive. However, the longer the baby is in your womb, the better.

Will I still feel my baby move?

You’ll feel your baby kicking, punching, and moving often in the early weeks of the third trimester. Later, as your baby gets larger, you’ll feel more stretches and rolls, and fewer kicks and punches.

As your uterus gets more crowded, you may feel your baby move less. If you think your baby is less active than usual, do a “kick count”. Keep track of the number of movements in one hour. If your baby moves fewer than 10 times in an hour, call your doctor.

How big will my baby grow during the third trimester?

As your baby grows, they add layers of fat to provide warmth after birth. The fat fills the extra space under the skin, making the skin less wrinkled. At birth, most babies weigh between 6 and 9 pounds. They are usually between 19 and 21 inches long.

Fetal development timeline week by week

Gestation is the period of time between conception and birth when a baby grows and develops inside the mother’s womb. Because it’s impossible to know exactly when conception occurs, gestational age is measured from the first day of the mother’s last menstrual cycle to the current date. It is measured in weeks.

This means that during weeks 1 and 2 of pregnancy, a woman is not yet pregnant. This is when her body is preparing for a baby. A normal gestation lasts anywhere from 37 to 42 weeks.

Week 1 to 2

• The first week of pregnancy starts with the first day of a woman’s menstrual period. She is not yet pregnant.
• During the end of the second week, an egg is released from an ovary. This is when you are most likely to conceive if you have unprotected intercourse.

During the first two weeks after the last menstrual period egg follicles mature in the ovaries under the stimulus of follicle-stimulating hormone (FSH) a hormone secreted by the pituitary gland in the brain. High levels of the hormone estradiol, produced by the developing egg follicle, cause secretion of luteinizing hormone (LH) ,yet another hormone from the pituitary gland. LH causes release of the egg from its follicle (ovulation)

For women with 28-day cycles, ovulation usually occurs on days 13 to 15.

Conception also called fertilization usually happens about 2 weeks after the start of your last menstrual period (also called LMP). Conception is when a man’s sperm fertilizes a woman’s egg. Conception happens in one of your fallopian tubes. These are the tubes between your ovaries and your uterus (womb).

You may not know the exact day you get pregnant. This is why health care providers use your ast menstrual period to find out how far along you are in pregnancy.

Week 3 (Gestational Age 3 weeks or Embryonic Age 1 week)

• During intercourse, sperm enters the vagina after the man ejaculates. The strongest sperm will travel through the cervix (the opening of the womb, or uterus), and into the fallopian tubes.
• A single sperm and the mother’s egg cell meet in the fallopian tube. When the single sperm enters the egg, conception occurs. The combined sperm and egg is called a zygote.
• The zygote contains all of the genetic information (DNA) needed to become a baby. Half the DNA comes from the mother’s egg and half from the father’s sperm.
• The zygote spends the next few days traveling down the fallopian tube. During this time, it divides to form a ball of cells called a blastocyst.
• A blastocyst is made up of an inner group of cells with an outer shell.
• The inner group of cells will become the embryo. The embryo is what will develop into your baby.
• The outer group of cells will become structures, called membranes, which nourish and protect the embryo.

The fertilized egg also called a zygote will begin producing the hormone human chorionic gonadotropin (hCG) the pregnancy hormone. Human chorionic gonadotropin (hCG) first becomes detectable in the mother’s blood and urine between 6 and 14 days after fertilization (3 to 4 weeks gestational age). During the 3rd week the sex of the fetus is determined by the father’s sperm, and twins may be formed. Fatigue and swollen or tender breasts are sometimes the first signs of pregnancy.

Week 4 (Gestational Age 4 weeks or Embryonic Age 2 weeks)

• Once the blastocyst reaches the uterus, it buries itself in the uterine wall (also called implantation).
• At this point in the mother’s menstrual cycle, the lining of the uterus is thick with blood and ready to support a baby.
• The blastocyst sticks tightly to the wall of the uterus and receives nourishment from the mother’s blood.

Week 5 (Gestational Age 5 weeks or Embryonic Age 3 weeks)

• Week 5 is the start of the “embryonic period” which lasts from the the 5th to the 10th week.  This is when all the baby’s major systems and structures develop.
• The embryo’s cells multiply and start to take on specific functions. This is called differentiation.
• Blood cells, kidney cells, and nerve cells all develop.
• The embryo grows rapidly, and the baby’s external features begin to form.
• Your baby’s brain, spinal cord, and heart begin to develop.
• Tiny buds start to appear that become your baby’s arms and legs.
• Baby’s gastrointestinal tract starts to form.
• It is during this time in the first trimester that the baby is most at risk for damage from things that may cause birth defects. This includes certain medicines, illegal drug use, heavy alcohol use, infections such as rubella, and other factors.

Weeks 6 (Gestational Age 6 weeks or Embryonic Age 4 weeks)

• The embryo is now about the size of a pea.
• The average crown to rump length is about 0.2 inches (0.4 cm)
• The eyes, nostrils, and arms are taking shape.
• The heart is beating at about 110 beats per minute and sometimes may be seen using a transvaginal ultrasound at this time.

Weeks 7 (Gestational Age 7 weeks or Embryonic Age 5 weeks)

• The embryo is now about 0. 4 inches (1 cm ) long.
• Arm and leg buds start to grow.
• Your baby’s brain forms into 5 different areas. Some cranial nerves are visible.
• Your baby’s eyes, nose, mouth, fingers, toes and ears are forming and begin to take shape.
• Tissue grows that will become your baby’s spine and other bones.
• Baby’s heart continues to grow and now beats at a regular rhythm (about 120 times a minute). This can be seen by vaginal ultrasound.
• Blood pumps through the main vessels.
• Your baby’s bones start to form but are still soft. They harden as you get farther along in your pregnancy.
• Your baby has eyelids, but they stay shut.
• Your baby’s genitals begin to form.
• By week 7 the trachea and bronchi of the lungs have formed and the pseudoglandular stage of lung development begins ²⁾
• Movement of the embryo can be detected by ultrasound.
• Crown–rump length of 7 mm or greater and no heartbeat, or mean sac diameter of 25 mm or greater and no embryo is considered consistent with early pregnancy loss ³⁾

Week 8 (Gestational Age 8 weeks or Embryonic Age 6 weeks)

• The average embryo at 8 weeks is 0.6 inches (1.6 cm) long and weighs less than 1/2 ounce (15 grams).
• Baby’s arms and legs have grown longer.
• Hands and feet begin to form and look like little paddles.
• Your baby’s brain continues to grow.
• The lungs start to form.
• In a process is called physiological gut herniation, the intestine elongates and moves outside of the abdomen herniating into the base of the umbilical cord and rotate counter-clockwise at about 8 weeks . The intestine returns into the fetal abdomen by about 12 weeks ⁴⁾.
• The placenta is working.

Week 9 (Gestational Age 9 weeks or Embryonic Age 7 weeks)

• The average embryo at 9 weeks is 0.9 inches (2.3 cm) long and weighs less than 1/2 ounce (15 grams).
• Nipples and hair follicles form.
• Arms grow and elbows develop.
• Baby’s toes can be seen.
• All baby’s essential organs have begun to grow.
• Tiny buds appear that become your baby’s teeth.
• The heart is beating at about 170 beats per minute.

Week 10 (Gestational Age 10 weeks or Embryonic Age 8 weeks)

• The average fetus at 10 weeks is 1.2 inches (3.2 cm) long and weighs 1.2 ounces (35 grams).
• The embryo’s tail has disappeared and it is now called a fetus. Fingerprints are being formed ⁵⁾ and bone cells are replacing cartilage.
• Your baby’s eyelids are more developed and begin to close.
• The outer ears begin to take shape.
• Baby’s facial features become more distinct.
• The intestines rotate.
• Fingers and toes continue to develop and your baby’s nails grow.
• You may be able to hear your baby’s heartbeat at your prenatal care checkup.
• At the end of the 10th week of pregnancy, your baby is no longer an embryo. It is now a fetus, the stage of development up until birth.

Week 11 (Gestational Age 11 weeks or Embryonic Age 9 weeks)

• The average fetus at 11 weeks is 1.6 inches (4.2 cm) long and weighs 1.6 ounces (45 grams).
• The fetus is starting to have breathing movements. It can open its mouth and swallow.

Weeks 12 (Gestational Age 12 weeks or Embryonic Age 10 weeks)

• The average fetus at 12 weeks is 2.1 inches (5.3 cm) long and weighs 2 ounces (58 grams).
• The fetus is starting to make random movements.
• The fetus begins to concentrate iodine in its thyroid and produce thyroid hormone at about this time.
• The pancreas is beginning to make insulin, and the kidneys are producing urine. The heart beat can usually be heard with and electronic monitor at this time.

Weeks 13 (Gestational Age 13 weeks or Embryonic Age 11 weeks)

• The average fetus at 13 weeks is 2.5 inches (6.5 cm) long and weighs 2.6 ounces (73 grams).
• Your baby’s eyelids close and will not reopen until about the 28th week.
• Baby’s face is well-formed.
• Limbs are long and thin.
• Nails appear on the fingers and toes.
• Genitals appear.
• Baby’s liver is making red blood cells.
• The head is very large — about half of baby’s size.
• Your little one can now make a fist.
• Tooth buds appear for the baby teeth.
• Your baby’s nose and taste buds are developing.
• Her skin starts to thicken, and hair follicles under her skin begin to grow.
• Your baby opens and closes her hands and brings them to her mouth.
• All major organs are formed now, but they are too immature for the fetus to survive out of the womb.
• Physiological gut herniation should be complete by this time
• The fetal bladder can be consistently seen using ultrasound after 13 weeks ⁶⁾.

Weeks 14 (Gestational Age 14 weeks or Embryonic Age 12 weeks)

• The average fetus at 14 weeks is 3.1 inches (7.9 cm) long and weighs 3.3 ounces (93 grams)
• The fetus’s toenails are appearing. The gender may sometimes be seen
• Your baby’s eyelids close and will not reopen until about the 28th week.
• Baby’s face is well-formed.
• Limbs are long and thin.
• Nails appear on the fingers and toes.
• Genitals appear.
• Baby’s liver is making red blood cells.
• The head is very large — about half of baby’s size.
• Your little one can now make a fist.
• Tooth buds appear for the baby teeth.
• Your baby’s nose and taste buds are developing.
• Her skin starts to thicken, and hair follicles under her skin begin to grow.
• Your baby opens and closes her hands and brings them to her mouth.
• All major organs are formed now, but they are too immature for the fetus to survive out of the womb.

Weeks 15 (Gestational Age 15 weeks or Embryonic Age 13 weeks)

• The average fetus at 15 weeks is 6.4 inches (16.4 cm) long and weighs 4.1 ounces (117 grams).
• Fetal movement may be sensed now (called quickening). Some mothers don’t feel the fetus moving until about 25 weeks.

Weeks 16 to 17 (Gestational Age 16 to 17 weeks or Embryonic Age 14 to 15 weeks)

• The average 16 week fetus is 7.1 inches (18.3 cm) long and weighs 5.2 ounces (146 grams).
• The average 17 week fetus is 7.9 inches (20.1 cm) long and weighs 6.4 ounces (181 grams).
• Hearing is beginning to form ⁷⁾
• The canalicular period of lung development has started and will continue until 25 weeks ⁸⁾
• The pseudoglandular stage of lung development ends at about 17 weeks. There are still NO ALVEOLI (the air sacs in the lungs where the exchange of oxygen and carbon dioxide occurs), so respiration is not possible at this time ⁹⁾.

Weeks 18 (Gestational Age 18 weeks or Embryonic Age 16 weeks)

• The average 18 week fetus is 8.6 inches (22 cm) long and weighs 7.9 ounces (223 grams).
• The ears are standing out, and the fetus is beginning to respond to sound.
• The cerebellar vermis can be demonstrated to be fully formed on ultrasound ¹⁰⁾.
• At this stage, baby’s skin is almost transparent.
• Fine hair called lanugo develops on baby’s head.
• Muscle tissue and bones keep developing, and bones become harder.
• Baby begins to move and stretch.
• The liver and pancreas produce secretions.
• Your little one now makes sucking motions.

Weeks 19 (Gestational Age 19 weeks or Embryonic Age 17 weeks)

• The average fetus at 19 weeks is 9.3 inches (23.7 cm) long and weighs 9.6 ounces (273 grams).
• The ears, nose and lips are now recognizable.

Weeks 20 (Gestational Age 20 weeks or Embryonic Age 18 weeks)

• The average fetus at 20 weeks is 9.9 inches (25.5 cm) long and weighs 11.7 ounces (331 grams).
• The fetus is covered in fine hair called lanugo, has some scalp hair, and is capable of producing IgG and IgM ( two types of antibodies)

Weeks 21 (Gestational Age 21 weeks or Embryonic Age 19 weeks)

• The average fetus at 21 weeks is 10.6 inches (27.2 cm) long and weighs 14.1 ounces (399 grams).
• Your baby can hear.
• The baby is more active and continues to move and float around.
• The mother may feel a fluttering in the lower abdomen. This is called quickening, when mom can feel baby’s first movements.
• By the end of this time, baby can swallow.
• The fetus is now able to suck and grasp, and may have bouts of hiccups.
• Some women may begin feeling Braxton Hicks contractions at this time.

Week 22 (Gestational Age 22 weeks or Embryonic Age 20 weeks)

• The average fetus at 22 weeks is 11.2 inches (28.8 cm) long and weighs 1.1 pound (478 grams).
• Survival out of the womb at this age would be expected to be ~9%.
• Survival without major morbidity among infants surviving to discharge would be expected to be 0% ¹¹⁾
• Lanugo hair covers baby’s entire body.
• Meconium, baby’s first bowel movement, is made in the intestinal tract.
• Eyebrows and lashes appear.
• The baby is more active with increased muscle development.
• The mother can feel the baby moving.
• Baby’s heartbeat can be heard with a stethoscope.
• Nails grow to the end of baby’s fingers.

Weeks 23 (Gestational Age 23 weeks or Embryonic Age 21 weeks)

• The average fetus at 23 weeks is 11.9 inches (30.4 cm) long and weighs 1.2 pounds (568 grams).
• The fetus is having rapid eye movements (REM) during sleep.
• The entire corpus callosum may not be be seen using transabdominal ultrasound before this age ¹²⁾
• Survival out of the womb at this age would be expected to be ~33%.
• Survival without major morbidity* among infants surviving to discharge would be expected to be ~2% ¹³⁾

Weeks 24 (Gestational Age 24 weeks or Embryonic Age 22 weeks)

• The average fetus at 24 weeks is 12.5 inches (32 cm) long and weighs 1.5 pounds (670 grams).
• The terminal saccular stage of lung development has started ¹⁴⁾
• Survival out of the womb at this age would be expected to be ~65%.
• Survival without major morbidity* among infants surviving to discharge would be expected to be ~ 9% ¹⁵⁾

Weeks 25 (Gestational Age 25 weeks or Embryonic Age 23 weeks)

• The average fetus at 25 weeks is 13.1 inches (33.6 cm) long and weighs 1.7 pounds (785 grams).
• The canalicular period of lung development is ending. Respiration is possible towards the end of this period ¹⁶⁾
• Survival out of the womb at this age would be expected to be ~81%.
• Survival without major morbidity* among infants surviving to discharge would be expected to be ~ 25% ¹⁷⁾
• Bone marrow begins to make blood cells.
• The lower airways of the baby’s lungs develop.
• Your baby begins to store fat.

Week 26 (Gestational Age 26 weeks or Embryonic Age 24 weeks)

• The average fetus at 26 weeks is 13.7 inches (35.1 cm) long and weighs 2 pounds (913 grams).
• Survival out of the womb at this age would be expected to be ~87%.
• Survival without major morbidity* among infants surviving to discharge would be expected to be ~ 29% ¹⁸⁾
• Eyebrows and eyelashes are well-formed.
• All parts of baby’s eyes are developed.
• Your baby may startle in response to loud noises.
• Footprints and fingerprints are forming.
• Air sacs form in baby’s lungs, but lungs are still not ready to work outside the womb.

Weeks 27 (Gestational Age 27 weeks or Embryonic Age 25 weeks)

• The average fetus at 27 weeks is 14.2 inches (36.5 cm) long and weighs 2.3 pounds (1055 grams).
• Survival out of the womb at this age would be expected to be ~94%. Survival without major morbidity among infants surviving to discharge would be expected to be ~ 50% ¹⁹⁾

Weeks 28 (Gestational Age 28 weeks or Embryonic Age 26 weeks)

• The average fetus at 28 weeks is 14.8 inches (37.9 cm) long and weighs 2.7 pounds (1210 grams).
• Survival out of the womb at this age would be expected to be ~94%.
• Survival without major morbidity among infants surviving to discharge would be expected to be ~ 59% ²⁰⁾
• Baby’s brain grows rapidly.
• The nervous system is developed enough to control some body functions.
• Your baby’s eyelids can open and close.
• The respiratory system, while immature, produces surfactant. This substance helps the air sacs fill with air.

Weeks 29 to 30 (Gestational Age 29 to 30 weeks or Embryonic Age 27 to 28 weeks)

• The average fetus at 29 weeks is 15.3 inches (39.3 cm) long and weighs 3 pounds (1379 grams).
• The average fetus at 30 weeks is 15.8 inches (40.6 cm) long and weighs 3.4 pounds (1559 grams).
• Baby’s brain grows rapidly.
• The nervous system is developed enough to control some body functions.
• Your baby’s eyelids can open and close.
• The respiratory system, while immature, produces surfactant. This substance helps the air sacs fill with air.

Weeks 31 to 34 (Gestational Age 31 to 34 weeks or Embryonic Age 29 to 32 weeks)

• The average fetus at 31 weeks is 16.4 inches (41.9 cm) long and weighs 3.9 pounds (1751 grams).
• The average fetus at 32 weeks is 16.8 inches (43.2 cm) long and weighs 4.3 pounds (1953 grams).
• The average fetus at 33 weeks is 17.3 inches (44.4 cm) long and weighs 4.8 pounds (2162 grams).
• The average fetus at 34 weeks is 17.8 inches (45.6 cm) long and weighs 5.2 pounds (2377 grams).
• Your baby grows quickly and gains a lot of fat.
• Rhythmic breathing occurs, but baby’s lungs are not fully mature.
• Baby’s bones are fully developed, but are still soft.
• Your baby’s body begins storing iron, calcium, and phosphorus.
• If the fetus is a boy, his testicles are descending.
• The distal femoral epiphysis ossification center can usually be seen in 72 % of fetuses at 33 weeks ²¹⁾

Weeks 35 to 37 (Gestational Age 35 to 37 weeks or Embryonic Age 33 to 35 weeks)

• The average 35 week fetus is 18.2 inches (46.7 cm) long and weighs 5.7 pounds (2595 grams).
• The average 36 week fetus is 18.6 inches (47.8 cm) long and weighs 6.2 pounds (2813 grams).
• The average 37 week fetus is 19.1 inches ( 48.9 cm) long and weighs 6.7 pounds (3028 grams).
• Baby weighs about 5 1/2 pounds (2.5 kilograms).
• Your baby keeps gaining weight, but will probably not get much longer.
• The skin is not as wrinkled as fat forms under the skin.
• Baby has definite sleeping patterns.
• Your little one’s heart and blood vessels are complete.
• Muscles and bones are fully developed.
• The proximal tibial epiphysis ossification center may be seen in 35 % of fetuses at 35 weeks ²²⁾
• The proximal humeral epiphysis ossification center may be seen at 38 weeks ²³⁾

Week 38 to 40 (Gestational Age 38 to 40 weeks or Embryonic Age 36 to 38 weeks)

• The average 38 week fetus is 19.5 inches (49.9 cm) long and weighs 7.1 pounds (3236 grams).
• The average 39 week fetus is 19.8 inches (50.9 cm) long and weighs 7.6 pounds (3435 grams).
• The average 40 week fetus is 20.2 inches (52 cm) long and weighs 8 pounds (3619 grams).
• The average 41 week fetus is 20.5 inches (52.7 cm) long and weighs 8.3 pounds (3787 grams).
• The proximal humeral epiphysis ossification center may be seen at 38 weeks ²⁴⁾
• Lanugo is gone except for on the upper arms and shoulders.
• Fingernails may extend beyond fingertips.
• Small breast buds are present on both sexes.
• Head hair is now coarse and thicker.
• In your 40th week of pregnancy, it has been 38 weeks since conception, and your baby could be born any day now.

Critical periods of fetal development

In every pregnancy, a woman starts out with a 3-5% chance of having a baby with a birth defect. This is called her background risk.

In pregnancy, each part of the baby’s body forms at a specific time. During these times, the body can be very sensitive to damage caused by medications, alcohol or other harmful exposures. Doctors call this specific time the “critical period of development” for that body part.

Figure 2. Critical periods of fetal development

Does the chance types of birth defects change throughout pregnancy?

Yes, the risk depends on what body part is developing at the time of exposure. Once a body part has formed, it is no longer at risk to develop major birth defects, but some exposures could still affect its growth and function.

The chart above (Figure 2) shows the critical periods of development for different parts of the body. The chart starts from the time of conception when the egg and sperm join. The weeks listed on the chart are the “embryonic age” or “fetal age” of a pregnancy. Note that this is different from a common way of dating a pregnancy called “gestational age.” Gestational age begins with the first day of a woman’s last menstrual period. This day is usually two weeks before a baby is conceived. This means that you can change gestational age to embryonic/fetal age by subtracting two weeks. For example, 12 gestational weeks (since the day of your last period) is the same as 10 fetal weeks (since the first day of conception).

The dark bars on the chart show when each part is most sensitive to harmful exposures and at risk for major birth defects. Birth defects are typically classified as “major” if they cause significant medical problems and need surgery or other treatment to repair. Heart defects, spina bifida, and clubfeet are examples of major birth defects.

The lightly shaded bars show periods when the body parts are still at risk to develop minor birth defects and functional defects. “Minor” birth defects by themselves do not cause significant medical problems and usually do not require treatment or surgery. Minor birth defects can also be variations of normal development. Wide-set eyes and large ears are examples of minor birth defects.

Both major and minor birth defects are physical or structural changes. However, “functional” defects change how a part of the body works without changing its physical structure. Intellectual disability and hearing loss are both examples of functional defects.

The chart also shows the location of the most common birth defects that can occur during each week. In general, major defects of the body and internal organs are more likely to occur between 3 to 12 embryo / fetal weeks. This is the same as 5 to 14 gestational weeks (weeks since the first day of your last period). This is also referred to as the first trimester. Minor defects and functional defects including twhose affecting the brain are also able to occur later in pregnancy.

What is the greatest risk from a harmful exposure during very early pregnancy?

Harmful exposures during very early pregnancy have the greatest risk of causing miscarriage. A fertilized egg divides and attaches to the inside of the uterus during the first two weeks of embryo development. Very harmful exposures during this period (first four weeks after the first day of your last period) may interfere with the attachment of the embryo to the uterus. Harmful exposures during this time can also damage all or most of the cells of the growing embryo. Problems with uterine attachment and severe cell damage can both result in a miscarriage. Sometimes this miscarriage is before a woman even realizes that she is pregnant.

Less severe exposures during this time may only damage a few of the embryo’s cells. The cells of the embryo have a greater ability to recover at this early stage than they do later on in pregnancy. If a woman does not have a miscarriage, we believe that the exposures during this time are not likely to cause a birth defect.

Doctors call the first four weeks of gestation the “all or none period”. “All” refers to high exposures damaging all of the embryo’s cells. This damage causes early miscarriage. “None” refers to exposures that are not high enough to have a significant effect on the pregnancy. Doctors can use the rule of the “all or none period” to determine the risk of many different types of exposures. However, there are some important exceptions to this rule.

What are the greatest risks from harmful exposures during the first trimester of pregnancy?

The first trimester of pregnancy is defined as up to the 14th week of pregnancy (13 weeks and 6 days) counting since the first day of your last menstrual period. Harmful exposures during the first trimester have the greatest risk of causing major birth defects. This is because many important developmental changes take place during this time. The major structures of the body form in the first trimester. These include the spine, head, arms and legs. The baby’s organs also begin to develop. Some examples of these organs are the heart, stomach and lungs. While the heart and stomach completely forms during the first trimester, the lungs continue to develop past the first trimester.

What are the greatest risks from harmful exposures during the second and third trimesters of pregnancy?

Harmful exposures during the second and third trimesters can cause growth problems and minor birth defects. Growth is an important part of the second and third trimester. The structures and organs that developed during the first trimester grow larger. Babies with growth problems may be much smaller or much larger than average. This size difference can put babies at risk for certain health problems.

Harmful exposures during the second and third trimesters can also cause functional defects like learning problems. The brain is part of the central nervous system and it develops during the entire pregnancy. Major, structural brain development lasts until about 16 fetal weeks (18 gestational weeks). However, the brain continues to develop for the rest of the pregnancy, after birth and through young adulthood.

While usually less well studied, some exposures in the second or third trimester might cause other pregnancy complications, such as premature delivery or low levels of amniotic fluid (the fluid that surrounds the developing baby in the uterus).

Finally, the use of certain medications and drugs at the end of pregnancy can cause withdrawal in some newborns. You should always tell your health care provider about all of the medications, supplements and/or drugs that you take.

Does this mean that an exposure might be harmful at certain times during pregnancy but not at other times?

Yes. Imagine your doctor gives you a new medication to take during your third trimester. We will call this “Medication A.” You read that Medication A increases the chance for heart defects. This means that babies may have a higher chance for major heart defects if their mothers’ take this medication during the heart’s critical period of development. We know that the heart’s critical period of development is from 3 to 6 embryonic weeks (5 to 8 gestational weeks). This means that using this medication in the third trimester cannot cause a major heart defect. Always talk to your health care provider before starting or stopping any medication.

Excess saliva pregnancy

Excessive saliva during pregnancy is also known as ptyalism gravidarum, hypersalivation or sialorrhea gravidarum, is common during the first trimester of pregnancy ¹⁾. Excessive saliva during pregnancy is usually associated with nausea and vomiting (emesis or hyperemesis) during the first trimester of pregnancy. You might need to spit out some saliva into a tissue quite often, and the bitter taste of the saliva can cause nausea and vomiting. The good news for most women is that it should ease after the first trimester. In rare cases, the increased salivation associated with hyperemesis (severe nausea and vomiting) does not abate at the end of the first trimester but continues, or even increases in amount, until delivery ²⁾.

Using gum or ice may be temporary coping strategies; however, some pregnant women always complain of bad taste and maintain that swallowing the excessive or thickened saliva perpetuates the sense of nausea ³⁾. Excessive saliva during pregnancy may diminish during sleep, however the patients may complain of excessive secretions as one cause of nocturnal wakening ⁴⁾. In addition, social encounters may be limited during pregnancy ⁵⁾.

Excessive saliva during pregnancy causes

As with most things in pregnancy, your hormones are to blame for excessive saliva. It can also be caused by pregnancy sickness, as nausea can make women try to swallow less, especially in those with hyperemesis gravidarum (extreme morning sickness).

Other causes include heartburn, which is common in pregnancy, and irritants like smoke, toxins and some medical conditions.

Some researchers consider that increased saliva during pregnancy (ptyalism gravidarum) has a physiologic, not psychologic origin ⁶⁾. It is generally agreed that salivary secretion is under neural control and that stimulation of the parasympathetic nerve supply of the salivary gland causes a profuse watery secretion with very little organic content ⁷⁾.

Excessive saliva during pregnancy treatment

While there is no medical treatment for excessive salivation during pregnancy, you may be able to ease symptoms by:

• eating smaller but more frequent meals
• brushing your teeth and using mouthwash several times a day
• chewing sugarless gum or sucking hard sweets
• taking frequent, small sips of water.

To date, some medical literature has recommended the use of central nervous system depressants such as barbiturates, anticholinergics such as belladonna alkaloid, or phosphorated carbohydrate ⁸⁾. In addition, Japanese patients sometimes use alpinia oxyphylla (a medicinal plant in China used for digesting, antidiuresis and/or salivation restraint) for the treatment of excess saliva in early pregnancy; however, individual differences in the effects of alpinia oxyphylla seem to be large. Therefore, there is no satisfactory treatment currently available for this complication during pregnancy.

Trouble getting pregnant

Trouble getting pregnant, difficulty conceiving is also known as infertility, which is usually defined as not being able to get pregnant after 12 months of unprotected sexual intercourse. A broader view of infertility includes not being able to carry a pregnancy to term. Finding out that you or your partner are unable to fall pregnant can be upsetting and difficult to deal with.

Because fertility in women is known to decline steadily with age, some health providers evaluate and treat women aged 35 years or older after just 6 months of unprotected sex. Women with infertility should consider making an appointment with a reproductive endocrinologist—a doctor who specializes in managing infertility. Reproductive endocrinologists may also be able to help women with recurrent pregnancy loss, defined as having two or more spontaneous miscarriages.

Pregnancy is the result of a process that has many steps.

To get pregnant:

1. A woman’s body must release an egg from one of her ovaries (ovulation).
2. A man’s sperm must join with the egg along the way (fertilize).
3. The fertilized egg must go through a fallopian tube toward the uterus (womb).
4. The fertilized egg must attach to the inside of the uterus (implantation).

Infertility may result from a problem with any or several of these steps.

Impaired fecundity (the ability to produce new offspring or fertility) is a condition related to infertility and refers to women who have difficulty getting pregnant or carrying a pregnancy to term.

• About 6% of married women aged 15 to 44 years in the United States are unable to get pregnant after one year of trying (infertility). Also, about 12% of women aged 15 to 44 years in the United States have difficulty getting pregnant or carrying a pregnancy to term, regardless of marital status (impaired fecundity).
• Infertility is not always a woman’s problem. Both men and women can contribute to infertility. Many couples struggle with infertility and seek help to become pregnant, but it is often thought of as only a woman’s condition. However, in about 35% of couples with infertility, a male factor is identified along with a female factor. In about 8% of couples with infertility, a male factor is the only identifiable cause.
• Almost 9% of men aged 25 to 44 years in the United States reported that they or their partner saw a doctor for advice, testing, or treatment for infertility during their lifetime.

For couples trying for a baby, it is normal to have feelings of uncertainty, disappointment and anxiety. It may affect a couple the same way or in different ways.

It is good to talk through any problems, and have both of you talk about how you feel.

If there are difficulties between you, talk to your doctor as a couple. Your doctor may refer you both to a counsellor if necessary.

There are many causes of infertility. For about 4 couples in 10 it will relate to a sperm problem. In another 4 couples in 10 there will be a female reproductive cause. Sometimes there is a combination of factors.

Treatment for infertility is available and can bring hope to people wanting to have a baby, but it also has financial, physical and emotional costs. And success is not guaranteed.

Having trouble getting pregnant with second baby

Secondary infertility is the inability to become pregnant or to carry a baby to term after previously giving birth to a baby. Secondary infertility shares many of the same causes of primary infertility.

Among the possible causes of secondary infertility are:

• Impaired sperm production, function or delivery in men
• Fallopian tube damage, ovulation disorders, endometriosis and uterine conditions in women
• Complications related to prior pregnancy or surgery
• Risk factor changes for you or your partner, such as age, weight and use of certain medications

If you have frequent, unprotected sex but don’t become pregnant — after a year if you’re younger than 35 or after six months if you’re 35 or older — talk to your health care provider.

Depending on the circumstances, both you and your partner might need medical evaluations. Your doctor can help determine whether there’s an issue that requires a specialist or treatment at a fertility clinic.

Secondary infertility can be surprising and stressful. Don’t try to cope alone. Seek support from your partner, family and friends as you talk to your health care provider about the next steps.

What is Unexplained infertility

Sometimes, the cause of infertility is never found. A combination of several minor factors in both partners could cause unexplained fertility problems. Although it’s frustrating to get no specific answer, this problem may correct itself with time. But, you shouldn’t delay treatment for infertility.

Good fertility health

Your age and your health can affect your chances of falling pregnant. Maintaining a healthy lifestyle may help you improve your fertility.

Age and fertility

When it comes to fertility, age matters. Many people today wait until they’re older to have children. But fertility declines over time, and you should consider this if you plan to have children later. Both women and men are most fertile in their early twenties.

In women, fertility declines more quickly with age. This decline becomes rapid after the age of 35. There are a number of reasons, but particularly the decline in the quality of the eggs released by the ovaries. Around one-third of couples in which the woman is over the age of 35 have fertility problems. This rises to two-thirds when the woman is over 40.

Women over 35 are also less likely to become pregnant as a result of fertility treatments, including IVF, and are more likely to have a miscarriage if they do become pregnant. Men’s fertility gradually declines from around the age of 40, but most men are able to father children into their 50s and beyond.

Avoid Sexually transmitted infections (STIs)

Sexually transmitted infections are sometimes called sexually transmitted diseases (STDs), such as chlamydia and gonorrhoea, can damage a woman’s fallopian tubes, which may make it more difficult to become pregnant. If you think you might have contracted an sexually transmitted infection (STI), go to your doctor or a sexual health clinic.

Sexually transmitted infections (STIs) are passed from one person to another through intimate physical contact – such as heavy petting – and from sexual activity including vaginal, oral, and anal sex. Sexually transmitted infections (STIs) are very common. In fact, the Centers for Disease Control and Prevention ¹⁾ estimates 20 million new infections occur every year in the United States. Sexually transmitted diseases (STDs) can mostly be prevented by not having sex. If you do have sex, you can lower your risk by using condoms and being in a sexual relationship with a partner who does not have an STD. Sexually transmitted infections (STIs) do not always cause symptoms, so it is possible to have an infection and not know it. That is why it is important to get tested if you are having sex. If you are diagnosed with an STD, know that all can be treated with medicine and some can be cured entirely.

There are dozens of sexually transmitted infections (STIs). Some sexually transmitted diseases (STDs), such as syphilis, gonorrhea, and chlamydia, are spread mainly by sexual contact. Other diseases, including Zika and Ebola, can be spread sexually but are more often spread through ways other than sex.

Be a healthy weight

Being underweight or overweight can lower your chances of conceiving. One cause of infertility is polycystic ovary syndrome (PCOS), which is made worse by being overweight or obese. Small reductions in weight can assist with fertility, so if you are above a healthy weight, weight management and physical activity is the first treatment option. Even a 5-10% loss of weight has been shown to greatly improve the chances of becoming pregnant ²⁾. Nutrition and exercise will play an important role in weight management.

Research ³⁾ shows that obesity is associated with increased production of androgens in adult women and during late female puberty or adolescence. Androgens are often called “male hormones” because males’ bodies make more of them than do women’s bodies, but both males and females need certain levels of androgens for normal health. Changes in hormone levels, including increases in androgens, can disrupt female reproductive cycles and lead to infertility.

In a research funded by the Reproductive Sciences Branch, investigators studied whether obesity prior to and during early puberty also increased androgen hormone production. Researchers compared androgen levels in normal-weight and obese girls between ages 8 and 14 years. Girls who were obese had higher androgen levels throughout puberty compared with normal-weight girls. The results of this study ⁴⁾ demonstrate that childhood obesity affects normal hormone production and that these early hormone level changes could influence fertility later in life.

Drink sensibly

The government advises that for women planning a pregnancy, not drinking alcohol is the safest option. This is because no studies have found a safe level of alcohol consumption during pregnancy and many women don’t know exactly when they become pregnant.

Men who exceed 3 to 4 units of alcohol a day may damage their sperm.

Avoid Smoking

Cigarette smoking affects men and women’s fertility and reproductive hormones. Research has implicated cigarette smoking in lower fertility in women, specifically in delayed conception, but the reason that this occurs is unknown. In another analysis of data from the BioCycle Study ⁵⁾, researchers examined the effect of cigarette smoking on women’s reproductive health. Researchers measured women’s reproductive hormones, including estradiol, progesterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH), across the menstrual cycle. The levels of these hormones, which vary during the menstrual cycle, are critical for a woman’s reproductive health. In the study, researchers found that smokers had abnormal increases in FSH and LH. High levels of these hormones are common during menopause and are associated with reduced fertility. This research points to a possible explanation for the adverse effect of smoking on women’s fertility and reproductive health ⁶⁾.

Keep your testicles cool

A man’s testicles should be one or two degrees cooler than the rest of their body. Tight underwear, hot showers and hot baths can all raise the temperature of the testicles.

Avoid radiation and dangerous chemicals

Exposure to radiation and chemicals such as glycol solvents, found in some paints, can damage fertility.

Infertility signs and symptoms

The main symptom of infertility is not getting pregnant. There may be no other outward signs or symptoms. Sometimes, an infertile woman may have irregular or absent menstrual periods. A menstrual cycle that’s too long (35 days or more), too short (less than 21 days), irregular or absent can mean that you’re not ovulating. Rarely, an infertile man may have some signs of hormonal problems, such as changes in hair growth or sexual function.

However, most couples will eventually conceive, with or without treatment.

Causes of infertility

There are many causes of infertility.

Sometimes it is a problem with the woman, sometimes with the man, sometimes with both and sometimes there is no obvious reason for it.

All of the steps during ovulation and fertilization need to happen correctly in order to get pregnant. Sometimes the issues that cause infertility in couples are present at birth, and sometimes they develop later in life.

Infertility causes can affect one or both partners. In general:

• In about one-third of cases, there is an issue with the male.
• In about one-third of cases, there is an issue with the female.
• In the remaining cases, there are issues with both the male and female, or no cause can be identified.

For example, a woman may have:

• hormonal disorders
• damaged or blocked fallopian tubes
• endometriosis
• very thick cervical mucus.

A man may have:

• low sperm count
• poor sperm movement or shape
• no sperm released due to an obstruction, or ejaculation failure.

Age is an important factor. From the age of 32, a woman’s chances of conceiving start to decrease, and from age 35, the rate of that decrease speeds up. Men aged 35 are half as fertile as they were at the age of 25, and from the age of 55, their fertility declines dramatically.

Your weight will also affect your fertility. Both women and men who are overweight have changes to their hormones that make it harder for them to be fertile.

Smokers are more likely to be infertile than non-smokers.

The more alcohol men and women drink, the less likely is a successful pregnancy.

Some sexually transmitted infections such as chlamydia and gonorrhea can reduce fertility in both men and women.

Infertility Prevention

Some types of infertility aren’t preventable. But several strategies may increase your chances of pregnancy.

Couples

Have regular intercourse several times around the time of ovulation for the highest pregnancy rate. Having intercourse beginning at least 5 days before and until a day after ovulation improves your chances of getting pregnant. Ovulation usually occurs at the middle of the cycle — halfway between menstrual periods — for most women with menstrual cycles about 28 days apart.

Men

For men, although most types of infertility aren’t preventable, these strategies may help:

• Avoid drug and tobacco use and excessive alcohol consumption, which may contribute to male infertility.
• Avoid high temperatures, as this can affect sperm production and motility. Although this effect is usually temporary, avoid hot tubs and steam baths.
• Avoid exposure to industrial or environmental toxins, which can impact sperm production.
• Limit medications that may impact fertility, both prescription and nonprescription drugs. Talk with your doctor about any medications you take regularly, but don’t stop taking prescription medications without medical advice.
• Exercise moderately. Regular exercise may improve sperm quality and increase the chances for achieving a pregnancy.

Women

For women, a number of strategies may increase the chances of becoming pregnant:

• Quit smoking. Tobacco has multiple negative effects on fertility, not to mention your general health and the health of a fetus. If you smoke and are considering pregnancy, quit now.
• Avoid alcohol and street drugs. These substances may impair your ability to conceive and have a healthy pregnancy. Don’t drink alcohol or use recreational drugs, such as marijuana or cocaine.
• Limit caffeine. Women trying to get pregnant may want to limit caffeine intake. Ask your doctor for guidance on the safe use of caffeine.
• Exercise moderately. Regular exercise is important, but exercising so intensely that your periods are infrequent or absent can affect fertility.
• Avoid weight extremes. Being overweight or underweight can affect your hormone production and cause infertility.

Infertility diagnosis

You and your partner will both need investigations to work out what the cause may be. Sometimes, the problem lies with the woman. Sometimes with the man. Sometimes with both. And sometimes, no cause is ever found.

If your doctor suspects there is a reason you have not fallen pregnant, there are a number of tests that can be done to determine your fertility and that of your partner. Your doctor can refer you for these tests, which will usually happen in hospital or at a fertility clinic.

Before infertility testing, your doctor or clinic works to understand your sexual habits and may make recommendations based on these. In some infertile couples, no specific cause is found (unexplained infertility).

• Infertility evaluation can be expensive, and sometimes involves uncomfortable procedures. Many medical plans may not reimburse the cost of fertility treatment. Finally, there’s no guarantee — even after all the testing and counseling — that you’ll get pregnant.

Tests for men

Male fertility requires that the testicles produce enough healthy sperm, and that the sperm is ejaculated effectively into the woman’s vagina and travels to the egg. Tests for male infertility attempt to determine whether any of these processes are impaired.

You may have a general physical exam, including examination of your genitals. Specific fertility tests may include:

• Semen analysis. Your doctor may ask for one or more semen specimens. Semen is generally obtained by masturbating or by interrupting intercourse and ejaculating your semen into a clean container. A lab analyzes your semen specimen. In some cases, sperm may be tested for in the urine.
• Hormone testing. You may have a blood test to determine the level of testosterone and other male hormones.
• Genetic testing. Genetic testing may be done to determine whether there’s a genetic defect causing infertility.
• Testicular biopsy. In select cases, a testicular biopsy may be performed to identify abnormalities contributing to infertility and to retrieve sperm to use with assisted reproductive techniques, such as IVF.
• Imaging. In certain situations, imaging studies such as a brain MRI, bone mineral density scan, transrectal or scrotal ultrasound, or a test of the vas deferens (vasography) may be performed.
• Other specialty testing. In rare cases, other tests to evaluate the quality of the sperm may be performed, such as evaluating a semen specimen for DNA abnormalities.

Sperm test

In up to half of cases, fertility problems are due to the male partner. Sometimes a lack of sperm or sperm that are not moving properly can cause a failure to conceive.

Your doctor can arrange a sperm test. The male partner will be asked to produce a sperm sample and take it for analysis, probably at your local hospital or a pathology laboratory.

Tests for women

Fertility for women relies on the ovaries releasing healthy eggs. Her reproductive tract must allow an egg to pass into her fallopian tubes and join with sperm for fertilization. The fertilized egg must travel to the uterus and implant in the lining. Tests for female infertility attempt to determine whether any of these processes are impaired.

You may have a general physical exam, including a regular gynecological exam. Specific fertility tests may include:

• Ovulation testing. A blood test measures hormone levels to determine whether you’re ovulating.
• Hysterosalpingography. Hysterosalpingography evaluates the condition of your uterus and fallopian tubes and looks for blockages or other problems. X-ray contrast is injected into your uterus, and an X-ray is taken to determine if the cavity is normal and ensure the fluid spills out of your fallopian tubes.
• Ovarian reserve testing. This testing helps determine the quality and quantity of the eggs available for ovulation. This approach often begins with hormone testing early in the menstrual cycle.
• Other hormone testing. Other hormone tests check levels of ovulatory hormones, as well as pituitary hormones that control reproductive processes.
• Imaging tests. Pelvic ultrasound looks for uterine or fallopian tube disease. Sometimes a hysterosonography (his-tur-o-suh-NOG-ruh-fee) is used to see details inside the uterus that are not seen on a regular ultrasound.

Depending on your situation, rarely your testing may include:

• Hysteroscopy. Based on your symptoms, your doctor may request a hysteroscopy to look for uterine or fallopian tube disease. During hysteroscopy, your doctor inserts a thin, lighted device through your cervix into your uterus to view any potential abnormalities.
• Laparoscopy. This minimally invasive surgery involves making a small incision beneath your navel and inserting a thin viewing device to examine your fallopian tubes, ovaries and uterus. A laparoscopy may identify endometriosis, scarring, blockages or irregularities of the fallopian tubes, and problems with the ovaries and uterus.
• Genetic testing. Genetic testing helps determine whether there’s a genetic defect causing infertility.

Not everyone needs to have all, or even many, of these tests before the cause of infertility is found. You and your doctor will decide which tests you will have and when.

Blood tests to check ovulation

Levels of hormones in a woman’s blood are closely linked to ovulation, when the ovaries release an egg into the fallopian tubes. Hormone imbalances can cause ovulation problems, and a blood test can help determine whether this is happening.

Going through a phase of not having periods, or having irregular periods, are also signs of ovulation problems. The most common cause of ovulation problems is polycystic ovary syndrome.

Test for Sexually transmitted infections (STIs)

Chlamydia is the most common sexually transmitted infection STI in the US. It can cause pelvic inflammatory disease and fertility problems. Your doctor can refer you for a test for chlamydia. This can be a urine test or a swab from the urethra (the tube from which urine passes) or the neck of the cervix.

Ultrasound scan

An ultrasound scan can be carried out to check the woman’s ovaries, womb and fallopian tubes. In a transvaginal ultrasound scan a small ultrasound probe is placed in the vagina. This scan can help doctors check the health of your ovaries and womb.

Certain conditions that can affect the womb, such as endometriosis and fibroids, can prevent pregnancy from occurring. The scan can also check for blockages in your fallopian tubes (the tubes that connect the ovaries and the womb), which may be stopping eggs from travelling along the tubes and into the womb.

X-ray of fallopian tubes

This is called a ‘hysterosalpingogram’ (HSG). Opaque dye is injected through the cervix while you have an X-ray. The dye will help your doctors to see if there are any blockages in your fallopian tubes. Blockages can prevent eggs passing down the tubes to the womb, and stop pregnancy occurring.
Laparoscopy

If you have a known pelvic problem, such as pelvic inflammatory disease (PID) or endometriosis, laparoscopy (keyhole surgery) may be done. This involves making a small cut in your abdomen so a thin tube with a camera (laparoscope) can be used to examine your womb, fallopian tubes and ovaries.

Infertility treatment

Infertility treatment depends on:

• What’s causing the infertility
• How long you’ve been infertile
• Your age and your partner’s age
• Personal preferences

If you are infertile and want to have a child, there are many options. There are a number of fertility treatments that are available to both of you.

Some causes of infertility can’t be corrected.

You may increase your chance of falling pregnant if you know your most fertile days.

In cases where spontaneous pregnancy doesn’t happen, couples can often still achieve a pregnancy through use of assisted reproductive technology like in vitro fertilisation (IVF). Infertility treatment may involve significant financial, physical, psychological and time commitments.

Treatment for men

Men’s options can include treatment for general sexual problems or lack of healthy sperm. Treatment may include:

• Altering lifestyle factors. Improving lifestyle and behavioral factors can improve chances for pregnancy, including discontinuing select medications, reducing/eliminating harmful substances, improving frequency and timing of intercourse, establishing regular exercise, and optimizing other factors that may otherwise impair fertility.
• Medications. Certain medications may improve a man’s sperm count and likelihood for achieving a successful pregnancy. These medicines may increase testicular function, including sperm production and quality.
• Surgery. In select conditions, surgery may be able to reverse a sperm blockage and restore fertility. In other cases, surgically repairing a varicocele may improve overall chances for pregnancy.
• Sperm retrieval. These techniques obtain sperm when ejaculation is a problem or when no sperm are present in the ejaculated fluid. They may also be used in cases where assisted reproductive techniques are planned and sperm counts are low or otherwise abnormal.

Treatment for women

Although a woman may need just one or two therapies to restore fertility, it’s possible that several different types of treatment may be needed before she’s able to conceive.

• Stimulating ovulation with fertility drugs. Fertility drugs are the main treatment for women who are infertile due to ovulation disorders. These medications regulate or induce ovulation. Talk with your doctor about fertility drug options — including the benefits and risks of each type.
• Intrauterine insemination (IUI). During IUI, healthy sperm are placed directly in the uterus around the time the woman’s ovary releases one or more eggs to be fertilized. Depending on the reasons for infertility, the timing of IUI can be coordinated with your normal cycle or with fertility medications.
• Surgery to restore fertility. Uterine problems such as endometrial polyps, a uterine septum or intrauterine scar tissue can be treated with hysteroscopic surgery.

Ovulation induction

Ovulation induction is designed to stimulate the ovary to increase egg production. Ovulation induction uses tablets or injections over a period of time. Ultrasounds and blood tests are performed to determine the best time to trigger ovulation using a hormone called HCG. Once ovulation has been triggered, semen is introduced either by sexual intercourse or intra-uterine insemination when collected semen is placed directly into the uterus through the cervix.

Ovulation induction is not recommended for women who have a BMI greater than 35.

Clomiphene citrate

Clomiphene (Clomid) is a tablet that is the most common medication used in US for ovulation induction. It is often recommended as the first option for improving fertility in women with polycystic ovary syndrome (PCOS) who are infertile and do not ovulate.

Metformin

Metformin can be used for treating infertility in women with PCOS who don’t ovulate and who have no other reasons for infertility.

Gonadotrophins

Gonadotrophins are hormones involved in regulating ovulation such as:

• follicle–stimulating hormone (FSH)
• luteinsing hormone (LH)
• human chorionic gonadotrophin (hCG)

Surgery for improving fertility

Ovarian drilling

A surgical procedure that may increase ovulation in PCOS. It is a minimally invasive procedure where an incision is made in the abdomen under a general anaesthetic and via the laparoscope small holes are drilled in the surface of the ovary. Following ovarian drilling, ovulation is often restored for up to 6-12 months.

As surgery is a more intensive treatment than taking medication or lifestyle treatment, ovarian drilling is not commonly used and is mostly used after other lifestyle or medical treatment has not helped.

Tubal surgery with microsurgery to unblock tubes

It is rare these days because of assisted reproductive technologies (ART).

Hydrotubation

Putting dye through the fallopian tube either under anesthetic or during ultrasound.

Assisted reproductive technology (ART)

For women who have not been able to conceive naturally or by using medications or lifestyle treatment to improve their fertility, another option is assisted reproductive technology. This includes treatments such as in vitro fertilization (IVF). Referral to a fertility specialist is necessary for these treatments.

Assisted reproductive technology is any fertility treatment in which the egg and sperm are handled. An assisted reproductive technology health team includes physicians, psychologists, embryologists, lab technicians, nurses and allied health professionals who work together to help infertile couples achieve pregnancy.

In vitro fertilization (IVF) is the most common assisted reproductive technology technique. In vitro fertilization (IVF) involves stimulating and retrieving multiple mature eggs from a woman, fertilizing them with a man’s sperm in a dish in a lab, and implanting the embryos in the uterus three to five days after fertilization.

Other techniques are sometimes used in an IVF cycle, such as:

• Intracytoplasmic sperm injection. A single healthy sperm is injected directly into a mature egg. Intracytoplasmic sperm injection is often used when there is poor semen quality or quantity, or if fertilization attempts during prior IVF cycles failed.
• Assisted hatching. This technique assists the implantation of the embryo into the lining of the uterus by opening the outer covering of the embryo (hatching).
• Donor eggs or sperm. Most assisted reproductive technology is done using the woman’s own eggs and her partner’s sperm. However, if there are severe problems with either the eggs or sperm, you may choose to use eggs, sperm or embryos from a known or anonymous donor.
• Gestational carrier. Women who don’t have a functional uterus or for whom pregnancy poses a serious health risk might choose IVF using a gestational carrier. In this case, the couple’s embryo is placed in the uterus of the carrier for pregnancy.

Complications of treatment

Complications of infertility treatment may include:

• Multiple pregnancy. The most common complication of infertility treatment is a multiple pregnancy — twins, triplets or more. Generally, the greater the number of fetuses, the higher the risk of premature labor and delivery, as well as problems during pregnancy such as gestational diabetes. Babies born prematurely are at increased risk of health and developmental problems. Talk to your doctor about ways to prevent a multiple pregnancy before you begin treatment.
• Ovarian hyperstimulation syndrome. Fertility medications to induce ovulation can cause ovarian hyperstimulation syndrome, in which the ovaries become swollen and painful. Symptoms may include mild abdominal pain, bloating and nausea that lasts about a week, or longer if you become pregnant. Rarely, a more severe form causes rapid weight gain and shortness of breath requiring emergency treatment.
• Bleeding or infection. As with any invasive procedure, there is a rare risk of bleeding or infection with assisted reproductive technology.

Coping and support

Coping with infertility can be extremely difficult because there are so many unknowns. The emotional burden on a couple is considerable. Taking these steps can help you cope:

• Be prepared. The uncertainty of infertility testing and treatments can be difficult and stressful. Ask your doctor to explain the steps, and prepare for each
• one.
  Set limits. Decide before starting treatment which procedures, and how many, are emotionally and financially acceptable for you and your partner. Fertility treatments may be expensive and often are not covered by insurance companies, and a successful pregnancy often depends on repeated attempts.
• Consider other options. Determine alternatives — adoption, donor sperm or egg, donor embryo, gestational carrier or adoption, or even having no children — as early as possible in the infertility evaluation. This may reduce anxiety during treatments and feelings of hopelessness if conception doesn’t occur.
• Seek support. Locate support groups or counseling services for help before and after treatment to help endure the process and ease the grief should treatment fail.

Managing emotional stress during treatment

Try these strategies to help manage emotional stress during treatment:

• Express yourself. Reach out to others rather than repressing guilt or anger.
• Stay in touch with loved ones. Talking to your partner, family and friends can be very beneficial. The best support often comes from loved ones and those closest to you.
• Reduce stress. Some studies have shown that couples experiencing psychological stress had poorer results with infertility treatment. Try to reduce stress in your life before trying to become pregnant.
• Exercise and eat a healthy diet. Keeping up a moderate exercise routine and a healthy diet can improve your outlook and keep you focused on living your life.

Managing emotional effects of the outcome

You’ll face the possibility of psychological challenges no matter your results:

• Not achieving pregnancy, or having a miscarriage. The emotional stress of not being able to have a baby can be devastating even on the most loving and affectionate relationships.
• Success. Even if fertility treatment is successful, it’s common to experience stress and fear of failure during pregnancy. If you have a history of depression or anxiety disorder, you’re at increased risk of these problems recurring in the months after your child’s birth.
• Multiple births. A successful pregnancy that results in multiple births introduces medical complexities and the likelihood of significant emotional stress both during pregnancy and after delivery.

Seek professional help if the emotional impact of the outcome of your fertility treatments becomes too heavy for you or your partner.

Female infertility

Doctors call infertility if a woman is not pregnant after 12 months or more of regular unprotected sex.

Infertility is common. Whether you are trying to fall pregnant for the first time, or are already parents who would like more children, infertility can be a stressful and frustrating experience for everyone involved.

Women need functioning ovaries, fallopian tubes and a uterus to get pregnant. Conditions affecting any one of these organs can contribute to female infertility. Some of these conditions are listed below and can be evaluated using a number of different tests. There is also plenty you can do to prevent infertility.

Female infertility causes

There are many causes of infertility.

Sometimes it is a problem with the woman, sometimes with the man, sometimes with both and sometimes there is no obvious reason for it (unexplained infertility).

Each of these factors is essential to become pregnant:

• You need to ovulate. To get pregnant, your ovaries must produce and release an egg, a process known as ovulation. Your doctor can help evaluate your menstrual cycles and confirm ovulation.
• Your partner needs sperm. For most couples, this isn’t a problem unless your partner has a history of illness or surgery. Your doctor can run some simple tests to evaluate the health of your partner’s sperm.
• You need to have regular intercourse. You need to have regular sexual intercourse during your fertile time. Your doctor can help you better understand when you’re most fertile.
• You need to have open fallopian tubes and a normal uterus. The egg and sperm meet in the fallopian tubes, and the embryo needs a healthy uterus in which to grow.

For pregnancy to occur, every step of the human reproduction process has to happen correctly. The steps in this process are:

• One of the two ovaries releases a mature egg.
• The egg is picked up by the fallopian tube.
• Sperm swim up the cervix, through the uterus and into the fallopian tube to reach the egg for fertilization.
• The fertilized egg travels down the fallopian tube to the uterus.
• The fertilized egg implants and grows in the uterus.

In women, a number of factors can disrupt this process at any step. Female infertility is caused by one or more of the factors below.

For example, a woman may have:

• hormonal disorders
• damaged or blocked fallopian tubes
• endometriosis
• very thick cervical mucus.

A man may have:

• low sperm count
• poor sperm movement or shape
• no sperm released due to an obstruction, or ejaculation failure.

Age is an important factor. From the age of 32, a woman’s chances of conceiving start to decrease, and from age 35, the rate of that decrease speeds up. Men aged 35 are half as fertile as they were at the age of 25, and from the age of 55, their fertility declines dramatically.

Your weight will also affect your fertility. Both women and men who are overweight have changes to their hormones that make it harder for them to be fertile.

Smokers are more likely to be infertile than non-smokers.

The more alcohol men and women drink, the less likely is a successful pregnancy.

Some sexually transmitted infections such as chlamydia and gonorrhea can reduce fertility in both men and women.

Disruption of ovarian function (presence or absence of ovulation (anovulation) and effects of ovarian “age”)

A woman’s menstrual cycle is, on average, 28 days long. Day 1 is defined as the first day of “full flow.” Regular predictable periods that occur every 24 to 32 days likely reflect ovulation. A woman with irregular periods is likely not ovulating.

Ovulation can be predicted by using an ovulation predictor kit and can be confirmed by a blood test to check the woman’s progesterone level on day 21 of her menstrual cycle. Although several tests exist to evaluate a woman’s ovarian function, no single test is a perfect predictor of fertility. The most commonly used markers of ovarian function include follicle stimulating hormone (FSH) value on day 3 to 5 of the menstrual cycle, anti-müllerian hormone value (AMH), and antral follicle count (AFC) using a transvaginal ultrasound.

Disruptions in ovarian function may be caused by several conditions and warrants an evaluation by a doctor.

When a woman doesn’t ovulate during a menstrual cycle, it’s called anovulation. Potential causes of anovulation include the following:

• Polycystic ovary syndrome (PCOS). PCOS is a condition that causes women to not ovulate, or to ovulate irregularly. Some women with PCOS have elevated levels of testosterone, which can cause acne and excess hair growth. PCOS is the most common cause of female infertility.
• Diminished ovarian reserve. Women are born with all of the eggs that they will ever have and a woman’s egg count decreases over time. Diminished ovarian reserve is a condition in which there are fewer eggs remaining in the ovaries than normal. The number of eggs a woman has declines naturally as a woman ages. It may also occur due to congenital, medical, surgical, or unexplained causes. Women with diminished ovarian reserve may be able to conceive naturally, but will produce fewer eggs in response to fertility treatments.
• Functional hypothalamic amenorrhea. Functional hypothalamic amenorrhea is a condition caused by excessive exercise, stress, or low body weight. It is sometimes associated with eating disorders such as anorexia.
• Improper function of the hypothalamus and pituitary glands. The hypothalamus and pituitary glands in the brain produce hormones that maintain normal ovarian function. Production of too much of the hormone prolactin by the pituitary gland (often as the result of a benign pituitary gland tumor), or improper function of the hypothalamus or pituitary gland, may cause a woman not to ovulate.
• Premature ovarian insufficiency (early menopause). Premature ovarian insufficiency, sometimes referred to as premature menopause, occurs when a woman’s ovaries stop working and menstruation ends before age 40. Although the cause is often unknown, certain factors are associated with early menopause, including immune system diseases, certain genetic conditions such as Turner syndrome or carriers of Fragile X syndrome, pelvic radiation therapy or chemotherapy treatment, and smoking. About 5% to10% of women with premature ovarian insufficiency conceive naturally and have a normal pregnancy.
• Menopause. Menopause is an age-appropriate decline in ovarian function that usually occurs around age 50. By definition, a woman in menopause has not had a period in one year. She may experience hot flashes, mood changes, difficulty sleeping, and other symptoms as well.

Fallopian tube obstruction (whether fallopian tubes are open, blocked, damaged or swollen)

Risk factors for blocked fallopian tubes (tubal occlusion) or pelvic adhesions can include a history of pelvic infection, history of ruptured appendicitis, history of gonorrhea or chlamydia, known endometriosis, or a history of abdominal surgery.

Tubal evaluation may be performed using an X-ray that is called a hysterosalpingogram or by chromopertubation in the operating room at time of laparoscopy, a surgical procedure in which a small incision is made and a viewing tube called a laparoscope is inserted.

• Hysterosalpingogram is an X-ray of the uterus and fallopian tubes. A radiologist injects dye into the uterus through the cervix and simultaneously takes X-ray pictures to see if the dye moves freely through fallopian tubes. This helps evaluate tubal caliber (diameter) and patency.
• Chromopertubation is similar to an hysterosalpingogram but is done in the operating room at the time of a laparoscopy. Blue-colored dye is passed through the cervix into the uterus and spillage and tubal caliber (shape) is evaluated.

Abnormal uterine contour (physical characteristics of the uterus)

Depending on a woman’s symptoms, the uterus may be evaluated by transvaginal ultrasound to look for fibroids or other anatomic abnormalities. If suspicion exists that the fibroids may be entering the endometrial cavity, a sonohystogram or hysteroscopy may be performed to further evaluate the uterine environment.

Uterine or cervical causes

Several uterine or cervical causes can impact fertility by interfering with implantation or increasing the likelihood of a miscarriage:

• Benign polyps or tumors (fibroids or myomas) are common in the uterus. Some can block fallopian tubes or interfere with implantation, affecting fertility. However, many women who have fibroids or polyps do become pregnant.
• Endometriosis scarring or inflammation within the uterus can disrupt implantation.
  Uterine abnormalities present from birth, such as an abnormally shaped uterus, can cause problems becoming or remaining pregnant.
• Cervical stenosis, a narrowing of the cervix, can be caused by an inherited malformation or damage to the cervix.
• Sometimes the cervix can’t produce the best type of mucus to allow the sperm to travel through the cervix into the uterus.

Other causes in women include:

• Cancer and its treatment. Certain cancers — particularly female reproductive cancers — often severely impair female fertility. Both radiation and chemotherapy may affect fertility.
• Other conditions. Medical conditions associated with delayed puberty or the absence of menstruation (amenorrhea), such as celiac disease, poorly controlled diabetes and some autoimmune diseases such as lupus, can affect a woman’s fertility. Genetic abnormalities also can make conception and pregnancy less likely.

Smoking and female fertility

Smoking can cause problems for virtually all aspects of the reproductive system. Women who smoke are more likely to have difficulty conceiving, may not respond as well to treatment for infertility, experience earlier menopause and have an increased risk of cervical and vulval cancer. Smoking is associated with an increased risk of infertility, for both women attempting to become pregnant for the first time and women who have previously been pregnant.

Women who smoke also have a poorer response to in vitro fertilisation (IVF). Smokers will also have an increased risk of ectopic pregnancy and miscarriage. Smoking during pregnancy has been linked to a variety of health problems in the baby including premature birth, low birthweight, cot death (also known as sudden infant death syndrome or SIDS) and breathing problems in the first six months of life.

Sexually transmitted infections (STIs)

Sexually transmitted infections (STIs) are sometimes called sexually transmitted diseases (STDs) are infections that can be passed on during sex, and in some cases can be passed from a woman to her baby during pregnancy and childbirth. If left untreated, sexually transmitted infections (STIs) can cause serious problems for both mother and child. If you think you may have an sexually transmitted infection (STI), it’s important to see a doctor.

Sexually transmitted infections (STIs) are caused by micro-organisms such as bacteria, viruses and parasites. These organisms can pass between people in semen, blood or vaginal and other bodily fluids.

Many STIs can also be transmitted by close skin-to-skin contact (for example during foreplay or oral sex), through blood-to-blood contact, and by sharing needles and other equipment for intravenous drug use.

Types of Sexually transmitted infections (STIs)

There are many different types of STIs. The most common STIs in US are:

• chlamydia (a bacterial infection)
• gonorrhea (a bacterial infection)
• syphilis (a bacterial infection)
• genital herpes (a viral infection)
• genital warts/human papilloma virus (HPV) (a viral infection)
• hepatitis B (a viral infection)
• HIV (a viral infection)
• trichomoniasis (a parasite).

There are also a range of infections that, while not strictly classified as STIs, are sometimes linked with sexual activity, such as:

• hepatitis A (a viral infection)
• thrush (a Candida fungal infection)
• bacterial vaginosis (an imbalance of bacteria in the vagina)
• pubic lice or crabs (a parasite)
• scabies (a parasite)
• lymphogranuloma venereum (caused by some types of chlamydia)
• mycoplasma genitalium (a bacterial infection).

Symptoms of Sexually transmitted infections (STIs)

Many people with STIs have no symptoms. They may not know about it until it causes complications or a partner is diagnosed.

Other people get symptoms such as:

• sores or bumps on the genitals, mouth or rectal area
• pain when urinating
• unusual discharge from the penis or vagina
• unusual vaginal bleeding
• pain during sex
• sore, swollen lymph nodes, especially in the groin
• pain in the lower abdomen
• rash on the body, hands or feet.

If you have one or more of these symptoms it doesn’t necessarily mean you have an STI, but it would be wise to see your doctor for a check-up.

Can having an sexually transmitted infection (STI) affect my pregnancy?

Sexually transmitted infections (STIs) can affect your ability to become pregnant (your fertility), as well as your pregnancy. If you are pregnant, or wanting to become pregnant, tested for sexually transmitted infections (STIs) is recommended even if you have been tested in the past. If you have concerns about this, discuss this with your doctor.

Women who are pregnant can get the same STIs as women who are not pregnant. If you get infected with an sexually transmitted infection (STI) while pregnant, it can cause serious problems for you and your developing baby, so if you are worried this is a possibility, discuss getting a check done with your doctor.

If you do contract an STI while pregnant, getting early treatment can reduce the risks. Even if the STI can’t be cured, there are things that can be done to protect you and your baby.

How can Sexually transmitted infections (STIs) affect my baby?

Some STIs, such as syphilis and HIV, can infect a baby while it’s still in the mother’s womb. Others, such as chlamydia and genital herpes, can infect the baby as it is being delivered.

Sexually transmitted infections (STIs) can pose significant health risks to unborn babies. These include:

• premature birth
• low birth weight
• birth defects
• illness
• death.

Getting regular medical care during your pregnancy and discussing any concerns you may have of STIs with your doctor or midwife help reduce the risk of any problems caused by STIs during your pregnancy.

Diagnosis and treatment for Sexually transmitted infections (STIs)

Untreated STIs stay active in the body and may be passed on to sexual partners, or your baby, without you being aware. Therefore, it’s important to get tested if you think you may have an STI.

Having a test for STIs is simple. The type of test depends on the STI, but tests usually involve a providing a urine sample, a swab, a blood test, or a physical examination.

If the test shows you have an STI, you may need further tests and treatment. STIs caused by bacteria, like chlamydia, can usually be treated with antibiotics. Other STIs, such as those caused by viruses (for example herpes), can be managed to control symptoms, but are not always curable.

Tips for avoiding Sexually transmitted infections (STIs)

Other than not having sex with a partner that could potentially have an STI, condoms (used during penetrative sex) and dental dams (used during oral sex) offer the best protection from STIs.

Other ways to avoid STIs are:

• staying with one uninfected partner or not having many sexual partners
• avoiding sex with a new partner until you’ve both been tested for STIs
• getting vaccinated against HPV and hepatitis
• getting circumcised (if you are a man)
• not taking drugs or drinking excessive alcohol (often associated with risk-taking behaviour).

Risk factors for infertility in women

Female fertility is known to decline with:

• Age. More women are waiting until their 30s and 40s to have children. In fact, about 20% of women in the United States now have their first child after age 35. About one-third of couples in which the woman is older than 35 years have fertility problems. Aging not only decreases a woman’s chances of having a baby, but also increases her chances of miscarriage and of having a child with a genetic abnormality.
• Aging decreases a woman’s chances of having a baby in the following ways:
  • She has a smaller number of eggs left.
  • Her eggs are not as healthy.
  • She is more likely to have health conditions that can cause fertility problems.
  • She is more likely to have a miscarriage.
• Smoking.
• Excessive alcohol use.
• Being overweight. Among American women, an inactive lifestyle and being overweight may increase the risk of infertility. A man’s sperm count may also be affected if he is overweight.
• Being underweight. Women at risk of fertility problems include those with eating disorders, such as anorexia or bulimia, and women who follow a very low calorie or restrictive diet.
• Excessive physical or emotional stress that results in amenorrhea (absent periods).

Prevention of infertility in women

If you’re a woman thinking about getting pregnant soon or in the future, you may improve your chances of having normal fertility if you:

• Maintain a normal weight. Overweight and underweight women are at increased risk of ovulation disorders. If you need to lose weight, exercise moderately. Strenuous, intense exercise of more than five hours a week has been associated with decreased ovulation.
• Quit smoking. Tobacco has multiple negative effects on fertility, not to mention your general health and the health of a fetus. If you smoke and are considering pregnancy, quit now.
• Avoid alcohol. Heavy alcohol use may lead to decreased fertility. And any alcohol use can affect the health of a developing fetus. If you’re planning to become pregnant, avoid alcohol, and don’t drink alcohol while you’re pregnant.
• Reduce stress. Some studies have shown that couples experiencing psychological stress had poorer results with infertility treatment. If you can, find a way to reduce stress in your life before trying to become pregnant.
• Limit caffeine. Research suggests that limiting caffeine intake to less than 200 milligrams a day shouldn’t affect your ability to get pregnant. That’s about one to two cups of 6 to 8 ounces of coffee per day.

Diagnosis of female infertility

If you’ve been unable to conceive within a reasonable period of time, seek help from your doctor for evaluation and treatment of infertility.

Fertility tests may include:

• Ovulation testing. An at-home, over-the-counter ovulation prediction kit detects the surge in luteinizing hormone (LH) that occurs before ovulation. A blood test for progesterone — a hormone produced after ovulation — can also document that you’re ovulating. Other hormone levels, such as prolactin, also may be checked.
• Hysterosalpingography. During hysterosalpingography (his-tur-o-sal-ping-GOG-ruh-fee), X-ray contrast is injected into your uterus and an X-ray is taken to detect abnormalities in the uterine cavity. The test also determines whether the fluid passes out of the uterus and spills out of your fallopian tubes. If abnormalities are found, you’ll likely need further evaluation. In a few women, the test itself can improve fertility, possibly by flushing out and opening the fallopian tubes.
• Ovarian reserve testing. This testing helps determine the quality and quantity of eggs available for ovulation. Women at risk of a depleted egg supply — including women older than 35 — may have this series of blood and imaging tests.
• Other hormone testing. Other hormone tests check levels of ovulatory hormones as well as thyroid and pituitary hormones that control reproductive processes.
• Imaging tests. A pelvic ultrasound looks for uterine or fallopian tube disease. Sometimes a hysterosonography (his-tur-o-suh-NOG-ruh-fee) is used to see details inside the uterus that can’t be seen on a regular ultrasound.

Depending on your situation, rarely your testing may include:

• Other imaging tests. Depending on your symptoms, your doctor may request a hysteroscopy to look for uterine or fallopian tube disease.
• Laparoscopy. This minimally invasive surgery involves making a small incision beneath your navel and inserting a thin viewing device to examine your fallopian tubes, ovaries and uterus. A laparoscopy may identify endometriosis, scarring, blockages or irregularities of the fallopian tubes, and problems with the ovaries and uterus.
• Genetic testing. Genetic testing helps determine whether there’s a genetic defect causing infertility.

Treatment of female infertility

Infertility treatment depends on the cause, your age, how long you’ve been infertile and personal preferences. Because infertility is a complex disorder, treatment involves significant financial, physical, psychological and time commitments.

Although some women need just one or two therapies to restore fertility, it’s possible that several different types of treatment may be needed.

Treatments can either attempt to restore fertility through medication or surgery, or help you get pregnant with sophisticated techniques.

Fertility restoration: Stimulating ovulation with fertility drugs

Fertility drugs regulate or stimulate ovulation. Fertility drugs are the main treatment for women who are infertile due to ovulation disorders.

Fertility drugs generally work like the natural hormones — follicle-stimulating hormone (FSH) and luteinizing hormone (LH) — to trigger ovulation. They’re also used in women who ovulate to try to stimulate a better egg or an extra egg or eggs. Fertility drugs may include:

• Clomiphene citrate. Clomiphene (Clomid) is taken by mouth and stimulates ovulation by causing the pituitary gland to release more FSH and LH, which stimulate the growth of an ovarian follicle containing an egg.
• Gonadotropins. Instead of stimulating the pituitary gland to release more hormones, these injected treatments stimulate the ovary directly to produce multiple eggs. Gonadotropin medications include human menopausal gonadotropin or hMG (Menopur) and FSH (Gonal-F, Follistim AQ, Bravelle).
• Another gonadotropin, human chorionic gonadotropin (Ovidrel, Pregnyl), is used to mature the eggs and trigger their release at the time of ovulation. Concerns exist that there’s a higher risk of conceiving multiples and having a premature delivery with gonadotropin use.
• Metformin. Metformin (Glucophage, others) is used when insulin resistance is a known or suspected cause of infertility, usually in women with a diagnosis of PCOS. Metformin helps improve insulin resistance, which can improve the likelihood of ovulation.
• Letrozole. Letrozole (Femara) belongs to a class of drugs known as aromatase inhibitors and works in a similar fashion to clomiphene. Letrozole may induce ovulation. However, the effect this medication has on early pregnancy isn’t yet known, so it isn’t used for ovulation induction as frequently as others.
• Bromocriptine. Bromocriptine (Cycloset), a dopamine agonist, may be used when ovulation problems are caused by excess production of prolactin (hyperprolactinemia) by the pituitary gland.

Risks of fertility drugs

Using fertility drugs carries some risks, such as:

• Pregnancy with multiples. Oral medications carry a fairly low risk of multiples (less than 10 percent) and mostly a risk of twins. Your chances increase up to 30 percent with injectable medications. Injectable fertility medications also carry the major risk of triplets or more (higher order multiple pregnancy).

Generally, the more fetuses you’re carrying, the greater the risk of premature labor, low birth weight and later developmental problems. Sometimes adjusting medications can lower the risk of multiples, if too many follicles develop.

• Ovarian hyperstimulation syndrome (OHSS). Injecting fertility drugs to induce ovulation can cause OHSS, which causes swollen and painful ovaries. Signs and symptoms usually go away without treatment, and include mild abdominal pain, bloating, nausea, vomiting and diarrhea.

If you become pregnant, however, your symptoms might last several weeks. Rarely, it’s possible to develop a more-severe form of OHSS that can also cause rapid weight gain, enlarged painful ovaries, fluid in the abdomen and shortness of breath.

• Long-term risks of ovarian tumors. Most studies of women using fertility drugs suggest that there are few if any long-term risks. However, a few studies suggest that women taking fertility drugs for 12 or more months without a successful pregnancy may be at increased risk of borderline ovarian tumors later in life.

Women who never have pregnancies have an increased risk of ovarian tumors, so it may be related to the underlying problem rather than the treatment. Since success rates are typically higher in the first few treatment cycles, re-evaluating medication use every few months and concentrating on the treatments that have the most success appear to be appropriate.

Fertility restoration: Surgery

Several surgical procedures can correct problems or otherwise improve female fertility. However, surgical treatments for fertility are rare these days due to the success of other treatments. They include:

• Laparoscopic or hysteroscopic surgery. These surgeries can remove or correct abnormalities to help improve your chances of getting pregnant. Surgery might involve correcting an abnormal uterine shape, removing endometrial polyps and some types of fibroids that misshape the uterine cavity, or removing pelvic or uterine adhesions.
• Tubal surgeries. If your fallopian tubes are blocked or filled with fluid (hydrosalpinx), your doctor may recommend laparoscopic surgery to remove adhesions, dilate a tube or create a new tubal opening. This surgery is rare, as pregnancy rates are usually better with IVF. For hydrosalpinx, removal of your tubes (salpingectomy) or blocking the tubes close to the uterus can improve your chances of pregnancy with IVF.

Reproductive assistance

The most commonly used methods of reproductive assistance include:

• Intrauterine insemination (IUI). During IUI, millions of healthy sperm are placed inside the uterus close to the time of ovulation.
• Assisted reproductive technology. This involves retrieving mature eggs from a woman, fertilizing them with a man’s sperm in a dish in a lab, then transferring the embryos into the uterus after fertilization. IVF is the most effective assisted reproductive technology. An IVF cycle takes several weeks and requires frequent blood tests and daily hormone injections.

Coping and support

Dealing with female infertility can be physically and emotionally exhausting. To cope with the ups and downs of infertility testing and treatment, consider these strategies:

• Be prepared. The uncertainty of infertility testing and treatments can be difficult and stressful. Ask your doctor to explain the steps for your therapy to help you and your partner prepare. Understanding the process may help reduce your anxiety.
• Seek support. Although infertility can be a deeply personal issue, reach out to your partner, close family members or friends, or a professional for support. Many online support groups allow you to maintain your anonymity while you discuss issues related to infertility.
• Exercise and eat a healthy diet. Keeping up a moderate exercise routine and eating healthy foods can improve your outlook and keep you focused on living your life despite fertility problems.
• Consider other options. Determine alternatives — adoption, donor sperm or egg, or even having no children — as early as possible in the infertility treatment process. This can reduce anxiety during treatments and disappointment if conception doesn’t occur.

Male infertility

Male infertility is due to low sperm production, abnormal sperm function or blockages that prevent the delivery of sperm. Illnesses, injuries, chronic health problems, lifestyle choices and other factors can play a role in causing male infertility.

Not being able to conceive a child can be stressful and frustrating, but a number of male infertility treatments are available.

Symptoms of male infertility

The main sign of male infertility is the inability to conceive a child. There may be no other obvious signs or symptoms. In some cases, however, an underlying problem such as an inherited disorder, hormonal imbalance, dilated veins around the testicle, or a condition that blocks the passage of sperm causes signs and symptoms.

Although most men with male infertility do not notice symptoms other than inability to conceive a child, signs and symptoms associated with male infertility include:

• Problems with sexual function — for example, difficulty with ejaculation or small volumes of fluid ejaculated, reduced sexual desire or difficulty maintaining an erection (erectile dysfunction)
• Pain, swelling or a lump in the testicle area
• Recurrent respiratory infections
• Inability to smell
• Abnormal breast growth (gynecomastia)
• Decreased facial or body hair or other signs of a chromosomal or hormonal abnormality
• Having a lower than normal sperm count (fewer than 15 million sperm per milliliter of semen or a total sperm count of less than 39 million per ejaculate)

Male infertility causes

Male fertility is a complex process. To get your partner pregnant, the following must occur:

• You must produce healthy sperm. Initially, this involves the growth and formation of the male reproductive organs during puberty. At least one of your testicles must be functioning correctly, and your body must produce testosterone and other hormones to trigger and maintain sperm production.
• Sperm have to be carried into the semen. Once sperm are produced in the testicles, delicate tubes transport them until they mix with semen and are ejaculated out of the penis.
• There needs to be enough sperm in the semen. If the number of sperm in your semen (sperm count) is low, it decreases the odds that one of your sperm will fertilize your partner’s egg. A low sperm count is fewer than 15 million sperm per milliliter of semen or fewer than 39 million per ejaculate.
• Sperm must be functional and able to move. If the movement (motility) or function of your sperm is abnormal, the sperm may not be able to reach or penetrate your partner’s egg.

Infertility in men can be caused by different factors and is typically evaluated by a semen analysis. When a semen analysis is performed, the number of sperm (concentration), motility (movement), and morphology (shape) are assessed by a specialist. A slightly abnormal semen analysis does not mean that a man is necessarily infertile. Instead, a semen analysis helps determine if and how male factors are contributing to infertility.

Smoking and male fertility

Research has shown that male smokers have lower sperm quality and count than non-smokers. Smoking can also lead to male erectile dysfunction. Two of the main chemicals in cigarettes are nicotine and carbon monoxide, which narrow the arteries and reduce the blood flow through the body, affecting the blood flow to the penis.

By quitting smoking you reduce the risk of impotence and improve your sperm quality, and are less likely to have delays in falling pregnant or experience infertility.

Disruption of testicular or ejaculatory function

Abnormal sperm production or function due to undescended testicles, genetic defects, health problems such as diabetes or infections such as chlamydia, gonorrhea, mumps or HIV. Enlarged veins in the testes (varicocele) can also affect the quality of sperm.

Problems with the delivery of sperm due to sexual problems, such as premature ejaculation; certain genetic diseases, such as cystic fibrosis; structural problems, such as a blockage in the testicle; or damage or injury to the reproductive organs.

• Varicoceles, a condition in which the veins on a man’s testicles are large and cause them to overheat. The heat may affect the number or shape of the sperm.
• Trauma to the testes may affect sperm production and result in lower number of sperm.
• Unhealthy habits such as heavy alcohol use, smoking, anabolic steroid use, and illicit drug use.
• Use of certain medications and supplements. Testosterone replacement therapy, long-term anabolic steroid use, cancer medications (chemotherapy), certain antifungal medications, some ulcer drugs and certain other medications can impair sperm production and decrease male fertility.
• Cancer treatment involving the use of certain types of chemotherapy, radiation, or surgery to remove one or both testicles
• Medical conditions such as diabetes, cystic fibrosis, certain types of autoimmune disorders, and certain types of infections may cause testicular failure.
• Infection. Some infections can interfere with sperm production or sperm health or can cause scarring that blocks the passage of sperm. These include inflammation of the epididymis (epididymitis) or testicles (orchitis) and some sexually transmitted infections, including gonorrhea or HIV. Although some infections can result in permanent testicular damage, most often sperm can still be retrieved.
• Ejaculation issues. Retrograde ejaculation occurs when semen enters the bladder during orgasm instead of emerging out the tip of the penis. Various health conditions can cause retrograde ejaculation, including diabetes, spinal injuries, medications, and surgery of the bladder, prostate or urethra. Some men with spinal cord injuries or certain diseases can’t ejaculate semen, even though they still produce sperm. Often in these cases sperm can still be retrieved for use in assisted reproductive techniques.
• Antibodies that attack sperm. Anti-sperm antibodies are immune system cells that mistakenly identify sperm as harmful invaders and attempt to eliminate them.
• Tumors. Cancers and nonmalignant tumors can affect the male reproductive organs directly, through the glands that release hormones related to reproduction, such as the pituitary gland, or through unknown causes. In some cases, surgery, radiation or chemotherapy to treat tumors can affect male fertility.
• Undescended testicles. In some males, during fetal development one or both testicles fail to descend from the abdomen into the sac that normally contains the testicles (scrotum). Decreased fertility is more likely in men who have had this condition.
• Hormone imbalances. Infertility can result from disorders of the testicles themselves or an abnormality affecting other hormonal systems including the hypothalamus, pituitary, thyroid and adrenal glands. Low testosterone (male hypogonadism) and other hormonal problems have a number of possible underlying causes.
• Defects of tubules that transport sperm. Many different tubes carry sperm. They can be blocked due to various causes, including inadvertent injury from surgery, prior infections, trauma or abnormal development, such as with cystic fibrosis or similar inherited conditions. Blockage can occur at any level, including within the testicle, in the tubes that drain the testicle, in the epididymis, in the vas deferens, near the ejaculatory ducts or in the urethra.
• Chromosome defects. Inherited disorders such as Klinefelter’s syndrome — in which a male is born with two X chromosomes and one Y chromosome (instead of one X and one Y) — cause abnormal development of the male reproductive organs. Other genetic syndromes associated with infertility include cystic fibrosis, Kallmann’s syndrome and Kartagener’s syndrome.
• Problems with sexual intercourse. These can include trouble keeping or maintaining an erection sufficient for sex (erectile dysfunction), premature ejaculation, painful intercourse, anatomical abnormalities such as having a urethral opening beneath the penis (hypospadias), or psychological or relationship problems that interfere with sex.
• Celiac disease. A digestive disorder caused by sensitivity to gluten, celiac disease can cause male infertility. Fertility may improve after adopting a gluten-free diet.
• Prior surgeries. Certain surgeries may prevent you from having sperm in your ejaculate, including vasectomy, inguinal hernia repairs, scrotal or testicular surgeries, prostate surgeries, and large abdominal surgeries performed for testicular and rectal cancers, among others. In most cases, surgery can be performed to either reverse these blockage or to retrieve sperm directly from the epididymis and testicles.

Hormonal disorders

• Improper function of the hypothalamus or pituitary glands. The hypothalamus and pituitary glands in the brain produce hormones that maintain normal testicular function. Production of too much prolactin, a hormone made by the pituitary gland (often due to the presence of a benign pituitary gland tumor), or other conditions that damage or impair the function of the hypothalamus or the pituitary gland may result in low or no sperm production.
• These conditions may include benign and malignant (cancerous) pituitary tumors, congenital adrenal hyperplasia, exposure to too much estrogen, exposure to too much testosterone, Cushing’s syndrome, and chronic use of medications called glucocorticoids.

Genetic disorders

Genetic conditions such as a Klinefelter’s syndrome, Y-chromosome microdeletion, myotonic dystrophy, and other, less common genetic disorders may cause no sperm to be produced, or low numbers of sperm to be produced.

Some other causes of male infertility include:

• Illicit drug use. Anabolic steroids taken to stimulate muscle strength and growth can cause the testicles to shrink and sperm production to decrease. Use of cocaine or marijuana may temporarily reduce the number and quality of your sperm as well.
• Alcohol use. Drinking alcohol can lower testosterone levels, cause erectile dysfunction and decrease sperm production. Liver disease caused by excessive drinking also may lead to fertility problems.
• Tobacco smoking. Men who smoke may have a lower sperm count than do those who don’t smoke. Secondhand smoke also may affect male fertility.
• Emotional stress. Stress can interfere with certain hormones needed to produce sperm. Severe or prolonged emotional stress, including problems with fertility, can affect your sperm count.
• Weight. Obesity can impair fertility in several ways, including directly impacting sperm themselves as well as by causing hormone changes that reduce male fertility.

Certain occupations including welding or those involving prolonged sitting, such as truck driving, may be associated with a risk of infertility. However, the research to support these links is mixed.

Risk factors for infertility in men

• Age. Although advanced age plays a much more important role in predicting female infertility, couples in which the male partner is 40 years old or older are more likely to report difficulty conceiving.
• Being overweight or obese.
• Smoking.
• Excessive alcohol use.
• Use of marijuana.
• Exposure to testosterone. This may occur when a doctor prescribes testosterone injections, implants, or topical gel for low testosterone, or when a man takes testosterone or similar medications illicitly for the purposes of increasing their muscle mass.
• Exposure to radiation.
• Frequent exposure of the testes to high temperatures, such as that which may occur in men confined to a wheelchair, or through frequent sauna or hot tub use can raise the core body temperature and may affect sperm production.
• Exposure to certain medications such as anabolic steroids, flutamide, cyproterone, bicalutamide, spironolactone, ketoconazole, antibiotics, antihypertensives, cimetidine or others, can also affect fertility.
• Exposure to environmental toxins including exposure to pesticides, lead, cadmium, or mercury.
• Damage related to cancer and its treatment, including radiation or chemotherapy. Treatment for cancer can impair sperm production, sometimes severely.

Complications of male infertility

Infertility can be stressful for both you and your partner. Complications of male infertility can include:

• Surgery or other procedures to treat an underlying cause of low sperm count or other reproductive problems
• Expensive and involved reproductive techniques
• Stress and relationship difficulties related to the inability to have a child

Prevention of male infertility

Many types of male infertility aren’t preventable. However, you can avoid some known causes of male infertility. For example:

• Don’t smoke.
• Limit or abstain from alcohol.
• Steer clear of illicit drugs.
• Keep the weight off.
• Don’t get a vasectomy.
• Avoid things that lead to prolonged heat for the testicles.
• Reduce stress.
• Avoid exposure to pesticides, heavy metals and other toxins.

Diagnosis of male infertility

Many infertile couples have more than one cause of infertility, so it’s likely you will both need to see a doctor. It might take a number of tests to determine the cause of infertility. In some cases, a cause is never identified.

Infertility tests can be expensive and might not be covered by insurance — find out what your medical plan covers ahead of time.

Diagnosing male infertility problems usually involves:

• General physical examination and medical history. This includes examining your genitals and asking questions about any inherited conditions, chronic health problems, illnesses, injuries or surgeries that could affect fertility. Your doctor might also ask about your sexual habits and about your sexual development during puberty.
• Semen analysis. You can provide a semen sample by masturbating and ejaculating into a special container at the doctor’s office or by using a special condom to collect semen during intercourse. Your semen is then sent to a laboratory to measure the number of sperm present and look for any abnormalities in the shape (morphology) and movement (motility) of the sperm. The lab will also check your semen for signs of problems such as infections. Often sperm counts fluctuate significantly from one specimen to the next. In most cases, several semen analysis tests are done over a period of time to ensure accurate results. If your sperm analysis is normal, your doctor will likely recommend thorough testing of your female partner before conducting any more male infertility tests.

Your doctor might recommend additional tests to help identify the cause of your infertility. These can include:

• Scrotal ultrasound. This test uses high-frequency sound waves to produce images inside your body. A scrotal ultrasound can help your doctor see if there is a varicocele or other problems in the testicles and supporting structures.
• Hormone testing. Hormones produced by the pituitary gland, hypothalamus and testicles play a key role in sexual development and sperm production. Abnormalities in other hormonal or organ systems might also contribute to infertility. A blood test measures the level of testosterone and other hormones.
• Post-ejaculation urinalysis. Sperm in your urine can indicate your sperm are traveling backward into the bladder instead of out your penis during ejaculation (retrograde ejaculation).

• Genetic tests. When sperm concentration is extremely low, there could be a genetic cause. A blood test can reveal whether there are subtle changes in the Y chromosome — signs of a genetic abnormality. Genetic testing might be ordered to diagnose various congenital or inherited syndromes.
• Testicular biopsy. This test involves removing samples from the testicle with a needle. If the results of the testicular biopsy show that sperm production is normal your problem is likely caused by a blockage or another problem with sperm transport. However, this test is not commonly used to diagnose the cause of infertility.
• Specialized sperm function tests. A number of tests can be used to check how well your sperm survive after ejaculation, how well they can penetrate an egg, and whether there’s any problem attaching to the egg. Generally, these tests are rarely performed and often do not significantly change recommendations for treatment.
• Transrectal ultrasound. A small, lubricated wand is inserted into your rectum. It allows your doctor to check your prostate, and look for blockages of the tubes that carry semen (ejaculatory ducts and seminal vesicles).

Treatment of male infertility

Often, an exact cause of infertility can’t be identified. Even if an exact cause isn’t clear, your doctor might be able to recommend treatments or procedures that will result in conception.

In cases of infertility, the female partner is also recommended to be checked. This can help to determine if she will require any specific treatments or if proceeding with assisted reproductive techniques is appropriate.

Treatments for male infertility include:

• Surgery. For example, a varicocele can often be surgically corrected or an obstructed vas deferens repaired. Prior vasectomies can be reversed. In cases where no sperm are present in the ejaculate, sperm can often be retrieved directly from the testicles or epididymis using sperm retrieval techniques.
• Treating infections. Antibiotic treatment might cure an infection of the reproductive tract, but doesn’t always restore fertility.
• Treatments for sexual intercourse problems. Medication or counseling can help improve fertility in conditions such as erectile dysfunction or premature ejaculation.
• Hormone treatments and medications. Your doctor might recommend hormone replacement or medications in cases where infertility is caused by high or low levels of certain hormones or problems with the way the body uses hormones.
• Assisted reproductive technology (ART). ART treatments involve obtaining sperm through normal ejaculation, surgical extraction or from donor individuals, depending on your specific case and wishes. The sperm are then inserted into the female genital tract, or used to perform in vitro fertilization or intracytoplasmic sperm injection.

When treatment for male infertility doesn’t work

In rare cases, male fertility problems can’t be treated, and it’s impossible for a man to father a child. Your doctor might suggest that you and your partner consider using sperm from a donor or adopting a child.

Lifestyle and home remedies for male infertility

There are a few steps you can take at home to increase your chances of achieving pregnancy:

• Increase frequency of sex. Having sexual intercourse every day or every other day beginning at least 4 days before ovulation increases your chances of getting your partner pregnant.
• Have sex when fertilization is possible. A woman is likely to become pregnant during ovulation — which occurs in the middle of the menstrual cycle, between periods. This will ensure that sperm, which can live several days, are present when conception is possible.
• Avoid the use of lubricants. Products such as Astroglide or K-Y jelly, lotions, and saliva might impair sperm movement and function. Ask your doctor about sperm-safe lubricants.

Alternative medicine for male infertility

Evidence is still limited on whether — or how much — herbs or supplements might help increase male fertility. None of these supplements treats a specific underlying cause of infertility, such as a sperm duct defect or chromosomal disorder. Some supplements might help only if you have a deficiency.

Supplements with studies showing potential benefits on improving sperm count or quality include:

• Alpha-lipoic acid
• Anthocyanins
• L-arginine
• Astaxanthin
• Beta-carotene
• Biotin
• L-acetyl carnitine
• L-carnitine
• Cobalamin
• Co-enzyme Q10
• Ethylcysteine
• Folic acid
• Glutathione
• Inositol
• Lycopene
• Magnesium
• N-acetyl cysteine
• Pentoxifylline
• Phosphodiesterase-5 inhibitors
• Polyunsaturated fatty acids
• Selenium
• Vitamins A, C, D and E
• Zinc

Talk with your doctor before taking dietary supplements to review the risks and benefits of this therapy, as some supplements taken in high doses (megadoses) or for extended periods of time might be harmful.

Coping and support

Coping with infertility can be difficult. It’s an issue of the unknown — you can’t predict how long it will last or what the outcome will be. Infertility isn’t necessarily solved with hard work. The emotional burden on a couple is considerable, and plans for coping can help.

Planning for emotional turmoil

• Set limits. Decide in advance how many and what kind of procedures are emotionally and financially acceptable for you and your partner and determine a final limit. Fertility treatments can be expensive and often aren’t covered by insurance.ul pregnancy often depends on repeated attempts. Some couples become so focused on treatment that they continue with fertility procedures until they are emotionally and financially drained.

• Consider other options. Determine alternatives — adoption or donor sperm or egg — as early as possible in the fertility process. This can reduce anxiety during treatments and feelings of hopelessness if conception doesn’t occur.
• Talk about your feelings. Locate support groups or counseling services for help before and after treatment to help endure the process and ease the grief if treatment fails.

Managing emotional stress during treatment

• Practice stress-reduction techniques. Examples include yoga, meditation and massage therapy.
• Consider going to counseling. Counseling such as cognitive behavioral therapy, which uses methods that include relaxation training and stress management, might help relieve stress.
• Express yourself. Reach out to others rather than holding in feelings of guilt or anger.
• Stay in touch with loved ones. Talking to your partner, family and friends can be helpful.