There's been a revolution in the field of reproductive medicine during the second half of the 20th century – first to help couples prevent conception and then to help them achieve it. 

Advances, especially in preventing unwanted pregnancies, have been hugely successful and have allowed us to feel a heightened sense of control.  We talk about "family planning" and take it for granted that we'll be able to reproduce at the time of our choosing.  Yet, figures from the American Society for Reproductive Medicine reveal that up to one in ten Americans will experience infertility at some point during their reproductive years.  This gap between perception and reality is significant.  For people to make fully informed family planning decisions, they need a clear understanding of all the issues that can affect fertility over the course of their lifetimes. 

Conception and successfully carrying a baby to term is a complex process.  It's dependent on sufficient numbers of healthy sperm traveling through open pathways so one can penetrate a healthy egg.  The fertilized egg must implant itself in the lining of the uterus and the uterine environment must remain hospitable for the egg to develop.  When any one of these factors is impaired, infertility can result.

What is infertility?  Physicians define infertility as the inability to conceive a child despite trying for one year.  The definition also applies to women who are able to get pregnant but then have repeat miscarriages. 

Infertility is not necessarily synonymous with sterility. There are degrees of infertility with the majority of infertile couples actually being sub-fertile, meaning they produce eggs and sperm but have difficulty conceiving.  A diagnosis of infertility means that becoming pregnant may be a challenge but not impossible. Being sterile means you're unable to conceive a child because no eggs or sperm are produced.  

Infertility may be temporary or permanent, depending on the cause and available treatments to correct it. It may be due to factors affecting the woman, the man, or both.  It may be due to a single cause or a combination of factors. In some cases, a specific cause can't be identified. No one can be blamed for infertility any more than anyone is to blame for having allergies or ulcers.

Treatment for infertility may range from simple education and counseling, to the use of medications that treat infections or promote ovulation, to highly sophisticated medical procedures such as in vitro fertilization.

New advances in medical technology are being envisioned and realized every year, giving hope to more couples.  These same advances are also raising troubling questions about ethical and legal issues – like genetic enhancement and sex selection, the fate of unused embryos, the consequences of multiple births and the changing nature of the family.