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Infertility is defined as the inability to conceive after one year of trying, or the inability to carry pregnancies to a live birth. It affects one in six couples of childbearing age in the United States today, at least ten million people. And in a career-oriented area like Washington, where many couples postpone childbearing decisions until career goals have been met, the one-in-six ration is probably conservative. Yet it is rarely discussed and even less understood.

For almost every couple, the condition comes as a surprise. And no wonder. It seems as if the whole is on guard against the production of unwanted children. Every day, 19.9 million women in this country wake up and remember to take the pill. In China, a woman with more than three children is considered an enemy of the state. In India, population experts fear that the country could end up at the end of the century with four times as many people as it had at the beginning: from 250 million in 1900 to one billion. The huge nation has resorted to quick vasectomies and cash rewards at commuter train stations. There are two billboards everywhere.

Although infertility can affect people from all walks of life, the childless poor usually have neither the time nor the money to undergo a long series of tests, commonly called infertility tests, to determine the cause of the problem. There may also be class differences in a person's willingness to endure many sacrifices in order to achieve a long-term goal. For these reasons, the inability to conceive and have children seems to be a middle and upper middle class problem.

However, the distress of infertility will affect an increasing number of couples in the coming years as the baby boomers reach their late twenties and early thirties. Many who have hitherto postponed marriage and childbearing for their careers will turn to both to complete their lives and will not find childbearing possible.

Men, after years of enjoying what they consider a healthy sex drive, will be surprised to learn that their sperm are too few or perhaps not active enough to achieve conception. Women may be given a finding of endometriosis, a condition in which parts of the uterine lining seed in various places along the reproductive tract. Unheard of in cultures where women marry young, it is a common finding in American women over the age of 30. Or women may be part of the 10.9 million who took the pill every day, regardless of whether prior gynecologic abnormalities should have warned the doctor against a prescription.

A generation ago, before the current explosion of medical technology, many couples who could not have children were told that there was nothing wrong with them: it was either all in their heads or in God's will. There was also a smirk in the audience, the insinuation that they were not acting right in bed.

In fact, male impotence is the source of less than five percent of male infertility cases, and the sources of impotence are extremely varied, from diabetes to perineal nerve injury to psychogenic causes.