"The most natural thing in the world" is a problem for about one person in every 10, says a Eugene physician who will speak next Tuesday in Medford.

"Everyone knows people who are infertile," said Dr. Doug Austin, a reproductive endocrinologist. He travels to rural areas in Oregon and Northern California to talk about infertility and how to treat it. He’ll speak at 7 p.m. Tuesday at the Smullin Center at Rogue Valley Medical Center.

Couples are generally defined as infertile if they have been trying to conceive for more than one year (six months if they’re 35 or older), or have repeatedly lost pregnancies, or have had surgery on their reproductive organs.

During a telephone interview, Austin said techniques developed in the past 25 years can help most infertile couples conceive. Physicians can now fertilize human eggs outside the body (in vitro fertilization), collect sperm directly from the testicles, and even inject a sperm cell directly into a human egg (a technique known as intracytoplasmic sperm injection).

"Most people don’t really need extraordinary intervention," he said. "About 75 percent of infertile couples can conceive short of in vitro fertilization."

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He said myths and misconceptions about infertility still abound despite growing awareness of the issues involved. Many men, for example, still view fertility as the province of women, but infertility is fairly well split down the middle between the sexes.

He said people often equate sexual performance with fertility, but there is no connection between the two. A man with a great libido may have no fertile sperm while a man with no sex drive may have plenty of fertile sperm.

Treating infertility typically begins with an analysis of each partner’s "plumbing." Men’s semen is tested for viability, and women are tested to determine whether they are producing fertile eggs on a monthly cycle.

Many problems can be resolved with drugs or surgery, but some couples eventually choose in vitro fertilization. That decision may force them to confront some of the most divisive ethical issues in American society, because the procedure typically involves fertilizing more than one egg.

"How does the couple view those embryos?" Austin said. "Are they persons?

"Our society has been unable to cope with this issue," he said, "We ask people individually to understand what their value system is."

Austin noted that physicians often implant more than one fertilized egg in a woman’s uterus to ensure that at least one survives. Normally some of the eggs slough off, but if they don’t, a couple who thought they could never have even one child may have to decide whether to have two, three or even four — or to select one embryo to grow to maturity.

"If spontaneous miscarriage hasn’t occurred, do they take the luck of the draw and have quadruplets?" he said.

Multiple pregnancies raise the specter of premature birth and attendant birth defects, making a difficult choice even more complicated, he said. "People are very challenged in making these decisions. They sometimes make decisions they know their families would not approve."

He said people need to understand that infertility is not their "fault."

"It’s not a personal slight. It doesn’t mean you didn’t live your life well. It’s biology. It’s just a medical problem."

To reserve space for Austin’s talk, call 541-345-7756 in Eugene. Space is limited.

Reach reporter Bill Kettler at 776-4492, or e-mail bkettler@mailtribune.com