Infertility

Infertility

Infertility is defined as not having the ability to conceive despite having frequent, unprotected sex for a minimum of a year for couples or over six months if the woman is aged 35 or older.

Women who get pregnant but are unable to remain pregnant

If there are difficulties in conceiving a baby due to issues in you or your partner

Infertility is not just a problem in women, men can be infertile too. Both men and women are likely to possess fertility problems. Pregnancy may be prevented by issues in you or your partner or a combination of factors.

Symptoms of Infertility

The sole symptom of infertility is not getting pregnant. There may be no other symptoms. Sometimes, a woman with infertility may have irregular menstrual periods or no periods at all. For a man, hormonal problems which causes changes in hair growth or sexual function may be the signs of infertility

When to see a doctor

Normally a doctor is not consulted for infertility unless you have been trying to have a baby, when the woman is aged 35 or older and have been trying to conceive for six months or longer.

A woman

Aged over 40

Having irregular or absent periods

Having very painful periods

Has known fertility problems

Has been diagnosed with endometriosis or pelvic disease

Has had multiple miscarriages

Has undergone treatment for cancer

For a man

Has Low sperm count or other problems with sperm

A history of prostate, testicular or sexual problems

Has undergone treatment for cancer

Has small testicles or swelling in the scrotum

Has others in the family with infertility problems

Causes for Infertility

Every step related to ovulation and fertilization has to go on correctly to get pregnant. Sometimes the issues that cause infertility in couples are hereditary or they develop sometime later in life.

Infertility causes can affect one or both partners:

  • In about one-third of cases, there is a problem with the man
  •  In about one-third of cases, there is a problem with the woman
  • Issues with both the man and the woman, or no known cause for the remaining one-third of the cases.

Causes for male infertility

  • Abnormal sperm production or function because of genetic defects, undescended testicles health problems like diabetes, or infections like chlamydia, gonorrhea, mumps, or HIV. Enlarged veins within the testes (varicocele) can also affect the quality of sperm.
  • Problems with the delivery of sperm because of structural problems, blockage within the testicle, sexual problems, like premature ejaculation; certain genetic diseases, like cystic fibrosis, or damage or injury to the reproductive organs.
  • Overexposure to environmental factors like pesticides, chemicals or radiation. Cigarette smoking, alcohol, marijuana, anabolic steroids, and taking medications to treat bacterial infections, hypertension, and depression can also affect fertility. Frequent exposure to heat, like in saunas or hot tubs ( the raised body temperature can affect sperm production).
  • Damage related to cancer and its treatment, Cancer treatments like radiation and chemotherapy can impair sperm production severely.

Causes of female infertility

  • Ovulation disorders, which affect the discharge of eggs from the ovaries. These include hormonal disorders like polycystic ovarian syndrome. Hyperprolactinemia, a condition during which you’ve got an excessive amount of prolactin — the hormone that stimulates breast milk production may also interfere with ovulation. Either an excessive amount of thyroid hormone (hyperthyroidism) or an insufficient thyroid hormone (hypothyroidism) can affect the cycle or cause infertility. Other underlying causes may include an excessive amount of exercise, eating disorders, or tumors.
  • Uterine or cervical abnormalities, including abnormalities with the cervix, polyps within the uterus, or the form of the uterus. Noncancerous (benign) tumors within the uterine wall (uterine fibroids) may cause infertility by blocking the fallopian tubes or stopping an embryo from implanting within the uterus.
  • Inflammation of the Fallopian tube (salpingitis) can cause the blockage or it may damage the fallopian tube which is caused by pelvic disease, which in turn is caused by endometriosis, adhesions, or sexually transmitted diseases.
  • Endometriosis – Endometrial tissue grows outside of the uterus may affect the function of the ovaries, uterus, and fallopian tubes.
  • When the ovaries stop working and menstruation ends before age 40 which is called Primary ovarian insufficiency (early menopause), the cause of which is not known, certain factors are associated with early menopause, including systemic diseases, certain genetic conditions like Turner syndrome or carriers of Fragile X- syndrome, and radiation or chemotherapy treatment.
  • Pelvic adhesions, bands of connective tissue that bind organs which will form after pelvic infection, appendicitis, endometriosis, or abdominal or pelvic surgery.
  • Cancer and its treatment- Certain cancers, particularly cancers of the reproductive system often impair female fertility. Both radiation and chemotherapy may affect fertility

Risk factors of infertility similar to both men and women

  • Age- Women’s fertility declines with age, women are most fertile in their 20s which gradually reduces in the mid-30s, and it drops rapidly after age 37. Infertility in older women is because of the lower number and quality of eggs, and health problems that affect fertility. Men over age 40 could also be less fertile than younger men.
  • Tobacco use- Smoking tobacco or marijuana by either male or female may reduce the likelihood of pregnancy. Smoking also reduces the effectiveness of fertility treatment. Miscarriages are more frequent in women who smoke. Smoking can cause erectile dysfunction and a lower the sperm count in men.
  • Alcohol use- There is no safe level for alcohol use during conception or pregnancy. Alcohol use may contribute to infertility in women. For men, heavy alcohol use decreases the sperm count and motility.
  • Being overweight-Being overweight may increase the chances of infertility. For men, sperm count also could be affected by being overweight.
  • Being underweight. Women with eating disorders, like anorexia, bulimia, and women who follow a very low-calorie or restrictive diet increases the risk of infertility.
  • Exercise issues – A scarcity of exercise contributes to obesity, which increases the danger of infertility. Rarely ovulation problems could even be associated with frequent strenuous, intense exercise in women who aren’t overweight.

Various medications and medicines also can affect male fertility

Chemotherapy or radiation which is used for cancer, Sulphasalazine, which is used for Rheumatoid Arthritis or ulcerative colitis, Calcium channel blockers, which are used for high blood pressure, Tricyclic antidepressants, anabolic steroids, which are used for improved athletic performance or hormonal issues like delayed puberty, recreational drugs like marijuana and cocaine.

– Exposure to toxins, such as pesticides, herbicides, and heavy metals

Prevention

Most of the types of infertility are not preventable.  Several conscious efforts may increase your chance of pregnancy.Have regular intercourse several times around the time of ovulation for the absolute best pregnancy rate. Intercourse beginning a minimum of 5 days before and until every day after ovulation improves your chances of getting pregnant. Ovulation usually occurs within the centre of the cycle — halfway between menstrual periods, for most women menstrual cycles are about 28 days apart.

Men

Although most kinds of infertility are not preventable in men, these strategies may help:

  • Avoid drug and tobacco use and drinking an excessive amount of alcohol, which can contribute to male infertility.
  • High temperatures found in hot tubs and hot baths should be avoided, as they will temporarily affect sperm production and motility.
  • Exposure to industrial or environmental toxins should be avoided as they may affect sperm production.
  • Limit medications which will impact fertility, both prescription and non-prescription drugs. Talk to your doctor about any medications you are taking regularly, but don’t stop taking prescription medications without medical advice.
  • Exercise moderately. Regular exercise may improve sperm quality and increase the possibilities for achieving a pregnancy.

Women

For women, these strategies may increase the possibility of becoming pregnant

  • Quit smoking- Tobacco has many negative effects on fertility, to not mention your general health and thus the health of a foetus. If you are considering pregnancy it is better to quit smoking.
  • Avoid alcohol and recreational drugs- These substances may impair your ability to conceive and have a healthy pregnancy. Don’t drink alcohol or use recreational drugs, like marijuana, if you’re trying to get pregnant.
  • Limit caffeine. Women trying to get pregnant might want to limit caffeine intake. Ask your doctor for guidance on the safe use of caffeine.
  • Exercise moderately. Regular exercise is a must, but exercising very intensely can affect your periods and become infrequent or absent which in turn can affect fertility.
  • Bodyweight extremes- Being overweight or underweight can affect your hormone production and cause infertility.

Infertility testing

If you’ve been trying to conceive and have not been able to have a baby then you should plan to see a doctor.

Some tests are performed to assess fertility

For a Man

Your doctor will first take your medical history, you may be asked about your general health, your sexual history and factors that might affect your fertility.  A physical examination will be done, where your genitals will be examined for any structural abnormalities or lumps.

A semen analysis will be done. Your doctor will ask you to provide a sample of semen. This sample will then be checked to determine the percentage of sperm present and whether the sperm are shaped normally and moving properly.

Depending on the results of your initial exam and semen analysis, your doctor might want to perform additional tests.

These tests may include:

  • Hormone testing
  • Genital ultrasound
  • Genetic testing
For a woman

Your doctor will first take your medical history. You may be asked about your present status of your health, your sexual history, and any conditions or illnesses that would contribute to infertility.

Then your pelvic area will be examined to see for abnormalities like fibroids or conditions like endometriosis or PID (Pelvic Inflammatory Disease).

Your doctor will want to ascertain if you’re ovulating monthly. This will be determined with an ovulation kit or through blood tests.

An ultrasound scan of the abdomen may be done to examine the ovaries and uterus.

Other common tests for women include:

  • Hysterosalpingography, which is a type of X-ray to evaluate the fallopian tubes and uterus.
  • Laparoscopy which uses a camera to look at the inside of the uterus.
  • Ovarian reserve testing, which uses different hormone tests to work out a woman’s potential for conceiving relevant tests include the FSH (follicular stimulating hormone)

Infertility treatments

The treatment that is recommended will depend upon many factors

Cause for infertility, if known

  • How long you’ve been trying to conceive
  • Age of you and your partner
  • Overall health of both, you and your partner

After the consultation- Depending on your personal preferences and the treatment options available treatment is given

For a Man

Depending on the cause of male infertility, treatment options for men can include surgery, medication, and assisted reproductive technology (ART).

Surgery can fix obstructions that are preventing sperm from being present within the ejaculate. It also can correct conditions like varicocele. In some cases, sperm are often retrieved directly from the testicles after which it is utilized in ART treatments.

Hormonal imbalances, ED (Erectile Dysfunction), and infections that affect the sperm count can be treated with medications.

ART refers to treatments like in vitro fertilization and intracytoplasmic sperm injection where fertilization is done in a lab outside the body. Sperm for ART treatments are often received from ejaculate, extraction from the testicles, or a donor.

For Women

The treatment for female infertility also can involve surgery, medication, and reproductive assistance like ART. Sometimes a combination of treatments is needed to address female infertility.

Due to the advancement of infertility treatments, surgical treatment is rarely done. Surgery can improve fertility by,

  • correcting abnormally shaped uterus
  • unblocking the blocked fallopian tubes
  • removing fibroids

Reproductive assistance can involve methods like IUI (Intra Uterine Insemination) and ART. During IUI, sperms are injected with the help of a long thin tube called the catheter into a woman’s uterus near the time of ovulation.

IVF is one sort of ART and involves the removal of eggs that are then fertilized with a man’s sperm in a laboratory. After fertilization, the embryo is placed back to the uterus.

The medications that used to treat female infertility work like the hormones that are naturally produced in a woman to either encourage or regulate ovulation.