Everything You Need To Know About Infertility
Did you know that over 8% of couples worldwide struggle with conception and fertility? In the United States, about 10% of women in their reproductive age gap struggle with conceiving. Also, contrary to popular misconceptions, males have the same propensity to infertility as women. According to recent statistics, about a third of infertility cases in couples are due to men. Women also contribute the same, and the rest is due to factors contributed by both parties.
What is Infertility?
By definition, infertility is described as the inability to conceive after one year of trying to have a child. Additionally, infertility is defined as the inability to carry a pregnancy to full term.
Types of infertility
Primarily, there are two types of infertility, namely primary and secondary infertility. For primary infertility, the couple in question have tried to conceive a child but have failed. In secondary infertility, the couple had previously conceived a child, and the female could carry it to full term, but currently, they cannot conceive.
The age bracket for definitive infertility varies. For women who are 35 years and below, infertility is described as the inability to conceive even after 52 weeks of unprotected sexual intercourse. For women above 35 years, the period is reduced to six months. As women age, their ability to conceive reduces due to a reduction in the production of sexual hormones and the early onset of menopause.
Causes Of Infertility
The etiology of infertility is quite diverse, and it ranges from dietary, hormonal, medical, or pathological reasons. Additionally, infertility could be due to lifestyle, environmental, or intrinsic factors. Mental disorders like depression and anxiety also play a role in infertility.
What Are The Causes Of Infertility In Women?
As earlier stated, females contribute to about a third of infertility cases. This could be due to:
As women age, it becomes more challenging for them to conceive. According to WHO, the ideal age of menopausal onset is about 35 years of age. However, recent studies have revealed that menopause can begin from as early as 25 years; this is known as premature menopause.
2. Obesity And Lifestyle
Obesity is linked to infertility in women. On average, obesity is one of the causes of infertility in about 6% of women. The American Society For Reproductive Medicine (AMSRM) states that obesity causes infertility in women by:
- Changing the metabolism and storage of the female sex hormones.
- Facilitates production of testosterone.
- Impacting hormonal imbalance.
Concurrently, excessive smoking, alcohol consumption, and substance abuse, particularly with cocaine or marijuana, predispose an individual to infertility. Furthermore, smoking is associated with vasoconstriction that discourages implantation and facilitates miscarriages.
Diet plays an indispensable role in maintaining the body’s overall physiological functions. Likewise, a healthy diet is essential in maintaining a healthy reproductive life. Recent studies show that folic acid deficiencies, vitamin B12, zinc, and iron deficiencies cause anemia and infertility in women.
Some genetic mutations are associated with infertility in women. The genetic mutations could be single genetic mutations leading to no or inadequate production of gonadotropic hormones or chromosomal mutations. An example is Turner’s Syndrome, where a female is born with only one X chromosome, consequently causing failed ovarian development rendering the female infertile.
5. Damage To The Fallopian Tubes
Inflammation, obstruction, or blockage of the fallopian tube hinders the ovum’s movement that is to be fertilized. Inflammation could be due to infection in the pelvic region or due to a sexually transmitted disease. The obstruction could also arise due to tumors, cysts, or fibroids.
6. Ovarian Disorders
The ovary is the primary female sexual organ. It is responsible for the storage and release of the female egg. Additionally, it is a gland responsible for producing estrogen and progesterone. Any disease or disorder affecting the ovary will inevitably cause infertility. Examples of such conditions include:
Premature Ovarian Syndrome
Also known as early menopause. Its a condition characterized by a premature drastic reduction in the production of female sex hormones. Women diagnosed with early onset of menopause are given hormone replacement therapy.
Polycystic Ovarian Syndrome (PCOS)
PCOS is among the principal causes of infertility in women. It is a condition characterized by numerous large ovarian cysts and fibroids. Additionally, women with PCOS present with irregular menstruation, acne, obesity, and premature hair loss.
Anovulation and Oligo Ovulation
Anovulation is a medical term describing failure in releasing an ovum from the ovary for a period exceeding three months. In comparison, oligo ovulation describes infrequent or irregular menstruation. The causes of anovulation and oligo ovulation are primarily hormonal imbalance, stress, obesity, and some ovarian diseases.
Endometriosis is a medical ailment characterized by the presence of endometrial tissue outside the womb. Endometriosis is among the leading causes of female infertility. It is associated with painful cramps and excessive menstrual bleeding.
Prolactin is a hormone that facilitates milk production in nursing mothers. The hormone also inhibits ovulation hence rendering nursing mothers infertile for a certain period. However, women with constant high prolactin levels tend to have irregular or no menses. Antagonist medication is given to such women to reduce prolactin levels and increase their chances of conception.
Causes Of Infertility In Men
The most common causes of impotence in men are:
1. Oligospermia and Azoospermia
Oligospermia is a medical terminology used to describe low sperm count in men. On the other hand, azoospermia refers to no sperm production. Individuals diagnosed with oligospermia have a sperm count of less than 15 million sperms per milliliter. Oligospermia lessens the chances of a man to impregnate a woman.
2. Abnormal Sperm Morphology
A normal sperm must have a head and tail. However, due to differences in sperm production, some sperms may have a large head, double tail, or crooked tail. Abnormal sperm morphology affects sperm’s ability to swim to the ovum or penetrate the ovum’s defensive zona pellucida layer.
3. Erectile dysfunction And Ejaculation Disorders
Erectile dysfunction is a disorder characterized by the inability to gain or hold an erection hard enough or long enough during sexual intercourse.
In comparison, ejaculation disorder, or premature ejaculation, an individual lacks control of ejaculation before or during copulation. The exact etiology of erectile dysfunction is unknown; however, it may be attributed to performance anxiety, depression, or an underlying physical condition.
Kleinfelter’s Syndrome is a chromosomal mutation where a man is born with three sex genes, two X chromosomes, and one Y chromosome. A typical presentation of Kleinfelter’s Syndrome in undescended testis. Males born with an undescended testis are at a higher risk of developing impotence and testicular cancer.
5. Environmental Factors
For ideal sperm production, the testicular temperature must be lower than the body temperature. Men who frequently visit saunas or work in a hot environment are at risk of being impotent due to inadequate sperm production.
6. Low Testosterone Hormone Levels
Testosterone is the principal sex hormone in males. It is responsible for spermiogenesis and maturation of the sperm. Low testosterone levels reduce the fecundity definition levels and cause a decline in one’s sex drive.
Varicocele is a medical term describing an inflamed epididymis. Inflammation, obstruction, or blocked epididymis limit sperm’s movement to the urethra for deposition in the female birth canal during sexual intercourse. Consequently causing male infertility.
Common Causes Of Infertility In Both Men And Women
In women, prolonged use of NSAIDS, marijuana, and cocaine causes infertility. Additionally, chemotherapy or radiation treatment of reproductive tumors lowers the chances of conception in women.
Similarly, in men, chemotherapy, radiation therapy, prolonged use of agricultural chemicals, and anabolic steroids can cause impotence. In addition, recent studies have shown that sulfasalazine, a drug used in the management of Crohn’s disease and rheumatoid arthritis, is capable of causing male infertility, particularly if used for long periods.
2. Mental Disorders
Anxiety and depression play an indispensable role in one’s fertility. In men, severe anxiety during sexual intercourse causes delayed erection and premature ejaculation. On the other hand, depression and anti-depressive medication can reduce the fecundity definition in females.
3. Pathological Factors
Diseases like anemia, thyroid disorders (hyperthyroidism and hypothyroidism), Cushing Syndrome, and diabetes mellitus causes impotence in both males and females. Additionally, some sexually transmitted infections, if left unchecked, could lead to infertility. Examples of sexually transmitted diseases that cause impotence are chlamydia, syphilis, and gonorrhea.
Such infections cause impotence by spreading to the oviduct and epididymis, inducing inflammation, scarring, and eventual obstruction. The latter hinders movement of the egg or the sperm in females and males, respectively.
To know the exact cause of infertility, a physician must consider the couple’s age, sexual history, social history, medication history, and sexual habits. For some couples, infertility is a medical mystery because there is no underlying cause to it.
However, if a couple within the reproductive age gap has tried for at least one year to conceive and have not succeeded, they should consider visiting a gynecologist first and maybe a fertility expert later.
For men, the following tests shall be conducted:
- Physical exam.
- Semen analysis.
- Blood tests.
- Imaging techniques like ultrasound.
- Testicular biopsy.
- Genetic Testing.
- Other Specific Tests.
1. Semen Analysis
A semen sample is collected and taken to the laboratory for analysis. In the lab, the specialist will check on the sperm morphology, sperm count, the presence of sperm, the quality of the semen, and sperm motility.
The test also analyzes the volume and liquidity of the ejaculate and maturity of the sperm.
2. Physical Test
For the physical test, the physician checks for the formation of varicocele that may hinder ejaculation. Once the exact cause of the varicocele is identified, it can be corrected surgically or through medication.
Additionally, the pelvic region, scrotum, penis, and testis are checked for any anomalies. Physical examination may identify undescended testis as the causative factor for infertility in males.
3. Blood Analysis
For blood analysis, the testosterone levels are checked. Additionally, the physician may recommend the anti-sperm antibodies test. The latter identifies if one’s body is naturally producing antibodies against the sperm.
4. Imaging techniques
The gynecologist may recommend an ultrasound of the external male reproductive organs to analyze any blockage in the duct systems or any structural anomaly.
5. Genetic Testing
It is done to rule out any underlying genetic or chromosomal mutation.
To rule out any underlying infection that might be the cause of impotence.
7. Testicular biopsy
Testicular biopsy is done to analyze any anomalies in spermiogenesis (sperm production) and sperm maturation.
8. Other Testing Techniques include:
- Vasography- to determine the integrity of the structure of the duct system.
- Sperm Penetration Assay.
- Kruer and World Health Organization Morphology – to determine the morphology of the sperm.
- Semen Leukocyte Analysis.
- Seminal Fructose Test – to examine if the sperm has adequate energy stores to swim to the ovum.
- Post Ejaculate Urinalysis- to check for retrograde ejaculation or obstructions.
For women, the main symptom of infertility is the absence of or irregular menstruation. However, a physician would recommend the following tests:
- Blood Tests.
- Ultrasound Scan.
- Other Testing Techniques.
The collected blood sample is analyzed for estrogen, progesterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) levels. High FSH and estrogen levels mean lower fertility, while high progesterone and luteinizing hormone facilitate ovulation.
Ultrasound Testing and Hysterosalpingogram (HSG)
Ultrasound is an imaging method used to examine the oviduct’s integrity and other related abnormalities in the female reproductive system. Hysterosalpingogram, also known as a tubogram, is an imaging technique where a physician inserts a fluorescent dye through the birth canal. The dye travels up the reproductive system outlining the structure of it.
A combination of ultrasound and HSG will detect any structural defect in the womb and obstruction in the oviduct.
A hysteroscopy is another imaging technique where the doctor inserts a flexible tube with a camera at the end. During a hysteroscopy, a sample tissue is collected for further lab analysis.
A laparoscopy is an invasive technique where the physician cuts a small section in the pelvic region to insert a flexible camera. Laparoscopy is a routine procedure in females suspected of having endometriosis. Laparoscopy aims to visualize the pelvic area.
A routine urinalysis can reveal a lot of information concerning fertility in women. Urine is the ideal sample for the measurement of luteinizing hormone levels, particularly during ovulation. Additionally, urinalysis is a routine procedure in lab diagnosis for sexually transmitted infections, especially for gonorrhea, chlamydia, and syphilis. The three STI’s are commonly implicated as one of the leading causes of secondary infertility in women.
Other Testing Techniques
Other testing techniques that may outline the etiology of infertility in women are:
- Thyroid Function Tests.
- Post-coital testing, where a physician examines the cervical mucus after intercourse.
- Anti-mullerian hormone test. Here the physician examines the number of eggs a female has.
- Endometrial Biopsy.
- Clomiphene Citrate Test.
Treatment Of Infertility
The treatment approach that your doctor chooses is dependent on:
- The age of the female.
- The cause of infertility.
- The couple’s decision based on the success rate, cost and risks vs benefits of each treatment approach.
Generally, there are four treatment approaches to infertility. These are:
- Medicinal Approach.
- Intrauterine Insemination (IUI).
- Assisted Reproductive Technology.
1. Medicinal Approach
This involves the use of drugs to enhance ovulation and fertility. Examples of such drugs are:
It is a Selective Estrogen Modulator (SERM) and an ovulation stimulant. Clomiphene acts by increasing the production of gonadotropins in the anterior pituitary, consequently increasing the number of eggs released per ovulation. It is used in women with PCOS, ovulation disorders, and those who want multiple pregnancies.
Letrozole is a non-steroidal aromatase inhibitor. It acts by temporarily lowering estrogen and progesterone levels, thus triggering gonadotropic hormone release from the anterior pituitary. Its uses are similar to clomiphene.
Human menopausal Gonadotropin (hMG)
hMG is a synthetic analog of the gonadotropic hormones. It is used in women whose infertility is caused by inadequacy of the anterior pituitary. hMG is given intravenously to stimulate ovulation.
Other drugs used as fertility boosters are:
- Metformin – used in women with diabetes mellitus, PCOS, and insulin resistance.
- Gonadotropin releasing hormone agonists like goserelin and leuprolide.
- Gonadotropin releasing hormone antagonist like ganirelix, cetrorelix, degarelix, and abarelix.
- Follicle-stimulating hormone works in a similar manner to hMG.
- Bromocriptine. It is a prolactin antagonist. It is used in the management of infertility due to hyperprolactinemia.
Surgery is applied as a corrective procedure in treating inflamed or blocked duct systems in both males and females.
3. Intrauterine Insemination (IUI)
Also known as artificial insemination. During this procedure, semen is collected and inserted through the vagina when the woman is ovulating to increase pregnancy chances. In some cases, IUI is coupled with fertility medication to increase the chances of conception.
4. Assisted Reproductive Technology (ART)
In assisted reproductive technology, reproductive manipulation is done outside the body. The techniques in ART are:
In-vitro Fertilization (IVF)
In IVF, the woman’s eggs are harvested and stored. The egg is later fertilized in the laboratory from a harvested sperm. The fertilized ovum is then embedded in the female womb.
Intra-cytoplasmic Sperm Injection
It is a modified version of IVF where a single sperm is injected into an ovum. This technique is used in couples where the male is the main factor for infertility. The fertilized egg is implanted into the woman.
Also known as gestational carriers. For this technique, a woman within the reproductive age gap is contracted by a couple to bear a child on their behalf.
Other ART Techniques
- Tubal embryo transfer or zygote intra-fallopian transfer (ZIFT). It involves implantation of the zygote to the fallopian tube instead of the uterine walls.
- Gamete intra-fallopian transfer (GIFT).
Prevention of Infertility
Although some cases of infertility are non-adjustable, the following strategies are used to enhance the chances of pregnancy and conception in both males and females.
- Avoid excessive consumption of tobacco, alcohol, marijuana, and cocaine.
- Reduce stress or avoid stressful conditions.
- Limit caffeine intake.
- Maintain a normal weight. Avoid being overweight or underweight. Additionally, do not engage in excessively strenuous exercises.
- For men, they should avoid hot temperatures, exposure to heavy metals, and pesticides.
- Limit exposure to industrial chemicals and radiation.
Conclusively, infertility and childbearing is a sensitive topic, especially in a relationship or a marriage. A couple experiencing trouble with conceiving should have open communication with themselves and their doctors. Luckily, there is a variety of solutions to one getting their bundle of joy. All it takes is initiative.