Overview
Infertility is a term that’s used to describe when a couple is unable to attain pregnancy after 1 year of having regular, unprotected sex, or after 6 months if the woman is older than 35 years.
Infertility is when a pair cannot get pregnant (conceive) despite having regular unprotected sex.
Subfertility is sometimes used to mean the same thing as infertility, but they’re slightly different. Subfertility means pregnancy is perhaps going to occur without medical intervention, but it takes longer than usual.
The term “infertility” also is used to describe the condition of women who can get pregnant but unable to carry a pregnancy to term because of miscarriage (sometimes called clinical spontaneous abortion), recurrent pregnancy loss, stillbirth, or other problems.
The repetitive loss of pregnancy is deemed separate from infertility. Even though some similarities may exist, the causes of loss of a pregnancy, repeated loss of a pregnancy, and stillbirth are largely specific to the causes of infertility.
There are 2 types of infertility:
1. Primary infertility – when someone who has never conceived a child before has difficulty conceiving it
2. Secondary infertility – where someone has 1 or more pregnancies in the past but has difficulty conceiving it again
Infertility isn’t just a woman’s problem. Men too could be infertile. Infertility in males is as normal as infertility in females. Infertility or reproductive problems are often treated with high-tech procedures and infertility drugs.
Cause
Infertility can be caused by various factors like egg or sperm development disorders, genetic factors, age, or too much exposure to certain chemicals and toxins.
What does it take for a couple to get pregnant?
For a couple to become pregnant, at least four things have to happen:
● A woman must produce and release a healthy egg from one of her ovaries (ovulation).
● A man must produce viable sperm that can effectively fertilize the woman’s egg (fertilization).
● The egg should travel through a fallopian tube towards the uterus (transportation).
● The fertilized egg should attach to the inside of the uterus (implantation).
Male Infertility Causes
Men can also contribute to infertility in a couple. To conceive a child, a male’s sperm must combine with a female’s egg. The testicles make and store sperm, which are ejaculated by the penis to deliver sperm to the female reproductive tract during sexual intercourse.
Making mature, healthy sperm that can travel depends on many things. Problems can stop cells from growing into sperm. Problems can keep the sperm from reaching the egg. Even the temperature of the scrotum may affect fertility. These are the main causes of male infertility:
Sperm Disorders
The most common problems are with making and growing sperm. Sperm may:
● not grow fully
● be oddly shaped
● not move the right way
● be made in very low numbers (oligospermia)
● not be made at all (azoospermia)
Sperm problems can be from the characteristics you are born with. Lifestyle selections can lower sperm numbers. Smoking, consuming alcohol, and taking certain medications can lower sperm numbers. Other causes of low sperm numbers encompass long-term sickness (such as kidney failure), childhood infections (such as mumps), and chromosome or hormone troubles (such as low testosterone).
Damage to the reproductive system can cause low or no sperm. About 4 out of every 10 men with a total lack of sperm (azoospermia) have an obstruction (blockage). A birth defect or a problem such as an infection can cause a blockage.
Varicoceles
Varicoceles are swollen veins within the scrotum. They’re found in 16 out of 100 of all men. they’re more common in infertile men (40 out of 100). They harm sperm growth by blocking proper blood drainage. it should be that varicoceles cause blood to flow back to the scrotum from the belly. The testicles are then too warm for creating sperm. This will cause low sperm numbers.
Retrograde Ejaculation
Retrograde ejaculation is when semen goes backward in the body. They go into the bladder instead of out the penis. This happens when nerves and muscles in the bladder don’t close during orgasm (climax). Semen may have normal sperm, but the semen cannot reach the vagina.
Retrograde ejaculation can be caused by surgery, medications, or health problems of the nervous system. Signs are cloudy urine after ejaculation and less fluid or “dry” ejaculation.
Immunologic Infertility
Sometimes a man’s body makes antibodies that attack his sperm. Antibodies are most often made because of injury, surgery, or infection. They keep sperm from moving and working normally. We don’t know yet exactly how antibodies lower fertility. We do know they can make it hard for sperm to swim to the fallopian tube and enter an egg. This is not a common cause of male infertility.
Obstruction
Sometimes sperm can be blocked. Repeated infections, surgery (such as vasectomy), swelling, or developmental defects can cause a blockage. Any part of the male reproductive tract can be blocked. With a blockage, sperm from the testicles can’t leave the body during ejaculation.
Hormones
Hormones made by the pituitary gland tell the testicles to make sperm. Very low hormone levels cause poor sperm growth.
Chromosomes
Sperm carry half of the DNA to the egg. Changes in the number and structure of chromosomes can affect fertility. For example, the male Y chromosome may be missing parts.
Medication
Certain medications can change sperm production, function, and delivery. These medications are most often given to treat health problems like:
● digestive problems
● infections
● cancer
Female Infertility causes
What causes female infertility?
The most common causes of female infertility include problems with ovulation, damage to fallopian tubes or uterus, or problems with the cervix. Age can contribute to infertility because as a woman ages, her fertility naturally tends to decrease.
Ovulation problems may be caused by one or more of the following:
● A hormone imbalance
● A tumor or cyst
● Eating disorders such as anorexia or bulimia
● Alcohol or drug use
● Thyroid gland problems
● Excess weight
● Stress
● Intense exercise that causes a significant loss of body fat
● Extremely brief menstrual cycles
Damage to the fallopian tubes or uterus can be caused by one or more of the following:
● A previous infection
● Polyps in the uterus
● Endometriosis or fibroids
● Scar tissue or adhesions
● Chronic medical illness
● A previous ectopic (tubal) pregnancy
● A birth defect
DES syndrome (The medication DES, given to women to prevent miscarriage or premature birth can result in fertility problems for their children.)
Abnormal cervical mucus can also cause female infertility. Abnormal cervical mucus can prevent the sperm from reaching the egg or make it more difficult for the sperm to penetrate the egg.
Treatment
Fertility treatments often include medications that help with hormones and ovulation, sometimes combined with minor surgical procedures. Assisted Reproductive Technology (ART) describes several kinds of procedures that can help you have a baby. ART includes procedures that make it easier for sperm to fertilize an egg, and help the egg implant in the uterine lining.
Two of the most common fertility treatments are:
1. intrauterine insemination (IUI)
- Healthy sperm is collected and inserted directly into the uterus when you’re ovulating.
2. in vitro fertilization (IVF)
- Eggs are taken from the ovaries and fertilized by sperm in a lab, where they develop into embryos. Then a doctor puts the embryos into the uterus.
Cryopreservation (aka freezing eggs, sperm, or embryos), egg or embryo donation, and gestational carriers (aka surrogacy) are also forms of ART.
Donor sperm, donor eggs, and surrogates are often utilized by same-sex couples or single those that want to possess a baby. you’ll also use sperm and/or eggs from a donor if an issue with the sperm cells or eggs is causing infertility issues.
Talking with a doctor who specializes in pregnancy and/or infertility can help you figure out which treatments are best for you. The GP or gynecologist can refer you to a fertility specialist.
Fertility Evaluation
Fertility evaluation involves the below test:
Infertility Tests
History and physical examination – The fertility physician will take a very thorough medical and fertility history. The doctor may ask you many of the following questions: How long have you been trying to get pregnant? How often are you having intercourse? Do you have pain with menstrual periods or intercourse? Have you been pregnant before? What happened with prior pregnancies? Have you had any sexually transmitted infections or abnormal pap smears? How often do you have menstrual cycles? Do you have any medical problems or prior surgeries? Do you have a family history of medical problems? These and many other questions will help doctors to design a specific assessment and potential treatment for you. In addition to a careful history, a physical evaluation may also be performed. Ultrasound is an effective method for determining uterine structure, tubes, and ovaries. Ultrasound can detect uterine abnormalities such as fibroids and polyps, distal fallopian tube occlusion, and ovarian abnormalities including ovarian cysts. Additionally, transvaginal ultrasound helps a doctor to determine the relative number of eggs available. This calculation is called the count of antral follicles and may correlate with possible fertility.
Transvaginal ultrasound – Laboratory testing – The physician can order different blood tests, based on the results of the assessment described above. Measurements of blood levels of some hormones such as estradiol and FSH linked to ovarian function and total egg numbers are the most common of these tests; TSH, which measures thyroid activity; and prolactin, a hormone that may impair menstrual activity if elevated.
Hysterosalpingogram (HSG) – This test is important for determining Fallopian tubal patenting, uterine filling defects such as fibroids and polyps, and uterine cavity scarring (Asherman syndrome). Many HSG-detected uterine and tubal abnormalities can be surgically rectified.
Semen analysis – The semen examination is the primary test for determining the male partner. Four parameters are analyzed: 1) semen volume – should be at least 1.5 to 2 ml. A smaller amount may suggest a structural or hormonal problem leading to deficient semen production; 2) sperm concentration – normal concentration should be at least 20 million sperm per 1 ml of semen. A lower concentration may lead to a lower chance for conception without treatment; 3) sperm motility or movement – normal motility should be at least 50%. Less than 50% motility may significantly affect the ability for sperm to fertilize the egg without therapy; and (4) morphology, or shape – three parts of the sperm are analyzed for morphology: the head, midpiece, and tail. Abnormality in any of those regions may indicate abnormal sperm function and compromise the ability of sperm to fertilize the egg. Ideally, using strict morphology criteria, a minimum of 5 – 15% normal forms leads to a better ability for sperm to fertilize the egg. An abnormal analysis of semen usually warrants a further assessment by a reproductive urologist. If need be, the doctor will refer you to a reproductive urologist.
Source
https://www.nichd.nih.gov/health/topics/infertility/conditioninfo
https://www.healthline.com/health/fertility#overview
https://www.nhs.uk/conditions/infertility/
https://www.uclahealth.org/obgyn/infertility
https://my.clevelandclinic.org/health/diseases/16083-infertility-causes
https://www.urologyhealth.org/urologic-conditions/male-infertility
https://americanpregnancy.org/getting-pregnant/female-infertility-70973
https://www.acog.org/patient-resources/faqs/gynecologic-problems/treating-infertility
https://www.plannedparenthood.org/learn/pregnancy/fertility-treatments
