Infertility is a very common condition affecting approximately 13-14% of reproductive-aged couples. Despite a stable prevalence of infertility in this population, the demand for infertility services has increased substantially over the past decade. Although infertility represents a small facet of the broad intellectual scope of reproductive endocrinology, patients seeking infertility treatment represent the mainstay of a clinical reproductive endocrinologist’s practice.

With more and more women and men experiencing infertility, getting pregnant isn’t always an easy task. Infertility can be frustrating to any relationship, and can lead to emotions such as anger, frustration and sadness.

Many people may be infertile during their reproductive years. They may be unaware of this because they are not seeking to create a pregnancy. On any one occasion, the chance of pregnancy is just one percent.

Combined infertility:

In some cases, both the man and woman may be infertile or sub-fertile, and the couple’s infertility arises from the combination of these conditions. In other cases, the cause is suspected to be immunological or genetic; it may be that each partner is independently fertile but the couple cannot conceive together without assistance.

Facts About Infertility:

  • It’s a myth that infertility is always a “woman’s problem.” Half of all cases of infertility result from problems with the man’s reproductive system.
  • The best protection against infertility is using a condom while you are not attempting to conceive a child. Condoms protect against sexually transmitted diseases, a major cause of infertility.
  • Of couples that seek medical treatment for infertility, 20 percent conceive before the treatment actually begins. One reason may be that anxiety about infertility may have contributed to the fertility problem, and contacting a doctor provides emotional relief.
  • Fifty percent of infertile couples conceive within two years of starting treatment.
  • A woman’s temperature rises about 1 degree Fahrenheit during the days she is ovulating (producing eggs). By taking her temperature every morning with a special thermometer, a woman and her partner can chart the rises and falls in her morning temperature. They can then plan intercourse for the days she is ovulating–her most fertile time.

Male Infertility:

Male infertility is most often due to a problem with sperm production or sperm delivery. The first test to be ordered is usually a semen analysis, completed from a collected sperm sample. Frequently, blood work is also completed at this time.

Sperm and its production can be adversely affected by hormonal issues, chronic disease, previous surgery, childhood diseases, environmental factors and lifestyle issues. There are various treatments available depending on the cause of the problem.

While there are many causes of male factor infertility, some are seen more commonly than others. These top causes of male factor infertility account for the majority of cases of infertility in men. Here is a listing of the top causes of infertility in men, in no particular order.

  1. Blockage of sperm: The vas deferens that carries sperm from the testicles to the penis can be blocked for a variety of reasons including prior vasectomy, injury, infection or physical anomaly.
  2. Infections: There are many types of infections that might cause sterility or low sperm counts in men. These can be recent infections or from childhood. Common infections can be mumps or certain types of sexually transmitted infections (STI).
  3. Chronic Disease: Diseases that can effect hormonal controls and sperm production, particularly when not controlled are also causes of infertility. Diabetes, hypertension and other problems can all effect the fertility of men.
  4. Erectile Dysfunction (ED): If you have a problem getting or maintaining an erection then there will be problems getting the sperm out. Sometimes this is caused by a chronic illness like hypertension or heart problems, it can also be caused by paralysis.
  5. Failure to Produce Sperm: If the body isn’t producing sperm there can be many reasons. Some may be from hormonal issues of testicular failure, while others may be from treatments for certain illnesses and cancer like chemotherapy and radiation therapy.
  6. Exposure to Harmful Substances: Environmental or work hazards can also lead to problems with fertility.
  7. Injury: If you have experienced injury to your testicles you may also have issues with sperm production.
  8. Varicocele: This is a varicosity, or varicose vein in the testicle. The varicosity damages the blood flow to the testes, making sperm production slowed or stopped.

Female Infertility:

Infertility in women may be due to problems with ovulation, barriers to egg and sperm meeting, barriers to implantation, poor hormonal support of the conceptus, immune system irregularities or any combination of the above. Testing is done to help determine which of these factors are involved and how to proceed with treatment.

Fertility can be a complicated thing. The causes of infertility can be male, female or both parties. Here are the most common causes of female factor infertility:

  1. Structural Issues: These account for about 15% of female factors. Mechanical issues usually refer to issues with the anatomy of the woman. It may be a blockage in the fallopian tube, a fibroid in the uterus, or a problem with the opening of the cervix. Some of these factors may be caused by previous medications or surgeries, like DES exposure when the woman was a fetus herself, or a surgery that would disrupt the stability or the cervix. Some of these causes may be treated with surgical intervention while others may need other forms of specialized treatment.
  2. Mechanical Issues: Some 25-40% of women will have fertility problems due to mechanical issues, such as scar tissue that block the fallopian tubes or the uterus.
  3. Ovulatory Issues: As many as 30% of all causes of female factor infertility are due to issues with ovulation. This may be complete ovarian failure due to hormonal issues, etc. It could be merely a problem with the timing or detection of ovulation. This is usually evaluated and treated with medications to help restore ovarian function.
  4. Multiple or Unknown Factors: It is possible that a woman will have multiple factors involved in her cause of infertility. This is why prompt medical evaluation by a qualified practitioner is always important. About 10% of women will have unknown causes of infertility.

When to see a fertility specialist:

A fertility specialist is usually an obstetrician-gynecologist (specialist in women’s reproductive health) with advanced education, research, and professional skills in reproductive endocrinology. These highly trained and qualified doctors are the specialists to see about infertility.

You may want to talk to your health care provider for a referral to a clinic where doctors and staff have this special training. In addition, fertility clinics often have specialized equipment and imaging technology needed to make a diagnosis and to do semen testing and other specialized tests right at the office.

Psychological impact

Infertility may have profound psychological effects. Partners may become more anxious to conceive, ironically increasing sexual dysfunction. Marital discord often develops in infertile couples, especially when they are under pressure to make medical decisions. Women trying to conceive often have clinical depression rates similar to women who have heart disease or cancer. Even couples undertaking IVF face considerable stress, especially the female partner .

However it’s important to remember that while infertility is a challenge to getting pregnant, it doesn’t mean that pregnancy is impossible. Assisted reproductive technologies (or ARTs) have made getting pregnant an achievable goal for many women just like you.

Assisted reproduction

Assisted reproduction refers to a number of advanced techniques that aid fertilization. These techniques are often used for women who have irreversible damage to their fallopian tubes or cervical mucous problems. It can also benefit couples with unexplained infertility.

IVF (In-Vitro Fertilization)

IVF is the most well known of assisted reproduction techniques. In this method, the woman takes fertility drugs to stimulate her ovaries to produce more eggs. The physician then retrieves one or more of the eggs by laparoscopy or by passing a needle through the vaginal wall. The partner’s sperm is then mixed with the eggs in a petri dish, and fertilization may take place.

If fertilization occurs, the embryo is allowed to develop outside the womb for a few days. Then it is implanted in the lining of the woman’s uterus with a small plastic tube. Most centers now place two to four embryos in the womb in the hope that one will burrow into the lining and begin to develop normally. Any leftover embryos are frozen to be used later, should the first IVF procedure fail to work. IVF increases the risk of multiple births.

Sources: Ehealth MD, Infertility

Related Posts