Having a baby is the dream of most couples after engagement or marriage. However, the reality of this dream is, for some, challenging; one or both partners are infertile.
Infertility is the inability for a couple to conceive and give birth to a child naturally.
You are considered infertile after two years of unsuccessful attempts to get a normal pregnancy or to get your wife pregnant. Less than a year of attempt does not mean you are infertile; in fact, about 80% of pregnancies occur in an interval of 18 months after the first sexual contact.
Scientists recognize two forms of infertility: male infertility, which represents about 20% of all infertility; and female infertility, the most common, accounts for almost 80% of all infertility.
Male Infertility Causes and Risk Factors
Male infertility is less common, and can be primary or secondary. If you have never been able to get a woman pregnant, your type of infertility is primary. In case you have been able to fertilize naturally, whatever have been the outcome and duration of the pregnancy, you suffer from secondary infertility.
At least, four main factors can lead to infertility in men. Those include abnormal sperm production or function (Oligospermia), Absence of sperm in the ejaculate (azoospermia), Lifestyle, and certain diseases.
Lifestyle – Medical experts have discovered that certain bad habits such tobacco or excessive alcohol consumption and the use of marijuana and cocaine can affect sperm production. Although it is controversial, it is also suggested that overheat of the testicles can lead to acute infertility.
Impotence – a normal pregnancy requires sexual intercourse between a man and a woman. A man needs to have erection to have sexual intercourse. If you have erectile dysfunction, penetration becomes difficult or even impossible; therefore, you will be unable to get a woman pregnant
Certain Diseases – some disease are known to be responsible for causing infertility in men. The list includes but not limited to Klinefelter syndrome, a chromosomal disorder that affects the development of male sexual organs; hypogonadism, a condition in which your sex glands produce insufficient or no androgen and/or sperm; hypothyroidism, lack production of thyroid hormone; hypercortisolism, a rare endocrine disorder causing excess production of cortisol in your body; and absence of the testicles.
Azoospermia – azoospermia is a rare form of disorder characterized by absence of sperm in your ejaculate. Sperm are naturally in the testicles; however, there is a problem of transport in your genital tract preventing them from reaching the ejaculate.
Oligoasthenospermia – this disorder is characterized by an abnormal sperm production or function. Oligoasthenospermia is the most frequent cause of male infertility. It includes:
1 – Oligospermia – this medical disorder affecting men only. You have oligospermia if your testes produce less than 20 million spermatozoa per ml of ejaculate. It is considered as the most common cause of male infertility. Depending on its cause, oligospermia may be temporary or permanent.
2 – Asthenospermia – this abnormality is characterized by a reduced motility of spermatozoa in the semen; asthenospermia is less common than oligospermia. If you have asthenospermia, the percentage of your sperm that has a normal motility is less than 40%.
3 – Varicocele– this is a swollen or dilatation of veins of your spermatic cord, tubular structures that passe from your abdominal cavity through your inguinal canal down into your scrotum to the back of your testicles. This dilatation may be the result of malfunctioning of the valves in the veins. When this disorder occurs, the blood can no longer back along the veins to reach the largest veins, resulting in stretching and inflammation of the vas deferens and its surrounding: arteries, veins, nerves, and lymphatic vessels.
4 – Teratospermia – also called teratozoospermia, teratospermia is characterized by the presence of more than 70% of sperm with abnormal morphology in the semen.
Other factors such as undescended testicle (cryptorchidism) and genital infection due to prolonged or repeated STDs can also cause male infertility.
Female Infertility Causes and Risk Factors
A variety of factors can lead to female infertility. The original causes can be anatomical, biochemical (immunological disorder), and physiological (disorders of ovulation).
Anatomic – frequent anatomic factors associated with female infertility are mainly tubal origin. This form of infertility tends to be due to obstruction of the fallopian tubes, generally following a salpingitis, infection and inflammation in the fallopian tubes. Salpingitis can be resulted from sexually transmitted diseases (STDs), puerperal infection (bacterial infection following childbirth), abortion, Intrauterine Devices (IUD), or regular hysterosalpingography (x-ray procedure used to examine the uterus and fallopian tubes). In some cases, there can be a blockage preventing implantation of the spermatozoid in the lining of the ovary, which can be linked to fibroid tumors, uterine malformations, or endometritis. Infertility can also be related to cervical abnormality or changes in the Cervical fluid (cervical mucus).
Immune infertility – Some women may develop a rare form of immunological disorder characterized by allergy to sperm, immune infertility. in a new study published by University of Virginia, scientists have discovered a new cause of infertility that happens in certain infertile women. This disorder cause the cervical fluid from certain infertile women to produce anti-sperm antibodies (ASA) in response to the radical spoke protein 44 (RSP44), causing their immune systems to attack and destroy the sperm.
Dysovulation – in some infertile women, their inability to conceive is due to irregularity or lack of ovulation during the menstrual cycle. This irregularity of ovulation tends to be due to hormonal disorders, infection of the ovary (cyst, tumor), or in rare cases, stress. The problem is considered as anovulation when there is no ovulation at all.
Other rare conditions that can lead to female infertility include:
- Premature menpause
- Dysfunction of the of the hypothalamus
- Vaginismus, painful spasm of the vagina due to involuntary muscular contraction, usually severe enough to prevent intercourse
- Polycystic Ovary Syndrome, a medical condition characterized by irregular menstrual periods, excess hair growth and obesity
- Hyperprolactinemia, endocrine disorder characterized by high levels of prolactin in the bloodstream.
Infertility Signs and Symptoms
Unlike most other medical conditions, the only symptom of infertility is the inability for a couple to conceive, carry and deliver a baby naturally. You give birth naturally, you are not infertile; you cannot give birth naturally, you are infertile.
How is infertility diagnosed?
In general, to know the cause of your inability to conceive, your physician will examine four factors, which can be the source of the problem: sperm, ovulation, female/male reproductive system, and incompatibility between sperm and female genital environment. However, diagnosis of female infertility is completely different from male infertility.
If you are a woman, your gynecologist may recommend the following exams:
Pelvic exam – it is a short and painless physical exam of your pelvic organs done to detect any anatomical abnormalities (uterine fibroids, ovarian cysts, uterine prolapse, etc.) or infections (yeast infections or bacterial vaginosis). In cases of lesions, your gynecologist can collect evidence to do a Pap test.
Ovulation testing – this blood test is done to measure your luteinizing hormone (LH) levels, a hormone that involves in various stages of reproduction. Because this hormone triggers ovulation, this test is important in the diagnosis.
Huhner test – performed around the time of your ovulation, this test allows your gynecologist to analyzing and determining the quality of mucus of your cervix after sexual intercourse to ensure its quality and compatibility with the sperm.
Pelvic ultrasound – Pelvic ultrasound is necessary in the diagnosis of infertility. It allows your gynecologist to detect abnormal ovaries, fallopian tubes or the uterus.
Hysterosalpingography – This X-ray of the uterus and fallopian tubes helps your doctor to view the permeability of the fallopian tubes and evaluate inside of the uterus through the injection of a thin, tube-like instrument (laparoscope) in the uterine cavity. This radiologic procedure is performed under general anesthesia. Adverse effects are endometriosis and scarring. Although useful, regular practice of hysterosalpingography can lead to infertility.
Endometrial biopsy – in this medical procedure, a fragment of your endometrium (the inside lining of the uterus) is removed to be examined under microscope. This test allows your doctor to detecting cellular abnormalities. In general, endometrial biopsy is performed on 23rd or 24th day of your menstrual cycle.
If you are a man suffering from infertility, your urologist may recommend the following exams:
Physical exam – during this exam, your doctor examines your genital area searching for visible abnormalities. There may be also an interrogation about your medical history, medications and sexual habits.
Spermocytogram – also called morphological study of spermatozoa or semen analysis, is an analysis of your semen characteristics, volume, viscosity, and pH. It is done after 3 to 4 days of abstinence. Spermocytogram allows your urologist to detecting abnormalities in the sperm such as teratozoospermia.
Other exams may include hormone testing, to determine your testosterone levels; and transrectal and scrotal ultrasound, used to detect retrograde ejaculation or/and ejaculatory duct obstruction.
Depending on the cause, the treatment of infertility can vary from a simple treatment to advanced medical therapies. In fact, some infertility causes are irreversible, infertility related to age for instance. No matter what form of treatment you are undergoing, you need to have as more sexual intercourse as possible. Because healthy sperm can live up to72 hours in the uterus after being ejaculated, regular intercourse is the best way to improve your chance of conception.
Male Infertility Treatment
There are many treatments for sperm abnormalities. Your urologist can recommend one of the following treatments:
Artificial insemination (AI) – this medical procedure is applicable in both male and female infertility. It consists of placing the sperm in your partner reproductive tract. The sperm can be provided by you (artificial insemination by husband, AIH) or in case you have azoospermia, by someone else (artificial insemination by donor sperm, AID). During the procedure, your doctor will select a sufficient number of normal sperm to introduce, after having treated them in the laboratory, directly into the uterine cavity of your partner. This insemination can be done in your doctor’s office by a special pipette, a laboratory device used to transport a measured volume of liquid.
The number of sperm required in the preparation must be at least one million to give a significant chance of success. If there is no success after three cycles of this method, you doctor will consider another methods. This technique can cause multiple pregnancies.
Azoospermia – the treatment of azoospermia is various. In case of endocrine abnormalities, such as hypogonadotropic hypogonadism, a combination of Human chorionic gonadotropin (hCG) and Human menopausal gonadotropins (hMG) can be effective for the return of the spermatogenesis after a few months. However, In case of congenital bilateral absence of vas deferens (CBAVD), obstruction, and hyperprolactinemia (high levels of prolactin in your body) surgical treatment can be required.
Varicocele –There are two possible treatments: surgical ligation of the spermatic cord or selective embolization, a non-surgical, minimally-invasive procedure performed by an interventional radiologist and interventional neuroradiologists.
Immune infertility – this requires a specific immunological therapy; talk to your doctor for available treatment.
Female Infertility Treatment
The treatment of female infertility is either surgery or fertility drugs, depending on the cause of the infertility. Surgical treatment is indicated in cases of Tubal factor. It aims at restoring the permeability of the fallopian tubes or to releasing the blockage from the cervix.
Surgery may include:
Assisted reproductive technology (ART) consist of several types of fertility treatments in which both eggs and sperm are handled by a specialist to enable women to conceive and carry a child.
Most common ART include IVF (In Vitro Fertilization), Zygote intrafallopian transfer (ZIFT), Gamete intrafallopian transfer (GIFT) and Intracytoplasmic sperm injection (ICSI). Talk to your doctor to know which option is more suitable to your situation.
Artificial insemination – is another commonly used infertility treatment in both men and women (see above for more information).
Medication – depending on the causes of your infertility, you doctor can suggest fertility drugs to help you regain your capability to conceive. Medications are prescribed in case of disorders on the cervical mucus or ovulation problems. Some of those drugs include:
Clomiphene citrate – Clomiphene (Clomid, Serophene) is an ovarian stimulant. Taken orally at the beginning of your cycle, this drug can stimulate your ovary and promote ovulation. Serophene is used in the treatment of polycystic ovary syndrome (PCOS) or other ovulatory disorders. The treatment is started between the 2nd and 5th day after the first day of your menstruation. Usually, at least 30% of women end up being pregnant after 3 cycles. Depending on your body reaction to the drug, you can get pregnant in your first cycle.
Some side effects reported are ectopic pregnancy, spontaneous miscarriage, blurred vision, headache, breast discomfort, uterine bleeding, ovarian enlargement (due to large amounts production of hormones), nausea and vomiting.
Human menopausal gonadotropins (hMG) – hMG are prescribed in case of failure of Clomiphene citrate or when the pituitary gland is unable to stimulate ovulation. Containing both FSH and LH, human menopausal gonadotropins act directly on your ovaries to mature follicles. They are taken in the form of injections at the beginning of the cycle.
Side effects may include ovarian enlargement, temporary breast enlargement, abdominal tenderness, bloating, fluid retention, weight gain, etc.
Gonadotropin-releasing hormone analogue (or GnRH analogue) – your doctor can decide to prescribe you GnRH analogue if you have premature or irregular ovulatory cycles. This group of drugs controls the activity of the gonadotrope cells in the pituitary gland. They may cause bone pain and hot flushes.
Follicle-stimulating hormone (FSH) – FSH is a hormone synthetized by gonadotropes in the anterior pituitary gland. Its secretion is stimulated by GnRH (gonadotropin- releasing hormone) produced by the hypothalamus. When taken as prescribed, it causes the growth of follicles, and allows ovulation by stimulating the ovaries to mature egg follicles.
Letrozole (Femara), metformin (Glucophage), and bromocriptine may also be recommended to you.
Yes. Although some infertility cannot be prevented, if you follow the tips below, you reverse or prevent infertility:
- Avoid being overweight
- Treat immediately all STDs or vaginal infection
- Use alcohol and caffeine moderately, when it is necessary
- Avoid tobacco and street drugs (marijuana, cocaine)
- Exercise regularly, but moderately – excessive heavy weight lifting can lead to infertility
- Limit your use of medications – overuse or even regular use of certain medications (prescription and nonprescription drugs) tend to increase considerably the risk of infertility.