Infertility: Everything You Need To Know About

Infertility refers to the inability to reproduce, it can be synonymous with sterility with only sporadically occurring spontaneous pregnancies. According to WHO “Infertility is a disease of the male or female reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse.”

Infertility does not mean being able to produce ever, it can be treated and cured. This disease is not confined to any gender, it is found in both males and females.

About 9% of men and 11% of women who are of reproductive ages in the United States face fertility problems. In one-third of infertile couples, the problem is with men and in one-third, the problem is with women, for the remaining one-third the problem is difficult to be found, this type of problem is termed unexplained infertility. [1]

Types of infertility

• Primary infertility- It deals with couples who have never been able to conceive, after at least one year of having sex without any birth control.

• Secondary infertility- It indicates difficulty in conceiving after being able to conceive naturally.

• Subfertility- Is any form of reduced fertility with a prolonged time of unwanted non-conception. There are chances of getting pregnant on their own, but it takes longer than average to get pregnant.

Risk factors for infertility in all genders

1. Age.
2. Diabetes.
3. Excessive consumption of alcoholic substances
4. Weight disorders can be obesity or extreme weight loss.
5. Eating disorders such as Nervosa or anorexia.
6. Sexually transmitted diseases.
7. Radiation therapy or cancer treatment.

Infertility in women

Signs of infertility in women

There are many noticeable signs that can be found in women, such as irregular periods (the gap between periods changes frequently), abnormal bleeding (bleeding can be heavy or light if compared to usual), missing periods regularly, periods can be painful, cramps, pelvic pain.

Some rare signs can be changes in the skin (growth of acne), change in desire for sex, loss of hair, growth of hair on areas like lips, chest, chin, and gaining of weight.

Symptoms like pain during sex and discharge of milky white substance from nipples (not related to breastfeeding) are also found.

Causes in women / Factors that Risk- There are a range of causes of infertility in women. There are factors that include the risk of infertility, some commonly

Known factors are:

1. Age: The ability to conceive falls with increasing age (usually falls after mid 30’s – rapidly falls after 37.) [2]
2. Diet: Good nutrition is vital for a healthy body, a nutritious diet helps to boost fertility. A poor diet can play havoc with our hormones, which in turn, can lead to ovulatory issues. Reproductive performance can be improved with the intake of folic acid, iron, zinc, vitamin B-12, etc.
3. Alcohol/tobacco use: Any amount of alcohol consumption can affect the chances of conceiving. Miscarriages are more frequent in women in women who smoke compared to non-smokers, it also reduces the possible effectiveness of fertility treatment.
4. Exercise issues: Vigorous exercise reduces the risk of ovulation problems and moderate exercise reduces the risk of miscarriage and increases the chance of having a baby. Both too much and too little exercise can lead to fertility problems.
5. Weight: Being both overweight and underweight can affect women’s fertility. Being underweight (BMI under 18.5) can reduce a woman’s fertility by causing hormone imbalances that affect ovulation and the chance of getting pregnant, whereas obese women have higher levels of a hormone called leptin (produced in fatty tissue) can disrupt the hormone balance and lead to reduced fertility.
6. Sexually transmitted disease: STDs often have no symptoms but when they go untreated they can spread up the reproductive system, causing damage, scarring, and inflammation in the uterus, ovaries, and fallopian tube, leading to infertility. The two most prevalent causes of STD (Sexually Transmitted Diseases)- related infertility are damage to fallopian tubes and pelvic inflammatory disease (PID).
7. Mental stress: This may affect ovulation and lead to reduced sexual activity. Mental stress can disrupt the connection between the brain and ovaries and cause delayed or absent ovulation. Research has shown that women with a history of depression are twice as likely to experience infertility. [3]
8. PCOS: Polycystic ovary syndrome, is one of the most common and treatable causes of infertility in women. Ovaries of the person suffering function abnormally and irregular periods may occur.
9. Adhesions: These are internal scars that can form from surgery, infection, inflammation, trauma, and radiation. Adhesions can wrap themselves around a woman’s reproductive organs, blocking fallopian tubes or causing another mechanical dysfunction.
10. Endometriosis: It is a common gynecological painful condition caused by the growth of endometrial tissue outside the uterus. Organs of the pelvic cavity are the most common locations for ectopic growths.
11. Uterine or cervical abnormalities: Abnormalities of the uterus can contribute to the inability to get pregnant. Uterine fibroids can distort the endometrial cavity making it difficult for implantation and can be treatable.
12. Primary ovarian insufficiency: (early menopause) – menopause is a natural decline in reproductive hormones when a woman reaches her 40’s or 50’s. Early occurrence of menopause can be caused by medical conditions such as premature ovarian failure or happens as the result of chemotherapy, radiation or surgical removal of the ovaries, women afflicted by premature menopause also experience infertility.

Diagnosis

Detecting infertility in different ways:

1. Pelvic exam- female reproductive and sexual organs are examined, and it is performed to check the structural problem or signs of infection or illness.
2. Blood test- A sample of blood is tested for a hormone called progesterone to check the ovulation process. Blood is also tested to check levels of follicle-stimulating hormone or, FSH (Follicle Stimulating Hormone), which triggers ovaries to prepare an egg for release.
3. Transvaginal ultrasound- It is also called endovaginal ultrasound, which is a type of pelvic ultrasound where a women’s uterus, ovaries, tubes, and cervix are tested. Transvaginal means across or through the vagina, where an ultrasound probe is placed inside the vagina during the test. The transducer emits sound waves that generate images of pelvic organs including ovaries.
4. Hysteroscopy- It is a procedure that allows doctors to look inside the uterus through a hysteroscope (a telescope with a light and a camera at its end) to diagnose the causes of abnormal bleeding.
5. Saline sonohysterogram (SHG) – It is the procedure to evaluate the uterus and the shape of the uterine cavity.
6. Laparoscopy- is a surgical procedure in which a fiber-optic instrument is inserted through the abdominal wall to view the organs in the abdomen.

Treatment

Treatment for infertility includes both medication and surgery, it depends upon factors like age, health condition, etc. Fertility drugs that work like natural hormones are usually the main treatment for women who suffer from infertility disorders due to ovulation. For people to whom medication is not enough, methods like IVF, surrogacy, and artificial insemination are adopted.

Infertility in men

Signs of infertility

Although most types of infertility in men are not preventable and vague, avoiding consumption of drugs, tobacco, and alcohol, exposure to industrial or environmental toxins may help. Regular exercise can prove to be helpful in increasing sperm count which increases the chances of achieving pregnancy. Symptoms are dependent on the cause of infertility such as a change in the growth of hair, change in the size of the testicle, pain, lump or swelling in the testicle, change in sexual desire, or problem with ejaculation.

Causes in men/ factors that risk

1. Age- male fertility starts to fall after 40 years.
2. Enlarged vein- varicocele in the scrotum (loose bag of skin that holds testicles). It is caused due to collected blood in the veins rather than circulating out of the scrotum.
3. Mental stress- due to stress hormones such as glucocorticoids being released, they decrease testosterone levels as well as sperm production.
4. Obesity- Being obese can lead to hormonal imbalance and affects sperm cells.
5. Anabolic steroid- It can sometimes lead to absent sperm count and shrunken testicles. The damage totally depends upon the intake of steroids.
6. Radiation therapy/ chemotherapy- The severity of radiation therapy depends upon how near to the testicle’s radiation was done. Whereas in chemotherapy, some types may reduce sperm count.
7. Hypospadias- Hypospadias affects about 1 in every 500 newborn boys. In this condition, the opening of the urethra is not located on the tip of the penis (a hole may be anyplace along the underside of the penis).
8. Ejaculation problem- Due to damage or injury to the reproductive organs, sexual diseases like premature ejaculation happens due to a combination of physical and psychological concerns. Sometimes semen may be ejaculated into the bladder.
9. Low sperm count- It means semen ejaculated during the orgasm is fewer than normal (it is considered low when it falls to less than 15 million sperm per milliliter of semen) [5].
10. Low sperm motility- It refers to the slow and inefficient movement of sperm toward the egg, usually caused due to poor diet, stress, etc.
11. Abnormally formed sperm- Due to genetic defects, health issues such as diabetes or infections such as mumps can affect the quality of sperm.

Diagnosis

Male infertility is more often related to sperm production or delivery, it can be diagnosed through physical examination or medical history.

Laboratory tests include semen analysis, hormonal analysis, and genetic analysis (if necessary).

Treatment

There are two ways to treat infertility in males:

1. Medical therapy
2. Natural treatment
3. Surgical therapy