Reproductive(Fertility) Health

Infertility

Written by
Dr. K Sneha
and medically reviewed by Dr. Sameer Kumar

Published on Aug 13, 2019 and last reviewed on Aug 22, 2019   -  7 min read

Abstract

Abstract

Have you tried everything and still not able to conceive? This article tells you about all the possible causes and treatment for male and female infertility.

Infertility

What Is Infertility?

Infertility is when a couple cannot conceive a child or get pregnant even after having unprotected sexual intercourse for a year. And women over 35 years old are considered infertile if they are not able to get pregnant after trying for 6 months. It also includes women who conceive but are not able to carry the pregnancy to term.

The two types of infertility in women are:

  1. Primary infertility - It is when a woman has never been able to get pregnant.

  2. Secondary infertility - It is when a woman has had a baby previously.

Not only a woman, but a man can also be infertile. Of all the cases, one-third is caused by male infertility, one-third by female infertility, and the remaining third can be due to unknown causes.

What Are the Causes of Male Infertility?

In men, infertility generally results from:

  1. Low sperm count - When the sperm count is under 15 million.

  2. Abnormal sperm shape - Abnormal shape can make it difficult for the sperm to move and fertilize an egg.

  3. Low sperm motility - Spem with low motility cannot swim and reach the fallopian tube to fertilize the egg.

The changes in the sperm count, quality, and motility are affected by the following factors:

  • Smoking.

  • Old age.

  • Alcoholism.

  • Obesity.

  • Infection, cancer, or surgery of testes.

  • Undescended testes.

  • Varicocele.

  • Varicose veins in the scrotum.

  • Blocked ejaculatory ducts.

  • Hypogonadism.

  • Low testosterone.

  • Overheated testicles.

  • Exposure to environmental irritants like pesticides, toxins, and heavy metals.

  • Klinefelter’s syndrome.

  • Inflammation of testicles during mumps.

  • Hypospadias (Instead of at the tips, the urethral opening is under the penis).

  • Cystic fibrosis (can result in obstructed or missing vas deferens).

  • Diabetes.

  • Cushing’s syndrome.

  • Thyroid problem.

  • Anemia.

  • Radiation therapy.

  • Chemotherapy.

  • Drug abuse.

  • Stress and anxiety.

  • Certain drugs (Tricyclic antidepressants, anabolic steroids, calcium channel blockers, Sulfasalazine).

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What Are the Signs of Male Infertility?

The common signs of male infertility are:

  • Decreased libido or sexual desire.

  • Pain or swelling in testicles.

  • Erectile dysfunction (problem in maintaining an erection).

  • Premature ejaculation.

  • Firm and small testes.

What Are the Causes of Female Infertility?

Infertility in women results when one of the following biological processes is affected:

  1. The process by which a mature egg is released from the ovary (Ovulation).

  2. The process where the sperm fertilizes the mature egg in the fallopian tube (Fertilization).

  3. And the process by which the fertilized egg gets attached to the wall of the uterus (Implantation).

The factors that can affect these processes are:

  • Age more than 35 years.

  • Smoking.

  • Alcoholism.

  • Obesity.

  • Sexually transmitted infections.

  • Eating disorders.

  • Too much or too little exercise.

  • Stress and anxiety.

  • Exposure to environmental irritants like pesticides, toxins, and heavy metals.

  • Premature ovarian failure.

  • Polycystic ovarian syndrome (PCOS).

  • Damaged or underdeveloped egg.

  • Hyperprolactinemia.

  • AIDS.

  • Cancer.

  • Thyroid diseases.

  • Damage or scarring of the fallopian tubes during pelvic surgery.

  • Fibroids.

  • Uterine polyp.

  • High cholesterol levels.

  • Endometriosis.

  • Blocked fallopian tube.

  • Chemotherapy.

  • Radiation therapy.

  • Long-term use of NSAIDs.

  • Drug abuse.

What Are the Signs of Female Infertility?

The signs of female infertility include:

  • Irregular periods.

  • Heavy menstrual bleeding.

  • Absence of periods.

  • Reduced sexual desire.

  • Skin changes.

  • Thinning hair.

  • Weight gain.

  • Increased facial and body hair.

  • Painful sex.

How Is Infertility in Men Diagnosed?

If you are trying for almost a year and are experiencing any of the above signs, it is best to get evaluated by a doctor. If the doctor suspects infertility, he or she will run some tests on you and your partner to find the exact cause.

On your visit, the doctor will take a complete medical history. He or she will ask about your overall health, your sexual history, and other risk factors. The doctor will also check your genitals for abnormalities. After this, the doctor might ask you to perform the following tests:

  • Semen analysis - The color, quality, quantity, and motility of sperm is checked. Presence of blood or infection is also checked in the semen.

  • Blood test - To check the levels of testosterone.

  • Ultrasound - To check for retrograde ejaculation and obstruction in the ejaculatory duct.

  • Urine test - To rule out chlamydia infection.

  • Genetic testing - To rule out genetic abnormalities.

How Is Infertility in Women Diagnosed?

For women, fertility begins to decrease after 30 years of age. If you are younger than 35, consult a doctor after one year of trying to get pregnant, and if you are 35 or older, visit a doctor after 6 months of trying.

On your visit, the doctor will ask you about your medical history, previous illnesses, sexual history, menstrual cycle, and any other factor that could affect your fertility. The following test is then performed:

  • Pelvic examination - Your pelvic area is checked to look for pelvic inflammatory disease, fibroids, or endometriosis.

  • Blood test - The doctor will tell you to check if you are ovulating every month with the help of ovulation kit or blood test.

  • Ultrasound - To examine the ovaries and uterus.

  • Hysterosalpingography - To check if the fallopian tube is patent.

  • Laparoscopy - Any abnormality in the uterus, fallopian tube, or endometriosis can be diagnosed.

  • Ovarian reserve testing - To determine the capacity of ovaries to produce egg cells.

  • Genetic testing - To rule out genetic abnormalities.

  • Thyroid function test.

  • Test to rule out sexually transmitted infections.

What Are the Treatment Options for Infertility?

The treatment options for both men and women depends on the following factors:

  1. Cause.

  2. Age.

  3. Overall health.

  4. How long you have been trying to conceive.

  5. Personal preference.

On your first visit, the doctor will suggest you increase the frequency of sexual intercourse during ovulation. If you are still not able to conceive, then the other treatment options are suggested.

For Men:

Depending on the cause, the various treatment options are:

  • Lifestyle changes - Regular exercise, reducing weight, avoiding smoking and alcohol, and increased frequency of sexual intercourse.

  • Medicines - Testicular function and sperm count can be increased with some medications. Ask a doctor for the names of the medicine.

  • Surgery - Surgery is indicated for removing varicose veins in varicocele and for blocked epididymis.

  • Sperm retrieval - In cases of blocked ejaculatory duct and retrograde ejaculation, sperm can be directly taken from the testes or bladder and injected into an egg.

For Women:

The treatment options for women are:

  • Fertility drugs - If the woman is infertile due to ovulation disorders, then fertility drugs are used. Consult a doctor about these drugs, as it can help regulate and induce ovulation. Depending on the cause, the different fertility drugs used are:

    • Clomifene.

    • Metformin.

    • Human menopausal gonadotropin (hMG).

    • Follicle-stimulating hormone.

    • Human chorionic gonadotropin.

    • Gonadotropin-releasing hormone.

    • Bromocriptine.

  • Surgery - If the fallopian tubes are blocked or scarred, or to treat endometriosis.

Assisted Reproductive Technology (ART):

Procedures that handle egg and sperm and are used to treat infertility are called ART. The methods included are:

  • Intrauterine insemination (IUI) - When the woman is ovulating, sperm are injected into the uterus, so they can fertilize the released egg. Done when in unknown causes of infertility or when the sperm count or motility is low.

  • In-vitro fertilization (IVF) - Eggs and sperm are collected and fertilized outside in a petri dish, and the fertilized eggs are placed in the uterus for implantation.

  • Intracytoplasmic sperm injection (ICSI) - During IVF, only a single sperm is injected into an egg.

  • Sperm donation - In IVF, sperm is collected from a donor.

  • Egg donation - During IVF, eggs can be received from a donor.

  • Gestational carrier - The embryo made from a couple's sperm and egg is placed in the uterus of a surrogate.

  • Assisted hatching - It is done when IVF is not successful or in older women. This procedure helps the embryo to implant or get attached to the wall of the uterus by making a small hole in the outer membrane of the embryo.

Natural Treatments for Infertility:

Natural treatment options are:

  • Acupuncture - The insertion of small and thin needles into various points of the body.

  • Yoga - It includes breathing techniques to promote relaxation and decrease stress and anxiety.

  • Aromatherapy - It used essential oils to reduce stress and promote fertility.

  • Diet - Avoid refined carbohydrates, trans fats, and processed foods. Consume a high-fiber diet and plant protein.

  • Vitamins - Zinc, folate, vitamin C and E, and iron promote fertility.

There are a lot of options available for couples who wish to have a child but are not able to conceive. If you have been unsuccessful even after trying for more than a year, it is best you consult a doctor. You can also consult experienced and professionally trained infertility doctors online.

Last reviewed at:
22 Aug 2019  -  7 min read

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