What is infertility?
Infertility means not being able to get pregnant after one year of trying. Or, six months, if a woman is 35 or older. Women who can get pregnant but are unable to stay pregnant may also be infertile. Pregnancy is the result of a process that has many steps.
- A woman must release an egg from one of her ovaries (ovulation).
- The egg must go through a Fallopian tube toward the uterus (womb).
- A men's sperm must join (fertilize) the egg along the way.
- The fertilized egg must attach to the inside of the uterus (implantation).
Is infertility a common problem?
Yes. About 10 percent of women (6.1 million) in ages 15-44 have difficulty getting pregnant or staying pregnant, according to the Centres for Disease Control and Prevention (CDC).
Is infertility just a woman's problem?
No, infertility is not always a woman's problem. Both women and men can have problems that cause infertility. About one-third of infertility cases are caused by women's problems. Another one third of fertility problems are due to the man. The other cases are caused by a mixture of male and female problems or by unknown problems.
What causes infertility in men?
Infertility in men is most often caused by:
- A problem called varicocele (VAIR-ih- koh-seel).
This happens when the veins on a man's testicle(s) are too large. This heats the testicles. The heat can affect the number or shape of the sperm.
This may be caused by the shape of the sperm. Sometimes injuries or other damage to the reproductive system block the sperm.
Sometimes a man is born with the problems that affect his sperm. Other times problems start later in life due to illness or injury. For example, cystic fibrosis often causes infertility in men. Male infertility refers to the inability of a male to achieve a pregnancy in a fertile female accounts for 40 - 50% of infertility.
o Pre-testicular causes
- Tobacco smoking
- DNA damage
o Testicular factors
o Post-testicular causes
o Physical examination Causes
Factors relating to male infertility include:
- Pre-testicular causes
- Pre-testicular factors refer to conditions that impede
- adequate support of the testes and include situations of
- poor hormonal support and poor general health
Hypogonadotropic hypogonadism due to various causes
o Obesity increases the risk of hypogonadotropic hypogonadism.
Strenuous riding (bicycle riding, horseback riding)
Medications, including those that affect spermatogenesis such as chemotherapy, anabolic steroids, cimetidine, spironolactone; those that decrease FSH levels such as phenytoin; those that decrease sperm motility such as sulfasalazine and nitrofurantoin
Genetic abnormalities such as a Robertsonian translocation
Male smokers also have approximately 30% higher odds of infertility.There is increasing evidence that the harmful products of tobacco smoking kill sperm cells.Therefore, some governments require manufacturers to put warnings on packets. Smoking tobacco increases intake of cadmium, because the tobacco plant absorbs the metal. Cadmium, being chemically similar to zinc, may replace zinc in the DNA polymerase, which plays a critical role in sperm production. Zinc replaced by cadmium in DNA polymerase can be particularly damaging to the testes. DNA damage As men age there is a consistent decline in semen quality, and this decline appears to be due to DNA damage.. These findings suggest that DNA damage is an important factor in male infertility.
Testicular factors refer to conditions where the testes produce semen of low quantity and/or poor quality despite adequate hormonal support and include:
Paternal age effect
Genetic defects on the Y chromosome
o Y chromosome micro deletions
Abnormal set of chromosomes
o Klinefelter syndrome
Neoplasm, e.g. seminoma
Varicocele (14% in one study)
Radiation therapy to a testis decreases its function, but infertility can efficiently be avoided by avoiding radiation to both testes.
Post-testicular factors decrease male fertility due to conditions that affect the male genital system after testicular sperm production and include defects of the genital tract as well as problems in ejaculation:
Vas deferens obstruction
Lack of Vas deferens, often related to genetic
markers for Cystic Fibrosis
Infection, e.g. prostatitis
Ejaculatory duct obstruction
The diagnosis of infertility begins with a medical history and physical exam by a physician, preferably a specialist with experience or who specializes in male infertility. Typically two separate semen analyses will be required. The provider may order blood tests to look for hormone imbalances, medical conditions, or genetic issues.
The history should include prior testicular or penile insults (torsion, cryptorchidism, trauma), infections (mumps or chitis, epididymitis), environmental factors (excessive heat, radiation, medications, and drug use (anabolic steroids, alcohol, smoking). Sexual habits, frequency and timing of intercourse, use of lubricants, and each partner's previous fertility experiences are important. Loss of libido and headaches or visual disturbances may indicate a pituitary tumor.
The past medical or surgical history may reveal thyroid or liver disease (abnormalities of spermatogenesis), diabetic neuropathy (retrograde ejaculation), radical pelvic or retroperitoneal surgery (absent seminal emission secondary to sympathetic nerve injury), or hernia repair (damage to the vas deferens or testicular blood supply). A family history may reveal genetic problems. Sperm sample The volume of the semen sample, approximate number of total sperm cells, sperm motility/forward progression, and % of sperm with normal morphology are measured. This is the most common type of fertility testing.Semen deficiencies are often labeled as follows:
Oligospermia or Oligozoospermia - decreased number of spermatozoa in semen
Aspermia - complete lack of semen
Hypospermia - reduced seminal volume
Azoospermia - absence of sperm cells in semen
Teratospermia - increase in sperm with abnormal morphology
Asthenozoospermia - reduced sperm motility
What increases a man's risk of infertility?
A man's sperm can be changed by his overall health and lifestyle. Some things that may reduce the health or number of sperm include:
heavy alcohol use
environmental toxins, including pesticides and lead
health problems such as mumps, serious conditions like kidney disease, or hormone problems
radiation treatment and chemotherapy for cancer
What causes infertility in women?
Most cases of female infertility are caused by problems with ovulation. Without ovulation, there are no eggs to be fertilized. Some signs that a woman is not ovulating normally include irregular or absent menstrual periods. Ovulation problems are often caused by polycystic ovarian syndrome (PCOS). PCOS is a hormone imbalance problem which can interfere with normal ovulation. PCOS is the most common cause of female infertility. Primary ovarian insufficiency (POI) is another cause of ovulation problems. POI occurs when a woman's ovaries stop working normally before she is 40. POI is not the same as early menopause.
Less common causes of fertility problems in women include:
blocked Fallopian tubes due to pelvic inflammatory disease, endometriosis, or surgery for an ectopic pregnancy
physical problems with the uterus
uterine fibroids, which are non-cancerous clumps of tissue and muscle on the walls of the uterus.
What things increase a woman's risk of infertility?
Many things can change a woman's ability to have a baby. These include:
being overweight or underweight
excess alcohol use
sexually transmitted infections (STIs)
health problems that cause hormonal changes, such as polycystic ovarian syndrome and primary ovarian insufficiency
How does age affect a woman's ability to have children?
Many women are waiting until their 30s and 40s to have children. In fact, about 20 percent of women now have their first child after age 35. So age is a growing cause of fertility problems. About one-third of couples in which the woman is over 35 have fertility problems. Aging decreases a woman's chances of having a baby in the following ways:
Her ovaries become less able to release eggs.
She has a smaller number of eggs left.
Her eggs are not as healthy.
She is more likely to have health conditions that can cause fertility problems.
She is more likely to have a miscarriage.
How long should women try to get pregnant before calling their doctors?
Most experts suggest at least one year. Women 35 or older should see their doctors after six months of trying. A woman's chances of having a baby decrease rapidly every year after the age of 30. Some health problems also increase the risk of infertility. So, women should talk to their doctors if they have:
Irregular periods or no menstrual periods
Very painful periods
Pelvic inflammatory disease
More than one miscarriage
It is a good idea for any woman to talk to a doctor before trying to get pregnant. Doctors can help you get your body ready for a healthy baby. They can also answer questions on fertility and give tips on conceiving.
How will doctors find out if a woman and her partner have fertility problems?
Doctors will do an infertility checkup. This involves a physical exam. The doctor will also ask for bothpartners health and sexual histories. Sometimes this can find the problem. However, most of the time, the doctor will need to do more tests. In men, doctors usually begin by testing the semen. They look at the number, shape, and movement of the sperm. Sometimes doctors also suggest testing the level of a man's hormones. In women, the first step is to find out if she is ovulating each month. There are a few ways to do this. A woman can track her ovulation at home by:
Writing down changes in her morning body temperature for several months
Writing down how her cervical mucus looks for several months
Using a home ovulation test kit Doctors can also check ovulation with blood tests. Or they can do an ultrasound of the ovaries. If ovulation is normal, there are other fertility tests available. Some common tests of fertility in women include:
Hysterosalpingography (HIS-tur- oh-sal- ping-GOGH-ru- fee): This is an X-ray of the uterus and Fallopian tubes. Doctors inject a special dye into the uterus through the vagina. This dye shows up in the X-ray. Doctors can then watch to see if the dye moves freely through the uterus and Fallopian tubes. This can help them find physical blocks that may be causing infertility. Blocks in the system can keep the egg from moving from the Fallopian tube to the uterus. A block could also keep the sperm from reaching the egg.
Laparoscopy (lap-uh- ROS-kuh- pee): A minor surgery to see inside the abdomen. The doctor does this with a small tool with a light called a laparoscope (LAP-uh- roh-skohp). She or he makes a small cut in the lower abdomen and inserts the laparoscope. With the laparoscope, the doctor can check the ovaries, Fallopian tubes, and uterus for disease and physical problems. Doctors can usually find scarring and endometriosis by laparoscopy. During this surgery doctors use a tool called a laparoscope to see inside the abdomen. The doctor makes a small cut in the lower abdomen and inserts the laparoscope. Using the laparoscope, doctors check the ovaries, Fallopian tubes, and uterus for disease and physical problems. Doctors can usually find scarring and endometriosis by laparoscopy. Finding the cause of infertility can be a long and emotional process. It may take time to complete all the needed tests. So don't worry if the problem is not found right away.
How do doctors treat infertility?
Infertility can be treated with medicine, surgery, artificial insemination, or assisted reproductive technology. Many times these treatments are combined. In most cases infertility is treated with drugs or surgery. Doctors recommend specific treatments for infertility based on:
how long the couple has been trying to get pregnant the
age of both the man and woman
the overall health of the partners
preference of the partners
Doctors often treat infertility in men in the following ways:
Sexual problems: Doctors can help men deal with impotence or premature ejaculation. Behavioral therapy and/or medicines can be used in these cases.
Too few sperm: Sometimes surgery can correct the cause of the problem. In other cases, doctors surgically remove sperm directly from the male reproductive tract. Antibiotics can also be used to clear up infections affecting sperm count.
Sperm movement: Sometimes semen has no sperm because of a block in the man's system. In some cases, surgery can correct the problem. In women, some physical problems can also be corrected with surgery.
A number of fertility medicines are used to treat women with ovulation problems. It is important to talk with your doctor about the pros and cons of these medicines. You should understand the possible dangers, benefits, and side effects.
What medicines are used to treat infertility in women?
Some common medicines used to treat infertility in women include:
Clomiphene citrate: This medicine causes ovulation by acting on the pituitary gland. It is often used in women who have polycystic ovarian syndrome (PCOS) or other problems with ovulation. This medicine is taken by mouth.
Human menopausal gonadotropin or hMG This medicine is often used for women who don't ovulate due to problems with their pituitary gland. hMG acts directly on the ovaries to stimulate ovulation. It is an injected medicine.
Follicle-stimulating hormone FSH works much like hMG. It causes the ovaries to begin the process of ovulation. These medicines are usually injected.
Metformin (Glucophage): Doctors use this medicine for women who have insulin resistance and/or PCOS. This drug helps lower the high levels of male hormones in women with these conditions. This helps the body to ovulate.
fertility drugs increase a woman's chance of having twins, triplets, or other multiples. Women who are pregnant with multiple fetuses have more problems during pregnancy. Multiple fetuses have a high risk of being born too early (prematurely). Premature babies are at a higher risk of health and developmental problems.
What is intrauterine insemination (IUI)?
Intrauterine insemination (IUI) is an infertility treatment that is often called artificial insemination. In this procedure, the woman is injected with specially prepared sperm. Sometimes the woman is also treated with medicines that stimulate ovulation before IUI.
IUI is often used to treat:
Mild male factor infertility
Women who have problems with their cervical mucus
Couples with unexplained infertility.
IUI is one of the procedures used to treat infertility.In this process,washed sperms from the male partner,(or from a sperm donor when the male partner produces no sperms) are deposited in a woman’s uterus around the time of ovulationthrough