What is infertility?
Infertility means a couple is not able to become pregnant after 1 year of having regular, unprotected sex. Infertility affects both women and men.
What causes infertility in women?
Women need functioning ovaries, fallopian tubes, and a uterus to get pregnant. Conditions affecting any one of these organs can contribute to female infertility. Some of these conditions are listed below and can be evaluated using a number of different tests.
Disruption of ovarian function: When a woman doesn’t ovulate during a menstrual cycle, it’s called anovulation. Potential causes of anovulation include the following.
- Polycystic ovary syndrome
- Diminished ovarian reserve
- Functional hypothalamic amenorrhea caused by excessive exercise, stress, or low body weight. It is sometimes associated with eating disorders such as anorexia.
- Improper function of the hypothalamus and pituitary glands
- Premature ovarian insufficiency (premature menopause)
Fallopian tube obstruction: Risk factors for blocked fallopian tubes (tubal occlusion) can include a history of pelvic infection, history of ruptured appendicitis, history of gonorrhea or chlamydia, known endometriosis, or a history of abdominal surgery.
Abnormal uterine contour: Depending on a woman’s symptoms, the uterus may be evaluated by transvaginal ultrasound to look for fibroids or other anatomic abnormalities. If suspicion exists that the fibroids may be entering the endometrial cavity, a sonohystogram (SHG) or hysteroscopy (HSC) may be performed to further evaluate the uterine environment.
What causes infertility in men?
- Infertility in men can be caused by different factors and is typically evaluated by a semen analysis. When a semen analysis is performed, the number of sperm (concentration), motility (movement), and morphology (shape) are assessed by a specialist. A slightly abnormal semen analysis does not mean that a man is necessarily infertile. Instead, a semen analysis helps determine if and how male factors are contributing to infertility.
- Disruption of testicular or ejaculatory function: Factors that cause testicular dysfunction in men include:
- Varicoceles, (a condition in which the veins on a man’s testicles are large and cause them to overheat).
- Use of certain medications and supplements Cancer treatment involving the use of certain types of chemotherapy.
- Radiation, or surgery to remove one or both testicles.
- Medical conditions such as diabetes, cystic fibrosis, certain types of autoimmune disorders, and certain types of infections may cause testicular failure.
Hormonal disorders: Improper function of the hypothalamus or pituitary glands. The hypothalamus and pituitary glands in the brain produce hormones that maintain normal testicular function. Production of too much prolactin, a hormone made by the pituitary gland (often due to the presence of a benign pituitary gland tumor), or other conditions that damage or impair the function of the hypothalamus or the pituitary gland may result in low or no sperm production.
Genetic disorders: Genetic conditions such as a Klinefelter’s syndrome, Y-chromosome microdeletion, myotonic dystrophy, and other, less common genetic disorders may cause no sperm to be produced, or low numbers of sperm to be produced.
You should know that in addition to the conditions mentioned above, such as: increasing age, smoking and alcohol, increasing or severely reducing weight and over-stress can also increase a woman and men risk of infertility.
Infertility can be treated with medicine, surgery, intrauterine insemination, or assisted reproductive technology. Often, medication and intrauterine insemination are used at the same time. Doctors recommend specific treatments for infertility on the basis of
- The factors contributing to the infertility.
- The duration of the infertility.
- The age of the female.
- The couple’s treatment preference after counseling about success rates
- The risks, and benefits of each treatment option.
Infertility treatment strategies
Medications to induce egg development and ovulation: The medications that help stimulate the ovary to develop mature eggs for ovulation come in two forms: pills taken by mouth and injections. The most commonly prescribed pill to stimulate ovulation (generally of one mature egg) is clomiphene citrate. The most commonly prescribed injections that stimulate the ovary are called gonadotropins.
Insemination: Intrauterine insemination, also known as IUI, is a process by which sperm is washed and prepared for placement into the uterine cavity.
In Vitro Fertilization (IVF): In vitro means “outside the body.” IVF is a process whereby eggs are collected and then fertilized by sperm outside the body, in an embryology laboratory.
Third party-assisted: This is when another person helps a couple get pregnant. They can help by donating sperm, donating eggs, or donating embryos. They may also serve as a surrogate or gestational carrier. This means another person actually carries the baby for you.
Surgery: After a thorough history, physical examination, and ultrasound are performed, your doctor may recommend surgery to correct and abnormality. In reproductive medicine, the most common surgical procedures are laparoscopy, hysteroscopy, and abdominal myomectomy.