Fertility Issues

What is infertility?

Infertility is a reproductive system problem that prevents individuals from conceiving. Infertility may affect everyone, and there are several reasons. Getting pregnant consists of various steps:

Your brain must create reproductive hormones to regulate ovarian function.
An egg must develop in the ovary.
When your ovary produces an egg, it is called ovulation.
Your fallopian tube must receive the egg.
Sperm must travel up your vagina, into the uterus, and into your fallopian tube.
The sperm fertilises the egg, resulting in an embryo.
The embryo moves from your fallopian tube to the uterus, where it implants.

A pregnancy cannot develop if any of the above steps are not completed.

If you're under 35, your doctor may diagnose infertility after one year (12 months) of attempting to conceive. Trying to conceive is described as engaging in frequent, unprotected sex. If you are 35 or older, your doctor may diagnose infertility after six months of unprotected intercourse.

Infertility is more frequent than you may expect. Fortunately, there are several treatment options available for those looking to start or extend their family.

What are the different forms of infertility?

There are several types of infertility, including:

Primary infertility: It occurs when you have never gotten pregnant and are unable to conceive after a year of regular, unprotected sexual intercourse (or six months if you are 35 or older).
Secondary infertility: It is the inability to conceive after at least one successful pregnancy.
Unexplained infertility: Fertility testing has not identified a cause why an individual or couple is unable to conceive.

Symptoms & Causes of Fertility Issues

What are the indicators of infertility?

The failure to conceive after six months or a year of consistent, unprotected sexual activity is the primary sign of infertility. You may not experience any more symptoms. However, some persons may have bodily signs such as:

Pelvic or abdominal discomfort.
Irregular vaginal bleeding, irregular periods, or no menstruation.
Ejaculatory or penile disorders.

What causes infertility?

There are several reasons for infertility, and there is not always a straightforward explanation for why you are unable to conceive. Only a healthcare practitioner can identify the reason and provide the best therapy for you.

While the reasons of infertility differ, research shows that:

33% of infertility cases include the partner's uterus and ovaries.
33% of infertility cases include the partner's penis and testicles.
33% of infertility affects both couples or is unexplained.
Twenty-five percent of infertile couples have more than one cause of infertility.

Infertility reasons

Some reasons for infertility only impact one couple, whilst others affect both. The risk factors for infertility are:

Age, especially in your late thirties or forties. Men's fertility starts to decline at the age of 50.
Eating disorders include anorexia nervosa and bulimia.
Excessive alcohol use.
Toxic environmental exposures include chemicals, lead, and pesticides.
Over-exercising.
Radiation treatment or chemotherapy.
Sexually transmitted infections (STIs).
Smoking and using tobacco products. (This behaviour occurs in around 13% to 15% of infertile cases.)
Substance abuse.
Being overweight or underweight.
Abnormalities of the brain's hormone-producing centres (hypothalamus or pituitary).
Chronic ailments and illnesses.

Causes of infertility in women

Ovulation problems are the most prevalent cause of infertility in ovaries. Ovulation is the process by which your ovary releases an egg to meet sperm and fertilise.

The following causes may lead to female infertility:

Endometriosis.
Your vagina, uterus, or fallopian tubes may be structurally abnormal.
Autoimmune disorders such as coeliac disease and lupus.
Kidney disease.
Pelvic inflammatory disease, or PID.
Disorders affecting the hypothalamus and pituitary glands.
Polycystic Ovarian Syndrome (PCOS).
Primary ovarian insufficiency, or insufficient egg quality.
Sickle-cell anaemia.
Uterine fibroids and uterine polyps.
Thyroid illness.
Previous surgical sterilisation (tubal ligation or salpingectomy).
Genetic or chromosomal problems.
Sexual dysfunction.
Your ovaries may be missing due to surgery or congenital defects.
Menstrual cycles are infrequent or nonexistent.

Causes of infertility in males

Male infertility is most often caused by issues with sperm shape, movement (motility), or quantity (low sperm count).

Other reasons of male infertility are:

Enlarged veins (varicocele) in your scrotum, the sac that houses your testicles.
Cystic fibrosis is a genetic condition.
Chromosomal diseases, including Klinefelter syndrome.
Tight clothes, regular use of hot tubs and saunas, and putting computers or heated pads on or near your testes all expose your testicles to excessive heat.
Injury to the scrotum or testicles.
Hypogonadism (low testosterone).
Misuse of anabolic steroids.
Sexual dysfunction includes erectile dysfunction, anejaculation, premature ejaculation, and retrograde ejaculation.
Undescended testicles.
Previous chemotherapy or radiation treatment.
The lack of testes might be surgical or congenital.
Prior to surgical sterilisation (vasectomy).

Diagnosis and Tests

How is female infertility diagnosed?

First, your healthcare practitioner will collect your complete medical and sexual history.

People with uteri must ovulate healthy eggs in order to be fertile. This implies that your brain must transmit hormonal signals to your ovary in order for an egg to be released, travel via your fallopian tube, and reach your uterine lining. Fertility testing entails discovering problems with any of these processes.

These tests may also aid in diagnosing or ruling out issues.

Your clinician will do a pelvic exam to look for structural issues or symptoms of illness.
A blood test may detect hormonal imbalances or determine if you are ovulating.
Transvaginal ultrasound: Your doctor puts an ultrasound wand into your vagina to check for problems with your reproductive system.
Hysteroscopy: Your doctor will introduce a thin, lighted tube (hysteroscope) into your vagina to inspect your uterus.
Saline sonohysterogram (SIS): Your physician injects saline (sterile salt water) into your uterus and performs a transvaginal ultrasound.
Sonohysterosalpingogram (HSG): During a SIS treatment, your physician flushes your fallopian tubes with saline and air bubbles to detect tubal obstructions.
X-ray hysterosalpingogram (HSG): X-rays detect an injected dye as it passes through your fallopian tubes. This test checks for bottlenecks.
Laparoscopy involves inserting a thin tube with a camera into a tiny abdominal incision. It aids in the diagnosis of conditions such as endometriosis, uterine fibroids, and scar tissue.

How is male infertility diagnosed?

Infertility in persons with a penis is often diagnosed by ensuring that sperm is ejaculated in a healthy state. Most fertility tests search for issues with sperm.

These tests may aid in diagnosing or ruling out issues.

Semen analysis detects low sperm count and poor sperm motility. Some patients need a needle biopsy to extract sperm from their testicles for analysis.

A blood test may determine thyroid and other hormone levels. Genetic blood tests seek for chromosomal abnormalities.
An ultrasound of your scrotum detects varicoceles and other testicular issues.

Management & Treatment

How is infertility treated?

Infertility treatment is mostly determined by the cause and your desired outcome. Your age, length of time you've been trying to conceive, and personal preferences all play a role in choosing on a therapy. Sometimes just one person needs therapy, while other times both couples are involved.

In most circumstances, individuals and couples with infertility have a good chance of becoming pregnant. Medications, surgery, and assisted reproductive technology (ART) may all help. Lifestyle modifications, such as increasing the frequency and timing of intercourse, may often increase your chances of becoming pregnant. Treatment may potentially include a variety of treatments.

Infertility treatment for women

Treatments for infertility in women and those designated female at birth are:

Lifestyle changes, such as gaining or losing weight, quitting smoking or using drugs, and improving your overall health, might increase your chances of becoming pregnant.
Fertility medicines encourage your ovaries to produce more eggs, increasing your chances of becoming pregnant.
Surgery may unblock blocked fallopian tubes and remove polyps, fibroids, and scar tissue.

Providers may provide ideas about how to boost your chances of conception. These might include things like:

Tracking ovulation using basal body temperature, a fertility tracking app, and noting the texture of your cervical mucus.
Using a home ovulation kit, which may be purchased at a drugstore or online, can predict ovulation.

Infertility Treatment for Men

Treatments for infertility with a penis or testes include:

Medications: Some medicines can raise the amount of testosterone or other hormones. You can also take drugs for erectile dysfunction to help you keep an erection during sex.
Surgery: Some men need surgery to clear out clogged tubes that carry sperm or fix problems with the structure of their bodies. Varicocele treatment can improve the health of sperm and raise the chances of getting pregnant.

Optimising Male Fertility

Several medical disorders may lead to male fertility difficulties, including:

A disorder in the hypothalamus or pituitary gland, regions of the brain that stimulate the testicles to generate testosterone and sperm (secondary hypogonadism).
Testicular disease.
Disorders of sperm transport.
Age might also play a role. Sperm motility and the quantity of normal sperm decline with age, decreasing fertility, particularly beyond the age of 50.

What's the best way to produce healthy sperm?

To improve your chances of making good sperm, you can do simple things like

Stay at a good weight: Some studies show that a higher body mass index (BMI) is linked to fewer sperm and less moving of sperm.
Take care of your body: Eat a lot of fruits and veggies. They are full of vitamins, which may help keep your sperm healthy.
STI: Avoid getting sexually transmitted diseases (STIs). Men can't have children because of sexually spread diseases like gonorrhoea and chlamydia. To avoid getting STIs, limit the number of sexual partners you have and always use a condom for sex. You can also stay in a mutually monogamous relationship with a partner who isn't affected.
Deal with stress: It's possible for stress to make it harder to be sexual and mess up the chemicals that are needed to make sperm.
Get going: Strong antioxidant enzymes can be raised through moderate exercise, which can help protect sperm.

What can't be done?

Sperm can be especially hurt by things in the surroundings, like being in too much heat or chemicals that are harmful. To keep fertility safe:

Do not smoke.
Limit your drinking.
To have sex, don't use lubrication.
Talk to your doctor or nurse about the medicines you are taking.
It's possible that wearing loose-fitting pants, sitting less, staying away from saunas and hot tubs, and limiting the time your scrotum is exposed to warm things like a laptop might improve the quality of your sperm.

What are some common fertility treatments?

Some couples need further assistance with conceiving using assisted reproductive technology (ART). ART refers to any reproductive therapy in which a healthcare professional handles the sperm or egg. To boost pregnancy chances, you may take drugs to promote ovulation before attempting one of these options:

IVF: In vitro fertilisation (IVF) entails extracting eggs from your ovary and combining them with sperm in a lab dish. Sperm fertilises eggs. A provider places one to three fertilised eggs (embryos) in your uterus.
ICSI: Intracytoplasmic sperm injection (ICSI): This technique may be done throughout the IVF cycle. An embryologist places a single sperm straight into each egg. A provider will then put one to three embryos into your uterus.
IUI: Intrauterine insemination (IUI) also known as Artificial insemination is a procedure in which a healthcare worker inserts sperm directly into your uterus using a long, thin tube.
Assisted hatching: It is a process of opening an embryo's outer covering to allow it to implant in your uterine lining.
Third-party ART: Couples may utilise donated eggs, sperm, or embryos. Certain couples need a gestational carrier or surrogate.

What are the complications of treatment?

Complications from infertility therapy include:

Multiples (twins, triplets, or more) are more likely if you produce numerous eggs and transfer more than one embryo. People carrying multiple foetuses are more likely to have difficulties such as miscarriage, early delivery, low birth weight, neonatal mortality, and long-term health issues.
Ovarian hyperstimulation syndrome (OHSS) is a fertility medication-related illness that produces painful and enlarged ovaries. It may develop severely and need prompt medical intervention.
Ectopic pregnancy: the possibility of an ectopic pregnancy is increased by IVF.
Failed cycles occur when you undergo infertility therapy but do not get pregnant.

Can infertility be cured?

Yes, however it is dependent on the reason. In 85% to 90% of instances, lifestyle changes, medication, ART, or surgery may resolve infertility and enable a person to conceive.