Infertility is the inability to get pregnant (conceive) after a period of one year of having unprotected sex. For women of over 35 years of age and/or those who habitually experience irregular menstrual cycles it is usually best to seek an appointment with a reproductive endocrinologist (fertility specialist) after a period of six months. Though the results of having been able to conceive are obviously related to signs in the woman’s body, evidently, both men and women are responsible for ensuring contribution to a couple’s fertility (or infertility).

Causes

Infertility in men:

Usually, a semen analysis provides answers in terms of: concentration (number of sperm cells), motility (movement) and morphology (shape)

Different conditions that can contribute to infertility:

Variocele: due to abnormally large veins in a man’s testicles, overheating ensues, thus causing the death of the reproductive cells

Diabetes, cystic fibrosis (secreted fluids become thicker in consistency and can no longer travel normally), testicular failure, infections, treatment with chemotherapy or radiation, trauma

Ejaculation issues

Antibodies that mistakenly attack sperm cells

Tumors, hormonal imbalances

Undescended testicles

Chromosome defects causing syndromes affecting the normal development of male reproductive organs

Celiac disease (a digestive disorder caused by gluten intolerance)

Heavy alcohol use, smoking, testosterone supplementation (causing the body to actually produce lower levels of testosterone since it makes primary use of its ‘outside’ source), anabolic steroid use (working on the same principle as testosterone supplementation), drug use

Exposure to pesticides and lead

 

Infertility in women:

Ovulation disorders (caused either by flaws in the regulation of reproductive hormones or in the ovary itself):

Polycystic ovary syndrome, which is also associated with insulin resistance, obesity, abnormal facial/bodily hair growth, and acne

Hypothalamic dysfunction which is the faulty production of the two hormones regulating ovulation each month – follicle-stimulating hormone (FSH) and luteinizing hormone (LH), thus producing irregular or absent menstruations

Premature ovarian insufficiency, in which the body mistakenly attacks ovarian tissue or premature loss of eggs due to genetic problems or chemotherapy

Excess of prolactin (hormone released by the pituitary gland having a role in determining breast development and milk production) causing lower levels of estrogen

Damage to the fallopian tubes, blocking the passage of the fertilized egg to the uterus

Endometriosis occurring in cases when tissue normally growing in the uterus grows in other locations

 

Uterine or cervical causes:

Benign polyps that may impair the reproductive process by blocking the fallopian tubes or by disrupting implementation of the fertilized egg into the uterus

Endometriosis, scarring or inflammation within the uterus

Uterine abnormalities present from birth

Cervical stenosis (inherited malformation or damage to the cervix)

Improper production of mucus to allow the free movement of the sperm to the egg

Aging decreases a woman’s chances of getting pregnant and increases chances of miscarriage and of having a baby with genetic abnormalities

Smoking, heavy alcohol use, drug use

Extreme weight gain or loss

Excessive physical or emotional stress causing amenorrhea (absent periods)

Symptoms and signs

The main sign of infertility is the couple’s inability to conceive after a period of unprotected intercourse over a period of one year

 

No other obvious signs may be present

Advice

Treatment depends on the cause, the length of time infertility has occurred, both partners’ age, and personal preferences for alternative methods of conception

For men:

Treatment of infections via antibiotic intake

Treatment for sexual intercourse problems such as erectile dysfunctions or premature ejaculations

Hormone treatments and medications if infertility is caused by excessive or insufficient levels of hormone activity

Surgery (for variocele) or for vasectomy reversal

Assistive reproductive technology – retrieving sperm either via normal ejaculation, surgical extraction or via donors, which will subsequently be inserted into the woman’s reproductive tract, or used in in vitro fertilization

For women:

Stimulating ovulation with the aid of fertility drugs

Intrauterine insemination – healthy sperm is injected directly into the woman’s uterus around the time of ovulation

Surgery to restore fertility in the cases of endometriosis, uterine septum (congenital malformation of the inside of the uterus), or intrauterine scarring

Assistive reproductive technology – in vitro fertilization being the most common procedure and it consists of retrieving multiple healthy eggs and sperm, fertilizing the eggs in a dish with the sperm and implanting the embryos in the uterus, three to five days after fertilization

Other ART techniques include: intracytoplasmic sperm injection (a single healthy sperm is injected into a mature egg), assisted hatching (assisting the implantation of the embryo by opening its outer covering – ‘hatching’, using donor eggs or sperm, or gestational carrier (a couple’s embryo is placed into the uterus of the carrier)

MISCONCEPTIONS
  • Infertility is strictly a female problem

    The best chances of conceiving naturally occur on the day of ovulation – multiple studies (Stanford and Dunson 2007)* have shown that since sperm can live up to a few days within the woman’s reproductive tract, the best chances occur approximately three days before ovulation, since the actual day itself is difficult to pinpoint, and the window for successful conceiving decreases after ovulation

    Positioning during intercourse affects the chances of conceiving

    If sperm count is low, one should abstain from frequent ejaculations – abstinence for more than ten days actually worsens the quality of the reproductive cells

    Overall health, eating habits and exercise have a direct effect on chances of conceiving – though having good overall health is naturally an ideal state, age is the most important predictor in chances of successful conceiving

    Regular periods are indicators of regular ovulations – 10-15% of regularly menstruating women are actually anovulatory

    If resorting to in vitro fertilization, a transference of more embryos results in higher chances of pregnancy – transferring more than two embryos does not increase the chances of conceiving (Lawlor D et al. Lancet Jan 2012)*

    Stress alone is responsible for infertility

Statistics

About 6% of married women between the ages of 15 and 44 in the United States have infertility issues

 

About 12% of women in the United States have difficulty getting pregnant or carrying a pregnancy to term, regardless of their marital status

 

A 2002 National Survey of Family Growth found that 7.5% of all sexually experienced men under the age of 45 reported having set an appointment with an infertility specialist during their lifetime, equaling to 3.3-4.7 million men

 

Approximately 25-30% of infertility issues are related to male factors

Did you know?

Impaired fecundity is a condition related to infertility and it refers to women who have difficulty in conceiving or in being able to carry a pregnancy to term

For a normal, healthy woman under the age of 35 the chances of conceiving each month are only 25-30% in natural cycles

It is estimated that the cumulative chance of a couple, over the course of one year, to get pregnant is of 80-90%

Though there are no ways of improving the quality of eggs in women who have a very low count of eggs, successful options consist in using donor egg IVF (in vitro fertilization) with either fresh or frozen donor eggs

Famous celebrities that have experienced fertility issues: Celine Dion, Mariah Carrey, Hugh Jackman, Jimmy Fallon, Sarah Jessica Parker, Nicole Kidman, Courtney Cox to name just a few