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Causes, Diagnosis and Treatment of Infertility

Infertility in women means they are unable to conceive after trying to get pregnant for one year, and in men, it means they are unable to make a woman pregnant after trying for one year.

Fast Facts about Infertility

  • Infertility is the inability to conceive or become pregnant after trying for one year
  • Infertility affects the reproductive tract in men and women
  • In women, the four types of infertility are endometriosis, uterine fibrosis, polycystic ovarian syndrome, and ovulatory disorders
  • In men, the main two types of infertility are azoospermia (absence of sperms) and oligospermia or low sperm count
  • In women, infertility can be due to endometriosis, blocked fallopian tubes, fibroids, or irregular menstrual cycle.  In men, the main reasons are azoospermia or oligospermia.  Environmental factors like high heat can destroy sperms
  • People at risk for infertility are those beyond the reproductive age, excessive alcohol users, smokers, and people having genetic problems
  • Infertility is recognized by the inability to conceive after trying for one year
  • Diagnosis of infertility in men determined by general physical examination, semen analysis, hormone testing, and transrectal and scrotal ultrasound.  In women, specific fertility tests include ovulation testing, laparoscopy, hormonal testing, genetic testing, and pelvic ultrasound
  • Treatment for men includes medication, surgery, hormones, and behavioral approaches.  In women, ovulation disorders are treated with fertility drugs that induce ovulation by working as natural hormones.  ART and artificial insemination are other methods
  • There is no prevention for infertility.  However, men can avoid high temperatures, and women must seek medical attention for endometriosis, polycystic ovarian syndrome, and irregular menstrual periods

Types of Infertility

In women, there are four types of infertility:

  • Endometriosis
  • Uterine fibrosis
  • Polycystic Ovarian Syndrome
  • Ovulatory disorders

In men, the main two types of infertility are:

  • Azoospermia – absence of sperms
  • Oligospermia – low sperm count

Common Causes of Infertility

Infertility can be caused due to problems in men or women, or sometimes in both.  Environmental factors can sometimes contribute to infertility. Genetic conditions and other medical issues may also be a contributing factor for infertility.

  • In women, the chief cause of infertility is problems with ovulation.  In normal women, the ovaries release a viable egg that travels down the fallopian tube. The sperm ejaculated by the man must travel up the fallopian tube and unite with the egg to form a fertilized egg.  The fertilized egg must attach inside the uterus and grow. Any problem in this sequence, can lead to infertility. Other reasons for female infertility are blocked fallopian tubes because of endometriosis, pelvic inflammatory disease, or surgery. In some cases, the presence of uterine fibroids or physical problems with the uterine wall can cause infertility. Age, poor diet, stress, smoking, drugs, alcohol intake, medications, environmental toxins, and genetic factors are other potential causes of female infertility.
  • In men, mature sperms must be ejaculated to unite with the female egg. If the man is unable to have an erection, or has less sperm, or less semen for the sperm to travel through the fallopian tube, it can cause infertility. These can be caused by hormonal problems, environmental factors, age, stress, testical exposure to high temperatures, cryptorchism (testes does not descend into the scrotum), wearing tight underwear, smoking, medication side effects, and genetic conditions such as Klinefelter syndrome.

Risk Factors for Infertility

Men and women are at risk for infertility from the following reasons:

  • Age – with age the fertility potential decreases in both men and women
  • Smoking
  • Alcohol use – especially in women
  • Being overweight
  • Genetic factors
  • Environmental toxins

Symptoms of Infertility

The main symptom of infertility is the inability to conceive after trying for one year.  In women, abnormal menstrual cycles can interfere with the process of conception.

Diagnosing Infertility

Being unable to get pregnant is an indication of infertility, however, thorough medical examination and testing is necessary to determine the cause of infertility. Couples must seek medical attention if they are unable to get pregnant after one year of trying to conceive. Women who experience irregularities in their menstrual cycles, or have a diagnosis of uterine fibroids or endometriosis must see the doctor to confirm their illness is not causing infertility.

Diagnosis of infertility in men is based on testing both ejaculation and production of healthy sperms. Not all tests may be necessary in each male with infertility.

  • General physical examination
  • Semen analysis
  • Hormone testing
  • Transrectal and scrotal ultrasound

In women, ovaries must periodically release eggs, which must unite with the male sperm in the fallopian tubes. A history of menstrual cycle and sexual habits is necessary to diagnose infertility. In addition, some specific fertility tests include:

  • Ovulation testing
  • Laparoscopy
  • Hormonal testing
  • Genetic testing
  • Pelvic ultrasound

Treatment Options for Infertility

Infertility in men and women are dependent on some common factors such as the duration of infertility and age.  Some of the causes cannot be treated.

  • Treatment for men includes addressing sexual problems, i.e. impotence or premature ejaculation, which can be treated with medication and behavioral approaches.  Another common reason for infertility in men is lack of sperms, or oligospermia, which can be corrected by surgical intervention or use of hormones.
  • In women, ovulation disorders are treated with fertility drugs that mimic natural hormones and thus induce ovulation. Common drugs are Clomid, Repronex, and Ovidrel.  Surgery is sometimes done to remove blockages in fallopian tubes or other such issues. Endometriosis in women is treated with ovulation therapy. Another popular treatment is assisted reproductive technology (ART) or invitro fertilization, where the egg and sperm are united in laboratory. A team of healthcare professionals, such as doctors, psychologists, embryologists, laboratory technicians, and nurses, typically work together to help infertile couples become pregnant. Artificial insemination involves injecting sperm into the women.

Prevention of Infertility

Infertility is generally not preventable, but in some cases, avoiding drugs, smoking, and excessive alcohol consumption can help. High temperatures can affect sperm production in men, therefore, avoiding hot tubs and steam baths is recommended. In women, chances of becoming pregnant can be increased by exercising moderately, achieving a healthy weight (not underweight or overweight), avoiding alcohol, tobacco, and drugs.

Coping with Infertility

The emotional burden of infertility on a couple is immense and can be difficult to deal with.  Some steps that can help cope with infertility are:

  • Joining support groups
  • Considering other options like adoption, surrogacy, egg or sperm donation
  • Deciding how far you want to go for procedures and treatment because the treatments are very expensive
  • Manage emotional stress with acupuncture, relaxation, and meditation

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