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. A woman is considered infertile if she has tried for 1 year to get pregnant and hasn’t used birth control. A man is considered infertile if he has too few sperm or his sperm are too unhealthy to combine with a woman’s egg. Many couples do not have trouble becoming pregnant. But there are factors that can make it difficult for some.

Symptoms of infertility

The main symptom of infertility is not being able to get pregnant. There may be no other symptoms. For women, if there are symptoms, they are usually related to the cause of infertility.

Certain factors may interfere with getting pregnant. However, these factors do not guarantee you will be infertile. For women, those factors can include:

For men, factors include:

• Infections
• A low sperm count (a higher count increases the chance the sperm and egg will meet)
• Problems with your male reproductive organs (such as undescended testicles, enlarged prostate, and varicoceles, or enlarged veins in the skin that surround a man’s testicles)
• Cancer treatment

Your doctor may recommend you be tested for infertility if any of these factors are concerns.

What causes infertility?

Making a baby (getting pregnant) is complex. Multiple things have to go right for both the man and the woman. Therefore, there are many causes of infertility in women and men.

A woman’s fertility can be affected by:

• This is the process by which the egg leaves the ovary and travels to meet the sperm. Some women don’t ovulate every month, which makes it harder to become pregnant.
• Problems with your reproductive system (fallopian tubes, cervix, uterus, ovaries). This might include a blockage, cancerous or noncancerous growths, scarring, enlarged ovaries, or an abnormal opening of the cervix.
• Disease and disorders. This might include endometriosis (when uterine tissue grows outside the uterus) or polycystic ovary syndrome (having enlarged ovaries containing fluid-filled sacs).
• Early-onset menopause. This would occur before the age of 40. It may be tied to an immune system disease, cancer treatments, or a genetic syndrome.
• As a woman gets older, it becomes harder to get pregnant.
• Cancer treatments. Radiation and chemotherapy affect fertility.
• Smoking and substance abuse. Smoking, alcohol, and drug use can make it difficult to get pregnant.
• Medicines, especially those treating cancer, fungus, and ulcers.
• Being overweight or underweight can affect fertility. Even too much or too little exercise can affect a woman’s chances of getting pregnant.
• Delayed puberty or absence of a period (menstruation).
• Uncontrolled diabetes, autoimmune diseases (when your body attacks itself), lupus, and celiac disease can make it difficult for a woman to become pregnant

A man’s fertility can be affected by:

• Unhealthy or poorly functioning sperm. This includes the quality of the man’s sperm. It also includes how well and how quickly the sperm move as they travel to meet the egg.
• A varicocele — enlarged veins inside the loose skin that surrounds a man’s testicles. It can cause low sperm count.
• This can be a bacterial infection inside the man’s testicles. It can also be a sexually transmitted infection (STI).
• Retrograde ejaculation — a man’s sperm goes into his bladder rather than outside the penis as it is supposed to.
• Autoimmune disorders (when the body attacks itself).
• Cancerous or non-cancerous growths.
• Undescended testicles. One or both of a man’s testicles remain in his abdomen. Testicles are supposed to drop down from the abdomen into the scrotal sac at birth.
• Hormone imbalance.
• Blockages within the many tubes that carry a man’s sperm.
• Certain genetic syndromes, such as Down syndrome.
• Medicines, especially those treating cancer, fungus, and ulcers.
• Certain surgeries, including vasectomy (a procedure to prevent sperm from leaving the testicles).
• Smoking and alcohol or drug use.
• Exposure to industrial chemicals and heavy metals.
• Radiation and X-rays.
• Overheating the testicles. This can occur by wearing underwear or pants that are too tight. It can also happen by using a hot tub for extended periods.

Sexual dysfunction — inability to have an erection for sex or problems ejaculating into the vagina (too soon or not at all). This could be due to physical or emotional issues.

How is infertility diagnosed?

For both men and women, your doctor will conduct a routine medical exam. He or she will ask you questions about your general health and how long you have been trying to have a baby. Your doctor will decide what additional testing is necessary.

Additional testing would likely begin with blood tests. These will check hormone levels and genetics (for both men and women) and egg quality. Women may have additional tests. These could include:

• Transvaginal ultrasound. A medical technician will insert a small wand, covered with latex, into your vagina. The wand is connected to a screen, where the technician can view images of the inside of your uterus and fallopian tubes. The technician will send the images to your doctor to review.
• This is an X-ray that involves injecting dye into your uterus to look for blockages inside your fallopian tubes. It does not require anesthesia.
• This surgical procedure is performed in a hospital. A thin, flexible scope is inserted into your abdomen to give your doctor a better look at your uterus and fallopian tubes. It helps look for polyps, growths, and blockages.

For men, the first test will be to collect a sample of his semen (the fluid that is ejaculated from the penis).  This is used to examine his sperm count, quality, and movement.

Men may undergo further physical exams, which would look for:

• Past injury to his testicles or penis.
• Discharge (fluid that should not be present in the man’s penis).
• A swollen or enlarged prostate.
• A varicocele (enlarged veins inside the skin around a man’s testicles).
• Recent high fevers.
• A history of mumps.

A biopsy of the man’s testicles may be necessary to get a better sperm sample.

Can infertility be prevented or avoided?

Some causes of infertility can’t be prevented or avoided. But both men and women can take steps to increase their chances of pregnancy.

Men should:

• Avoid tobacco, drugs, and excessive alcohol use.
• Avoid high temperatures, such as hot tubs or saunas.
• Avoid industrial or environmental toxins.
• Exercise regularly.

Women should:

• Quit smoking.
• Avoid alcohol and street drugs.
• Exercise moderately, but not so much that it interferes with your periods.
• Maintain a healthy weight.

Infertility treatment

Infertility treatment is based on the cause of your infertility. It can range from medicines to implanting an embryo through assisted reproductive technology (ART).

For men, issues that affect fertility can include hormone imbalances or erectile dysfunction. These issues can be treated with medicine. Other issues could include blockages in the tubes that carry sperm or varicoceles in the testicles. These can be repaired with surgery.

For women, treatment can also include medicine or surgery, depending on the underlying problem. The most common medicines used to treat female infertility stimulate the ovaries. This helps the ovaries produce more eggs and increases the chances of getting pregnant. Surgery can be done if there are blockages or problems with the fallopian tubes. It also is used to remove areas of endometriosis (when uterine tissue grows outside the uterus), fibroids, polyps, or scarring, which all can affect fertility.

Assisted Reproductive Technology (ART)

ART uses different technologies to help a couple get pregnant. It may help people who have gone through various infertility treatments but still can’t get pregnant. Some options include:

• Intrauterine insemination (IUI). This procedure inserts healthy sperm into the woman’s uterus around the time of ovulation. It uses a long, narrow tube to insert the sperm. It can be done in the doctor’s office.
• In vitro fertilization (IVF). This is more expensive and complex than IUI. It requires stimulating the ovaries with hormones and removing eggs from the woman. The eggs are fertilized with sperm in a laboratory. Once an embryo develops, it is placed into the woman’s uterus. While they can be successful, there is no guarantee that IUI or IVF will result in a pregnancy.
• Third party-assisted ART. 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.

Living with infertility

Living with infertility is emotionally difficult. The disappointment of not becoming pregnant after trying each month can be hard on relationships. It can also be hard on your own personal emotional health. It’s difficult to see friends, family, and even strangers have babies when you cannot. For those women who try IVF treatment, the hormones and egg-stimulating medicines can affect your emotional health. Long-term studies suggest they can impact your physical health, as well (possible links to breast and ovarian cancer). If you are experiencing infertility, talk with your doctor about how to cope with disappointment each month. Sometimes a support group can help. Some couples turn to adoption after trying unsuccessfully to have a baby through pregnancy.

Questions to ask your doctor

• If I’m over the age of 35, do I have to wait a year before being tested for infertility?
• What could be the reason for my infertility if my tests and my male partner’s test are fine?
• At what age does your fertility decline?
• What’s the best time in your monthly cycle to get pregnant?
• If I am currently using birth control, how long should I wait in between stopping the birth control and trying to get pregnant?
• Do birth control devices cause infertility?