INFERTILITY: EVERYTHING YOU NEED TO KNOW

Photo from familydoctor.org

You are not alone if you and your partner are having difficulty having a baby. Infertility affects 10% to 15% of couples in the United States. Infertility is defined as the inability to become pregnant despite having frequent, unprotected sex for at least a year for the majority of couples.

Infertility can be caused by a problem with you or your partner, or by a combination of factors that prevent pregnancy. Fortunately, there are numerous safe and effective treatments that can significantly increase your chances of becoming pregnant.

WHAT ARE THE CAUSES OF INFERTILITY?

To become pregnant, all of the steps during ovulation and fertilization must be completed correctly. Sometimes the problems that lead to infertility in couples are present at birth, and other times they emerge later in life.

Causes of infertility can affect one or both partners. There are times when no cause can be found.

Male infertility causes

These could include:

Sperm production or function that is abnormal: because of undescended testicles, genetic defects, health issues like diabetes, or infections like chlamydia, gonorrhea, mumps, or HIV Varicocele, or enlarged veins in the testes, can also impair sperm quality.

Problems with sperm delivery: due to sexual issues, such as premature ejaculation; certain genetic diseases, such as cystic fibrosis; structural issues, such as a testicle blockage; or damage or injury to the reproductive organs

Excessive exposure to environmental factors such as pesticides and other chemicals, as well as radiation: Cigarette smoking, alcohol, marijuana, anabolic steroids, and medications used to treat bacterial infections, high blood pressure, and depression can all have an impact on fertility. Heat exposure on a regular basis, such as in saunas or hot tubs, can raise body temperature and affect sperm production.

Cancer-related harm and its treatment, such as radiation or chemotherapy: Cancer treatment can have a negative impact on sperm production, sometimes severely.

Female infertility causes

Female infertility can be caused by a variety of factors, including:

Ovulation disorders, which affect the release of eggs from the ovaries: Hormonal disorders such as polycystic ovary syndrome are examples of this. Hyperprolactinemia, or having too much prolactin — the hormone that stimulates breast milk production — can also interfere with ovulation. Thyroid hormone levels that are too high (hyperthyroidism) or too low (hypothyroidism) can disrupt the menstrual cycle or cause infertility. Other possible underlying causes include excessive exercise, eating disorders, or tumors.

Primary ovarian insufficiency (early menopause): When the ovaries stop functioning and menstruation ceases before the age of 40. Although the cause is frequently unknown, certain factors such as immune system diseases, certain genetic conditions such as Turner syndrome or carriers of Fragile X syndrome, and radiation or chemotherapy treatment have been linked to early menopause.

Pelvic adhesions: Scar tissue bands that bind organs can form as a result of a pelvic infection, appendicitis, endometriosis, or abdominal or pelvic surgery.

Cancer and its treatment: Female fertility is frequently impaired by certain cancers, particularly reproductive cancers. Radiation and chemotherapy can both have an impact on fertility.

Uterine or cervical abnormalities: including cervix abnormalities, polyps in the uterus, and uterine shape. Uterine fibroids, which are noncancerous (benign) tumors in the uterine wall, can cause infertility by blocking the fallopian tubes or preventing a fertilized egg from implanting in the uterus.

Damage or blockage of the fallopian tubes: Inflammation of the fallopian tube is a common cause (salpingitis). This can be caused by a sexually transmitted infection, endometriosis, or adhesions, or it can be caused by pelvic inflammatory disease.

Endometriosis: Endometrial hyperplasia, which occurs when endometrial tissue grows outside of the uterus, may impair the function of the ovaries, uterus, and fallopian tubes.

WHAT ARE THE RISK FACTORS OF INFERTILITY?

Many of the risk factors are the same for both male and female infertility. They are as follows:

Age: Women's fertility declines gradually with age, especially in their mid-30s, and rapidly after the age of 37. Infertility in older women is most likely due to a decrease in the number and quality of eggs, but it can also be due to health issues that affect fertility. Men over the age of 40 may have lower fertility than younger men.

Tobacco consumption: Tobacco or marijuana use by either partner may reduce the chances of pregnancy. Smoking also reduces the efficacy of fertility treatments. Women who smoke have a higher rate of miscarriage. Men who smoke are more likely to develop erectile dysfunction and have a low sperm count.

Being underweight: Women with eating disorders, such as anorexia or bulimia, and those who follow a very low-calorie or restrictive diet are at risk of infertility.

Problems with exercise: Obesity is exacerbated by a lack of exercise, which raises the risk of infertility. In women who are not overweight, ovulation problems may be associated with frequent strenuous, intense exercise.

Using alcohol: There is no safe level of alcohol consumption for women during conception or pregnancy. Infertility may be exacerbated by alcohol use. Heavy alcohol consumption in men can reduce sperm count and motility.

Being overweight: An inactive lifestyle and being overweight may increase the risk of infertility in American women. Being overweight can also have an impact on sperm count in men.

HOW IS INFERTILITY DIAGNOSED?

Before undergoing infertility testing, your doctor or clinic will work with you to understand your sexual habits and may make suggestions to improve your chances of becoming pregnant. There is no clear cause of infertility in some couples (unexplained infertility).

Infertility evaluations can be costly and sometimes involve unpleasant procedures. Some health insurance policies may not cover the cost of fertility treatment. Finally, even after all of the testing and counseling, there is no guarantee that you will become pregnant.

Men's tests

Male fertility necessitates that the testicles produce enough healthy sperm and that the sperm is effectively ejaculated into the vagina and travels to the egg. Male infertility tests seek to determine whether any of these processes are impaired.

You may be subjected to a general physical examination, which may include a genital examination. Specific fertility tests may include the following:

Semen analysis: Your doctor may request one or more sperm samples. Masturbation or interrupting intercourse and ejaculating your sperm into a clean container is the most common way to obtain sperm. Your sperm specimen is examined in a laboratory. Urine may be tested for the presence of sperm in some cases.

Hormone testing: A blood test may be performed to determine your testosterone and other male hormone levels.

Genetic testing: To determine whether a genetic defect is causing infertility, genetic testing may be performed.

Testicular biopsy: A testicular biopsy may be performed in some cases to identify abnormalities that contribute to infertility or to retrieve sperm for assisted reproductive techniques such as IVF.

Imaging: Imaging studies such as a brain MRI, transrectal or scrotal ultrasound, or a vas deferens test (vasography) may be performed in some cases.

Other specialty testing: Other tests to evaluate the quality of the sperm, such as examining a sperm specimen for DNA abnormalities, may be performed in rare cases.

Women's tests

Women's fertility is dependent on their ovaries producing healthy eggs. The reproductive tract must allow an egg to enter the fallopian tubes and combine with sperm to fertilize. The fertilized egg must travel to the uterus and implant in the lining of the uterus. Female infertility tests attempt to determine whether any of these processes are impaired.

A general physical exam, including a regular gynecological exam, may be performed on you. Specific fertility tests may include the following:

Ovulation testing: A blood test determines whether you're ovulating by measuring hormone levels.

Hysterosalpingography: Hysterosalpingography (his-tur-o-sal-ping-GOG-ruh-fee) examines your uterus and fallopian tubes for blockages or other problems. An X-ray contrast agent is injected into your uterus, and an X-ray is taken to see if the cavity is normal and if fluid is spilling out of your fallopian tubes.

Ovarian reserve testing: This testing aids in determining the number of eggs available for ovulation. This method is frequently preceded by hormone testing early in the menstrual cycle.

Other hormone testing: Other hormone tests look at ovulatory hormone levels as well as pituitary hormones, which control reproductive processes.

Imaging tests: Pelvic ultrasound is used to detect uterine or ovarian disease. A sonohysterogram, also known as a saline infusion sonogram, is sometimes used to see details inside the uterus that a regular ultrasound cannot.

Depending on your circumstances, you may be subjected to the following tests:

Hysteroscopy: Your doctor may order a hysteroscopy to look for uterine disease based on your symptoms. During the procedure, your doctor will insert a thin, lighted device through your cervix into your uterus to look for any possible abnormalities.

Laparoscopy: Making a small incision beneath your navel and inserting a thin viewing device to examine your fallopian tubes, ovaries, and uterus is all that is required for this minimally invasive surgery. A laparoscopy can detect endometriosis, scarring, fallopian tube blockages or irregularities, and ovaries and uterine problems.

Not everyone requires all, or even many, of these tests before determining the cause of infertility. You and your doctor will decide which tests to have and when to have them.

WHAT ARE THE TREATMENTS FOR INFERTILITY?

Treatment for infertility is dependent on:

The cause of the infertility

How long you have been infertile

Your age and the age of your partner

Individual preferences

Some causes of infertility are irreversible.

When a spontaneous pregnancy does not occur, couples can often achieve a pregnancy through the use of assisted reproductive technology. Treatment for infertility may necessitate significant financial, physical, psychological, and time commitments.

Men's Treatment

Men's treatment for general sexual issues or a lack of healthy sperm may include the following:

Changing lifestyle factors: Improving lifestyle and certain behaviors, such as discontinuing certain medications, reducing or eliminating harmful substances, improving frequency and timing of intercourse, exercising regularly, and optimizing other factors that may otherwise impair fertility, can improve chances for pregnancy.

Medications: Certain medications may increase sperm count and the likelihood of a successful pregnancy. These medications have the potential to improve testicular function, including sperm production and quality.

Surgery: Surgery may be able to reverse a sperm blockage and restore fertility in some cases. In some cases, surgically repairing a varicocele may improve overall pregnancy chances.

Sperm retrieval: When ejaculation is difficult or there are no sperm in the ejaculated fluid, these techniques are used to obtain sperm. They may also be used when assisted reproductive techniques are being considered and sperm counts are low or otherwise abnormal.

Women's treatment

Some women only require one or two therapies to improve their fertility. Other women may require a combination of treatments in order to become pregnant.

Stimulating ovulation with fertility drugs: Fertility medications are the primary treatment for women who are infertile due to ovulation problems. These drugs either regulate or induce ovulation. Discuss your fertility drug options with your doctor, including the benefits and risks of each type.

Intrauterine insemination (IUI): Healthy sperm is placed directly in the uterus during IUI, around the time the ovary releases one or more eggs to be fertilized. The timing of IUI can be coordinated with your normal cycle or with fertility medications, depending on the cause of infertility.

Surgery to restore fertility: Endometrial polyps, a uterine septum, intrauterine scar tissue, and some fibroids can all be treated with hysteroscopic surgery. Endometriosis, pelvic adhesions, and larger fibroids may necessitate laparoscopic surgery or surgery involving a larger abdominal incision.

HOW CAN INFERTILITY BE PREVENTED?

Some types of infertility cannot be avoided. However, there are a few things you can do to increase your chances of getting pregnant.

Couples

For the highest pregnancy rate, engage in regular intercourse several times around the time of ovulation. Intercourse that begins at least five days before and continues until a day after ovulation increases your chances of becoming pregnant. For most women with 28-day menstrual cycles, ovulation occurs in the middle of the cycle, halfway between menstrual periods.

Men

Although most types of infertility in men are not preventable, the following strategies may be beneficial:

Avoid using drugs and tobacco, as well as excessive alcohol consumption, which may contribute to male infertility.

High temperatures, such as those found in hot tubs and hot baths, can temporarily impair sperm production and motility.

Avoid being exposed to industrial or environmental toxins that can impair sperm production.

Prescription and over-the-counter medications that may have an effect on fertility should be avoided. Discuss any medications you take on a regular basis with your doctor, but don't stop taking prescription medications without first seeking medical advice.

Moderate exercise is recommended. Regular exercise may improve sperm quality and increase the likelihood of conceiving.

Women

A variety of strategies for women may increase their chances of becoming pregnant:

Stop smoking. Tobacco has numerous negative effects on fertility, not to mention your overall health and that of a fetus. If you smoke and are thinking about getting pregnant, you should quit right away.

Avoid consuming alcohol and using illegal drugs. These substances have the potential to impair your ability to conceive and carry a healthy pregnancy. If you're trying to get pregnant, don't drink alcohol or use recreational drugs like marijuana.

Caffeine should be avoided. Caffeine consumption should be limited by women who are trying to conceive. Consult your doctor for advice on how to use caffeine safely.

Moderate exercise is recommended. Regular exercise is important, but exercising so hard that your periods become infrequent or absent can have an impact on fertility.

Avoid extremes in weight. Being overweight or underweight can have an impact on hormone production and lead to infertility.

CONCLUSION

Being diagnosed with infertility does not mean that your hopes of having a child are over. Although it may take some time, many infertile couples will eventually be able to have a child. Some will be able to do so on their own, while others will require medical attention.

Many factors, including your ages, the cause of your infertility, and your personal preferences, will influence the treatment that is best for you and your partner. Similarly, whether or not a particular infertility treatment results in a pregnancy is dependent on a variety of factors.

In some cases, a fertility problem may not be treatable. Your doctor may advise you and your partner to consider donor sperm or eggs, surrogacy, or adoption, depending on the circumstances.

The fertility landscape in the United States remains fluid, with many shifts in attitudes and cultural norms.