What is Infertility? Facts, Causes & Treatment Options

Man & Woman looking at a pregnancy test in bed

Anyone can face challenges as they begin trying to start a family. However, many couples face monthly disappointment and subsequent negative feelings as their hope to become pregnant is not realized.

Of all U.S. couples trying to conceive, 85% achieve pregnancy within one year, with the greater likelihood of pregnancy occurring within earlier months. That means 15% of couples attempting to conceive, or more than one in every 10 U.S. couples, experience infertility, which is defined as the inability to conceive while having frequent unprotected sex within one year.

Infertility is a serious condition knowing no boundaries; any couple wishing to conceive may be affected. Infertility may arise due to reproductive health issues with either partner (which may be either present at birth or occur later in life) or a combination of factors inhibiting conception.

Infertility causes occur in one-third each of female and male partners, as well as one-third combined factors stemming from either both partners and/or unknown causes.

As we begin National Infertility Week Awareness, Capital Women’s Care explores the causes of infertility and various treatment options to empower you and your partner with knowledge and understanding of infertility and what options are available to help fulfill your desire to start a family. 

Natural Conception

All steps of natural conception – from ovulation to fertilization of the egg with the sperm – need to happen correctly for it to result in pregnancy. Infertility may result if this proper sequence is affected by health issues involving one or both partners’ reproductive organs and systems.

Infertility Risk Factors

While some infertility factors cannot be controlled, there are certain infertility risk factors you can eliminate to increase your chances of conceiving.

Men and women share certain risk factors that can lead to infertility:

  • Avoid tobacco use. Smoking tobacco or marijuana by either partner may reduce likelihood of pregnancy. Smoking also reduces possible effectiveness of fertility treatment. Miscarriages are more frequent in women who smoke. Smoking can increase erectile dysfunction risk and low sperm count in men. For women, smoking has many negative health effects for the mother and fetus.  If you are a woman who smokes and are considering becoming pregnant, quit now.
  • Avoid alcohol use. For women, there's no safe level of alcohol use during conception or pregnancy. Alcohol use may contribute to infertility. For men, heavy alcohol use can decrease sperm count and mobility (motility.)
  • Maintain healthy weight. Among American women, an inactive lifestyle and being overweight may increase infertility risk. For men, sperm count also may be affected by being overweight.
  • Being underweight. Women at risk of fertility problems include those with eating disorders (anorexia or bulimia) and those following very low-calorie or restrictive diets.
  • Avoid weight extremes. For women, being overweight or underweight can affect your body’s hormone production, inhibiting fertility and conception. 
  • Exercise issues. Lack of exercise contributes to obesity, which increases infertility risk. Less often, ovulation problems with infrequent or absent periods may be associated with frequent strenuous, intense exercise in non-overweight women. Both partners should follow regular physician-approved exercise regimens.
  • Limit caffeine. Women trying to get pregnant may want to limit caffeine intake. Ask your doctor for guidance on safe use of caffeine.

Common Causes of Infertility in Women

  • Advancing maternal age. With 1 out of every 5 women having their first child after age 35, female age-related infertility is the most common infertility form. Of couples in which the female partner is age 35, 1 out of 3 of those couples trying to conceive face fertility complications.

Egg numbers and their quality diminish at a rapid rate as women age. Women are rarely fertile beyond age 45 and have higher risk of birth defects, greater likelihood of miscarriage, or experiencing a high-risk pregnancy should they conceive utilizing their own eggs.

  • Ovulation disorders. Ovulation problems affect 40% of women facing difficulty in becoming pregnant.

Normal, regular ovulation is essential for natural conception.Menstrual cycles should occur every 21-35 days. Ovulation begins 2 weeks before the onset of a period. If menstrual cycle is 35-plus days, ovulation is not predictable or not even occurring.

Sometimes ovulation disorders like PCOS (polycystic ovary syndrome) and hypogonadotropic hypogonadism impede fertility. Exams and appropriate testing determine if either disorder is present. Both may be treated with medicines via pill or injection (gonadotropins) to induce egg development and ovulation. 

Using a menstrual calendar, ovulation prediction kit or tracking your basal body temperature daily can help pinpoint ovulation to increase chances for successful natural conception.

  • Tubal blockage or occlusion. Signifies the egg can’t be fertilized by sperm or reach the endometrial cavity because one or both fallopian tubes are blocked or filled with fluid (hydrosalpinx.)

Blocked fallopian tubes may be removed or separated from the uterus prior to pursuing fertility treatments. If both fallopian tubes are blocked, the only recourse for conception is invitro fertilization (IVF.)

  • Uterine fibroids. 40% of reproductive-aged women have uterine fibroids, although fibroid presence may not cause infertility.

Fibroids may cause heavy periods or bleeding between periods.Those projecting into the uterine cavity (submucosal fibroids) impede fertility and need to be surgically removed.

  • Endometrial polyps. These finger-like projections grow from the endometrium (uterine lining) and can decrease female fertility by up to 50%.

Endometrial polyps are abnormalities rarely associated with cancer (in less than 1% of women diagnosed before menopause.)

  • Endometriosis. Many cells like those within the uterine cavity extend outside the uterus, affecting 10-50% of reproductive-age females.

Endometriosis causes inflammation and scarring detrimental to the egg, sperm and embryo.

  • Primary ovarian insufficiency (early menopause.)  This occurs when ovaries stop working and menstruation ends before age 40. Although its cause is often unknown, certain factors are associated with early menopause, including immune system diseases, genetic conditions (Turner syndrome or carriers of Fragile X syndrome) and radiation or chemotherapy.
  • Pelvic adhesions. Scar tissue bands that bind organs can form after pelvic infection, appendicitis, endometriosis or abdominal or pelvic surgery.

Common Male Infertility Causes

The male is a contributing factor in 40-50% of infertility cases and sole factor in one-third of infertility cases.

Common male infertility issues are due to:

  • Abnormal sperm production or function. Causes include undescended testicles, genetic defects, diabetes, or chlamydia, gonorrhea, mumps or HIV. Enlarged veins in the testes (varicocele) can also affect sperm quality.
  • Sperm delivery problems. Infertility can occur due to sexual problems (premature ejaculation), genetic diseases (cystic fibrosis), structural problems (testicular blockage), or damage or injury to reproductive organs.
  • Overexposure to certain environmental factors. Factors impeding fertility include pesticides, other chemicals and radiation. Cigarette smoking, alcohol, marijuana, anabolic steroids, illnesses accompanied by prolonged high fevers and medications for treating bacterial infections, high blood pressure and depression can also affect fertility. Speak with your doctor about your over the counter and prescribed medications and follow their recommendations. Frequent exposure to heat via saunas or hot tubs can raise body temperature and affect sperm production.
  • Sperm production damage related to cancer and its treatment, including radiation or chemotherapy. This can impair sperm production, sometimes severely.

When to Seek Help

Women usually don’t need to see their doctor about infertility unless they have been regularly trying to get pregnant for at least 1 year. However, women need to see their doctor sooner than 1 year (ideally at 6 months since trying to conceive) if they are:

  • Age 35 or over and have been trying to conceive for six months or longer or over age 40.
  • Have irregular or no periods.
  • Have very painful periods.
  • Have diagnosed fertility problems or experienced multiple miscarriages.
  • Have been diagnosed with pelvic inflammatory disease or sexually transmitted diseases (chlamydia and gonorrhea.)
  • Have had cancer treatment, including radiation and chemotherapy.

Men should speak to their doctor if they:

  • Have a known, diagnosed low sperm count or problems relating to sperm motility or abnormal sperm structure. 
  • Have a history of testicular, prostate or sexual problems.
  • Have had cancer treatment, including radiation and chemotherapy.
  • Have small testicles or scrotal swelling.
  • Have family history of infertility problems.

Fertility Evaluation and Testing

If infertility is suspected, a complete history and physical exam are completed to design a specific evaluation and potential treatment. Depending upon your physician’s findings, treatment may be partner-specific or include both partners.

The quest to discover infertility issues oftentimes begins with examination of the female, especially if there are issues with menstrual cycle regularity and/or pain and bleeding between cycles and/or intercourse. Some questions your doctor will ask include about how long you have been trying to become pregnant, if you experience pain during your period or intercourse, if you had prior pregnancies, experienced abnormal pap smears or history of sexually transmitted diseases, how often you menstruate, if you have medical issues or any prior surgeries and details about your family history and medical problems.

Depending upon your history, your doctor may initiate tests. A transvaginal ultrasound evaluates the uterus, fallopian tubes and ovaries for damage and/or abnormalities, including polyps, fibroids, fallopian tube blockages, ovarian cysts, as well as assessing the relative number of viable eggs (antral follicle count) correlating with fertility potential.

Specific blood lab tests may be ordered depending on your physician’s evaluation. Oftentimes this includes checking estradiol and FSH levels which indicate ovarian function and overall egg numbers; TSH to determine thyroid functionality; and prolactin levels which can affect menstrual function if elevated.

The hysterosalpingogram (HSG) test evaluates fallopian tube patency (in event of prior pelvic infection) and uterine filling defects (polyps, fibroids and uterine cavity scarring.) Many uterine or tubal abnormalities detected by the HSG test can be surgically corrected.

Outpatient surgeries utilizing either laparoscopy and/or hysteroscopy can effectively diagnose and remove abnormalities like endometrial polyps, uterine fibroids, endometriosis, scar tissue and damaged Fallopian tubes. Oftentimes, conception chances increase and become successful without additional treatment after polyp, fibroid or scar tissue removal.

Evaluation of potential male infertility focuses on the semen and includes a four-part analysis:

  • Semen volume should be at minimum 1.5 to 2 ml. Any smaller amount suggests structural or hormonal problem leading to insufficient semen production.
  • Normal sperm concentration should be 20 million sperm/1 ml. semen. Lower concentration levels may lead to lower chance for conception.
  • Sperm motility (movement) should be around 50%. Less than 50% may significantly affect the sperm’s ability to fertilize the egg naturally without therapy.
  • Evaluate the shape of each sperm’s three individual parts (head, midpiece and tail.) Abnormality in any of those three areas compromise a sperm’s ability to fertilize the egg. A minimum of 5-15% of normal sperm forms leads to better ability for sperm to fertilize the egg.

Semen analysis includes testing sperm samples two separate times to confirm consistent abnormalities. Should confirmation of abnormalities occur, the male partner is referred to a reproductive urologist.

Infertility Treatment Options

Fortunately, many safe, effective therapies are available to significantly improve conception and likelihood of successful conception that leads to a full-term pregnancy and healthy baby.

Hormone therapies for both male and female partners can help in instances when reproductive hormones of either or both partners are imbalanced. These are given as oral medications or as injections. Your doctor will monitor you to align therapies to correct these imbalances which can lead to successful natural conception.

Both male and female partners may undergo surgery to correct reproductive issues.

Assisted reproductive technology surgeries (ART) are also available:

Intrauterine insemination is an option in which the sperm is washed and prepared for placement into the uterine cavity. This method brings a higher concentration of motile sperm closer to the fallopian tubes and the ovulated egg, increasing chances for successful conception.

Invitro fertilization with intracytoplasmic sperm injection is a procedure in which semen is washed and prepared for direct injection into previously harvested eggs, with one sperm injected into each egg collected during the IVF process. Fertilization occurs outside the female, with successfully fertilized eggs then implanted into the womb. A common complication of this therapy is multiple pregnancies; this may be minimized by limiting the number of embryos used.

Third party reproduction may be considered if one or both partners are diagnosed to be infertile. Third party donors may donate eggs, sperm, or embryos. Gestational surrogate carriers are females designated to agree to carrying a baby within her womb for others.

Your Capital Women’s Care team is here for you should you have any questions or concerns about infertility, its treatments and the options available to you and your partner to help you achieve your goal of starting a family.

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The providers of Capital Women's Care seek the highest quality medical and ethical standard in an environment that nurtures the spirit of caring for every woman.

 

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