National Infertility Awareness Week – April 24 through April 30, 2022

Pregnancy test showing not pregnant result

Infertility: What You Need to Know

Infertility knows no boundaries, with many couples facing challenges when trying to start or build a family. About 2/3 of infertility issues can be identified resulting from either female- or male-specific factors or an identifiable combination of both female and male factors. The remaining 1/3 of infertility causes remain unknown, including unidentifiable combined male and female factors.

About 10% of U.S. women, roughly 6.1 million, ages 15 to 44 years old have difficulty becoming pregnant or staying pregnant and 1 out of 7 U.S. couples experience infertility, according to the Centers for Disease Control and Prevention (CDC).

Oftentimes, female infertility causes can be difficult to pinpoint and diagnose. Fortunately, there are many treatments that your Capital Women’s Care practitioner can recommend, depending on the infertility cause. However, many infertile couples will successfully conceive without any treatment.
Even with infertility obstacles, many couples eventually conceive without requiring necessary treatment.

National Infertility Awareness Week is April 24 through April 30, and your Capital Women’s Care Team wants to share vital information with you and your partner concerning infertility. We discuss female- and male-specific types plus recommendations to improve your reproductive health so you and your partner can successfully start or build your family.

What Is Infertility?

Infertility is defined as trying to conceive with frequent, unprotected sex for at least 1 year without pregnancy.

When to Seek Treatment

When to seek professional help depends upon a woman’s age:

  • up to age 35, most doctors recommend trying to get pregnant for at least 1 year before instituting any testing or treatment.
  • if you're 35 to 40 years old, discuss your concerns with your doctor after 6 months of trying.
  • If you're 40+ years old, your doctor might suggest testing or treatment right away.

Men should see their doctor if they:

  • have erection or ejaculation problems, low sex drive or other sexual function problems.
  • experience pain, discomfort, or a lump and/or swelling in the testicle area.
  • have a history of testicle, prostate or sexual problems.
  • experience groin, testicle, penis or scrotum surgery.
  • or have a partner over age 35 years.

Your doctor might also want to begin testing or treatment right away if you or your partner has known fertility problems or if you have a history of irregular or painful periods, pelvic inflammatory disease, repeated miscarriages, cancer treatment, or endometriosis.

Pregnancy results from an intricate multi-step process. For pregnancy to occur, each step of the human reproduction process must occur correctly:

  • 1 of the 2 ovaries releases a mature egg.
  • the egg travels through the fallopian tube.
  • sperm travel through the cervix and uterus and into the fallopian tube to reach the egg for fertilization to occur.
  • the fertilized egg travels down the fallopian tube to the uterus.
  • And the fertilized egg implants to the uterine wall and grows.

If infertility questions arise, it’s common practice to begin eliminating potential causes via female-specific factors if no other factors present.

Women’s Infertility Issues

In women, many factors may disrupt this process during any of its steps, including:

Ovulation Causes. Having a menstrual cycle that is too long (35 or more days), too short (less than 21 days), irregular or absent. Ovulating infrequently or not at all accounts for most infertility cases.

Problems with reproductive hormone regulations by the hypothalamus, pituitary gland or ovary can lead to ovulation disorders, including:

  • Polycystic ovary syndrome (PCOS.) PCOS causes a hormone imbalance which affects ovulation. PCOS is associated with insulin resistance and obesity, abnormal hair growth on the face or body and acne. PCOS is the most common cause of female infertility.
  • Hypothalamic dysfunction. Two hormones produced by the pituitary gland are responsible for stimulating ovulation each month: follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Excessive physical or emotional stress, a very high or very low body weight or recent substantial weight gain or loss can disrupt FSH and LH production, affecting ovulation. Irregular or absent periods are its most common signs.
  • Primary ovarian insufficiency. Also called premature ovarian failure, this is usually caused by an autoimmune response or by premature egg loss, resulting from genetics or chemotherapy. The ovary no longer produces eggs, lowering estrogen production in women under 40 years.
  • Too much prolactin. The pituitary gland can initiate an excess of prolactin (hyperprolactinemia), which reduces estrogen production. It can also be caused by medications taken for other conditions.

Fallopian Tubes Causes (Tubal Infertility)

Damaged or blocked fallopian tubes keep sperm from reaching the egg or block passage of the fertilized egg into the uterus for implantation. Causes of fallopian tube damage or blockage can include:

Uterine or Cervical Causes

Several uterine or cervical causes can interfere with egg implantation or increase miscarriage risk:

  • Benign polyps or tumors (fibroids or myomas.) These are common within the uterus, but some can block fallopian tubes or interfere with implantation, thus affecting fertility. However, many women with fibroids or polyps do successfully conceive.
  • Uterine problems present at birth, like an unusually shaped uterus, can cause problems becoming or maintaining pregnancy.
  • Cervical stenosis, a narrowing of the cervix, can be caused by an inherited malformation or cervical damage.
  • Additionally, sometimes the cervix can't produce the best type of mucus to allow sperm to travel through the cervix and into the uterus.

Infertility Risk Factors

Certain factors may put women at higher risk of infertility, including:

  • Age. The quality and quantity of a woman's eggs begin to decline with age. In the mid-30s, the rate of follicle loss speeds, resulting in fewer and poorer quality eggs. This makes conception more difficult and increases risk of miscarriage.
  • Smoking. Besides damaging the cervix and fallopian tubes, smoking increases risk of miscarriage and ectopic pregnancy. It's also thought to age ovaries and deplete eggs prematurely. Stop smoking before beginning fertility treatment for maximum chance of successful treatment if required.
  • Weight. Being overweight or significantly underweight may affect ovulation. Having a healthy body mass index (BMI) might increase ovulation frequency and likelihood for conception.
  • Sexual history. Sexually transmitted infections such as chlamydia and gonorrhea can damage the fallopian tubes. Having unprotected sex with multiple partners increases risk of developing a sexually transmitted infection that may cause later fertility problems.
  • Alcohol. Excessive alcohol consumption can reduce fertility.

Infertility Prevention Tips

Implementing infertility prevention tips within your personal preconception health plan can assist you toward conception and pregnancy:

  • Maintain a healthy weight. Overweight and underweight women are at increased risk of ovulation disorders. If you need to lose weight, exercise moderately. Strenuous, intense exercise of more than 5 hours a week has been associated with decreased ovulation.
  • Quit smoking. Tobacco has multiple negative effects on fertility, as well as your general health and the health of a developing fetus. If you smoke and are considering pregnancy, quit immediately.
  • Avoid alcohol. Heavy alcohol use may lead to decreased fertility and any alcohol use can affect the health of your baby. If you're planning to become pregnant, avoid alcohol and don't drink alcohol while pregnant.
  • Reduce stress. Some studies indicate stress can cause couples to have poorer results with infertility treatment. Try to reduce stress in your life before trying to conceive.

Male Infertility Issues

Male issues are the primary known infertility cause in about 1/3 of overall cases within the U.S. and contribute to unknown infertility issues.

Infertility in men is most often caused by:

  • a varicocele. This happens when the veins on the testicle(s) are too large, causing heat which can affect the number or shape of sperm.
  • other factors resulting in low or non-existent sperm count.
  • sperm movement. This may be caused by sperms’ shape, injuries or other damage to the reproductive system that may block the sperm.
  • Sometimes males are born with the problems affecting sperm. Other times problems start later in life due to illness or injury. For example, cystic fibrosis often causes infertility in men.

A man's sperm viability can be changed by his overall health and lifestyle. Some things that may reduce the health or number of sperm include:

Infertility Testing

Doctors perform an infertility checkup involving a physical exam, including review of both partners' health and sexual histories. Sometimes this alone can identify the problem. However, most of the time, additional testing is required.

In women, the first step is to discern if ovulation occurs each month. A few ways to track ovulation at home include

Doctors can also check ovulation with blood tests or do an ultrasound of the ovaries. If ovulation is normal, there are other fertility tests available. Some common women’s fertility tests include:

  • Hysterosalpingography, an x-ray of the uterus and fallopian tubes. Doctors inject a special dye into the uterus through the vagina that shows in the x-ray. Doctors can then watch to see if the dye moves freely through the uterus and fallopian tubes. This helps them locate physical blockages that may be causing infertility. Blocks in the system can keep the egg from moving from the fallopian tube to the uterus and could also keep sperm from reaching the egg.
  • Laparoscopy is a minor surgery to view the inner abdomen. The doctor does this with a small tool fitted with a light (laparoscope) and makes a small cut in the lower abdomen where the laparoscope is inserted. The doctor checks the ovaries, fallopian tubes and uterus for disease and physical problems. Doctors can usually find scarring and endometriosis via laparoscopy.

In men, doctors usually initiate semen analysis, including discerning the number, shape and movement of the sperm. Sometimes doctors suggest testing the man's hormone levels.

Identifying infertility cause can be stressful to couples. During this process, it’s important for couples to maintain open communication with each other and share personal feelings. It’s also important to reach out to a support group or counselor if you wish for additional support. Finally, relaxation and eliminating unnecessary stress helps you both so you can focus and make decisions about infertility issues together.

Your Capital Women’s Care team of professionals is here to answer your questions or address your concerns about infertility or any women’s health issue. Our knowledgeable, compassionate staff offers you optimal comprehensive care, treatment and services so you may enjoy a long quality life.

Sources:

https://infertilityawareness.org/
https://www.mayoclinic.org/diseases-conditions/female-infertility/sympto...
https://www.womenshealth.gov/a-z-topics/infertility
https://americanpregnancy.org/getting-pregnant/female-infertility/
https://medlineplus.gov/femaleinfertility.html
https://my.clevelandclinic.org/health/diseases/17774-female-infertility
https://www.nichd.nih.gov/health/topics/infertility/conditioninfo/causes...
https://www.cdc.gov/reproductivehealth/infertility/index.htm
https://www.mayoclinic.org/diseases-conditions/female-infertility/diagno...
https://www.mayoclinic.org/diseases-conditions/infertility/diagnosis-tre...

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