National Infertility Awareness Week (April 23-April 29)

Overcoming Infertility

Anyone can be challenged to have a family. Infertility doesn’t discriminate – it affects people of all races, religions, sexualities and economic statuses. It causes extensive emotional challenges for individuals and couples who face difficulty in having children and creating a family.

According to the Mayo Clinic, infertility results from female factors about 33% of the time and both female and male factors about 33% of the time. The cause is either unknown or a combination of male and female factors in the remaining 33% of infertility cases.

Infertility is a common problem within the U.S., according to the Centers for Disease Control and Prevention (CDC.)

Among heterosexual women aged 15 to 49 years with no prior births, about 1 in 5 (19%) are unable to get pregnant after 1 year of trying to conceive. Additionally, about 1 in 4 (26%) women within this group have difficulty conceiving or carrying a pregnancy to term (known as impaired fecundity.)

Infertility and impaired fecundity are less common among women with 1 or more prior births. Within this group, about 6% of married women aged 15 to 49 years are unable to get pregnant after 1 year of trying to conceive and 14% have difficulty getting pregnant or carrying a pregnancy to term.

What’s more, infertility extends beyond female factors. Infertility can also be caused solely by male-only factors, combined male-female factors or factors that are unidentifiable and therefore remain unknown.

According to the World Health Organization (WHO), infertility affects millions of people of reproductive age worldwide and has detrimental impact on their families and communities. It’s estimated between 48 million couples and 186 million individuals live with infertility globally.

National Infertility Awareness Week is April 23 through April 29. Your Capital Women’s Care practitioners want to share information about infertility, a breakdown of common infertility causes, risks and tests relating to both males and females and when to see a fertility specialist. We also share an overview of what to expect as you begin the journey toward identifying infertility factors and initiating subsequent treatments plus tips to help you and your partner overcome fertility obstacles, including new research paving the way toward increased likelihood of successful pregnancy.

What Is Infertility?

According to the CDC, infertility is defined as not being able to conceive after 1 year or longer of unprotected sex. Infertility is also defined as when a woman conceives but experiences continued miscarriages or stillbirths.

Some providers evaluate and treat women aged 35 years or older after 6 months of unprotected sex due to proven data identifying steady declines in female fertility in correlation with age. For women over age 40, it’s advisable to speak with your practitioner immediately concerning testing and subsequent treatment if necessary.

While infertility issues may arise for many wishing to conceive, it’s reassuring to note many infertile couples go on to successfully conceive without medical treatment.

Infertility Risk Factors in Women

There are several factors that increase female infertility risk. Female fertility is known to decline with:

Age. About 1 in 5 (22%) couples in which the woman is 30-39 years of age have problems conceiving their first child, compared to about 1 in 8 (13%) couples in which the woman is younger than 30 years of age. Fertility declines with age primarily because egg quality declines over time. Additionally, older women have fewer eggs in reserve and are more likely to have health conditions that can cause fertility problems. Aging also increases a woman’s chances of miscarriage and having a child with genetic abnormality.
Smoking.
Excessive alcohol use.
Overweightness, obesity or being underweight.
Extreme weight gain or loss.
Excessive physical or emotional stress resulting in amenorrhea (absent periods.)

Common Infertility Causes in Women

A woman’s fertility relies on several key processes taking place correctly:

the ovaries release healthy eggs.
the reproductive tract must allow an egg to pass into the fallopian tubes and join with sperm for fertilization.
and the fertilized egg must travel to the uterus and successfully implant within its lining.

Female infertility may be caused by several health or medical issues, including:

disruption of ovulation or ovarian function. When ovulation doesn’t occur during the monthly menstrual cycle, it’s known as anovulation. Anovulation can be a symptom of the following conditions:
– polycystic ovary syndrome (PCOS), a condition that causes women to not ovulate, or to ovulate irregularly. Some women with PCOS have elevated levels of testosterone, which can cause acne and excessive body hair growth. PCOS is the most common cause of female infertility.

– diminished ovarian reserve (DOR.) Women are born with the quantity of eggs they will have, with the number of eggs declining naturally over time. DOR is a condition in which there are fewer eggs remaining in the ovaries than expected for a given age. It may occur due to congenital (condition present at birth), medical, surgical or unexplained causes. Women with DOR may be able to conceive naturally but will produce fewer eggs in response to fertility treatments.

– functional hypothalamic amenorrhea (FHA), a condition caused by excessive exercise, weight loss, stress or often a combination of these factors. FHA is sometimes associated with eating disorders like anorexia.

– improper function of the hypothalamus and pituitary glands. The hypothalamus and pituitary glands in the brain produce hormones that maintain normal ovarian function. Production of too much of the hormone prolactin by the pituitary gland (often due to a benign pituitary gland tumor), or improper function of the hypothalamus or pituitary gland, may cause a woman’s body to avoid ovulation.

– premature ovarian insufficiency (POI), sometimes referred to as premature menopause, occurs when a woman’s ovaries fail before she is age 40 years. Although certain exposures, like chemotherapy or pelvic radiation therapy and certain medical conditions causing POI, the cause is often unexplained. About 5% to 10% of women with POI conceive naturally and have a normal pregnancy.

– or menopause, a natural decline in ovarian function that usually occurs around age 50 years. By definition, a woman in menopause hasn’t had a period for at least 1 year.
Fallopian tube obstruction (whether fallopian tubes are open, blocked, or swollen.) Risk factors for blocked fallopian tubes (tubal occlusion) can include history of pelvic infection, ruptured appendix, gonorrhea, chlamydia, endometriosis, or prior abdominal surgery.
Fallopian tubes may be evaluated by hysterosalpingogram or by chromotubation.

– Hysterosalpingogram is an X-ray of the uterus and fallopian tubes. A radiologist injects dye into the uterus through the cervix and simultaneously takes X-ray pictures to see if the dye moves freely through fallopian tubes indicating they are open.

– Chromotubation is like a hysterosalpingogram but is done in the operating room at the time of a laparoscopy. Blue-colored dye is passed through the cervix into the uterus and through the fallopian tubes. This test is used to evaluate if the fallopian tubes are open and to assess if they are dilated.
Physical characteristics of the uterus. Depending on a woman’s symptoms, the uterus may be evaluated by transvaginal ultrasound to look for fibroids or other problems, including intrauterine adhesions, endometrial polyps, adenomyosis and congenital uterine anomalies. A sonohysterogram or hysteroscopy may also be performed for further evaluation.

Women’s Fertility Tests

Female fertility tests discern if any of these processes are impaired. Female fertility testing usually is the first step toward identifying potential fertility issues.

In women, the first step is to find out if she is ovulating each month. There are a few ways to do this. A woman can track her ovulation at home by:

writing down changes in her morning body temperature for several months.
writing down how her cervical mucus looks for several months.
using a home ovulation test kit (available at drug or grocery stores.)

Doctors can also check ovulation with blood tests. Or they can do an ultrasound of the ovaries. If ovulation is normal, there are other fertility tests available.

Your practitioner may recommend a general physical exam, plus regular gynecological exam and specified fertility tests that may include:

ovulation testing via blood test measures hormone levels to determine ovulation.
hysterosalpingography evaluates the condition of your uterus and fallopian tubes and looks for blockages or other issues. X-ray contrast is injected into your uterus, with an X-ray taken to determine if it’s normal and to see if the fluid spills from fallopian tubes.
ovarian reserve testing helps determine egg quantity available for ovulation, initialized usually with hormone testing early in the menstrual cycle.
other hormone testing to evaluate ovulatory hormone levels plus pituitary hormones controlling reproductive processes.
imaging tests, that may include pelvic ultrasound to investigate presence of uterine or ovarian disease or a sonohysterogram (saline infusion sonogram) to see details within the uterus not visible in regular ultrasound imagery.

Depending on your personal evaluation and symptoms, your practitioner may require the following tests in rare instances:

hysteroscopy for uterine disease evaluation. During the procedure, your doctor inserts a thin, lighted device through your cervix into your uterus to view and identify any potential abnormalities.
laparoscopy to examine reproductive organs. This minimally invasive surgery involves making a small incision beneath your navel and inserting a thin viewing device to examine fallopian tubes, ovaries and uterus. A laparoscopy may identify endometriosis, scarring, blockages or irregularities of the fallopian tubes and ovarian or uterine issues.

It’s vital to state women don’t need to have all, or even many, of these tests before infertility cause is identified. You and your Capital Women’s Care practitioner will devise a recommended testing plan based on your personal symptoms, individual health history and treatment preferences.

Common Infertility Causes in Men

Male fertility is also a complex process including several key factors that need to correctly occur for conception to take place:

produce healthy sperm via correct testicle function and presence of testosterone and other hormones to trigger and maintain sperm production.
carry sperm to semen via delicate tubes that transport them for mixture to take place.
normal or high numbers of sperm occur within the semen. If sperm count is low, it decreases the odds that fertilization of the egg occurs. A low sperm count is fewer than 15 million sperm per milliliter of semen or fewer than 39 million per ejaculate.
sperm must be functional and able to move. If the movement (motility) or function of sperm is abnormal, it may not be able to reach or penetrate the egg.

Checking male fertility usually occurs once female infertility is ruled out. In men, doctors usually begin by testing the semen. They look at the number, shape, and movement of the sperm. Sometimes doctors also suggest testing the level of a man’s hormones.

Male fertility issues can be caused by several health issues and medical treatments, including:

varicocele, a swelling of the veins that drain the testicle that is the most common reversible cause of male infertility. Although the exact reason that varicoceles cause infertility is unknown, it may be related to abnormal blood flow. Varicoceles lead to reduced sperm quantity and quality.
some infections can interfere with sperm production or health or can cause scarring that blocks sperm passage, including inflammation of the epididymis (epididymitis) or testicles (orchitis) and some sexually transmitted infections (STIs), including gonorrhea or HIV. Although some infections can result in permanent testicular damage, most often sperm can still be retrieved.
ejaculation issues including retrograde ejaculation, which occurs when semen enters the bladder during orgasm instead of emerging from the penis tip. Various health conditions can cause retrograde ejaculation, including diabetes, spinal injuries, medications and surgery involving the bladder, prostate or urethra.
antibodies which attack sperm, specific immune system cells that mistakenly identify sperm as harmful invaders and attempt to eliminate them.
Tumors that are cancers and nonmalignant tumors can affect the male reproductive organs directly, through the glands that release hormones related to reproduction, like the pituitary gland, or through unknown causes. In some cases, surgery, radiation or chemotherapy to treat tumors can affect male fertility.
undescended testicles in some males, during fetal development where 1 or both testicles fail to descend from the abdomen into the sac normally containing the testicles (scrotum.) Decreased fertility is more likely in men who have had this condition.
hormone imbalances resulting from disorders of the testicles themselves or an abnormality affecting other hormonal systems including the hypothalamus, pituitary, thyroid and adrenal glands. Low testosterone (male hypogonadism) and other hormonal problems have many possible underlying causes.
defects of tubules that transport sperm. Many different tubes carry sperm. They can be blocked due to various causes, including inadvertent injury from surgery, prior infections, trauma or abnormal development, such as with cystic fibrosis or similar inherited conditions. Blockage can occur at any level, including within the testicle, in the tubes that drain the testicle, in the epididymis, in the vas deferens, near the ejaculatory ducts or in the urethra.
chromosome defects linked to inherited disorders like Klinefelter syndrome, where a male is born with two X chromosomes and one Y chromosome (instead of one X and one Y), cause abnormal development of male reproductive organs. Other genetic syndromes associated with infertility include cystic fibrosis and Kallmann syndrome.
problems with sexual intercourse that may include difficulty keeping or maintaining an erection sufficient for sex (erectile dysfunction), premature ejaculation, painful intercourse, anatomical abnormalities such as having a urethral opening beneath the penis (hypospadias), or psychological or relationship problems that interfere with sex.
celiac disease diagnosis, a digestive disorder caused by sensitivity to a protein found in wheat called gluten. The condition may contribute to male infertility. Fertility may improve after adopting a gluten-free diet.
certain medications like testosterone replacement therapy, long-term anabolic steroid use, cancer medications (chemotherapy), some ulcer drugs, some arthritis drugs and certain other medications can impair sperm production and decrease male fertility.
prior surgeries may prevent sperm from joining ejaculate, including vasectomy, scrotal or testicular surgeries, prostate surgeries, and large abdominal surgeries performed for testicular and rectal cancers, among others.

Additionally, several environmental factors also correlate with male fertility issues, including:

Overexposure to heat, toxins and chemicals can reduce sperm production or function. Specific causes include:

industrial chemicals. Extended exposure to certain chemicals, pesticides, herbicides, organic solvents and painting materials may contribute to low sperm counts.
heavy metal exposure. Exposure to lead or other heavy metals also may cause infertility.
radiation or X-rays. Exposure to radiation can reduce sperm production, though it will often eventually return to normal. With high doses of radiation, sperm production can be permanently reduced.
overheating the testicles. Elevated temperatures may impair sperm production and function. Although studies are limited and are inconclusive, frequent use of saunas or hot tubs may temporarily impair your sperm count.

Male Fertility Tests

In instances where male fertility testing is advised, a general physical exam, including examination of the genitals, is often recommended. Specific fertility tests may include:

semen analysis of 1 or more semen specimens may be recommended. Semen is obtained through ejaculation into a clean container. A lab analyzes the semen and, in some cases, urine may be tested for the presence of sperm.
hormone testing via blood test can determine testosterone and other male hormone levels.
genetic testing may be done to determine whether a genetic defect is causing infertility.
testicular biopsy may be performed to identify abnormalities contributing to infertility or to retrieve sperm for assisted reproductive techniques, such as invitro fertilization (IVF.)
imaging studies like a brain MRI, transrectal or scrotal ultrasound, or testing the vas deferens (vasography) may be performed.
or other specialty testing to evaluate sperm quality may be performed, like evaluating semen specimens for DNA abnormalities.

Lifestyle Factors Affecting Fertility

Additionally, there are several lifestyle factors that have known adverse effects on both male and female fertility, including:

Overweightness and obesity. Both men and women should maintain a healthy weight. Overweight and underweight women are at increased risk of ovulation disorders. In males, obesity can impair fertility in several ways, including directly impacting sperm and causing hormone changes that reduce male fertility.
Alcohol use. In women, heavy alcohol use may lead to decreased fertility, with any alcohol use affecting the health of a developing fetus. If you’re planning to become pregnant, avoid alcohol, and don’t drink alcohol while pregnant. In men, alcohol can lower testosterone levels, cause erectile dysfunction and decrease sperm production in men. Liver disease due to excessive alcohol consumption can also lead to male fertility issues.
Tobacco use. Men who smoke tobacco products may have lower sperm counts than those men who don’t smoke tobacco products. Secondhand smoke exposure can also cause problems with male fertility. For women, tobacco has multiple negative effects on fertility, plus your general health and the health of a fetus. If you smoke and are considering pregnancy, quit now.
Drug use. In men, anabolic steroids taken to stimulate muscle strength and growth can cause the testicles to shrink and sperm production to decrease. Use of cocaine or marijuana may temporarily reduce the number and quality of sperm. Women should also avoid illicit drugs to reduce risk of birth defects and other significant health issues in an unborn baby. Women should discuss over the counter and prescribed medications with their practitioner prior to conceiving.
Environmental exposures. Men and women should avoid extended exposure to certain chemicals, pesticides, herbicides, organic solvents, painting materials, heavy metals like lead, plus radiation and x-rays due to their adverse effect on fertility. Talk with your doctor about environmental exposures to avoid when planning pregnancy.
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 become pregnant.

Infertility Treatment Options

Infertility can be treated with medicine, surgery, artificial insemination, or assisted reproductive technology. In many instances, treatments are combined. In most cases infertility is treated with drugs or surgery.]

Doctors recommend specific treatments for infertility based on:

test results.
how long the couple has been trying to conceive.
ages and overall health of both partners.
and preference of treated partners.

Doctors often treat infertility in men in the following ways:

Sexual problems: Doctors can help men deal with impotence or premature ejaculation. Behavioral therapy and/or medicines can be used in these cases.
Too few sperm: Sometimes surgery can correct the cause of the problem. In other cases, doctors surgically remove sperm directly from the male reproductive tract. Antibiotics can also be used to clear up infections affecting sperm count.
Sperm movement: Sometimes semen has no sperm because of a block in the man’s system. In some cases, surgery can correct the problem.

In women, some physical problems can also be corrected with surgery. Several fertility medicines are used to treat women with ovulation problems. It’s important to talk with your doctor about the pros and cons of these medicines. It’s important to fully understand possible dangers, benefits, and side effects so you and your partner make the best-informed treatment decision.

Many fertility drugs increase a woman’s chance of having multiple births (twins, triplets, or other multiples.) Women who are pregnant with multiple fetuses have more problems during pregnancy. Multiple fetuses have a high risk of being born too early (prematurely). Premature babies are at a higher risk of health and developmental problems.

Intrauterine insemination (IUI) is an infertility treatment known also as artificial insemination. In this procedure, the woman is injected with specially prepared sperm. Sometimes the woman is also treated with medicines that stimulate ovulation before IUI.

IUI is often used to treat:

mild male factor infertility.
women who have problems with cervical mucus.
and couples having unexplained infertility.

Assisted reproductive technology (ART) is a group of different infertility treatment methods to help infertile couples. ART works by removing eggs from a woman’s body. Eggs are then mixed with the partner’s sperm to form embryos, which are then implanted into the woman’s uterus. Success rates vary depending upon several factors. According to a 2014 CDC report on ART, the average percentage of ART cycles leading to a live birth were:

39% in women under 35 years of age.
30% in women aged 35 to 37 years.
21% in women aged 37 to 40 years.
and 11% in women aged 41 to 42 years.

ART can be expensive and time-consuming, but it’s allowed many couples to have children who otherwise wouldn’t have been conceived. The most common complication of ART is multiple fetuses; however, this can be prevented or minimized.

Common ART methods include:

In vitro fertilization (IVF) which is fertilization that takes place outside the body. IVF is the most effective ART. It’s often used when a woman’s fallopian tubes are blocked or when a man produces too few sperm. Doctors treat the woman with a drug that causes the ovaries to produce multiple eggs. Once mature, the eggs are removed from the woman. They are put in a dish in the lab along with the man’s sperm for fertilization. After 3 to 5 days, healthy embryos are implanted within the woman’s uterus.
Zygote intrafallopian transfer (ZIFT) or Tubal Embryo Transfer is like IVF. Fertilization occurs in the laboratory. The very young embryo is transferred to the fallopian tube instead of the uterus.
Gamete intrafallopian transfer (GIFT) involves transferring eggs and sperm into the woman’s fallopian tube, so fertilization occurs within the woman’s body. Few practices offer the GIFT option.
Intracytoplasmic sperm injection (ICSI) is often used for couples in which there are serious issues with the sperm. Sometimes this method is also used for older couples or for those with failed IVF attempts. In ICSI, a single sperm is injected into a mature egg. The embryo is then transferred to the uterus or fallopian tube.

ART procedures sometimes involve the use of donor eggs (eggs donated from another woman), donor sperm, or previously frozen embryos. Donor eggs are sometimes used for women who can’t produce eggs. Also, donor eggs or donor sperm are sometimes used when the woman or man has a genetic disease that can be passed on to the baby. An infertile woman or couple may also use donor embryos. These are embryos either created by couples in infertility treatment or from donor sperm and donor eggs. The donated embryo is then transferred to the female partner’s uterus.

Surrogacy is another option for infertile couples is surrogacy. Women without eggs or who have unhealthy eggs might also consider this option. A surrogate is a woman who agrees to become pregnant using the man’s sperm and her own egg. The child will be genetically related to the surrogate and the male partner. After birth, the surrogate gives the baby up for adoption to the couple.

Gestational carrier is a woman who agrees to carry an embryo derived from the male partner’s sperm and the female partner’s egg. Women having ovaries but no uterus may be able to use a gestational carrier. This may also be an option for women who shouldn’t become pregnant due to a serious health problem. In this instance, a woman uses her own egg, which is then fertilized by the man’s sperm. The embryo is then placed inside the gestational carrier’s uterus. The carrier isn’t genetically related to the baby, who is given to the couple at birth.

Recent research by the CDC indicates ART babies are 2-4 times more likely to have certain kinds of birth defects, which may include heart and digestive system problems, and cleft lips or palate. Researchers don’t know why this happens. The birth defects may not be due to the technology. Other factors like age of the parents may be involved. More research is needed. While the risk is relatively low, parents should take these findings into consideration when making decisions concerning ART.

Overcoming Fertility Obstacles

Coping with infertility can be extremely difficult because there are so many unknowns. The journey can take an emotional toll on a couple. Taking these steps can help you and your partner cope:

Be prepared. The uncertainty of infertility testing and treatments can be difficult and stressful. Ask your doctor to explain the steps and prepare for each one.

Set limits. Decide before starting treatment which procedures, and how many, are emotionally and financially acceptable for you and your partner. Fertility treatments may be expensive and often are not covered by insurance companies, and a successful pregnancy often depends on repeated attempts.

Consider other options. Determine alternatives ‚Äî donor sperm or egg, gestational carrier or adoption, or even having no children ‚Äî as early as possible in the infertility evaluation. This may reduce anxiety during treatments and feelings of hopelessness if conception does