All You Need to Know About Infertility
Definition of infertility
A diagnosis of infertility means you haven’t been able to get pregnant after a year of trying. If you’re a woman over 35, it means you haven’t been able to get pregnant after 6 months of trying.
Women who are able to conceive but not carry a pregnancy to term may also be diagnosed with infertility.
A woman who’s never been able to get pregnant will be diagnosed with primary infertility. A woman who’s had at least one successful pregnancy in the past will be diagnosed with secondary infertility.
Infertility isn’t just a woman’s problem. Men can be infertile too. In fact, men and women are equally likely to have fertility problems.
According to a research, about one-third of infertility cases can be attributed to female infertility while men’s problems account for another third of infertility cases.
The remaining third of cases may be caused by a combination of male and female infertility, or they may have no known cause.
Causes of male infertility
Generally speaking, infertility in men is related to issues with the following:
- effective production of sperm
- sperm count, or the number of sperm
- shape of the sperm
- movement of the sperm, which includes both the wiggling motion of the sperm themselves and the transport of the sperm through the tubes of the male reproductive system
There are a variety of risk factors, medical conditions, and medications that can also affect fertility.
Risk factors associated with infertility in men include, but aren’t limited to:
- older age
- smoking cigarettes
- heavy use of alcohol
- being overweight or obese
- exposure to toxins, such as pesticides, herbicides, and heavy metals
Some examples of medical conditions that can cause male infertility include:
- retrograde ejaculation
- varicocele, or the swelling of the veins around the testicles
- testicles that haven’t descended into the scrotum
- having antibodies that attack your sperm and destroy them
- a hormonal imbalance, such as low testosterone production
Medications and drugs
Various medications and drugs can also affect male fertility, such as:
- chemotherapy or radiation therapy, which are used for cancer
- sulfasalazine (Azulfidine, Azulfidine EN-Tabs), which is used for rheumatoid arthritis (RA) or ulcerative colitis (UC)
- calcium channel blockers, which are used for high blood pressure
- tricyclic antidepressants
- anabolic steroids, which are used for improved athletic performance or hormonal issues such as delayed puberty
- recreational drugs such as marijuana and cocaine
The bottom line
Any of these things, or even a combination of them, could lead to infertility in men. Learn about the signs of male infertility.
Causes of female infertility
Female infertility can be caused by a variety of factors that affect or interfere with the following biological processes:
- ovulation, when the mature egg is released from the ovary
- fertilization, which occurs when sperm meets the egg in the fallopian tube after traveling through the cervix and uterus
- implantation, which occurs when a fertilized egg attaches to the lining of the uterus where it can then grow and develop into a baby
Risk factors for female infertility include:
- increasing age
- smoking cigarettes
- heavy use of alcohol
- being overweight, obese, or significantly underweight
- having certain sexually transmitted infections (STIs) that can damage the reproductive system
A variety of medical conditions can affect the female reproductive system and cause infertility in women.
- ovulation disorders, which can be caused by polycystic ovary syndrome (PCOS) or hormonal imbalances
- pelvic inflammatory disease (PID)
- uterine fibroids
- premature ovarian failure
- scarring from a previous surgery
Medications and drugs
Certain medications and drugs that can affect female infertility include:
- chemotherapy or radiation therapy
- long-term use of high-dosage nonsteroidal anti-inflammatory drugs such as aspirin and ibuprofen
- antipsychotic medications
- recreational drugs such as marijuana and cocaine
The bottom line
Ovulation problems cause around one-quarter of the infertility issues seen in couples.
An irregular or absent period are two signs that a woman may not be ovulating.
If you’ve been trying to conceive and haven’t been able to, you’re likely wondering when you should plan to see a doctor.
Read on to discover which tests they’ll perform to assess the fertility of you and your partner.
Men should plan to see a doctor after one year of trying to conceive or if any of the following apply:
- erectile dysfunction (ED)
- problems with ejaculation, such as delayed ejaculation or retrograde ejaculation
- low sex drive
- pain or swelling in the genital area
- having undergone a previous surgery in the genital area
Your doctor will first take your medical history. During this time, they’ll ask about your overall health, your sexual history, and factors that could affect your fertility. They’ll also perform a physical examination where they check your genitals for any structural abnormalities or lumps.
A semen analysis will likely then be performed. Your doctor will ask you to provide a sample of semen. This sample will then be checked in a laboratory to see how many sperm are present and whether the sperm are shaped normally and moving properly.
Depending on the results of your initial exam and semen analysis, your doctor may want to perform additional tests.
These tests may include:
- hormone testing
- genital ultrasound
- genetic testing
A woman’s fertility begins to decrease following age 30. Women under 35 should visit a doctor after one year of trying to get pregnant while women 35 and over should visit a doctor after 6 months of trying.
Your doctor will first take your medical history. They’ll ask about the current state of your health, your sexual history, and any conditions or illnesses that could contribute to infertility.
Then they’ll perform an examination of your pelvic area to check for abnormalities such as fibroids or conditions such as endometriosis or PID.
Your doctor will want to see if you’re ovulating every month. This can be determined with an at-home ovulation testing kit or through blood testing at the doctor’s office.
An ultrasound may also be used to examine the ovaries and uterus.
Other common tests for women include:
- hysterosalpingography, which is a type of X-ray used to evaluate the fallopian tubes and uterus
- laparoscopy, which uses a camera to examine the internal organs
- ovarian reserve testing, which uses a combination of hormone tests to determine a woman’s potential for conceiving — relevant tests include the follicle-stimulating hormone (FSH) test
If you and your partner have been trying to get pregnant and haven’t been able to, you may wish to seek treatment. The type of treatment that’s recommended can depend on a variety of factors, including:
- the cause of infertility, if known
- how long you’ve been trying to conceive
- your ages
- the overall health of both you and your partner
- the personal preferences of you and your partner, following consultation about your treatment options
Male infertility can be treated in a variety of ways, depending on the cause. Treatment options for men can include surgery, medication, and assisted reproductive technology (ART).
Surgery can fix obstructions that are preventing sperm from being present in the ejaculate. It can also correct conditions such as varicocele. In some cases, sperm can be retrieved directly from the testicles after which it can be used in ART treatments.
Medications can be used to treat issues such as hormonal imbalances. They can also be used to treat other conditions that can affect male fertility, such as ED or infections that affect sperm count.
ART refers to treatments in which eggs and sperm are handled outside of the body. It can include treatments such as in vitro fertilization (IVF) and intracytoplasmic sperm injection. Sperm for ART treatments can be received from ejaculate, extraction from the testicles, or a donor.
The treatment for female infertility can also involve surgery, medication, and reproductive assistance such as ART. Sometimes several types of treatment are needed to help address female infertility.
Although surgery can sometimes be used to treat female infertility, it has become rarer now due to advancements in other fertility treatments. Surgery can improve fertility by:
- correcting an abnormally shaped uterus
- unblocking fallopian tubes
- removing fibroids
Reproductive assistance can involve methods such as intrauterine insemination (IUI) and ART. During IUI, millions of sperm are injected into a woman’s uterus near the time of ovulation.
IVF is one type of ART and involves the removal of eggs that are then fertilized with a man’s sperm in a laboratory. After fertilization, the embryo is placed back into the uterus.
The medications used to treat female infertility work like hormones that are naturally present in the body to either encourage or regulate ovulation.
The bottom line
There’s a myriad of fertility drugs available.
Infertility and natural treatments
Natural treatments can include methods such as acupuncture and yoga.
One 2018 review found that at least 29 percent of couples had tried some form of natural or alternative infertility treatment, either alone or to complement traditional treatments.
Acupuncture involves the insertion of small, thin needles into various points of the body. It’s believed that these points can help stimulate the body’s energy flow.
There’s no definitive evidence to support acupuncture as a treatment for infertility.
Multiple clinical trials did find limited evidence that acupuncture could improve both ovulation and menstruation in women with PCOS.
Yoga incorporates postures and breathing techniques to promote relaxation and decrease stress levels.
Studies on yoga as an infertility treatment are limited. However, it’s believed that practicing yoga can be beneficial in relieving the stress that can be associated with undergoing fertility treatments.
Various vitamins and minerals can be beneficial in promoting fertility.
Some to look out for include:
- vitamin C
- vitamin E
You can also consider other supplements, such as probiotics, which can promote healthy digestion and improve overall wellness.
A variety of fertility teas are commercially available for purchase, but do they work?
Investigations into the effects of these tea formulations on fertility are extremely limited. However, one recent review found that antioxidant compounds found in green tea may help fertility by improving parameters such as sperm count and motility.
Essential oils are derived from plants, typically from their roots, seeds, or leaves. They may be utilized in aromatherapy to promote relaxation and reduce stress levels. Aromatherapy can involve massaging with, bathing with, or burning essential oils.
Further research is needed to evaluate the effects that essential oils may have on fertility.
For women, fertility-boosting food recommendations are aimed at improving infertility caused by problems with ovulation. Therefore, they won’t work for infertility that’s caused by physical conditions such as a block in the fallopian tubes or uterine fibroids.
Some dietary recommendations for boosting fertility include:
- choosing carbs wisely by focusing on fiber-rich foods (like vegetables and whole grains) while avoiding refined carbs that are high in sugar
- avoiding trans fats, which are present in many fried and processed food products
- swapping some of your animal protein for vegetarian sources of protein
- selecting high-fat dairy (like whole milk) instead of low-fat products
Following these recommendations, and eating a nutrient-rich diet in general, can also help men improve the health of their sperm.
Implementing dietary changes along with lifestyle changes such as being more active can help promote fertility.
Women are most fertile around the time that they ovulate. Tracking your ovulation and then concentrating your sexual activity around this time can improve your chances of conceiving.
Ovulation occurs one day out of the month. At this time, your ovaries release a mature egg, which begins to travel through your fallopian tubes. If the egg encounters sperm during its journey, fertilization can occur.
If an egg isn’t fertilized, it will die within about 24 hours of ovulation. However, sperm can live within a woman’s body for up to five days, increasing the chances of fertilization. Because of this, you’re actually fertile for around five to six days out of the month.
Ovulation doesn’t occur at the same time every month, so it’s important to recognize the signs of ovulation. These can include bodily changes such as abdominal cramping and a small rise in body temperature.
Infertility facts and statistics
Infertility rate is high among women in urban areas. This may be due to lifestyle or a later age at first marriage. Considering religion, Muslims show the lowest infertility rate. Scheduled tribes have high infertility rate. With increasing levels of educational attainment among women, infertility rate increases. This can be related to the fact that with aspirations for attaining higher educational level, marriage is delayed as a result of which in confirmation with aforementioned causation factors (higher age at marriage, urban living style etc.), infertility rate is high among this sub group of population. Standard of living has inverse relation with infertility rate. Working women have high infertility rate.
Working women are 13% more likely to be childless compared to non-working women. Women in the central and the southern region are 18 and 63% respectively more likely to be childless compared to women in the northern region.
Outlook on infertility
Being diagnosed with infertility doesn’t mean that your dreams of having a child have come to an end. It may take some time, but a number of couples who experience infertility will eventually be able to have a child. Some will do so on their own, while others will need medical assistance.
The treatment that’s right for you and your partner will depend on many factors, including your ages, the cause of the infertility, and your personal preferences. Similarly, whether or not a specific infertility treatment results in a pregnancy can depend on many factors.
In some cases, a fertility problem may not be able to be treated. Depending on the circumstances, your doctor may suggest that you and your partner consider donor sperm or eggs, surrogacy, or adoption.
The landscape of fertility in the India continues to be dynamic, with many changes in attitudes and cultural norms.
For any further details please get in touch with your health provider or if you are in Gurgaon you can get in touch with Dr. Mamta Pattnayak (Gynae and Obstetrician in Fortis Hospital, Gurgaon)