Infertility



Overview


Infertility is defined as not being able to get pregnant after one year of unprotected sex.
There are 2 types of infertility:
• Primary infertility refers to couples who have not become pregnant after at least 1 year of having sex without using birth control methods.
• Secondary infertility refers to couples who have been able to get pregnant at least once, but now are unable.

Pregnancy is the result of a process that has many steps.


To get pregnant
• A woman’s body must release an egg from one of her ovaries (ovulation).
• A man’s sperm must join with the egg along the way (fertilize).
• The fertilized egg must go through a fallopian tube toward the uterus (womb).
• The fertilized egg must attach to the inside of the uterus (implantation).

Infertility may result from a problem with any or several of these steps.


Infertility results from female factors around one third of the times, from male factors on one third of the times. In remaining, the cause is either unknown or combined factors.

Male Infertility

Infertility in men can be caused by different factors and is typically evaluated by a semen analysis.
When a semen analysis is performed, the number of sperm (concentration), motility (movement), and morphology (shape) are assessed by a specialist.
A slightly abnormal semen analysis does not mean that a man is necessarily infertile. Instead, a semen analysis helps determine if and how male factors are contributing to infertility.

Male infertility may be due to:
• Decreased number of sperm
• Blockage that prevents the sperm from being released(obstruction)
• Defects in the sperm

Male infertility can be caused by:
• Birth defects
• Cancer treatments, including chemotherapy and radiation
• Exposure to high heat for prolonged periods
• Heavy use of alcohol, marijuana, or cocaine
• Hormone imbalance
• Impotence
• Infection
• Medicines such as cimetidine, spironolactone, and nitrofurantoin
• Obesity
• Older age
• Retrograde ejaculation
• Scarring from sexually transmitted infections (STIs), injury, or surgery
• Smoking
• Toxins in the environment
• Vasectomy or failure of vasectomy reversal
• History of testicular infection from mumps


Female Infertility

Women need functioning ovaries, fallopian tubes, and a uterus to get pregnant. Conditions affecting any one of these organs can contribute to female infertility. Some of these conditions are listed below and can be evaluated using a number of different tests.


Ovulatory Dysfunction (inability to ovulate)


A woman’s menstrual cycle is, on average, 28 days long. Regular predictable periods that occur every 21 to 35 days likely reflect ovulation. A woman with irregular periods is likely not ovulating.
The most commonly used markers of ovarian function include follicle stimulating hormone (FSH) value on day 3 to 5 of the menstrual cycle, anti-müllerian hormone value (AMH), and antral follicle count (AFC) using a transvaginal ultrasound.

• 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. It’s 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). Excess physical or emotional stress, a very high or very low body weight, or a recent substantial weight gain or loss can disrupt production of these hormones and affect ovulation. Irregular or absent periods are the most common signs.

• Premature ovarian failure. Also called primary ovarian insufficiency, this disorder is usually caused by an autoimmune response or by premature loss of eggs from the ovaries(possibly from genetics or chemotherapy). The ovary no longer produces eggs, and it lowers estrogen production in women under the age of 40.

• Thyroid dysfunction. Low or high levels of thyroid hormone production by thyroid gland affects ovulation resulting in low fertility

• Excessive prolactin. The pituitary gland may cause excess production of prolactin (hyperprolactinemia), which reduces estrogen production and may cause infertility. Usually related to a pituitary gland problem, this can also be caused by medications given for another disease.

Fallopian tube dysfunction


Risk factors for blocked fallopian tubes (tubal occlusion) can include a history of pelvic infection, history of ruptured appendicitis, history of gonorrhea or chlamydia, known endometriosis, a history of abdominal surgery or a history of prior ectopic pregnancy

Tubal evaluation may be performed using an X-ray that is called a hysterosalpingogram (HSG), or by chromopertubation.

Hysterosalpingogram (HSG) 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. This helps evaluate tubal patency.

Chromopertubation is done in the operating room at the time of a laparoscopy. Blue-colored dye is passed through the cervix into the uterus and spillage and tubal shape is evaluated.


Uterine or cervical causes


Several uterine or cervical causes can impact fertility by interfering with implantation or increasing the likelihood of a miscarriage:
• Benign polyps or tumors (fibroids) are common in the uterus. Some can block fallopian tubes or interfere with implantation, affecting fertility. However, many women who have fibroids or polyps do become pregnant.
• Endometriosis scarring or inflammation within the uterus can disrupt implantation.
• Uterine anomalies present from birth, such as an abnormally shaped uterus, can cause problems becoming or remaining pregnant.
• Cervical stenosis, a narrowing of the cervix, can be caused by an inherited malformation or damage to the cervix.

Unexplained infertility


Sometimes, the cause of infertility is never found. A combination of several minor factors in both partners could cause unexplained fertility problems. Although it’s frustrating to get no specific answer, this problem may correct itself with time. But you shouldn’t delay treatment for infertility.


Infertility treatment


Infertility can be treated with medicine, surgery, intrauterine insemination, or assisted reproductive technology.
Often, medication and intrauterine insemination are used at the same time. Doctors recommend specific treatments for infertility on the basis of
• The factors contributing to the infertility.
• The duration of the infertility.
• The age of the female.
• The couple’s treatment preference after counseling about success rates, risks, and benefits of each treatment option.
• Male infertility may be treated with medical, surgical, or assisted reproductive therapies depending on the underlying cause.


Tips to optimize fertility:


• Maintain a normal weight. Overweight and underweight women are at increased risk of ovulation disorders. If you need to lose weight, exercise moderately.
• Quit smoking. Tobacco has multiple negative effects on fertility, not to mention your general health and the health of a fetus. If you smoke and are considering pregnancy, quit now.
• Avoid alcohol. Heavy alcohol use may lead to decreased fertility. Any alcohol use can affect the health of a developing fetus.
• Reduce stress. Some studies have shown that couples experiencing psychological stress had poorer results with infertility treatment

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