Infertility

Overview

Infertility is defined and primarily characterised by the inability to conceive or get pregnant, due to a health issue with either partner involved or a mix of symptoms in both individuals. In many cases, however, it’s important to bear in mind that millions of couples do face issues with conceiving for a long period of time. If you and you partner have been trying to conceive for over a year, it may be best to see a medical professional in that scenario.

Most approved medical organizations utilize a time period of more than one year to diagnose infertility and, on an average, roughly 8% - 12% of couples struggle with it every year. For women over 35, it’s diagnosed if you’ve been trying to conceive for over 6 months. It’s also important to note that women who can get pregnant can also be diagnosed with infertility if they are unable to carry a pregnancy to full-term

It’s important to note that, contrary to preconceived notions in society, infertility isn’t a women’s problem; men and women are equally likely to possess conditions that contribute towards infertility. The data seems to suggest that one-third of infertility cases are caused by male infertility, another one-third by female infertility and the remaining cases are caused by a mix of factors or do not have a known cause.

Symptoms of Infertility

Although the main symptom of infertility is, quite obviously, the inability to get pregnant, there are also other symptoms that present themselves such as:

For Males:
i) Inability to produce sufficient amounts of sperm.
ii) Abnormal shape of sperm, in a way that affects conception at a fundamental level.
iii) The ability of the sperm to transport itself through the male reproductive organ.

For Females:
i) An irregular period cycle that’s seemingly erratic and random.
ii) A menstrual cycle of 35 days or more.
iii) A menstrual cycle of 21 days or less.

Causes of Infertility

The symptoms outlined above may be the result of any number of lifestyle, medical or genealogical causes, however the more predominant causes for infertility at a younger age includes:

For Males:
i) Lifestyle choices such as heavy use of alcohol, smoking cigarettes, being overweight or obese or consistently exposing oneself to pesticides or other harsh chemicals can affect the production of sperm.

ii) Certain drugs or medical procedures, like chemotherapy, antidepressants or even receational drugs like cocaine and marijuana if used over long periods of time can have irreversible effects on your fertility.

iii) Medical conditions such as specific diseases like retrograde ejaculation or varicocele or even other conditions such as antibodies attacking the sperm present in the male body and lowering their count.

For Females:

i) Much lijke males, increasing age and harsh lifestyle choices like heavy indulgence of alcohol and cigarettes can have an effect on a woman’s reproductive health, while being significantly underweight can also affect their ability to carry a pregnancy to full term.

ii) Medical conditions like certain STIs (Sexually Transmitted Infections) can also damage a woman’s reproductive health, alongside diseases like uterine fiboids, endometriosis or even scarring from a former medical condition.

iii) Lastly, similar medications and medical surgeries can cause infertility in women, even including long term usage of high-dosage anti-inflammatory drugs like aspirin or Ibuprofen.

Prevention of Infertility

For couples who are planning to get pregnant soon or have any plans of conceiving children in the distant future, they might want to spend some time on making responsible lifestyle changes.

In the realm of fitness and physical health, which has an significant impact on reproductive health, try spending more time on exercise, as obesity can affect both male and female fertility, while women have to be wary of being underweight. Consistent exercise over several weeks has also been associated with deceased ovulation.

Couples should also avoid heavy indulgence in alcohol and cigarettes, as both these vices tend to have heavy-handed effects on your body and its ability to conceive in the long-term.

Lastly, a more broader change to inculcate in you life is healthier stress management techniques, as studies have shown that intense stress has a strong correlation with couples having poorer results in their infertility treatment.

Tests and Treatments for Infertility

Infertility is primarily diagnosed on the basis of fertility tests for men and women. These tests can, however, involve procedures that feel invasive or uncomfortable and can also be rather expensive. Also bea in mind that the tests may not always guarantee a clear path towards pregnancy, even after all the counselling and procedures.

For men, fertility tests can range from semen analysis, where a healthcare team takes a sample of your sperm to detect whether your sperm is in healthy condition or not, judging based on both quantity and quality, to even genetic testing to better understand whether the infertility stems from a genetic history.

In any case, the main motive behind male fertility tests is to detect whether or not the male counterpart’s penis is capable of producing sperm, whether that sperm can exit the male reproductive system and whether it can penetrate the ovulating egg after. The tests help detect whether there are any issues that arise at any point during these steps that are treatable.

For women, the fertility evaluation process can be more complex and varied, often involving hormonal assessments, imaging tests, and sometimes even surgical procedures. More generally, blood tests help by measuring hormone levels like FSH, LH, progesterone, and estradiol helps assess ovarian function and ovulation regularity.

Ovulation predictor kits (OPKs) are home-based tests that detect a surge in the luteinizing hormone (LH), which precedes ovulation. They offer a preliminary indication of ovulation, however they don’t outright confirm it. Basal body temperature (BBT) charting, on the other hand, involves tracking your resting body temperature daily, which slightly increases after ovulation. It's helpful in identifying ovulation patterns but requires consistent measurements and interpretation.

Other medical procedures are more focused on assessing the health of the fallopian tubes. Procedures like hysterosalpingography (HSG) use contrast dye injected into the cervix to evaluate the fallopian tubes for blockages. It can be uncomfortable but relatively less invasive. Laparoscopies hold a similar approach, however they are minimally invasive surgical procedures that use a camera inserted through a small incision to directly visualize the fallopian tubes and other pelvic organs for blockages or abnormalities like endometriosis.

If these medical procedures fail to yield results, other tests focus on assessing uterine health. Ultrasounds, for example, use sound waves to create pictures of the uterus and ovaries, checking for fibroids, polyps, or other structural abnormalities. In hysteroscopies, similar to laparoscopies, a thin camera is inserted through the cervix to examine the uterine lining for issues like scarring or adhesions.
Cervical mucus evaluation: Examining the quality and quantity of cervical mucus can indicate potential issues with sperm migration through the cervix.

Ovarian reserve testing: Tests like Anti-Müllerian Hormone (AMH) levels can give an idea of remaining egg supply, particularly relevant for women considering delayed childbearing.

Types of Infertility

There are only two types of infertility primary and secondary infertility, with both these terms generally being used to describe a couple that is trying to conceive:

Primary Infertility: Under this type of infertility, the patient that is diagnosed who has never conceived a child in the past has difficulty conceiving a child and couldn’t get pregnant after a year of trying if younger than 35 or after six months of trying if older than 35.

Secondary infertility: Under this kind of infertility, the person that is diagnosed has had at least 1 or more pregnancies in the past, but is facing difficulties in conceiving at the moment and couldn’t get pregnant after a year of trying if younger than 35 or after six months of trying if older than 35.