If you and your partner are having a hard time getting pregnant, you may be one of the millions of couples suffering from infertility. In the United States, infertility affects roughly 15% of couples. Fortunately, medical advances have provided a number of pathways to treat fertility problems and increase your chance of getting pregnant.
What is Infertility?
A couple is considered infertile if they are unable to get pregnant after actively trying for 1 year. About half of couples are able to get pregnant after trying for 6 months, and about 90% will get pregnant within a year.
A couple’s infertility may be due to a problem with either the man’s or the woman’s medical conditions, reproductive system, or both. Infertility is sometimes a symptom of an underlying health problem that needs medical attention.
When Should I See My Doctor About Infertility?
If you have been trying to get pregnant for at least a year, make an appointment with your gynecologist. You may want to visit your doctor earlier if you are having difficulty getting pregnant and:
- You are over the age of 35
- Your menstrual cycles are irregular or absent
- You have endometriosis, pelvic inflammatory disease, or have been treated for cancer
- You have had fertility problems or more than one miscarriage in the past
What are the Main Causes of Infertility in Men?
Low sperm count or abnormal sperm
Common causes of low production of sperm can be due to genetic defects, diabetes, infections, injuries, or past surgeries. As a man ages, sperm production decreases, along with sperm motility, thus reducing the chances of pregnancy occurring.
Problems with sperm transference
The patient may have problems with premature ejaculation or there may be a blockage due to a past injury or surgery. Some conditions may cause semen to flow into the bladder instead of through the penis, known as retrograde ejaculation.
Damage due to cancer treatment
Men who have been treated with radiation or chemotherapy may have sustained damage to sperm production.
Chemical or toxic exposure
Abusing substances such as tobacco, alcohol, marijuana, and steroids may affect a man’s fertility. Overexposure to pesticides or heat can also damage sperm production.
Test for Men
Evaluation for male fertility will include a medical history and physical examination to detect any physical abnormalities. In some cases, examination using trans-rectal ultrasound (TRUS) can be used to identify specific abnormalities, such as obstructions blocking the sperm from being released during ejaculation. The absence of sperm (azoospermia) can also be due to missing vas deferens or seminal vesicles.
Semen analysis. This is the primary test for infertility in men. Collection and prompt evaluation of a sample of semen can help determine whether there are any defects in the number, shape, and movement (motility) of sperm.
Blood tests can be used to evaluate hormone levels such as:
- Free and total testosterone
- Luteinizing hormone (LH)
- Follicle-stimulating hormone (FSH)
- Prolactin (PRL)
- Sex hormone binding globulin
Biopsy. In some instances, a biopsy of testicular tissue can identify infertility problems such as sperm production, abnormal growths, tumors, or underdeveloped reproductive organs.
What are the Main Causes of Female Infertility
This is a relatively common disorder in which endometrial tissue grows outside the uterus.
Certain hormonal disorders, such as polycystic ovary syndrome or disorders that cause the body to produce too much testosterone, can prevent proper ovulation leading to a cause of infertility. Eating disorders, excessive exercise, tumors, or trauma can also inhibit ovulation.
Some conditions cause scarring or blockages of the fallopian tubes, which prevents the egg and sperm from joining.
Your fallopian tubes, which move the mature egg from your ovaries to your uterus, may be partially or completely blocked by adhesions, which are areas of scar tissue that cause organs to become stuck together and prevent the egg’s movement. Adhesions can be caused by diseases such as endometriosis, salpingitis, pelvic inflammatory disease, and certain sexually transmitted infections. They are also often the result of tubal surgery.
Abnormal conditions in the womb
Some conditions prevent the fertilized egg from properly implanting in the uterus, such as uterine fibroids or an abnormally-shaped uterus.
Some patients experience early menopause, also known as primary ovarian insufficiency, before age 40. Perimenopause refers to the years before menopause, when the ovaries gradually start to make less estrogen. During this time, estrogen levels fluctuate, which can cause heavy, irregular menstrual cycles and cramping. You may be experiencing these symptoms if your infertility’s factor may be early menopause.
Cancer, cancer treatment, hyporthyroidism or hyperthyroidism
All are known to potentially interfere with the ability to conceive.
Miscarriages occur in about 1 in 4 pregnancies. The risk of miscarriage increases with age and other health factors such as alcohol, caffeine, or tobacco use.
Many couples experience multiple miscarriages when trying to get pregnant. Some of these couples do not seek medical help for infertility because having a miscarriage means that at least they are able to conceive. However, having recurrent miscarriages may be cause for concern as there could be an underlying medical issue that is keeping your pregnancy from progressing.
Recurrent miscarriage is defined as having two or more consecutive miscarriages before the pregnancy has reached 20 weeks. Only clinical pregnancies – those that can be detected with an ultrasound – count for diagnosing a miscarriage. About 5% of women will experience recurrent miscarriages.
With proper medical intervention, most women who have recurrent miscarriages are eventually able to conceive and carry a pregnancy to full term.
There are several tests that can be performed in order to evaluate the functioning of your reproductive system. In addition to a physical exam, your gynecologist can conduct:
A pelvic ultrasound or a hysterosonography can help detect the presence of disease or abnormality.
Hysterosalpingography is an X-ray imaging technique that can show your doctor the shape of your uterus and fallopian tubes, as well as determine if there are any blockages.
Your doctor can check your hormone levels, as well as evaluate the function of your thyroid and pituitary glands that are related to reproduction.
Ovarian reserve testing
Your doctor can test the quality and quantity of your eggs with blood tests.
In rare cases, a genetic defect may be affecting your ability to get pregnant.
This is a minimally-invasive surgical technique that can help your doctor diagnose problems inside your pelvis that may be causing infertility. A small incision is made in your lower abdomen, and a slender, flexible tube fixed with a camera is inserted in order to examine your uterus, ovaries, and fallopian tubes.
Treatment Options for Infertility
If your gynecologist finds a problem, she will refer you to a fertility specialist, such as a reproductive endocrinologist, for treatment. There may be several options available to you. After a thorough history, physical examination, and ultrasound are performed, your health care doctor may recommend surgery to correct the abnormality if any. In reproductive medicine, the most common surgical procedures are laparoscopy, hysteroscopy, and abdominal myomectomy (removal of uterine fibroids).
Your specialist will review all of your options with you and your partner, and help you choose the right course of action for your family. A fertility treatment plan, involving both the man and woman, may include changes in nutrition, lifestyle, and environmental factors. This will increase success rates to a healthy pregnancy.