Infertility
If a couple cannot conceive after regularly having unprotected sex, then they may have infertility.
It is possible that one partner is not able to contribute to conception or that a woman cannot carry a pregnancy to full term. This is often defined as not conceiving after 12 months of regular sexual intercourse without the use of contraception.
Around 10% of women in the United States between the ages of 15 and 44 struggle to conceive or stay pregnant. Worldwide, 8 to 12% of couples experience fertility problems. The majority of cases are thought to be caused by factors that affect the man.
Treatment is often available.
Infertility is a common problem in men. There are many reasons for it.
Semen and sperm
Semen is the white, milky fluid that comes out of a man's penis during orgasm. Sperm is what makes up this fluid. The fluid comes from the prostate gland, the seminal vesicles, and other sex glands.
The sperm is produced in the testicles.
When a man ejaculates, his semen is released. This fluid helps transport the sperm towards the egg.
The following problems can occur:
- Low sperm count: A man ejaculates a low number of sperm. If a man's sperm count is below 15 million, it is considered low. Around one third of couples experience difficulty conceiving due to a low sperm count.
- Sperm movement (motility): The sperm are not as able to move around as they should in order to reach the egg.
- Abnormal sperm: The sperm may have an unusual shape, making it more difficult to move and fertilize an egg.
If the sperm are not in the right shape or if they cannot travel quickly and accurately to the egg, conception may be difficult. Up to 2 percent of men have suboptimal sperm.
If your semen does not look or feel normal, it may not be able to transport the sperm effectively.
This can result from:
- A medical condition: This could be a testicular infection, cancer, or surgery.
- Testicles that get too hot: Causes can include an undescended testicle, a varicocele, or a varicose vein in the scrotum. The use of saunas or hot tubs, wearing tight clothes, and working in hot environments can all contribute.
- Ejaculation disorders: If the ejaculatory ducts are blocked, semen may end up in the bladder.
- Hormonal imbalance is when the levels of certain hormones in the body are not normal. This can result in a testosterone deficiency.
Other causes may include:
- Genetic factors: A man must have an X and Y chromosome. If he has two X chromosomes and one Y chromosome, as is the case with Klinefelter’s syndrome, the testicles will develop abnormally and there will be low testosterone and a low sperm count or no sperm.
- If you get mumps, it can affect your sperm production.
- Hypospadias: The urethral opening is located below the penis rather than its tip. This abnormality is usually corrected during infancy. If it is not corrected, it may be harder for male sperm to reach the female's cervix. Hypospadias affects about one in every 500 newborn boys.
- Cystic fibrosis is a chronic disease that causes the production of a sticky mucus. This mucus mainly affects the lungs, but males may also have a missing or obstructed vas deferens. The vas deferens carries sperm from the epididymis to the ejaculatory duct and the urinary tract.
- Radiation therapy: This can impair sperm production. The severity usually depends on how close to the testicles the radiation was aimed. Radiation therapy can cause infertility in men.
- Some conditions that can interfere with fertility in males are anemia, Cushing's syndrome, diabetes, and thyroid disease.
Some medications can increase the risk of fertility problems in men.
- Sulfasalazine: This anti-inflammatory drug can significantly reduce a man’s sperm count. When it is prescribed for Crohn’s disease or rheumatoid arthritis, the sperm count often returns to normal after stopping the medication.
- Anabolic steroids can have serious effects on sperm count and mobility.
- Chemotherapy: Some types of chemotherapy may reduce the number of sperm in the semen.
- Marijuana and cocaine can harm the sperm count.
- Male fertility starts to decline after 40 years of age.
- Exposure to chemicals can increase the risk. For example, pesticides may increase the risk.
- Excessive drinking: This can lower male fertility. Moderate drinking has not been shown to have a significant impact on fertility in most men, but it may affect men who already have a low sperm count.
- Being overweight or obese may reduce your chances of becoming pregnant.
- Stress can impair sexual activity.
Laboratory studies suggest that long-term use of acetaminophen during pregnancy may lower testosterone production in males. Women are advised not to take the drug for more than one day at a time.
There are many reasons why women may become infertile.
Risk factors
There are some risks associated with this activity that you should be aware of. These include:
- A person's ability to conceive starts to decline around the age of 32 years.
- Smoking: Smoking significantly increases the risk of infertility in both men and women. It may also lessen the effects of fertility treatment. Smoking during pregnancy increases the chance of miscarriage. Passive smoking has also been associated with diminished fertility.
- Alcohol consumption can decrease the chances of becoming pregnant.
- Being overweight or obese can increase your chances of infertility in both women and men.
- Eating disorders can cause serious weight loss and infertility problems.
- A lack of folic acid, iron, zinc, and vitamin B-12 can affect fertility. Women who are at risk for infertility, such as those who are vegan, should ask a doctor about supplements.
- Physical activity: Too much or too little exercise can have negative effects on fertility.
- Sexually transmitted infections (STIs): Some viruses can damage the fallopian tubes in women and cause inflammation in men's testicles. Other STIs may also cause infertility.
- Some chemicals can harm fertility in both men and women. A mouse study has found that ingredients in some household detergents may reduce fertility.
- Stress can have an impact on ovulation and sperm production in men and decreased sexual activity in women.
Medical conditions
Some medical conditions can affect a person's ability to have children.
Ovulation disordersInfertility is caused by a variety of factors, but one of the most common is unknown.
Ovulation is the monthly release of an egg. Sometimes the eggs will never be released, and sometimes they will only be released in some cycles.
Ovulation disorders can be due to:
- Ovarian failure before the age of 40 is called premature ovarian failure.
- PCOS is a disorder in which the ovaries do not work normally and may not produce eggs.
- If prolactin levels are high and the woman is not pregnant or breastfeeding, it may affect her ability to ovulate and conceive.
- Poor egg quality can prevent a pregnancy. Older women have a higher risk of having poor egg quality.
- Having a thyroid problem can lead to an hormonal imbalance.
- Health conditions: These include AIDS or cancer.
If there are problems with the uterus or fallopian tubes, this can cause infertility.Ovarian hormones can prevent the egg from traveling from the ovary to the uterus or womb.
If the egg does not travel out of the body, it can be harder to conceive naturally.
Causes include:
- Pelvic surgery can sometimes cause scarring or damage to the fallopian tubes or the cervix, which is the neck of the uterus. Cervical surgery can sometimes cause scarring or shortening of the cervix.
- Submucosal uterine fibroids: Benign or noncancerous tumors occur in the muscular wall of the uterus. They can interfere with implantation or block the fallopian tube, preventing sperm from fertilizing the egg. If a woman has large submucosal uterine fibroids, their cavity might become bigger, increasing the distance between her uterus and ovaries. Sperm needs to travel.
- Endometriosis is when cells that are normally found in the lining of the uterus start growing elsewhere in the body.
- Previous sterilization treatment: If you have had your fallopian tubes blocked, the process of reversing it can be done but the chances of becoming pregnant again are not high.
Medications, treatments, and drugs
Some drugs can have a negative effect on a woman's fertility.
- Taking NSAIDs for a long time may make it difficult to conceive.
- Chemotherapy: Some chemotherapy drugs can cause ovarian failure. In some cases this may be permanent.
- Radiation therapy can have harmful effects on fertility. If this treatment is aimed near the reproductive organs, it may increase the risk of fertility problems.
- Some women who use marijuana or cocaine may have fertility problems.
Cholesterol
One study has found that high cholesterol levels may affect a woman's fertility.
Treatment for infertility will depend on many factors, including the age of the person who wants to conceive, how long their infertility has lasted, and their personal preferences.
Frequency of intercourse
The couple might be advised to have sexual intercourse around the time of ovulation. Sperm can survive inside the female for up to 5 days, while an egg can be fertilized for up to 1 day after ovulation. theoretically, it is possible to conceive on any of the 6 days that occur before and during ovulation. The process of becoming pregnant.
The survey suggests that the days most likely to be fertile are the two days before ovulation and the day of ovulation.
Some people believe that the number of times a couple has intercourse should be reduced in order to increase sperm supply, but this is unlikely to result in a difference.
Fertility treatments for men
The treatment for infertility will depend on the cause of the infertility.
- Erectile dysfunction or premature ejaculation: There are many different approaches to treating it with medication, such as behavioral therapies. Or, both may be needed.
- Varicocele: If a varicose vein in the scrotum is causing problems, it may be surgically removed.
- Ejaculation can be blocked in the laboratory by extracting sperm directly from the testicles.
- Ejaculation can be reversed in the laboratory by taking sperm directly from the bladder.
- If a man has a blocked epididymis, it may be repaired through surgery. The epididymis is a coil-like structure in the testicles which helps store and transport sperm. If the epididymis is not functioning correctly, then sperm may not be ejaculated properly.
Fertility treatments for women
If fertility problems are detected, drugs might be prescribed to help induce ovulation.
They include:
- Clomifene (Clomid Serophene): This medication helps induce ovulation in women who suffer from PCOS or another disorder that causes them to ovulate irregularly or not at all. It raises levels of the pituitary hormone FSH and LH.
- If Clomifene is not effective, metformin may be helpful in women with PCOS if they have insulin resistance.
- Human menopausal gonadotropin or hMG (Repronex): This contains both FSH and LH. If a patient does not ovulate because their pituitary gland is not working correctly, they may receive this drug as an injection.
- Follicle-stimulating hormone (Gonal-F Bravelle): This hormone is produced by the pituitary gland, which controls estrogen production by the ovaries. It stimulates the ovaries to produce mature egg follicles.
- Ovidrel (human chorionic gonadotropin) is used together with clomiphene hMG and FSH to stimulate the ovaries to ovulate.
- Analogs of Gn-RH: These help women who ovulate too early during hmG treatment. They deliver a continuous supply of Gn-RH to the pituitary gland, which alters the production of hormones and allows the doctor to induce a follicle. FSH (follicle-stimulating hormone) is responsible for stimulating growth in the body.
- Bromocriptine (Parlodel): This medication inhibits the production of prolactin. Prolactin is a hormone that stimulates milk production during breastfeeding. Women with high levels of this hormone may experience irregular ovulation cycles and fertility problems outside of pregnancy and lactation.
Reducing the risk of getting pregnant multiple times
Multiple births can happen when fertility drugs are injected, such as twins or triplets. The chance of a multiple birth is lower with an oral fertility drug.
Treatment during pregnancy and careful monitoring can help reduce the risk of complications. The more fetuses there are, the greater the risk of premature labor.
If a woman needs an HCG injection to stimulate ovulation and ultrasound scans show that too many follicles have developed, it is possible to withhold the HCG injection. Couples may decide to go ahead with the pregnancy even if they desire it very strongly.
If too many embryos develop, some of them can be removed. Couples will have to weigh the ethical and emotional implications of this procedure.
Surgical procedures for women
If the fallopian tubes are blocked or scarred, surgical repair may make it easier for eggs to travel through.
Endometriosis may be treated through laparoscopic surgery. A small incision is made in the abdomen and a thin, flexible microscope with a light at the end called a laparoscope is inserted through it. The surgeon can remove implants and scar tissue, reducing pain and aiding fertility.
Assisted conception
There are various ways to become pregnant using assisted reproduction technologies.
IUI is a process where sperm is inserted directly into a woman's uterus.At the time of ovulation, a fine catheter is inserted through the cervix into the uterus. A sperm sample is placed directly into the uterus. The best specimens are selected.
The woman may be given a low dose of hormones that stimulate the ovaries.
In vitro fertilization is more commonly done when a man's sperm count, movement, or fertility are less than ideal. In some cases, it can also be helpful if a man has severe erectile dysfunction.
In-vitro fertilization (IVF)Sperm are placed with eggs that have not been fertilized in a petri dish. The embryo is then placed in the uterus for a possible pregnancy. Sometimes the embryo is frozen for future use.
Intracytoplasmic sperm injection (ICSI)In order to achieve fertilization during an IVF procedure, a single sperm is injected into an egg. The likelihood of fertility increases significantly for men with low sperm concentrations.
Sperm or egg donationIf you cannot conceive naturally, sperm or eggs can be received from a donor. In vitro fertilization usually uses donor eggs.
Assisted hatchingThe embryologist makes a small hole in the outer membrane of the embryo known as the zona pellucid. This opens up the embryo's ability to implant into the uterine lining, which improves the chance that the embryo will attach to or be born inside of the uterus.
This might be an option if IVF has not been effective and the woman's embryo growth rates have been poor. Sometimes, the woman's membrane becomes harder as she gets older. This can make it difficult for the embryo to implant.
Ejaculation may be achieved by electric or vibratory stimulation.Ejaculation is achieved with electric or vibratory stimulation. This can help a man who cannot ejaculate normally for example because of a spinal cord injury.
Surgical sperm aspirationThe sperm is removed from a part of the male reproductive tract, such as the vas deferens or epididymis.
Infertility can be primary or secondary.
Primary infertility is when a couple has not conceived after trying for at least 12 months using either birth control or fertility treatments.
Secondary infertility is when a person has previously conceived, but they are no longer able to conceive naturally.
Most people will visit a doctor if they have not gotten pregnant after 12 months of trying.
If the woman is over 35 years old, the couple may want to see a doctor sooner if they are trying to get pregnant. Fertility testing can take some time, and fertility starts to decline gradually in women in their 30s.
Some things you might want to know about conception and fertility.
A doctor can provide advice and help with preliminary assessments. It is best for a couple to see the doctor together.
The doctor may ask about the couple's sexual habits and make suggestions regarding these. Tests and investigations are available, but testing does not always reveal the root cause.
Infertility tests for men
The doctor will ask the man about his medical history, medications, and sexual habits. They will also do a physical examination. The doctor will check the man's testicles for lumps or abnormalities, and their penis for any abnormalities.
- Semen analysis: A sample may be taken to test for sperm count, motility, color, and quality. Sperm counts can fluctuate, so several samples may be necessary.
- A blood test will measure levels of testosterone and other hormones.
- Ultrasound: This can reveal problems such as ejaculatory duct obstruction or retrograde ejaculation.
- A chlamydia test can show if the infection has affected fertility, and antibiotics can treat it.
Infertility tests for women
A woman will have a physical examination and the doctor will ask about her medical history, medications she is taking, when her period usually starts, and any sexual habits she may have.
She will have a number of tests, including a gynecologic examination.
- Hormone test: This can measure hormone levels and whether a woman is ovulating.
- Hysterosalpingography is a procedure in which a woman's uterus is injected with fluid and X-rays are taken to determine if the fluid travels out of the uterus properly. If there is a blockage, surgery may be necessary.
- Laparoscopy: A thin, flexible tube with a camera at the end is inserted through the abdomen and into the pelvis. This allows a doctor to look inside the fallopian tubes, uterus, and ovaries. If there are signs of endometriosis, scarring from past surgeries, or blockages in the tubes, this can be seen during laparoscopy.
Other tests include:
- The ovarian reserve testing is to find out how many eggs are available after ovulation.
- Genetic testing is used to see if there is a genetic abnormality that is interfering with fertility.
- A pelvic ultrasound is used to produce an image of the uterus, fallopian tubes, and ovaries.
- A Chlamydia test may indicate that the person needs antibiotics to treat the infection.
- A thyroid function test may be affected by this change in hormone balance.
If you are unable to conceive, there can be some complications. For example, if you are under a lot of stress, this can lead to depression.
Some physical effects may result from treatment.
Ovarian hyperstimulation syndrome
The ovaries can produce too much fluid and result in too many follicles, the small sacs in which an egg develops.
Ovarian hyperstimulation syndrome (OHSS) is usually caused by taking medications to stimulate the ovaries, such as clomifene and gonadotrophins. It can also develop after in-vitro fertilization.
Symptoms include:
- bloating
- constipation
- dark urine
- diarrhea
- nausea
- abdominal pain
- vomiting
They are usually mild and easy to treat.
Occasionally, a blood clot may form in an artery or vein, liver or kidney problems may develop, and respiratory distress may occur. In severe cases, OHSS can be fatal.
Ectopic pregnancy
This is when an embryo implants outside the womb. If it remains in the fallopian tube, complications may develop, such as the rupture of the tube. This pregnancy has no chance of continuing.
Surgery is needed urgently, and unfortunately the tube on that side will be lost. However, a future pregnancy is possible with the other ovary and tube.
Women undergoing fertility treatment have a slightly higher risk of an ectopic pregnancy. An ultrasound scan can detect this type of pregnancy.
Coping mentally
It is difficult to predict how long the treatment will last and how successful it will be. It can be stressful for both partners, and their relationship may be affected.
Some people find that joining a support group helps them because they can talk to others who are in a similar situation.
If you are experiencing a lot of mental and emotional stress, it is important to tell a doctor. They may be able to recommend a counselor or other support system. Online support from organizations such as Resolve can be very helpful.
For couples who have difficulty becoming pregnant or choosing to have children later in life there are many options available now.
In 1978, the first baby was born as a result of in vitro fertilization. By 2014, over 5 million people had been born after being conceived through IVF.
Medical technology is constantly changing and becoming more available to more people, which is resulting in increased success rates for fertility treatments.
Paying for fertility treatment can be expensive, but there are programs that can help cover the costs.
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