What is Infertility?

If getting pregnant has been a challenge for you and your partner, you're not alone. Ten to 15 percent of couples in the United States are infertile. Infertility is defined as not being able to get pregnant despite having frequent, unprotected sex for at least a year. Infertility may be due to a single cause in either you or your partner, or a combination of factors that may prevent a pregnancy from occurring or continuing. Fortunately, there are many safe and effective therapies for overcoming infertility. These treatments significantly improve your chances of becoming pregnant.

Symptoms

Most couples achieve pregnancy within the first six months of trying. Overall, after 12 months of unprotected intercourse, approximately 90 percent of couples will become pregnant. The majority of the remaining couples will eventually conceive, with or without treatment.

The main sign of infertility is the inability for a couple to get pregnant. There may be no other obvious symptoms.

In some cases, an infertile woman may have abnormal menstrual periods. An infertile man may have some signs of hormonal problems, such as changes in hair growth or sexual function.

Causes

To become pregnant, the complex processes of ovulation and fertilization need to work just right. For some couples attempting pregnancy, something goes wrong along the way, resulting in infertility.

The cause or causes of infertility can involve one or both partners. In general:

In about one-third of cases, infertility is due to a cause involving only the male partner.

In another one-third of cases, infertility is due to causes involving both the male and female.

In the remaining one-third of cases, infertility is due to a cause involving only the female.

Causes of male infertility

A number of things can affect sperm count, ability to move (motility) or ability to fertilize the egg. The most common causes of male infertility include:

Abnormal sperm production or function due to various problems, such as undescended testicles, genetic defects or repeated infections.

Problems with the delivery of sperm due to sexual problems, such as premature ejaculation or painful intercourse (dyspareunia); health issues, such as retrograde ejaculation; certain genetic diseases, such as cystic fibrosis; or structural problems, such as blockage of the part of the testicle that contains sperm (epididymis).

General health and lifestyle issues, such as poor nutrition, obesity, or use of alcohol, tobacco and drugs.

Overexposure to certain environmental factors, such as pesticides and other chemicals. In addition, frequent exposure to heat, such as in saunas or hot tubs, can elevate your core body temperature. This may impair your sperm production and lower your sperm count.

Damage related to cancer and its treatment. Both radiation and chemotherapy treatment for cancer can impair sperm production, sometimes severely. The closer radiation treatment is to the testicles, the higher the risk of infertility. Removal of one or both testicles due to cancer also may affect male fertility.

Age. Men older than age 40 may be less fertile than younger men.

Causes of female infertility

The most common causes of female infertility include:

Fallopian tube damage or blockage, which usually results from inflammation of the fallopian tube (salpingitis). Chlamydia, a sexually transmitted infection, is the most frequent cause.

Endometriosis, which occurs when the uterine tissue implants and grows outside of the uterus, often affecting the function of the sperm, egg and ovaries, uterus, and fallopian tubes.

Ovulation disorders, which can prevent the ovaries from releasing eggs (anovulation). Underlying causes may include injury, tumors, excessive exercise and starvation. In addition, some medications can be associated with ovulation disorders.

Elevated prolactin (hyperprolactinemia), the hormone that stimulates breast milk production. High levels in women who are not pregnant or nursing may affect ovulation.

Polycystic ovary syndrome (PCOS), a condition in which your body produces too much of the hormone androgen causing ovulation problems. PCOS is also associated with insulin resistance and obesity.

Early menopause, which is the absence of menstruation and the early depletion of ovarian follicles before age 40. Although the cause is often unknown, certain conditions are associated with early menopause, including immune system diseases, radiation or chemotherapy treatment, and smoking.

Uterine fibroids, which are benign tumors in the wall of the uterus and are common in women in their 30s and 40s. Rarely, they may cause infertility by blocking the fallopian tubes. More often, fibroids interfere with proper implantation of the fertilized egg.

Pelvic adhesions, bands of scar tissue that bind organs after pelvic infection, appendicitis, or abdominal or pelvic surgery. This scar tissue formation may impair fertility.

Other causes in women

Medications. Temporary infertility may occur with the use of certain medications. In most cases, fertility is restored when the medication is stopped.

Thyroid problems. Disorders of the thyroid gland, either too much thyroid hormone (hyperthyroidism) or too little (hypothyroidism), can interrupt the menstrual cycle and cause infertility.

Cancer and its treatment. Certain cancers, particularly female reproductive cancers, often severely impair female fertility. Both radiation and chemotherapy may affect a womans ability to reproduce. Chemotherapy may impair reproductive function and fertility in men and women.

Other medical conditions. Medical conditions associated with delayed puberty or amenorrhea, such as Cushing;s disease, sickle cell disease, kidney disease and diabetes, can affect a female fertility.

Western Medicine Treatment

Treatment of infertility depends on the cause, how long you have been infertile, your age and your partner’s age, and many personal preferences. Some causes of infertility can't be corrected. However, a woman can still become pregnant with assisted reproductive technology or other procedures to restore fertility.

Treatment for men

Approaches that involve the male include treatment for:

General sexual problems. Addressing impotence or premature ejaculation can improve fertility. Treatment for these problems often is with medication or behavioral approaches.

Lack of sperm. If a lack of sperm is suspected as the cause of a mans infertility, surgery or hormones to correct the problem or use of assisted reproductive technology is sometimes possible. In some cases, sperm can be taken directly from the testicles or recovered from the bladder and injected into an egg in the laboratory setting.

Treatment for women

Fertility drugs are the main treatment for women who are infertile due to ovulation disorders. These medications regulate or induce ovulation. In general, they work like natural hormones, such as follicle-stimulating hormone (FSH) and luteinizing hormone (LH), to trigger ovulation. Commonly used fertility drugs include:

Clomiphene citrate (Clomid, Serophene). This drug is taken orally and stimulates ovulation in women who have polycystic ovary syndrome (PCOS) or other ovulatory disorders. It causes the pituitary gland to release more FSH and LH, which stimulate the growth of an ovarian follicle containing an egg.

Human menopausal gonadotropin (Repronex, Menopur). This injected medication is for women who don't ovulate on their own due to the failure of the pituitary gland to stimulate ovulation. Unlike clomiphene, which stimulates the pituitary gland, human menopausal gonadotropin (hMG) and other gonadotropins directly stimulate the ovaries. This drug contains both FSH and LH.

Follicle-stimulating hormone (Bravelle). FSH works by stimulating maturation of egg follicles the ovaries.

Human chorionic gonadotropin (Ovidrel, Pregnyl). Used in combination with clomiphene, hMG and FSH, human chorionic gonadotropin (HCG) stimulates the follicle to release its egg (ovulate).

Gonadotropin-releasing hormone analogs. This treatment is for women with irregular ovulatory cycles or who ovulate prematurely, before the lead follicle is mature enough, during hMG treatment. Gonadotropin-releasing hormone (Gn-RH) analogs suppress pituitary gland activity, which alters hormone production so that a doctor can
induce follicle growth with FSH.

Aromatase inhibitors. This class of medications, which includes letrozole (Femara) and anastrozole (Arimidex), is approved for treatment of advanced breast cancer. Doctors sometimes prescribe them for women who do not ovulate on their own and who have not responded to treatment with clomiphene citrate. These drugs are not approved by the Food and Drug Administration for inducing ovulation, and their effect on early pregnancy is not yet known.

Metformin (Glucophage). This oral drug is taken to boost ovulation. It is used when insulin resistance is a known or suspected cause of infertility. Insulin resistance may play a role in the development of PCOS.

Bromocriptine (Parlodel). This medication is for women whose ovulation cycles are irregular due to elevated levels of prolactin, the hormone that stimulates milk production in new mothers. Bromocriptine inhibits prolactin production.

Surgery

Depending on the cause, surgery may be a treatment option for infertility. Blockages or other problems in the fallopian tubes can often be surgically repaired. Laparoscopic techniques allow delicate operations on the fallopian tubes.

If you have endometriosis, your doctor may treat you with ovulation therapy, in which medication is used to stimulate or regulate ovulation, or in vitro fertilization, in which the egg and sperm are joined in the laboratory and transferred to the uterus.

Assisted reproductive technology (ART)

Each year thousands of babies are born in the United States as a result of ART. An ART health team includes physicians, psychologists, embryologists, laboratory technicians, nurses and allied health professionals who work together to help infertile couples achieve pregnancy.

The most common forms of ART include:

In vitro fertilization (IVF). IVF involves retrieving mature eggs from a woman, fertilizing them with a man's sperm in a dish in a laboratory, and implanting the embryos in the uterus three to five days after fertilization.

Electric or vibratory stimulation to achieve ejaculation. Electric or vibratory stimulation brings about ejaculation to obtain semen. This procedure can be used in men with a spinal cord injury who can't otherwise achieve ejaculation.

Surgical sperm aspiration. This technique involves removing sperm from part of the male reproductive tract, such as the epididymis, vas deferens or testicle. This allows retrieval of sperm if the ejaculatory duct is blocked.

ntracytoplasmic sperm injection (ICSI). This procedure consists of a microscopic technique (micromanipulation) in which a single sperm is injected directly into an egg to achieve fertilization in conjunction with the standard IVF procedure.

Assisted hatching. This technique attempts to assist the implantation of the embryo into the lining of the uterus by opening the outer covering of the embryo (hatching).

ART works best when the woman has a healthy uterus, responds well to fertility drugs, and ovulates naturally or uses donor eggs. The man should have healthy sperm, or donor sperm should be available. The success rate of ART is lower after age 35.

Complications of treatment

Certain complications exist with the treatment of infertility. These include:

Multiple pregnancy. The most common complication of ART is a multiple fetus pregnancy. Generally, the greater the number of fetuses, the higher the risk of premature labor. Babies born prematurely are at increased risk of health and developmental problems.

The number of quality embryos kept and matured to fetuses and birth ultimately is a decision made by the couple. If too many are conceived, the removal of one or more fetuses (multifetal pregnancy reduction) is possible to improve survival odds for the other fetuses.

Ovarian hyperstimulation syndrome (OHSS). If overstimulated, a womans ovaries may enlarge and cause pain and bloating. Mild to moderate symptoms often resolve without treatment, but severe cases, marked by abdominal swelling and shortness of breath, require emergency treatment. Younger women and those who have polycystic ovary syndrome have a higher risk of developing OHSS than do other women.

Bleeding or infection. As with any invasive procedure, there is a risk of bleeding or infection with assisted reproductive technology.

Low birth weight. The greatest risk factor for low birth weight is a multiple fetus pregnancy. In single live births, there may be a greater chance of low birth weight associated with ART.

Birth defects. There is some concern about the possible relationship between ART and birth defects. More research is necessary to confirm this possible connection. Weigh this factor if you are considering whether to take advantage of this treatment. ART is the most successful fertility-enhancing therapy to date.

Adopted from maoclinic.com