Infertility

What is infertility?

Infertility is a problem of the
reproductive system. It affects the body’s ability to reproduce. It could be caused by a
problem with the man’s system, the woman’s system, or both. For a pregnancy, these must
happen:

  • The man must make healthy sperm.
  • The woman must make healthy eggs.
  • The fallopian tubes must be open to let the sperm to reach the egg.
  • The sperm must be able to fertilize the egg.
  • The fertilized egg must implant in the uterus.
  • The embryo must be healthy.

Infertility is not just a woman’s
concern. Half the time, a male factor causes or is a part in the problem. Many couples
have more than 1 factor that plays a role.

In a few cases, a cause for infertility can’t be found.

If you think you are not able to
get pregnant, see your healthcare provider soon. The age of the woman and how long you
have been trying to get pregnant may affect treatment.

What causes infertility?

Many things can cause infertility.
It can be a problem in the female reproductive system. It can be a problem in the male
reproductive system. Or it may be both. Below are things that can affect fertility.

Female factors

  • Ovulation
    problems.
    The woman doesn’t make enough hormones to develop, mature, and release a
    healthy egg.
  • Anatomical problems. A problem with the woman’s anatomy can
    prevent the egg and the sperm from meeting. The most common problem is blocked
    fallopian tubes. Other problems may include scar tissue in the pelvis from past
    surgeries or infections.
  • Endometriosis.The tissue that lines the uterus implants outside the uterus in this
    condition. It usually implants on other reproductive organs or in the belly. Each
    month, this misplaced tissue reacts to the hormone changes of the menstrual cycle.
    This means it builds up, breaks down, and bleeds. This can cause scar tissue to
    form and affect fertility.
  • Birth
    defects.
    Certain birth defects can affect fertility. One of the most common problems
    happens when a female baby is exposed to DES (diethylstilbestrol) in her mother’s
    womb. Pregnant women in the 1940s and 1950s took this medicine to prevent
    pregnancy loss. But it was found to cause problems with the development in the
    uterus and cervix in the baby. This would later hurt her ability to get pregnant
    as a woman.
  • Infection.Pelvic inflammatory disease (PID) is caused by a type of bacteria such as
    gonorrhea and chlamydia. PID can affect the uterus, fallopian tubes, the ovaries,
    or all of these. It causes scar tissue to grow between organs. This leads to
    ongoing pelvic pain and raises the risk for an ectopic pregnancy. This is when the
    fertilized egg implants outside the uterus.
  • Immune
    system problems.
    A problem with a woman’s immune system can lead to pregnancy loss. Antibodies
    in a woman’s system can fail to recognize a pregnancy. Or there may be an abnormal
    immune response to the pregnancy. Women can also develop antisperm antibodies,
    which attack and destroy sperm.

Male factors

  • Low or no
    sperm production.
    Without enough healthy sperm, the chance of fertilization is decreased.
  • Abnormal
    sperm function.
    Sperm must be able to swim and penetrate the egg.
  • Varicocele.This is a condition in which varicose veins develop around the testes. It’s a
    very common cause of infertility in men. It’s treated with surgery.
  • Hormone
    disorders.
    Hormone problems can affect sperm production and fertility.
  • Chromosome defects.Some defects are linked to male infertility.
  • Birth
    defects.
    Problems in a man’s reproductive system can happen in the womb. Some birth
    defects are due to a man’s exposure to DES (diethylstilbestrol) taken by his
    mother during pregnancy.
  • Immune
    system problems.
    A man may have antisperm antibodies. These attack
    and destroy sperm.

These lifestyle habits can also affect sperm quality and function:

  • Use of recreational drugs such as marijuana or cocaine
  • Heavy alcohol use
  • Smoking
  • Taking certain medicines
  • Too much heat to the genital area, such as using a hot tub

What are the symptoms of infertility?

A couple is defined as infertile if conception does not happen in these cases:

  • After 1 year of unprotected sex
  • After 6 months in women over age 35
  • If there are known problems causing infertility

How is infertility diagnosed?

To diagnose infertility, both the man and the woman are tested.

Some healthcare providers can do a
basic infertility evaluation. But, many causes of infertility are best treated by a
reproductive endocrinologist. This is an OB/GYN who has had education and training in
infertility. He or she should be certified with the American Board of Obstetrics and
Gynecology.

The healthcare provider will test
both partners to find the cause of infertility. The healthcare provider is looking for
answers to these questions:

  • Is the woman ovulating regularly?
  • Is the man making healthy sperm?
  • Are the woman’s egg and the man’s
    sperm able to unite and grow normally?
  • Are there any problems with implantation?
  • Is the woman able to maintain the
    pregnancy?

The below tests are often part of
the basic testing for infertility.

Both partners

Female

  • Physical
    exam.
    You will have a full physical exam. This includes a Pap test and testing for
    infections.
  • Ovulation
    evaluation.
    You can check to see if you are ovulating by keeping a
    basal body temperature chart. This is your morning body temperature. Other
    ovulation prediction methods use urine samples.
  • Hormone
    testing.
    Hormone testing may be advised. Some hormones increase and decrease at
    various times in the monthly cycle.
  • Ultrasound.This can show the follicles on the ovaries. These are the sacs that contain
    the developing eggs. It can also show the thickness of the uterine tissues. Your
    healthcare provider can also check for problems such as ovarian cysts or
    fibroids.
  • X-rays.
    A hysterosalpingogram may be advised. For this test, a dye is injected
    into the cervical opening to see inside the uterus. This lets the radiologist see
    if the fallopian tubes are open.

Male

A semen sample is taken and tested in the lab. The healthcare
provider can:

  • Check the sperm count
  • Test sperm motility
  • Check the shape of sperm
  • Assess the ejaculate liquid

Other tests may be done that
test the sperm’s ability to penetrate the egg, as well as male hormone testing.

Men may need to see a urologist
for more testing.