What is infertility?

Infertility is the inability to get pregnant after one year of timed, unprotected sex. Approximately 85 percent of couples become pregnant within a year of trying. Women who achieve pregnancy but have experienced multiple miscarriages or stillbirths may also be classified as infertile.

Causes of infertility

Infertility can be caused by both the male and the female partners. Approximately 33 percent of infertility cases are caused by the man and another 33 percent by the female. In the remaining 33 percent of couples, the cause cannot be found.

Infertility is caused by a variety of factors including:

  • Advanced maternal age
    A woman’s ability to conceive decreases starting in her early 30s. As a woman ages, the number of eggs decreases rapidly, and the quality of her eggs also decreases. Most women are unable to conceive after the age of 45. Female age-related infertility is the most common cause of infertility.
  • Ovulation disorders
    Common conditions can impact your body’s ability to release an egg (ovulate) on a regular schedule. Conditions that can affect ovulation include polycystic ovary syndrome (PCOS) and hypogonadotropic hypogonadism (HH)
  • Tube blockage
    Women who have had a history of sexually transmitted diseases such as gonorrhea, chlamydia or pelvic inflammatory disease can increase their likelihood of having a blocked fallopian tube. If a woman’s fallopian tube becomes blocked, the egg cannot reach the sperm to be fertilized.
  • Uterine fibroids
    Uterine fibroids don’t cause infertility, yet a woman with submucosal uterine fibroids (fibroids that grow in the uterine cavity) has a more difficult time getting pregnant. Women who have the fibroids removed dramatically improve their chances of getting pregnant.
  • Endometrial polyps
    Women with endometrial polyps, growths in the uterus that grow from the lining, can experience infertility. Women who have these growths removed greatly increase their chance of getting pregnant.
  • Male factor infertility
    Abnormalities in a man’s semen motility or number of semen in an ejaculation may cause a couple to be infertile. Men may be treated with hormones or lifestyle changes, and if the semen quality and quantity does not improve, the couple may need to try more advanced fertility treatments.
  • Endometriosis
    Endometriosis, where endometrial lining grows on the outside of the uterine cavity, can affect a woman’s fertility by producing scarring and inflammation in the reproductive organs.
  • Unexplained infertility
    In approximately 15 percent of patients, the cause of a couple’s infertility is unknown. Fertility treatments can still be effective in cases of unexplained infertility.

Risks factors for infertility

Although risk factors can vary from men to women, there are several that impact both men and women including:

  • Age
    A woman’s fertility gradually declines after 30 years old and drops rapidly after 37. Older men are typically less fertile than younger men, and research shows their children also have higher rates of medical conditions or psychiatric disorders.
  • Use of tobacco
    Smoking decreases both women’s and men’s fertility. In men, it can lower their sperm count, and in women, it can cause miscarriage.
  • Drinking alcohol
    Women and men who drink alcohol are more likely to experience infertility. In men, it can reduce sperm motility and count, while in women, it can increase the chance for a birth defect in your child.
  • Being overweight or obese or being underweight
    Both being overweight and being overweight can increase your likelihood of experiencing fertility issues.

Risk factors that affect a women’s fertility include:

  • History of sexually transmitted diseases - which could lead to pelvic inflammatory disease and scarring in and around the reproductive organs.
  • Intense exercise routine - women who follow intense exercise regimens may experience infertility.
  • Tubal disease that was potentially caused by a STD may increase your likelihood of experiencing infertility.

Factors that affect a man’s fertility include:

  • Exposure to toxins such as lead, mercury, radioactivity or X-rays
  • Prescription medication
  • Genital exposure to hot temperatures such as in hot tubs, steam rooms, etc.
  • Hernia repair surgery
  • History of genital infection
  • Undescended testicles

Symptoms of infertility

Symptoms that may reveal an issue with a woman’s fertility include:

  • You suffer from amenorrhea
  • You have irregular periods
  • You have had treatment for cancer
  • You have pelvic inflammatory disease or endometriosis
  • You have prior fertility issues
  • You have had multiple miscarriages

Symptoms that may reveal issues with a man’s fertility include:

  • You have been previously diagnosed with low sperm count
  • Prior history of testicular, prostate or sexual issues
  • You have had cancer treatments
  • You have small testicles
  • You have been diagnosed or have signs of a varicocele (swelling in the scrotum)
  • You have a family history of infertility issues.

If you have any of the symptoms above, talk to your doctor about doing an evaluation for infertility. If you are under 35 and you have been trying to get pregnant for one year or if you are over 35 and have been trying to get pregnant for six months or longer but do not have any of the symptoms above, talk to your doctor as soon as possible.

Diagnosis of infertility

To diagnose infertility, your doctor will take a full medical history for both partners as well as ask questions to understand your sexual habits.

Tests that may help diagnose abnormalities in men:

  • Semen analysis
    A semen analysis can check for sperm motility (how they are moving) and the number of sperm in an ejaculation.
  • Hormone testing
    Hormone testing may be performed to test for testosterone and other male hormones in your body.
  • Genetic testing
    Genetic testing can help identify if a genetic defect is causing your infertility.
  • Imaging
    Your doctor may perform a variety of diagnostic imaging tests such as a transrectal or scrotal ultrasound or a test of the vas deferens.
  • Testicular biopsy

Fertility tests a woman may have to undergo include:

  • Ovulation testing
    A blood test that measures ovulation.
  • Hysterosalpingography
    A hysterosalpingography is a test that can determine if a fallopian tube blockage is causing your infertility. During this test, contrast dye is injected into the uterus while an X-ray is taken to examine it for any abnormalities.
  • Ovarian reserve testing
    During ovarian reserve testing, your doctor will be able to determine the quantity and quality of your eggs.
  • Hormone testing
    Hormone testing can determine if abnormal hormone levels are causing your reproductive issues.
  • Imaging tests
    A pelvic ultrasound can identify any abnormalities in the pelvic cavity that may be causing your fertility issues.

If a cause of your fertility has not been found, your doctor may order a more advanced test such as:

  • Hysteroscopy
    A hysteroscopy is a diagnostic test where a medical instrument is inserted through the vagina and into the uterus to evaluate the reproductive organs for abnormalities.
  • Laparoscopy
    A laparoscopy is minimally invasive surgery that may be used to diagnose endometriosis, identify blockages in the fallopian tubes or to find other abnormalities in the ovaries and uterus.
  • Genetic testing
    Genetic testing may be recommended if your doctor suspects a genetic issue is causing your infertility.

Treatment of infertility

Treatment for fertility will depend on a variety of factors including:

  • What is the cause of your fertility
  • Length of time you have been infertile
  • Your age as well as your partner’s age
  • Your preference and potentially your disposable income

During a clinic visit, your Mercy Health doctor will outline their recommended treatment plan, including success rates, estimated cost as well as what to expect during the process. Some patients may only need one therapy to achieve pregnancy, while other patients may need a more advanced treatment plan.

Treatment options for female infertility may include:

  • Medication
    Your doctor may recommend starting with medication that can stimulate ovulation. This treatment can be effective in patients who are infertile due to an issue with ovulation. There are a variety of medications that can stimulate ovulation. Talk to your doctor about the potential cost of each option.
  • Intrauterine insemination (IUI)
    An intrauterine insemination is a procedure where sperm are placed directly into the uterus around the time a woman’s ovary releases an egg to be fertilized. The timing of the IUI can be coordinated with fertility medications or with your normal cycle.
  • Surgery
    If you have scarring in the uterus, endometrial polyps or a uterine septum, you may need surgery to correct these issues before you can get pregnant.
  • In-vitro fertilization or IVF
    IVF is an assisted reproductive technology (ART) treatment. This is a fertility treatment that involves human and science intervention to help a woman achieve pregnancy. IVF involves stimulating a woman’s ovaries for collection. Once the eggs are collected outside a woman’s body, they are fertilized with a man’s sperm in a lab dish. After the embryos develop for a few days, they are implanted back into the woman for implantation.

Other procedures that may be used in an IVF cycle include:

  • Intracytoplasmic sperm injection (ICSI)
    ICSI is an ART procedure where a healthy sperm is injected directly into a mature egg. This process may be used if a man has poor semen quality or if prior IVF cycles failed.
  • Assisted hatching
    Assisted hatching is a technique that helps improve implantation rates. During this procedure, the doctor creates a small opening in the outer covering of the embryo to help it attach to the uterine lining.
  • Donor eggs or sperm
    If the quality of the egg or sperm is poor, IVF can be performed with donor eggs or sperm.
  • Gestational carrier
    If a woman is not able to sustain a pregnancy due to issues in the uterus, a couple can choose a healthy woman to carry their child. In this case, the couple’s embryo is implanted via IVF into the gestational carrier. The gestational carrier will carry the baby until delivery.

There are a variety of lifestyle modifications your doctor may recommend to help improve male fertility. Modifications may include:

  • Stop smoking
  • Eliminate alcohol
  • Lose weight
  • Exercise regularly
  • Avoid hot temperatures to the genitals
  • Discontinue certain medications

Other treatment options for male infertility may include:

  • Medications
    There are medications that can improve a man’s sperm count and quality.
  • Surgery
    A man may need surgery to repair a varicocele or reverse a sperm blockage.
  • Sperm retrieval
    A man may need to undergo sperm retrieval when IUI or ART is being planned.

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