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INFERTILITY: Causes, Diagnosis, Risks, And Treatments

INFERTILITY

Infertility becomes a condition when a couple tries to conceive but fails to get pregnant within one year. It may be due to a single cause in females or males. Also, it can be a combination of factors that may prevent a pregnancy from occurring or continuing.

What Causes Infertility?

A woman’s fertility can be affected by:

  • Problems with ovulation. This is how the egg leaves the ovary and travels to meet the sperm. Some women don’t ovulate every month.
  • Problems with the reproductive system. This can include issues on the cervix, fallopian tubes, uterus, or ovaries. In addition, this might consist of a blockage, growths, scarring, enlarged ovaries, or an abnormal cervix opening.
  • Early-onset menopause. This situation can occur before the age of 40. Also, it may be tied to an immune system disease, cancer treatments, or a genetic syndrome.
  • Diseases and disorders. These can include cancer, endometriosis, diabetes, pelvic inflammatory disease, autoimmune diseases, celiac disease, and lupus.
  • Smoking and substance abuse.
  • Delayed puberty or absence of a period.
  • I am underweight or overweight. Even too little or too much exercise can affect a woman’s pregnancy chances.
  • After age 35, conceiving can be more challenging for a woman.

A man’s fertility can be affected by:

  • Bacterial infection. An infection inside the man’s testicles could be a sexually transmitted infection.
  • Unhealthy or poorly functioning sperm. The quality of the man’s sperm and how quickly they move.
  • A varicocele. Vein’s enlargement inside the loose skin surrounding a man’s testicles causes a low sperm count.
  • Undescended testicles. This occurs when one or both of a man’s testicles remain in his abdomen. Testicles are supposed to drop from the abdomen into the scrotal sac at birth.
  • Retrograde ejaculation. When a man’s sperm goes into his bladder rather than outside the penis.
  • It was overheating the testicles. Wearing tight underwear or pants can overheat the testicles. Also, it can happen by using a hot tub for extended periods.
  • Sexual dysfunction. Erectile dysfunction can be part of this or problems ejaculating too soon or not at all.

How Is Infertility Diagnosed?

Before infertility testing, the doctor or clinic works to understand the sexual habits and may make recommendations to increase the chances of getting pregnant. In some infertile couples, unexplained infertility or no specific cause can also be found. In fact, infertility evaluation can be expensive and sometimes involves uncomfortable procedures with no guarantee of getting pregnant even after testing and counseling.

Tests for men

The test for male fertility requires that the testicles produce enough healthy sperm. The process includes ejaculating the sperm effectively into the vagina and traveling to the egg. This way an attempt to determine whether any of these processes are impaired.

There may be a general physical exam for the test, including examining the genitals. Below are specific fertility tests, including:

  • Semen analysis. This test includes the doctor asking for one or more semen specimens. Semen is generally obtained by masturbating or interrupting intercourse and ejaculating the semen into a clean container. A lab analyzes the semen specimen, and in some cases, urine may be tested for the presence of sperm.
  • Genetic testing. This test may determine whether there’s a genetic defect causing infertility.
  • Hormone testing. A blood test may determine the testosterone level and other male hormones.
  • Testicular biopsy. This may be performed to identify abnormalities contributing to a man’s infertility in special cases. Also, this is used to retrieve sperm for assisted reproductive techniques like IVF.
  • Imaging. Some cases may include imaging studies like brain MRI, transrectal or scrotal ultrasound, or a test of the vas deferens (vasography).
  • Another specialty testing. In rare cases, further specialty testing may be performed to evaluate the sperm’s quality, like assessing a semen specimen for DNA abnormalities.

Tests for women

For women, fertility relies on the ovaries that release healthy eggs. The reproductive tract must allow an egg to pass into the fallopian tubes and join with sperm for fertilization. And then, the fertilized egg must travel to the uterus and implant in the lining. 

The tests for female infertility try to determine if any of these processes are impaired. Also, they may need to undergo a general physical exam, which includes a regular gynecological exam. Below are the specific fertility tests used to diagnose women’s fertility:

  • Ovulation testing. In this process, a blood test measures hormone levels to determine whether a woman is ovulating.
  • Hysterosalpingography. It evaluates the condition of the uterus and fallopian tubes on which blockages or other problems can be determined. The X-ray contrast is injected and taken out into the uterus to determine if the cavity is normal and see if the fluid spills out of the fallopian tubes.
  • Ovarian reserve testing. This testing helps determine the number of eggs available for ovulation. Often it begins with testing the hormones early in the menstrual cycle.
  • Another hormone testing. The other hormone tests check levels of ovulatory hormones and pituitary hormones that control reproductive processes.
  • Imaging tests. A pelvic ultrasound can also be done to look for uterine or ovarian disease. Sometimes, a sonohysterogram can see uterus details that regular ultrasound can’t do.

Depending on the situation, rarely the testing may include hysteroscopy to look for uterine disease, wherein the doctor inserts a thin, lighted device through the cervix into the uterus to view any potential abnormalities. Also, a laparoscopy may involve making a small incision beneath the navel and inserting a thin viewing device to examine the fallopian tubes, ovaries, and uterus. However, not everyone needs to have all, or even many, of these tests before the cause of infertility is found. 

What Are The Risks Factors Contributing The Infertility?

For all genders:

The factors below increase the risk of infertility:

  • Age (over the age of 35 for women or over 40 for men).
  • Diabetes
  • Eating disorders, including anorexia nervosa and bulimia.
  • Excessive alcohol use
  • Over-exercising
  • Radiation therapy or other cancer treatments
  • Sexually transmitted diseases (STDs)
  • Smoking
  • Stress
  • Substance abuse
  • Weight problems (obesity or underweight)
  • Environmental toxins exposure, such as lead and pesticides

For female: 

The factors below increase the risk of infertility:

  • Blocked fallopian tubes
  • Kidney disease
  • Abnormal menstruation
  • Celiac disease
  • Pelvic inflammatory disease
  • Past ectopic (tubal) pregnancy
  • Sickle cell anemia
  • Thyroid disease
  • Uterine problems, including uterine fibroids, uterine polyps, and endometriosis
  • PCOS (Polycystic ovary syndrome), ovarian cysts, and primary ovarian insufficiency
  • Pituitary gland disorders, such as Cushing’s syndrome

For male:

The factors below increase the risk of infertility:

  • Injury to the scrotum or testicles
  • Genetic disorders, such as cystic fibrosis
  • Testicular cancer and treatments
  • Enlarged veins in the scrotum (varicocele), the sac that holds the testicles
  • Undescended testicles
  • Low testosterone (hypogonadism) or low testosterone
  • Retrograde ejaculation or premature ejaculation 
  • Anabolic steroids misuse
  • Exposures to high heat to testicles from tight clothing or frequent hot tubs and saunas

What Are Ther Treatments For Infertility?

Many advances have been made to diagnose and treat fertility problems. Both men and women must have a complete and accurate diagnosis to determine the best treatment options. Aside from surgery, below are some treatment options to treat infertility:

  • Intrauterine insemination (IUI). The treatment involves inserting a healthy sperm into the woman’s uterus around the time of ovulation. The procedure uses a long, narrow tube to insert the sperm and can only be done in the doctor’s office.
  • In vitro fertilization (IVF). The process of IVF requires stimulating the ovaries with hormones and removing eggs from the woman. And then, the eggs are fertilized with sperm in a laboratory. Once an embryo develops, it is placed into the woman’s uterus. 
  • Third-party-assisted ART. This procedure involves another person helping a couple get pregnant. They can help by donating eggs, donating sperm, or donating embryos. Also, they may serve as surrogate or gestational carriers. This means another person actually carries the baby instead.

The Bottom Line

Living with infertility is emotionally challenging. In addition, the disappointment of not becoming pregnant after trying each month can be hard on relationships. Key Wellness, PLLC offers services to diagnose the causes of infertility, what has been done, and review what needs to be evaluated further. They believe in keeping the process as simple as possible, but the goal is a baby.

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