What is it?
It is the inability to get pregnant after a year of regular unprotected sex. Both men and women can contribute to infertility. Women who can get pregnant but cannot stay pregnant may also be infertile (miscarriage).
- There are many different causes of infertility caused by one or both partners.
- This is usually a result of abnormal ovaries, uterus, fallopian tubes, and endocrine system. The most common is an ovulation disorder. Other causes include blocked fallopian tubes caused by pelvic inflammatory disease or endometriosis, birth defects affecting the uterus’ structure, and uterine fibroids (associated with repeated miscarriages).
- A woman’s infertility can be increased due to age (35 and older because there are fewer less healthy eggs), hormonal dysfunctions (severe emotional stress causing amenorrhea (absent periods), and polycystic ovary syndrome (PCOS) (a condition that makes it more difficult for ovaries to produce a mature egg)), thyroid problems, infections, cervical issues, uterus & fallopian tube issues, smoking, excessive alcohol use, and extreme weight gain or loss.
- This occurs when both man and woman have problems that cause infertility. It is not determined based on causes of infertility but the existence of infertility-linked issues with both partners. Combined infertility usually causes unexplained infertility.
- This is usually a result of problems in semen ejection, sperm count, or abnormal shape & movement of the sperm. The most common cause of male infertility is varicoceles, a varicose vein found in the scrotum. Other causes include the complete absence of sperm (azoospermia), low sperm count (oligospermia), abnormal sperm shape (teratozoospermia), problems with sperm movement (asthenozoospermia), completely immobile sperm (necrozoospermia), the sperm that’s dead, a block, previous vasectomy, or retrograde ejaculation (occurs when semen that’s supposed to be ejaculated through the urethra is redirected to the urinary bladder), problems with erections, or other sexual problems.
- A man’s infertility can be increased due to age (40 & over), obesity, smoking, excessive alcohol use & marijuana use, drugs, infections, testosterone or radiation (or both) exposure, regular exposure to high temperatures to the testes (such as when on a wheelchair, or frequent sauna or hot tub), certain medications (such as flutamide, cyproterone, bicalutamide, spironolactone, ketoconazole, or cimetidine), environmental toxins (including pesticides, lead, cadmium, or mercury), damage to the testicles, and endocrine problems.
- This happens when infertility problems in both partners cause certain issues that cannot be interpreted clearly. Approximately 10% of infertile women have unexplained infertility. This simply means that the commonly performed tests to diagnose the cause of infertility are all normal and do not define the reason for infertility.
The diagnosis is not too complicated but can occasionally be difficult (depending on partners’ health indicators). To get a complete grasp, both partners should undergo several tests. Medical history is essential to provide indications that cause infertility, such as lifestyle and other factors.
For the woman, tests are conducted to check for ovulation and any abnormalities in the uterus or fallopian tubes. Other tests are conducted to check hormone levels such as FSH (which helps control the menstrual cycle and stimulates the growth of eggs in the ovaries.), LH (a hormone stimulating ovulation, egg cell release from the ovary), prolactin (hormone to produce milk), and progesterone (a hormone regulating ovulation and menstruation.). This checkup is usually performed within one or two menstrual cycles.
For the man, tests include semen analysis to assess the quality & quantity of sperm and varicocele (which can increase the testes temperature that affects sperm factors (such as sperm count). Semen analysis is typically done at three and 6-month intervals after the operation to correct varicocele.
A reproductive endocrinologist (a doctor specializing in managing infertility, recurrent pregnancy loss, and spontaneous miscarriages) will suggest specific treatments based on infertility factors and the partners’ treatment choice after advising on different options.
Male infertility may be treated with medical, surgical, or assisted reproductive therapies. Intrauterine inseminations (IUIs) or in vitro fertilization (IVF) may be suggested to help with infertility. Varicocelectomy is a surgical procedure to treat varicocele. 50% of men who undergo varicocelectomy are fertile within the first year. It usually takes about six months to produce a sufficient quantity of new sperm for fertilization.
Female infertility may be treated with medications or surgery. Medications are taken either orally or injected to aid in stimulating ovulation. A woman who takes fertility drugs may increase her chances of having multiple pregnancies. Although, multiple pregnancies will lead to a higher risk of premature births. If fallopian tubes have a disease that causes infertility, surgery is performed to repair the tubes or remove blockages. However, These surgeries increase the risk of ectopic pregnancy (a pregnancy occurring outside the uterus). Other surgeries include surgery to remove patches of endometriosis that can double the chances for pregnancy and surgery be remove uterine fibroids, polyps, or scarring, but can affect fertility.
There are different types of treatment:
Intrauterine insemination (IUI) or artificial insemination
It is when specially prepared sperm are inserted into the woman’s uterus. In some cases, the woman is given medications to prompt ovulation before IUI. IUI is usually used to treat mild male factor infertility, unexplained infertility, cervical factor infertility, female infertility affected by mild endometriosis (layer of tissue covering the inside of the uterus, grows outside the uterus), and female infertility with ovulation problems.
Assisted Reproductive Technology (ART)
It is all fertility treatments where the eggs or embryos are handled outside the body. These procedures can involve using donor eggs, sperm, or embryos. If a woman can’t produce eggs, she’ll receive donor eggs. Donor eggs or sperm can also be used to prevent a genetic disease from being passed on to the baby. An infertile couple may use donor embryos created by couples in infertility treatment or created from donor sperm and donor eggs. The donated embryo is transferred to the uterus. This means that the child is not genetically related to either parent.
Gestational carrier: is when a woman uses her egg, fertilizes with her partner’s sperm, and then the embryo is placed inside another healthy woman’s uterus. Women with ovaries but no uterus may be able to use this procedure. It can also be an option for women who have serious health problems and shouldn’t get pregnant.
Preimplantation genetic diagnosis (PGD): is a genetic procedure used before implantation to identify genetic defects within an embryo created through in vitro fertilization and prevent certain diseases or disorders from being passed on to the child. Typically, the female or male (or both) have been genetically screened and selected as carriers.
There are different types of ART:
- In vitro fertilization (IVF): is the most common effective type of ART and is a procedure where fertilization occurs outside of the body. It consists of using a needle to remove a woman’s mature eggs from ovaries, combining them with sperm in the laboratory to create embryos. After a few days, they are transferred into the woman’s uterus or given to another woman. Embryos can also be frozen for a future transfer called frozen embryo transfer (FET). Preimplantation genetic testing identifies genetic disorders or chromosomal abnormalities in embryos created during an IVF cycle. One or more cells are biopsied from each embryo and sent for testing. The procedure is referred to as preimplantation genetic screening (PGS) and preimplantation genetic diagnosis (PGD).
- Intracytoplasmic sperm injection (ICSI): is a type of IVF usually used for male factor infertility. Sometimes it is also used for older couples or those with failed IVF attempts. A single sperm is injected into a mature egg and transferred into the uterus or fallopian tube in this procedure. An alternative referred to as “conventional” fertilization is when the egg and several sperm are placed in a petri dish (a shallow, circular, transparent dish with a flat cover) together. The sperm fertilizes an egg on its own.
- Gamete intrafallopian transfer (GIFT): involves harvesting eggs & sperm, combining 3-4 eggs with 200,000 sperm, and transferring them into the woman’s fallopian tube, so fertilization occurs naturally in the woman’s body. GIFT is considered a more invasive process than IVF. GIFT is also an option when intrauterine insemination (IUI) is unsuccessful and in cases where ovulatory disorders and cervical problems are causing infertility. In addition, GIFT can be a good option in cases where the male partner has fertility problems, such as a low sperm count.
- Zygote intrafallopian transfer (ZIFT): is a combination of IVF and GIFT. ZIFT fertilization occurs in the laboratory, similar to IVF. Then the young embryo is transferred to the fallopian tube instead of the uterus. Since the fertilized egg is transferred directly into the tubes, the procedure is also called tubal embryo transfer (TET). This is more successful than GIFT because there’s a higher chance of fertilization. This treatment can be performed for issues like tubal blockage or damage, anatomic problems with the uterus (severe intrauterine adhesions), and sperm not penetrating an egg.
- Tubal embryo transfer (TET): involves transferring more advanced embryos that are more advanced in development than those in ZIFT (cleaved embryos). The aim is to achieve fertilization in-vitro (in the laboratory) and replace the cleaved embryos in the Fallopian tube, the usual spot for fertilization. It is suitable only for women with at least one healthy Fallopian tube. This procedure is also used for women keen to have gamete intra-Fallopian transfer (GIFT). Still, it isn’t 100% effective for women who encounter problems in embryo transfers through the cervix.
Problems With Receiving Treatment
Availability and quality of infertility treatments are still a challenge in many parts of the world, especially developing countries. In addition, major barriers include lack of trained professionals, the availability of equipment and infrastructure, and the high costs of treatment medicines. These are factors even for countries actively managing infertility needs.
Governments need to recognize that infertility can usually be prevented and implement policies and programs such as fertility awareness in sexual education programs, promote healthy lifestyles (including prevention, diagnosis, and early treatment of STIs), prevent unsafe abortion complications, postpartum depression, abdominal/pelvic surgery, address environmental toxins causing infertility, and more.