Medical Centric

INFERTILITY

Men's Health, Sexual Health, Women's Health / By

INFERTILITY

Infertility in human is the inability to conceive after 12 months of unprotected sexual intercourse without the use of birth control.

  • Infertility could also mean the inability to carry a pregnancy to full time. This means a woman gets pregnant but keeps having miscarriages or stillbirths.
  • About 20-35% of infertility cases stems from the woman, 20-30% is traced to the man and the rest of the time, it is caused by combined problems in both partners or due to unknown causes.
  • 8-12% of couples worldwide experience infertility problems.
  • Often times, the factors that cause infertility in couples are present at birth, and at times they develop later in life.

CAUSES

IN MEN

The milky juice that a man releases during ejaculation is called a semen. This semen is made up of sperm and fluid. The sperm is produced in the testicle and the fluid comes from the prostate gland, the seminal vesicle, and some other sex glands. During ejaculation, the semen is released through the penis and the sperm is transported towards the egg by the fluid. Infertility in men arises when there is:

  • Low sperm count i.e. a low amount of sperm is ejaculated. A sperm count that is below 15 million is considered small.
  • Abnormal sperm i.e. the shape of the sperm is unusual making it difficult to move and fertilize an egg.
  • Low sperm motility i.e. the sperm cannot swim well and therefore cannot reach the egg.

The above problem can result from:

  • Medical conditions such as diabetes, cystic fibrosis, mumps, hypospadias.
  • Sexually Transmitted diseases such as gonorrhea, HIV, chlamydia.
  • Unhealthy habits such as excess alcohol consumption, illegal drug use, anabolic steroid use (popular with athletes and bodybuilders), smoking and testosterone supplementation can seriously reduce sperm count and motility.
  • Exposure to chemicals such as lead and pesticides.
  • Overheated testicles which can be caused by varicocele (a condition in which the veins on a man’s testicles are largely making them overheat), undescended testicles, frequent exposure to heat that may result from wearing tight clothes, working in hot environment, the use of hot tubs or saunas.
  • Age
  • Overweight or obesity
  • Mental stress especially if it leads to reduced sexual activity
  • Cancer treatment such as chemotherapy and radiation.
  • Structural problems such as injury to the reproductive organs or blockage in the testicles.

IN WOMEN

  • To get pregnant, an egg must be released from one of the ovaries,
  • The egg must fertilize,
  • The fertilized egg must go through a fallopian tube towards the womb,
  • And attach to the inside of the uterus.

Infertility in women arises when there is:

Ovulation disorder, which affects the release of eggs from the ovaries and is the most common cause of infertility in women.

An ovulation disorder can result from:

  • Polycystic ovary syndrome (PCOS)
  • Premature ovarian failure, where the ovaries stop functioning or fail before age of 40
  • Poor egg quality
  • Thyroid problems
  • Hyperprolactinemia
  • Chronic conditions such as AIDS or cancer

Uterus or Fallopian tube abnormalities, this can prevent the egg from moving from the ovary down to the womb.

This abnormality may be due to:

  • Surgery, which includes pelvic or cervical surgery.
  • Endometriosis, a condition where endometrial tissue lining the uterus grows outside of the uterus.
  • Submucosal fibroids, where benign tumors occur in the uterine wall.
  • Sexually transmitted infections such as chlamydia can damage the fallopian tube

Medical conditions such as lupus, poorly controlled diabetes, amenorrhea (absence of menstruation), and genetic abnormalities

Age

Alcohol use

Being overweight or underweight

Smoking

Exposure to certain chemicals such as lead and pesticides

SYMPTOMS

The major symptom of infertility is the inability to conceive

At times, an infertile woman may have irregular or absent menstrual periods.

DIAGNOSIS AND TREATMENT

Diagnosis in men may include:

  • Semen analysis, where your semen is collected for analysis in the lab
  • Blood test, to determine the level of testosterone or any other male hormones
  • Genetic testing to check for any genetic defect that may be causing infertility.

Diagnosis in women may include:

  • Blood test, to measure hormone levels to determine ovulation
  • An imaging test, to look for uterine or fallopian tube diseases
  • Ovarian reserve testing, to determine the quality and quantity of eggs available for ovulation

Hysterosalpingography, to check the condition of the uterus and fallopian tubes and look for blockages and other problems.

TREATMENT

Treatment in men:

  • Improving lifestyle and behaviors
  • Medications
  • Surgery
  • Sperm retrieval

Treatment in women:

Fertility drugs may be used to regulate or induce ovulation

The blocked fallopian tube may be repaired by surgery making it easier for eggs to pass through

Intrauterine insemination, at the time of ovulation, healthy sperms are placed directly in the uterus. This procedure is done when a man has a low sperm count, low sperm motility or when the cause of infertility is unknown.

Assisted Reproductive Technology, a procedure where eggs are surgically removed from a woman’s ovaries, are combined with sperm in the laboratory and are returned to the woman’s body or donated to another woman. The most common type is the In vitro fertilization (IVF).

Other types include:

Assisted Hatching

Gestational Carrier

Intracytoplasmic sperm injection (ICSI)

Donor eggs or sperm