Undeniably, infertility is a heartbreaking challenge for many couples. It impacts both partners in many ways—psychological, physical, mental, spiritual, and medical detriments. It occurs when conception does not happen even after prolonged efforts.
Causes of infertility are hormonal imbalances, structural issues, medical conditions, and lifestyle factors. Understanding these causes, diagnoses, and treatments is essential to finding the right solution. So, read on to today’s comprehensive guide to overcoming infertility and achieving your dream of parenthood.
What Is Infertility? A Quick Overview!
Infertility is a condition in which women can’t get pregnant after one year or more of trying to conceive despite having frequent, unprotected sex. But statistically, 70% of couples trying to conceive become successful within the first six months, and over 80% of women get pregnant within 12 months.
Infertility can occur due to male, female, or unexplained factors. Some causes of infertility are preventable, and in cases, treatment is required to treat infertility.
| Fact: In the United States, almost 19% of married women [it equates to 1 in 5] aged 15 to 49 with no prior births are unable to get pregnant after one year of trying. 26% of women, or 1 in 4 women of this age, experience challenges to conceive or carry the pregnancy to term.About 1 in 20 couples, or approximately 5%, struggle with secondary infertility. Approximately 48 million couples and 186 million individuals around the world live with infertility. |
What Are The Possible Causes Of Female Infertility?
That’s a fact; conception and then carrying the pregnancy to the term is a complicated process. Many problems can arise in this process that lead to infertility in females. Below is the list of causes of infertility in the case of females; however, it doesn’t mean it is all-inclusive.
I) Failure To Ovulate
This is the most common cause of female infertility, and it affects 40% of women with infertility issues. Ovulation failure can happen for several reasons.
- Ovarian or gynecological conditions. For instance, polycystic ovary syndrome (PCOS) or primary ovarian insufficiency (POI).
- Diminished ovarian reserve.
- Endocrine disorders like thyroid disease or problems with the hypothalamus.
II) Problems In The Menstrual Cycle
The menstrual cycle prepares the female body for pregnancy. Problems in this menstrual cycle can lead to infertility in most women. Typically, the menstrual cycle includes several phases. Problems with any of the phases can make it difficult to get pregnant or lead to infertility.
III) Reproductive System Structural Problem
Structural problems in the reproductive system mean the presence of abnormal tissues in the uterus or fallopian tubes. When the fallopian tubes are blocked due to these tissues, eggs can’t reach the uterus from the ovaries. Plus, sperm can’t reach the eggs. As for the uterus, its structural problem that can interfere with the implantation can also cause infertility.
Some reproductive system structural problems include
- Endometriosis: Tissues that normally line the uterus are found in other places. Such as in the fallopian tubes.
- Uterine fibroids: Growths that appear around the wall or within the uterus.
- Polyps: Polyps are noncancerous growths on the surface of the uterus. It interferes with fertility and makes it difficult to get pregnant.
- Scarring: Scarring can happen due to previous injuries, infections, or surgery. It increases the risk of miscarriage and may also lead to infertility.
- Unusually shaped uterus: If a woman has an unusually shaped uterus, it affects the implantation and interferes with carrying the pregnancy to term.
IV) Cervical Mucus Problems
During the ovulation period, the mucus membrane of the cervix naturally becomes thinner. It allows the sperm to swim through it more easily. However, if there is any problem with the mucus membrane, it can make it harder for the woman to conceive.
V) Pelvic Inflammatory Disease (PID)
Pelvic Inflammatory disease or PID is an infection of the upper female genital tract. It includes the womb, ovaries, and fallopian tubes. PID can damage the fallopian tube and cause scar tissue formation. Ultimately, it makes it virtually impossible for the egg to travel through the womb. PID is often caused by a sexually transmitted disease.
VI) Medicine And Drugs
Some medications and drugs can cause side effects and affect the fertility of women. Some of the common ones include
- NSAIDS or steroidal anti-inflammatory drugs: Long-term use of NSAIDS like ibuprofen or aspirin can affect fertility.
- Neuroleptic medicines: Neuroleptic medicines used to treat psychosis cause missed periods and infertility.
- Spironolactone: It is a drug used to treat edema. It can temporarily affect women’s fertility.
VII) Sterilization
Some women often choose sterilization procedures to prevent conception. Sterilization procedures block the fallopian tubes. These procedures are reversible. But in some cases, a woman may not be able to have a child even after having her sterilization reversed.
VIII) Autoimmune Disorders
An autoimmune disorder occurs when the immune system of the body attacks its own tissues it would normally ignore. Conditions like lupus, Hashimoto’s, and rheumatoid arthritis affect fertility.
The exact reason is still not understood. However, it is thought that inflammation in the uterus or placenta or medications used to treat these conditions can be the reason.
Statistics on Causes Of Infertility
The World Health Organization performed a large multinational study to determine the causes of infertility. The study shows that in 37% of infertile couples, female causes are major. Plus, in 35% of cases, both male and female factors played a role, and infertility was caused by males in 8% of cases. For women, the most common causes of infertility include-Ovulatory problems: 25%Endometriosis: 15%Pelvic adhesions: 12% Tubal blockage: 11% Other tubal/uterine abnormalities: 11% Hyperprolactinemia: 7% |
What Leads To Infertility In Men?
Check out the cause that leads to infertility in men.
I) Abnormal semen and sperm
Infertility in males is often caused by the poor quality of semen that carries sperm. Possible causes for the abnormal semen include:
- Very low sperm count or no sperm at all
- The sperms are not moving properly. It makes fertilization difficult.
- Sperm can also sometimes be in an abnormal shape. It makes it harder to move and fertilize the eggs.
In some cases, the exact cause of the abnormal semen and sperm can be unknown. However, studies suggest that high scrotum temperature can affect sperm quality.
II) Testicular problems
The testicle produces sperm and stores it. If there is any issue in the testicles, it affects the fertility in men and the quality of the semen. Some testicular problems are as follows.
- Infections in the testicles
- Testicular cancer
- Testicular surgery
- Congenital defect (defects in the testicles from birth)
- Undescended testicles (when one or both testicles do not descend to the scrotum)
- Injury in the testicles
III) Sterilization
Some men who don’t want any further children often choose a vasectomy. In the vasectomy procedure, the vas deferens (the tube that carries sperm out of the testicles) are cut and sealed. So, there is no sperm in the semen. A vasectomy surgery can be reversed. But in some cases, reversal may not be successful.
IV) Ejaculation disorders
Ejaculation disorders, like premature ejaculation, delayed ejaculation, retrograde ejaculation, or anejaculation, prevent the normal release of sperm. Moreover, these ejaculation disorders hinder the proper delivery of sperm to the female reproductive tract, making it impossible for sperm to reach the egg and fertilize it.
V) Hypogonadism
The male hormone testosterone plays a major role in sperm production. In Hypogonadism, testosterone levels are too low to produce sperm. It can be caused by tumors or illegal drug use. In rare cases, Klinefelter syndrome can also be the reason behind infertility. It is a condition with an extra female chromosome.
VI) Medicines and drugs
Drugs and medicines can also cause infertility in males. Some of them include
- Sulfasalazine: It temporarily reduces sperm count. However, it can become normal after stopping the drugs.
- Anabolic steroids: Their long-term use reduces sperm count and mobility.
- Herbal remedies: Some herbal remedies like Tripterygium wilfordii affect the size of the testicles and sperm production.
- Chemotherapy: It markedly affects sperm production.
- Illegal drugs: Cocaine and Marijuana can affect the semen quality.
What Is Secondary Infertility?
In simple words, secondary infertility is when women struggle to get pregnant after a successful first pregnancy. To be classified as secondary infertility, the previous birth of the child must have occurred without any assisted fertility treatments or medications.
Typically, healthcare providers diagnose secondary infertility when a woman can’t conceive for six months to a year.
What Causes Secondary Infertility?
There are many reasons for a woman to struggle with secondary infertility. Common reasons include-
- Age
- Complications from the first or previous pregnancy
- Complications from the previous surgery
- Impaired eggs or impaired sperms
- Increase in body weight or BMI (Body Mass Index)
- Medications or due to some medical conditions
- Sexually transmitted infections
- Drinking alcohol or smoking
Unexplained Infertility
Unexplained infertility is diagnosed when no clear causes are found despite all the infertility testing. Actually, it does not mean there is no cause at all—it is just that the causes remain undetected.
According to the American Society for Reproductive Medicine (ASRM), about 30% of couples who are struggling to conceive have unexplained infertility diagnosed. There can be a natural barrier, causing the sperm not to reach the egg to embryo implantation. Moreover, some issues, like egg and sperm quality, are hard to assess.
However, despite all this, treatments like IVF can markedly enhance the success rate of pregnancy. The National Institute for Health and Care Excellence (NICE) recommends IVF treatment for women with unexplained infertility who have not conceived for 2 years of having regular unprotected sex.
Risk Factors for Infertility In Men And Women
Infertility affects both men and women, and it can be influenced by a number of factors. Let’s have a quick overview of the risk factors of infertility in men and women.
Risk Factors for Infertility in Women
Some factors affect how easily women can ovulate, get pregnant, or deliver a child. Some of the risk factors include.
- Age: Women in their late 30s and older are less fertile than women in their early 20s.
- Endometriosis
- Hormone imbalance
- Chronic diseases. Such as lupus, diabetes, hypertension, arthritis, and asthma
- Too much body fat or very low body fat
- Sexually transmitted diseases
- Mother has taken DES during pregnancy
- Fallopian tube disease
- Multiple miscarriages
- Pelvic surgery
- Fibroids
- Abnormalities in the uterus
- Environmental factors, including smoking, drinking alcohol
- To exposure to workplace hazards or toxins.
Risk Factors Of Infertility For Men
Infertility is not a problem solely for women. Researchers believe that risk factors for declining male fertility are environmental during the century, including pollution, reduction, and drug abuse.
Environmental Risk Factors For Male Infertility
- Workplace exposure to toxic substances. For instance, lead, cadmium, mercury, ethylene oxide, vinyl chloride, radiation, or X-rays.
- Smoking cigarettes or marijuana. Excessive drinking of alcohol
- Prescription medications for conditions like ulcers or psoriasis.
- Exposure to diethylstilbestrol (DES) before birth.
- Frequent exposure of genitalia to high temperatures. It may include hot baths, whirlpools, or steam rooms.
Medical Conditions Affecting Male Fertility
- Hernia repair
- History of prostatitis
- History of genital infection
- Mumps after puberty
- Sexually transmitted infections (STIs) like chlamydia
Can Infertility Be Cured?
Yes, infertility can be cured. However, that depends on the cause. In 85% to 90% of cases, infertility can be treated through lifestyle modification and conventional medical therapies, such as medication or surgery.
When Should You Seek Help For Infertility?
If you are under 35 and have not gotten pregnant after a year of trying, you should consult with a doctor. In case you are 35 to 39, you should seek help after six months of trying. But women who are 40 years old should not wait more than a few months.
Fertility tests take time, and the fertility of females decreases with age. A 25-year-old woman has a 25-30% chance of pregnancy per cycle. But it drops below 5% by age 40. So, it is better to make an appointment early.
How Is Infertility Diagnosed?
Now, let’s check out what tests are done to diagnose infertility in males and females.
How Is Infertility Diagnosed In Women?
First, your doctor will review your medical and sexual history. As you know, female fertility relies on ovulating healthy eggs, hormonal signals, and proper eggs. Tests are done to identify any issues in any of these steps.
I) Physical exam
In females, the healthcare provider may:
- Measure the weight to see if the woman has a healthy body mass index.
- Examine the pelvic area to check for any lumps, infections, or tenderness that can be a sign of ovarian tumors or fibroids.
- A blood test is done for a hormone called progesterone to check whether you’re ovulating. If you have irregular menstruation, the test is done to measure the gonadotropin hormone. These are the hormones that stimulate the ovaries to produce eggs.
II) X-ray Hysterosalpingogram (HSG)
Here, an X-ray tracks an injected dye as it moves through the fallopian tubes. The test is done to check for any blockages in the fallopian tube.
III) Sono Hysterosalpingogram (Sono-HSG)
During the Sono-hysterosalpingogram (ultrasound hysterosalpingography) procedure, your provider injects the saline through the cervix into the uterine cavity to visualize the uterus and fallopian tubes. This ultrasound exam helps to diagnose infertility and other reproductive issues.
How Is Infertility Diagnosed In Men?
To find out the cause of infertility in males, tests are included:
I) Semen analysis
Semen analysis is done to find out the problem with the sperm. For instance, checking out whether there is a low count of sperm or sperm that are moving properly.
II) Chlamydia test
Here, a sample of urine of a male is tested to check for Chlamydia. That is because Chlamydia can affect fertility. If your Chlamydia test is positive, your healthcare provider will prescribe antibiotics to treat infertility.
III) Scrotal ultrasound
A scrotal ultrasound can also be done to find varicoceles or other testicular problems.
IV) Blood test
Blood tests can assess the thyroid or other hormone levels. A genetic blood test is done to check for chromosomal abnormalities.
How Is Infertility Treated?
If you are struggling with fertility problems, what treatment you will get will depend on what is causing the problem.
Generally, there are three types of fertility treatment: medicines, surgical procedures, and assisted reproductive technology (ART). Below is an overview in this regard for a quick insight.
1. Medicines
The most common fertility medicines include-
- Clomifene: It encourages ovulation (the monthly release of an egg) in women who do not regularly ovulate or not at all.
- Tamoxifen: It is an alternative to Clomiphene used to treat ovarian problems.
- Metformin: Metformin is useful for women suffering from polycystic ovary syndrome.
- Gonadotropins: Stimulate ovulation in women and treat infertility in men.
- Gonadotropin-releasing hormone and dopamine agonists: They also stimulate ovulation in women.
2. Surgical Procedures
Some surgical procedures are followed to investigate infertility problems and treat them. For instance,
I) Fallopian tube surgery
If your fallopian tubes are blocked or scarred, you may need surgery to repair them. This surgery removes the scar tissue and allows the eggs to pass through more easily. However, the success of the procedures depends on the severity of the damage.
II) Endometriosis, fibroids, and PCOS
Endometriosis occurs when tissue similar to the lining of the womb grows outside of the uterus. In this case, laparoscopic surgery destroys or removes cysts. It can also treat submucosal fibroids (small growths inside the womb). As for polycystic ovary syndrome (PCOS), laparoscopic ovarian drilling can be an option if the ovarian medications don’t work out.
III) Correcting an epididymal blockage and surgery to retrieve sperm
Surgical sperm extraction treats infertility as it retrieves the sperm when blockages prevent natural release. Generally, it is done under local anesthesia and outpatient procedures.
Here, sperm is collected, assessed on the same day, and frozen for future use. This option helps men with blockages, missing vas deferens, or failed vasectomy reversals.
3. Assisted Reproductive Technology
Infertility in men and women can also be treated with assisted reproductive technology.
- Intrauterine Insemination (IUI): Sperm is collected and then inserted directly into the uterus during ovulation to enhance the chances of pregnancy.
- In-vitro Fertilisation (IVF): In this process, sperm and eggs are combined in the lab. After 3 to 5 days, the fertilized eggs are placed in the uterus.
- ZIFT (Zygote Intrafallopian Transfer): Unlike IVF, where fertilized eggs are placed into the uterus, in ZIFT, fertilized eggs are placed into the fallopian tube. Moreover, ZIFT requires an extra surgical procedure named laparoscopy to transfer the fertilized eggs into the tube.
- GIFT (Gamete Intrafallopian Transfer): In GIFT, sperm and eggs are placed directly into the fallopian tube. This procedure allows the fertilization to occur naturally within the body, not in the lab like IVF or ZIFT.
Final Words
Infertility is a challenging journey. However, understanding the causes of infertility can let you take control of your options. It is always best for both partners to visit the healthcare provider. That is because infertility can affect either one or both. Trying to conceive is an emotional process. So, of course, it is important to support each other as much as possible.
FAQs
Now, at this point of the discussion, let’s try to address some of your common concerns through the queries that are frequently asked by people.
What causes weak fertility?
Weak fertility or infertility can arise from a number of reasons. It includes age, smoking, alcohol, obesity, and hormonal imbalance. Moreover, structural problems in the reproductive system or exposure to environmental toxins can lead to infertility.
How can I fight infertility?
You will need a comprehensive approach to address infertility. For instance, you will need to change your lifestyle and get medical treatment. In some cases, you may also need potentially assisted reproductive technologies (ART) like IVF.
Can stress cause infertility?
Well, stress alone does not affect the fertility of humans. However, stress hormones like cortisol can interfere with the signaling between the brain and ovaries. It can trip up ovulation.
How does sleep affect fertility?
Sleep can affect fertility by influencing hormone production in both men and women. Research shows that women who sleep less than seven hours a day are 15% less likely to get pregnant compared to women who sleep seven to eight hours a day. As for men, little sleep wrecks overall sperm quality, and sleeping too long decreases sperm health.
Can birth control cause infertility?
Actually, no. Birth control, like hormonal contraceptives, does not cause infertility. It does not matter at all how long you have been using or which method you have been utilizing. They just simply temporarily prevent pregnancies and do not lead to infertility.
What technology can be utilized to improve fertility?
To improve fertility, advanced technologies like In Vitro Fertilization (IVF), Intracytoplasmic Sperm Injection (ICSI), and advanced cryopreservation techniques (like vitrification) can be used. These technologies can be utilized along with genetic testing and AI-powered embryo selection.
