Infertility is a complex and emotionally challenging condition that affects millions of individuals and couples worldwide. The term “infertility” is defined as the inability to conceive after one year of unprotected intercourse or six months for women over 35. The signs of infertility vary between women and men and stem from a variety of causes.
In this article, we’ll examine the types, prevalence, causes, symptoms, diagnosis, and treatment options for infertility in both women and men.
What is Infertility?
Infertility is a medical condition characterized by the inability to achieve pregnancy despite regular, unprotected sexual intercourse. Infertility can result from issues in either the male or female reproductive system or a combination of both.
Infertility is not just a female issue; men contribute to approximately 40-50% of infertility cases. Understanding the underlying causes and seeking timely medical intervention can improve the chances of conception.
The Three Main Types of Infertility
We discuss infertility in three scenarios with known and unknown variables.
Primary Infertility
Primary infertility refers to couples or individuals who have never been able to conceive a child, despite trying for at least one year. This type of infertility often prompts individuals to seek medical advice early on, as the inability to conceive can be distressing.
Approximately 30% to 40% of infertility cases are related to primary infertility.
Secondary Infertility
Secondary infertility occurs when a couple or individual has previously conceived but is unable to do so again after at least one year of trying. This can be particularly frustrating, as it often raises questions about changes in health or lifestyle that may have contributed to the issue.
Approximately 40% to 50% of people with infertility issues fall into this category.
Unexplained Infertility
Unexplained infertility is diagnosed when no specific cause for infertility can be identified after thorough testing of both partners. This can be one of the most challenging forms of infertility, as it leaves couples without clear answers or a targeted treatment plan. For more details on unexplained infertility, it’s essential to work closely with a fertility specialist.
It’s estimated that somewhere between 10% to 30% of cases are based on unexplained infertility.
While there is quite a span between each of the three main types of infertility, it’s clear that secondary infertility and primary infertility make up a large majority of reported instances.
How Common is Infertility?
As previously mentioned, infertility is a problem that affects both men and women. A quick examination of the numbers shows how each sex is affected by infertility.
In Women
Infertility affects approximately 10-15% of women of reproductive age. The likelihood of infertility increases with age, particularly after 35, due to a decline in the quantity and quality of eggs. Factors such as lifestyle, underlying health conditions, and environmental exposures can also play a role.
In Men
Male infertility is also common, contributing to 40-50% of infertility cases. Factors such as low sperm count, poor sperm motility, or abnormal sperm morphology are common causes. Lifestyle factors, including smoking, excessive alcohol use, and exposure to environmental toxins, can significantly impact male fertility.
Causes and Symptoms of Infertility in Women and Men
Causes of Infertility in Women
In women, infertility can result from a variety of factors, including ovulation disorders, fallopian tube damage, endometriosis, uterine or cervical abnormalities, and age-related decline in egg quality. Conditions like polycystic ovary syndrome (PCOS) and hormonal imbalances are also common contributors. For a detailed explanation of female infertility causes, it’s essential to consult with your healthcare provider.
Signs Of Infertility In Women
Women experiencing infertility may notice irregular or absent menstrual cycles, painful periods, hormonal imbalances (such as acne or excessive hair growth), or pain during intercourse. These symptoms often prompt further investigation into potential fertility issues.
Causes of Infertility in Men
In men, infertility is often linked to low sperm count, poor sperm quality, hormonal imbalances, or structural issues like varicocele. Lifestyle factors, such as smoking, excessive alcohol use, and exposure to environmental toxins, can also play a significant role.
Signs of Infertility in Men
Men with infertility may experience changes in sexual desire, pain or swelling in the testicles, reduced facial or body hair, or difficulty with ejaculation. These symptoms can indicate underlying issues that require medical attention.
Diagnosis And Tests For Infertility
Diagnosing infertility in men and women can be accomplished using various tests and observations. I’ve broken those diagnoses and tests into separate sections for women and men.
Diagnosis in Women
Diagnosing infertility in women involves a series of tests to evaluate ovulation, fallopian tube function, and overall reproductive health. These tests help identify potential issues that may be preventing conception. Below are the most common diagnostic tests for female infertility:
Ovulation Testing
Ovulation testing is typically done through blood tests that measure hormone levels, such as progesterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH).
These hormones play a critical role in regulating the menstrual cycle and ovulation. Blood samples are taken at specific points in the cycle to confirm whether ovulation is occurring. For example, a progesterone test is often done about a week before the expected period to confirm ovulation.
If hormone levels are abnormal, it may indicate conditions like polycystic ovary syndrome (PCOS) or hypothalamic dysfunction. For more details on ovulation testing, you may want to speak with a fertility specialist.
Hysterosalpingography (HSG)
Hysterosalpingography (HSG) is an X-ray procedure used to check for blockages or abnormalities in the fallopian tubes and uterus. During the test, a contrast dye is injected into the uterus, and X-ray images are taken to see if the dye flows freely through the fallopian tubes.
Blockages or structural issues can prevent the egg and sperm from meeting, leading to infertility. This test is often recommended for women who have had pelvic infections or surgeries in the past.
Ovarian Reserve Testing
Ovarian reserve testing assesses the quantity and quality of a woman’s eggs, which is particularly important for women over 35.
This test typically involves blood tests to measure levels of anti-Müllerian hormone (AMH) and FSH, as well as an ultrasound to count the number of follicles in the ovaries. A low ovarian reserve may indicate a reduced chance of conception.
Pelvic Ultrasound
A pelvic ultrasound uses sound waves to create images of the uterus and ovaries. This test can detect structural abnormalities, such as fibroids, polyps, or ovarian cysts, which may interfere with conception.
It is a non-invasive procedure that provides valuable information about the health of the reproductive organs.
Laparoscopy
Laparoscopy is a minimally invasive surgical procedure that allows doctors to examine the reproductive organs directly. A small camera is inserted through a tiny incision in the abdomen, providing a clear view of the uterus, fallopian tubes, and ovaries.
This procedure can diagnose and treat conditions like endometriosis, scar tissue, or blocked fallopian tubes.
Diagnosis in Men
Diagnosing male infertility often begins with a semen analysis to evaluate sperm count, motility, and morphology. Additional tests may include hormone testing, scrotal ultrasound, genetic testing, and testicular biopsy. Below are the most common diagnostic tests for male infertility:
Semen Analysis
A semen analysis is the primary test for male infertility. It evaluates sperm count, motility (movement), and morphology (shape). A sample is collected through ejaculation and analyzed in a lab.
Abnormal results may indicate issues like low sperm count, poor sperm motility, or abnormal sperm shape, which can affect fertility.
Hormone Testing
Hormone testing measures levels of testosterone, FSH, LH, and other hormones that play a role in sperm production. Blood tests are used to determine if hormonal imbalances are contributing to infertility.
For example, low testosterone levels can impair sperm production, while high FSH levels may indicate testicular dysfunction.
Scrotal Ultrasound
A scrotal ultrasound uses sound waves to create images of the testicles and surrounding structures. This test can detect issues like varicocele (enlarged veins in the scrotum), blockages, or abnormalities in the testicles. It is a non-invasive procedure that provides valuable information about the health of the male reproductive system.
Genetic Testing
Genetic testing can identify inherited conditions that may affect fertility, such as Klinefelter syndrome or Y chromosome deletions.
Blood or saliva samples are used to analyze genetic material and determine if any abnormalities could be contributing to infertility.
Testicular Biopsy
In some cases, a testicular biopsy is performed to assess sperm production. A small sample of testicular tissue is taken and examined under a microscope to determine if sperm is being produced normally.
This test is typically recommended for men with azoospermia (no sperm in the semen) or severe sperm abnormalities.
Management and Treatment of Infertility
If you are having trouble with infertility, various treatments may help you conceive. We’ve broken down fertility treatments into individual sections for men and women, including what each treatment is, how it’s performed, and how it helps.
Infertility Treatments for Women
Treatment options for female infertility depend on the underlying cause and may include medications, surgery, or assisted reproductive technology (ART). Below is a detailed breakdown of these treatments:
Clomiphene Citrate
Clomiphene citrate is an oral medication commonly used to stimulate ovulation in women with polycystic ovary syndrome (PCOS) or irregular ovulation. It works by encouraging the release of hormones needed for egg development.
How It’s Performed: The medication is taken for five days at the beginning of the menstrual cycle. Blood tests and ultrasounds may be used to monitor ovulation.
How It Helps: Clomiphene increases the chances of ovulation, making conception more likely.
Letrozole
Letrozole, originally used to treat breast cancer, is now a common medication for inducing ovulation. It reduces estrogen levels, which triggers the body to produce more follicle-stimulating hormone (FSH).
How It’s Performed: Like clomiphene, letrozole is taken orally for five days at the start of the menstrual cycle. Ovulation is monitored through blood tests and ultrasounds.
How It Helps: Letrozole is particularly effective for women with PCOS and has a higher success rate than clomiphene in some cases.
Gonadotropins
Gonadotropins are injectable hormones that directly stimulate the ovaries to produce multiple eggs. They are often used in conjunction with ART procedures like in vitro fertilization (IVF).
How It’s Performed: The injections are administered daily, and progress is closely monitored through ultrasounds and blood tests to avoid overstimulation of the ovaries.
How It Helps: Gonadotropins are useful for women who do not respond to oral medications and can increase the number of eggs available for fertilization.
Laparoscopy
Laparoscopy is a minimally invasive surgery used to diagnose and treat conditions like endometriosis, scar tissue, or blocked fallopian tubes.
How It’s Performed: A small camera is inserted through a tiny incision in the abdomen, allowing the surgeon to remove abnormal tissue or repair blockages.
How It Helps: This procedure can restore fertility by addressing structural issues in the reproductive organs.
Hysteroscopy
Hysteroscopy is a procedure used to examine and treat issues within the uterus, such as fibroids, polyps, or septums.
How It’s Performed: A thin, lighted scope is inserted through the cervix to visualize the uterine cavity. Abnormal tissue can be removed during the procedure.
How It Helps: Hysteroscopy improves the chances of implantation by creating a healthier uterine environment.
Intrauterine Insemination (IUI)
Intrauterine insemination (IUI) involves placing washed and concentrated sperm directly into the uterus around the time of ovulation.
How It’s Performed: Sperm is collected, processed to remove low-quality sperm, and then inserted into the uterus using a thin catheter. The procedure is often combined with ovulation-stimulating medications.
How It Helps: IUI increases the number of sperm that reach the fallopian tubes, improving the chances of fertilization.
In Vitro Fertilization (IVF)
In vitro fertilization (IVF) is a widely used ART procedure that involves retrieving eggs from the ovaries, fertilizing them with sperm in a lab, and transferring the resulting embryos into the uterus.
How It’s Performed: The process includes ovarian stimulation, egg retrieval, fertilization in a lab, and embryo transfer. Hormonal medications are used to prepare the uterus for implantation.
How It Helps: IVF bypasses many common fertility issues, such as blocked fallopian tubes or severe endometriosis, and offers a high success rate for many couples.
Infertility Treatments For Men
Male infertility treatments depend on the underlying cause and may include medications, surgery, or assisted reproductive technology (ART). Below is a detailed breakdown of these treatments:
Hormone Treatments
Hormone treatments are used to address hormonal imbalances that impair sperm production. Medications like clomiphene or gonadotropins may be prescribed to boost testosterone and sperm production.
How It’s Performed: These medications are taken orally or via injection, and hormone levels are monitored through blood tests.
How It Helps: Hormone treatments can improve sperm production in men with hormonal deficiencies.
Antibiotics
Antibiotics are used to treat infections in the reproductive tract, such as epididymitis or prostatitis, which can affect sperm quality.
How It’s Performed: A course of antibiotics is prescribed based on the type of infection.
How It Helps: Clearing infections can improve sperm production and function.
Varicocele Repair
A varicocele is an enlargement of the veins within the scrotum, which can impair sperm production.
How It’s Performed: Surgery involves tying off the affected veins to improve blood flow. The procedure is typically done under general anesthesia.
How It Helps: Varicocele repair can improve sperm count, motility, and morphology.
Vasectomy Reversal
For men who have had a vasectomy, this procedure reconnects the vas deferens to allow sperm to re-enter the semen.
How It’s Performed: The procedure is performed under a microscope to reconnect the cut ends of the vas deferens.
How It Helps: It restores fertility in men who have previously undergone sterilization.
Sperm Retrieval
For men with blockages or conditions like azoospermia (no sperm in the semen), sperm can be retrieved directly from the testicles or epididymis.
How It’s Performed: Techniques like testicular sperm extraction (TESE) or percutaneous epididymal sperm aspiration (PESA) are used to collect sperm.
How It Helps: Retrieved sperm can be used in ART procedures like IVF or ICSI.
Intracytoplasmic Sperm Injection (ICSI)
Intracytoplasmic sperm injection (ICSI) is a specialized ART procedure where a single sperm is injected directly into an egg to facilitate fertilization.
How It’s Performed: The procedure is performed in conjunction with IVF. A single sperm is selected and injected into an egg using a fine needle.
How It Helps: ICSI overcomes issues like low sperm count or poor motility and is particularly useful for severe male infertility.
Donor Sperm
If a man has no viable sperm, donor sperm can be used for ART procedures like IUI or IVF.
How It’s Performed: Donor sperm is obtained from a sperm bank and used in the chosen ART procedure.
How It Helps: It provides an alternative for couples where male infertility cannot be treated.
Lifestyle Changes For Both Genders Can Help With Infertility
Both men and women can improve their fertility by maintaining a healthy weight, avoiding exposure to environmental toxins, managing stress, and adopting a balanced diet. These changes, both before and after signs of infertility, can enhance overall reproductive health and increase the chances of conception.
Lifestyle Changes For Men:
- Maintain a Healthy Weight: Being obese or underweight can negatively impact sperm production and quality.
- Quit Smoking: Smoking is linked to lower sperm count and motility.
- Limit Alcohol Consumption: Excessive alcohol consumption can reduce testosterone levels and impair sperm production.
- Avoid Recreational Drugs: Drugs like marijuana and anabolic steroids can harm sperm quality.
- Reduce Stress: Chronic stress may interfere with hormones needed for sperm production.
- Avoid Heat Exposure: Prolonged exposure to hot tubs, saunas, or tight underwear can affect sperm health.
- Exercise Regularly: Moderate exercise can improve overall health and sperm quality, but avoid excessive or intense workouts.
- Eat a Balanced Diet: Focus on foods rich in antioxidants (e.g., fruits, vegetables, nuts) to support sperm health.
Lifestyle Changes For Women:
- Maintain a Healthy Weight: Being overweight or underweight can disrupt ovulation and hormonal balance.
- Quit Smoking: Smoking accelerates the loss of eggs and can damage reproductive organs.
- Limit Alcohol and Caffeine: Excessive consumption can affect fertility and increase the risk of miscarriage.
- Exercise Moderately: Regular, moderate exercise can improve fertility, but excessive exercise may disrupt menstrual cycles.
- Reduce Stress: High stress levels can interfere with ovulation and hormonal regulation.
- Avoid Environmental Toxins: Limit exposure to chemicals, pesticides, and pollutants that may affect fertility.
- Eat a Nutrient-Rich Diet: To support reproductive health, focus on foods high in iron, folate, and omega-3 fatty acids.
- Track Your Menstrual Cycle: Understanding your cycle can help identify ovulation patterns and optimize timing for conception.
Common Myths About Infertility
Infertility is a widely misunderstood condition, and many myths cause unnecessary stress and misinformation. Below, we break down some of the most common infertility myths about men and women.
Common Myths About Female Infertility
Infertility Is Only a Woman’s Problem
One of the biggest misconceptions is that infertility is always due to female factors. In reality, men and women contribute to infertility at nearly equal rates. According to the National Institute of Health, male factors account for 40-50% of infertility cases. This is why both partners should undergo fertility testing if conception is not happening.
If You Have Regular Periods, You’re Fertile
While a regular menstrual cycle is a positive indicator of ovulation, it does not guarantee fertility. Conditions such as endometriosis, blocked fallopian tubes, or poor egg quality can still affect a woman’s ability to conceive, even with a seemingly normal cycle.
Age Doesn’t Matter Until After 40
Many people believe that fertility doesn’t decline until after 40, but in reality, a woman’s egg quality and quantity start decreasing significantly after 35. While many women conceive in their late 30s and early 40s, the chances of natural conception drop each year, and the risk of complications increases.
Birth Control Causes Infertility
Some women worry that long-term birth control use can permanently damage fertility. While some hormonal contraceptives may delay the return of ovulation for a short time after stopping, they do not cause long-term infertility. Most women regain normal fertility within a few months.
Being Healthy Means You Won’t Have Fertility Issues
While maintaining a healthy lifestyle can positively impact fertility, it doesn’t eliminate all risks. Conditions such as polycystic ovary syndrome (PCOS), endometriosis, and unexplained infertility can affect even women who exercise regularly, eat well, and avoid smoking or alcohol.
Common Myths About Male Infertility
Men Stay Fertile for Life
While men can produce sperm throughout their lifetimes, male fertility does decline with age. Sperm quality, motility, and count tend to decrease after age 40, increasing the risk of conception difficulties and genetic abnormalities in offspring.
If A Man Can Ejaculate, He’s Fertile
Ejaculation alone does not indicate fertility. Sperm count, motility, and morphology play crucial roles in successful conception. A man can have a normal sex life but still have a low or non-existent sperm count, leading to infertility issues.
Boxers Are Better Than Briefs for Fertility
A long-standing myth suggests that wearing tight underwear or briefs can cause infertility by increasing scrotal temperature. While extreme heat exposure (like frequent hot tub use) can impact sperm production, there is limited scientific evidence that underwear choice has a significant effect on male fertility. While not verifiably a myth, experts largely disagree on this point.
Taking Testosterone Supplements Boosts Fertility
Testosterone supplements are often mistaken for fertility boosters, but they can reduce sperm production. Testosterone therapy can also decrease levels of follicle-stimulating hormone (FSH), which is essential for sperm production. Artificially increasing testosterone levels signals the body to stop natural sperm production, leading to lower sperm counts and, in some cases, complete infertility.
Understanding the truth about infertility is essential for making informed decisions about reproductive health. Both men and women should be aware of the fundamental factors affecting fertility and seek medical advice if they encounter challenges in conceiving and notice signs of infertility.
Infertility is a multifaceted condition that requires a comprehensive approach to diagnosis and treatment. Advances in medical science have made it possible for many individuals and couples to overcome infertility and achieve their dream of parenthood. If you suspect infertility, seek guidance from a fertility specialist to explore your options and develop a personalized treatment plan.
The information provided is for educational purposes only. It should not be a replacement for medical care or advice. This info is not intended to diagnose or replace medical treatment. Consult your doctor if you have any questions about your fertility health.