Common fertility problems - men and women

Infertility is typically defined as failure to conceive after 1 year of unprotected sex.  Contrary to the common assumption, infertility affects both men and women equally. It is also a reasonably common problem, with 15 - 20% of couples not being successful after trying for a year¹.

Let us first understand the steps for pregnancy to occur: 

• A woman’s ovaries must be able to release a viable egg.
• Then the egg must be able to travel down the fallopian tube.
• The man must be able to ejaculate.
• His sperm must be able to travel to the fallopian tube. 
• The sperm and egg must unite to fertilize the egg.
• The fertilized egg must attach to the inside of a receptive uterus (or implant).
• The fertilized egg needs to be nurtured by the body to allow the fetus to develop and grow until it is ready for birth.

Problems with any of the steps above can cause infertility.

Female infertility causes

• Most cases of infertility in women result from problems with ovulation.  Some conditions affecting ovulation include Premature Ovarian Failure, in which the ovaries stop functioning before natural menopause, and Polycystic Ovary Syndrome (PCOS) in which the ovaries may not release an egg regularly or may not release a viable, healthy egg.  Among women who have PCOS, even when a healthy egg is released and fertilized, the uterus may not be receptive to implantation of a fertilized egg, which results in infertility.

• Blocked fallopian tubes due to Endometriosis, Pelvic Inflammatory Disease, or surgery.  Endometriosis is a disease where there is growth outside the uterus of  tissue that is similar to the tissue in the uterus' lining. Pelvic inflammatory Disease is an infection of reproductive organs like the uterus and the fallopian tubes.

• Physical problems with the uterus wall.

• Uterine Fibroids. These are non-cancerous tumours that grow in and around the uterus.

• Miscarriage: Many women, have no problems conceiving, but cannot sustain a pregnancy because of miscarriage.  Miscarriage is loss of pregnancy before 20 weeks of pregnancy.  Miscarriage is very common, especially in the first 13 weeks.  Estimates are that about 10-25% pregnancies will end in miscarriage².  Most miscarriages are because of chromosomal abnormalities. Other causes are hormonal problems, advanced maternal age, trauma and lifestyle issues (smoking, alcohol, drugs, poor health etc.). If you feel that you are having a miscarriage, call a doctor immediately.  The doctor can treat you to prevent infections or hemorrhaging.  Some signs that you need to watch out for are:

• mild to severe abdominal pain (more than menstrual cramps)
• weight loss
• bleeding
• sudden decrease in pregnancy signs

• A woman’s risk for infertility can also be affected by certain lifestyle and environmental factors, including (but not limited to)³:

  • Age
  • Stress
  • Poor diet
  • Being overweight or underweight
  • Smoking, drugs, and alcohol
  • Medication
  • Environmental toxins
  • Genetic conditions
  • Other health problems, such as STD (Sexually Transmitted Disease)

Male infertility causes

The male fertility process involves the production of mature sperm and getting the sperm to reach and fertilize the egg.  Although it may seem to be a simpler process than female fertility, male fertility also requires many conditions to be met: the ability to have and sustain an erection, having enough sperm, having enough semen to carry the sperm to the egg, and having sperm of the right shape that move in the right way.  A problem meeting any of these conditions contributes to infertility. 

Like female infertility, male infertility can result from physical problems, such as testes that don’t make enough normal sperm, hormonal problems, and lifestyle or environmental factors, including (but not limited to)³:

• Age
• Stress
• Exposing the testes to high temperatures, which can affect the ability of the sperm to move and to fertilize an egg.  For instance: 
  • Cryptorchism is a condition where the testes do not descend into the scrotum.  Although it does not usually affect the ability to have and sustain an erection, cryptorchism means that the testes are still inside the body cavity, which has a higher temperature than the external scrotum.
  • Tight underwear—For some men, wearing tight underwear can also increase the temperature of the testes.
• Smoking, drugs, and alcohol
• Medications
• Environmental toxins
• Genetic conditions, such as Klinefelter Syndrome (chromosome abnormality)
• Other health problems

Infertility does not mean that a couple cannot have babies. In fact about most of couples can conceive with conventional (medicine or surgery) infertility treatments.

What are some treatments for infertility?

• Medication.
• Surgery of reproductive organs.
• Artificial insemination (the woman is injected with carefully prepared sperm from the husband, partner, or a donor).
• Assisted reproductive technology (ART), such as IVF (In Vitro Fertilization). This is when the fertilization takes place outside the body because of blocked/absent fallopian tubes. The fertilized egg is then implanted in a woman's uterus.
• In addition, lifestyle changes may also help alleviate infertility, such as reducing stress, diet modification, stopping use of drugs or alcohol, or reducing the temperature around the testes.
• Many couples say they have successfully conceived using alternative treatments like acupuncture, homeopathy, ayurveda, yoga etc.. Talk to your doctor, and do your research before you pick one of these. Try to talk to couples who have undergone and benefited from these treatments. Ask around in the Parentree Groups. It is important to check these treatments and the practitioners thoroughly so you do not fall victim to false claims. One study found that nearly 20% of Indian manufactured Ayurvedic medicines (but purchased in the USA) had dangerous metals like lead, mercury and arsenic⁴.

In their second year of trying, and even without any treatment, 40 - 60% of couples who were infertile can get pregnant¹.

With advanced technologies like IVF, even more couples can get pregnant.

Trying for a baby can be stressful and it need all the support you can gather. Talk to other couples/women. Join the Parentree group of women trying to have a baby.

Many couples have overcome challenges and have had lovely healthy babies.

What goes into a fertility evaluation?

A standard fertility evaluation includes physical exams and medical and sexual histories of both partners. Men undergo a semen analysis that evaluates sperm count and sperm movement.

For women, doctors first check to see whether ovulation is occurring and whether the woman has irregular cycles. This can be determined and monitored through blood tests that detect hormones or even an ultrasound examinations of the ovaries.

There are also tests that evaluate how sperm and eggs interact, as well as whether either party is developing antibodies to the sperm. This occurs when the man's or the woman's immune system recognizes the sperm as something foreign and attacks it.

A fertility evaluation can take a long time to narrow down a cause. And, in some cases, doctors cannot determine a cause for infertility in the man or woman.  In addition, some known causes of infertility do not have any treatments.

References

1. Dunson, David B., Baird, Donna D., Colombo, Bernardo "Increased Infertility With Age in Men and Women", Obstet Gynecol 2004 103: 51-56

2. "ACOG Education Pamphlet AP090 -- Early Pregnancy Loss: Miscarriage and Molar Pregnancy", American College of Obstetricians and Gynaecologists

3. National Institute of Child Health and Human Development, National Institutes of Health, Dept of Human Health Services, USA

4. Robert B. Saper; Russell S. Phillips; Anusha Sehgal; Nadia Khouri; Roger B. Davis; Janet Paquin; Venkatesh Thuppil; Stefanos N. Kales, "Lead, Mercury, and Arsenic in US- and Indian-Manufactured Ayurvedic Medicines Sold via the Internet", JAMA. 2008;300(8):915-923

Last updated: Aug 29, 2008