Infertility– it’s a daunting word that can come attached to a magnitude of feelings, including frustration, anger, disappointment, and grief. For those trying to conceive and start a family, the word itself can make one uneasy. However, with proper preparation and understanding, even those who have been told by a medical professional that their journey will be longer than others can move forward with a heart full of hope. This month, in a two-part series, we take an in-depth look on infertility, its causes, and how to prevent and treat it.
What is infertility?
Infertility is generally defined as the inability to get pregnant after one year of trying, or six months of trying if you are 35 years or older. Being unable to stay pregnant after conception may be a sign of infertility as well.
Pregnancy only happens when certain steps are followed successfully. In order to get pregnant:
- An egg must be released from one of the ovaries of a person with a uterus (ovulation).
- The egg must go through a fallopian tube toward the uterus, or womb.
- A sperm must join with (or fertilize) the egg along the way.
- The fertilized egg must attach to the inside of the uterus (implantation).
Infertility can happen if there are interferences with any of these steps.
Infertility is a pretty common problem; about 10 percent of women (6.1 million) in the United States ages 15 to 44 have difficulty getting or staying pregnant, according to the Centers for Disease Control and Prevention. About 1 in 6 couples or intended parent(s) experience difficulty getting pregnant.
Who causes infertility? The man or the woman?
People with both types of sex organs can have problems that cause infertility. About one-third of infertility cases are caused by issues related to the female reproductive system. Another one-third of fertility problems are due to problems related to the male reproductive system. For about 20% of those who have infertility problems, the exact causes are never pinpointed. The remaining issues are a combination of complications with both the male and female reproductive system.
What infertility issues are associated with the male reproductive system?
Infertility in those with a male reproductive system is most often caused by:
- Varicocele. This happens when the veins on the testicle(s) are too large. This heats the testicles, which can affect the number or shape of the sperm.
- Factors that cause the testes to make too few sperm, or no sperm at all.
- Movement of the sperm. This may be caused by the shape of the sperm, and can be caused by injuries or other damage to the reproductive system that block the sperm.
Sometimes, people with testes are born with problems that affect their sperm. Other times, problems start later in life due to illness or injury. Cystic fibrosis, for example, often causes infertility in those with male reproductive organs.
Sperm health can be changed by a person’s overall health and lifestyle. Some things that may reduce the health or number of sperm include:
- Heavy alcohol use
- Smoking cigarettes
- Environmental toxins, including pesticides and lead
- Health problems such as mumps, serious conditions like kidney disease, or hormone problems
- Radiation treatment and chemotherapy for cancer
What are the warning signs for infertility in those with male reproductive organs?
- Fluctuations in sexual desire: Fertility is also linked with hormone health. Changes in virility, often governed by hormones, could bode problems with one’s fertility.
- Pain or swelling in the testicles: There are several different conditions that could lead to inflammation of the testicles, many of which could contribute to infertility.
- Problems maintaining an erection: The ability to maintain an erection is also often linked to hormone levels. Reduced hormones may result, which could potentially translate into trouble conceiving.
- Issues with ejaculation: Similarly, an inability to ejaculate is a sign that it might be time to visit a medical professional.
- Small, firm testicles: The testes house sperm, so testicle health is paramount to male fertility. Small or firm testicles could indicate potential issues that should be looked at by a doctor.
What about infertility problems within the female reproductive system?
As mentioned earlier, infertility issues arise when something interrupts the process of getting pregnant. As such, there are many things that can go wrong within each step. For those with female reproductive organs, there can be issues with the eggs, ovulation itself, as well as problems with the fallopian tubes or uterus.
Damage to the fallopian tubes or uterus can be caused by one or more of the following:
- Pelvic inflammatory disease
- A previous infection
- Polyps in the uterus
- Endometriosis or fibroids
- Scar tissue or adhesions
- Chronic medical illness
- A previous ectopic (tubal) pregnancy
- A birth defect
- Physical problems with the uterus
- DES syndrome (Taking the medication DES, which is given to women to prevent miscarriage or premature birth, can result in fertility problems for their children.)
Ovulation problems may be caused by one or more of the following:
- A hormone imbalance
- A tumor or cyst
- Eating disorders such as anorexia or bulimia
- Alcohol or drug use
- Thyroid gland problems
- Excess weight
- Intense exercise that causes a significant loss of body fat
- Extremely brief menstrual cycles
- Polycystic ovarian syndrome (PCOS)
Abnormal cervical mucus can also cause infertility, as it can prevent the sperm from reaching the egg, or make it more difficult for the sperm to penetrate the egg.
Most cases of infertility within people with a female reproductive system are caused by problems with ovulation. Without ovulation, there are no eggs to be fertilized. Some signs that you are not ovulating normally include irregular or absent menstrual periods. Ovulation problems are often caused by polycystic ovarian syndrome (PCOS). PCOS is a hormone imbalance problem which can interfere with normal ovulation. PCOS is the most common cause of female infertility.
Primary ovarian insufficiency (POI) is another cause of ovulation problems. POI occurs when the ovaries stop working normally before someone turns 40, but is not the same as early menopause.
Signs and symptoms of infertility are often related to other underlying conditions. For example, 10 to 15 percent of untreated chlamydia cases will lead to pelvic inflammatory disease (PID). PID leads to a blockage of the fallopian tubes, which prevents fertilization.
Many things can change your ability to have a baby. These include:
- Excess alcohol use
- Poor diet
- Athletic training
- Being overweight or underweight
- Sexually transmitted infections (STIs)
- Health problems that cause hormonal changes, such as polycystic ovarian syndrome and primary ovarian insufficiency
What signs of infertility show up for people with a female reproductive system?
- Irregular periods: The average menstrual cycle is 28 days long, but anything within a few days of that can be considered normal, as long as those cycles are consistent. Someone whose cycles vary so greatly that she can’t even begin to estimate when her period might arrive is experiencing irregular periods. This can be related to hormone issues, or to polycystic ovarian syndrome (PCOS). Both of these can contribute to infertility.
- Painful or heavy periods: Most people who have a uterus experience cramps with their periods, however, painful periods that interfere with your daily life may be a symptom of endometriosis.
- No periods: It’s not uncommon to have an off month here and there. Factors like stress or heavy workouts can cause your period to temporarily disappear. But if you haven’t had a period in months, it’s time to get your fertility checked.
- Symptoms of hormone fluctuations: Signs of hormone fluctuations in women could indicate potential issues with fertility. Talk to your doctor if you experience skin issues, a reduced sex drive, facial hair growth, thinning hair, or weight gain
- Pain during sex: Some people have experienced painful sex their entire lives, so they’ve convinced themselves it’s normal, but it’s not. It could be related to hormone issues, endometriosis, or other underlying conditions that could also be contributing to infertility.
How does age impact fertility?
Many people choose to wait until later in life to have children– some even in their late 30s and 40s. In fact, about 20 percent of people in the United States now have their first child after age 35.
Despite this trend, about one-third of couples or intended parent(s) in which the person intending to carry the pregnancy is over 35 have fertility problems.
Aging will decrease the chances of having a baby in the following ways:
- Ovaries become less able to release eggs
- There are a smaller number of eggs left
- The eggs are not as healthy
- It is more likely for there to be health conditions that can cause fertility problems
- It is more likely for a miscarriage to occur
Some health problems also increase the risk of infertility. You should talk to your doctor if you have:
- Irregular periods or no menstrual periods
- Very painful periods
- Pelvic inflammatory disease
- More than one miscarriage
When should I talk to a doctor about symptoms related to infertility? Should I ever go to the Emergency Room?
Most experts suggest trying to get pregnant for at least one year before calling a doctor or fertility specialist. Those 35 or older should see their doctors after six months of trying. Your chance of having a baby decrease rapidly every year after the age of 30.
It is always a good idea to talk to a doctor before trying to get pregnant. Doctors can help you get your body ready for a healthy baby. They can also answer questions on fertility and give tips on conceiving.
It is also important to contact your healthcare provider, or even go to the ER, if you experience any of the following symptoms:
- Abnormal bleeding
- Severe or debilitating abdominal pain
- Discharge that is unusual in viscosity or scent
- Pain or discomfort during intercourse
- Soreness or itching in the vaginal area
I think I’m ready to talk to a doctor about infertility– what can I expect?
Your doctor will start with an infertility checkup; this will involve a physical exam and a questionnaire about your (and your partner’s, if applicable) health and sexual histories. Occasionally, this in and of itself can help find the problem. Most of the time, however, the doctor will need to do more tests.
For those with a male reproductive system, doctors usually begin by testing the semen. They look at the number, shape, and movement of the sperm. Sometimes they also suggest testing the level of a man’s hormones.
For those with a uterus, the first step is to find out if they are ovulating each month (also called Fertility Awareness). There are a few ways to do this. You can track your ovulation at home by:
- Writing down changes in your morning body temperature for several months
- Writing down how her your mucus looks for several months
- Using a home ovulation test kit (available at drug or grocery stores)
Doctors can also check ovulation with blood tests. Or they can do an ultrasound of the ovaries. If ovulation is normal, there are other fertility tests available.
Healthcare providers may use one or more of the following tests/exams to evaluate fertility:
- A urine or blood test to check for infections or a hormone problem, including thyroid function
- Pelvic exam and breast exam
- A sample of cervical mucus and tissue to determine if ovulation is occurring
- Laparoscope inserted into the abdomen to view the condition of organs and to look for blockage, adhesions or scar tissue.
- HSG, which is an x-ray used in conjunction with a colored liquid inserted into the fallopian tubes making it easier for the technician to check for blockage.
- Hysteroscopy uses a tiny telescope with a fiber light to look for uterine abnormalities.
- Ultrasound to look at the uterus and ovaries. May be done vaginally or abdominally.
- Sonohystogram combines an ultrasound and saline injected into the uterus to look for abnormalities or problems.
Finding the cause of infertility can be a long and emotional process. It may take time to complete all the needed tests, so don’t worry if the problem is not found right away.
Tune in next time for how to treat and prevent common fertility issues!