Infertility in Women and Men: Causes and Treatment

Infertility is the inability to become pregnant even though a couple is not using any method of birth control and has regular sexual intercourse.

There are two types of infertility;

• Primary infertility: not becoming pregnant after at least one year of unprotected intercourse.
• Secondary infertility: being unable to become pregnant now despite having had at least one previous pregnancy.

Causes of Infertility

Many physical and psychological factors can cause infertility. These may lie with the woman only, the man only, or both partners.

Causes of female infertility

During conception, the egg released from the ovary meets the male sperm cell as it travels toward the uterus through a channel called the fallopian tube. After fertilization, it implants in the uterus and the pregnancy continues to develop as an embryo. However, one or more of the following problems can disrupt this normal process and prevent pregnancy.

• Autoimmune diseases, which are disorders arising from the body's immune system (such as antiphospholipid syndrome)
• Congenital abnormalities of the reproductive system
• Cancer or tumors
• Bleeding and clotting disorders
• Diabetes
• Excessive exercise
• Eating and nutrition disorders
• Medications (chemotherapy drugs)
• Hormonal disorders
• Obesity
• Advanced age
• Ovarian cysts and polycystic ovary syndrome
• Blocked fallopian tubes (which can be caused by infection, endometriosis or abdominal surgery)
• Smoking or alcohol use
• Thyroid disorders

Causes of Male Infertility

Male infertility is often caused by a low sperm count, a blockage preventing sperm from being released, or sperm defects.

The most common causes of male infertility:

• Congenital defects
• Cancer treatments (chemotherapy, radiotherapy)
• Prolonged exposure to heat (for example, in people who work seated for long periods, such as long-distance drivers, or who wear thick underwear)
• Heavy alcohol or substance use
• Hormonal imbalances
• Impotence
• Infections
• Certain medications (cimetidine, spironolactone, nitrofurantoin)
• Smoking
• Obesity
• Advanced age
• Retrograde ejaculation (semen flowing into the bladder instead of out of the body)
• Blockages in the sperm and semen ducts after sexually transmitted diseases, trauma or surgery,
• Environmental toxins,
• Vasectomy

Healthy couples under 30 with a regular sex life have a 25–30% chance of becoming pregnant each month. In women, the chance of becoming pregnant gradually decreases after age 35, and especially after 40. The risk of miscarriage also increases after 35. Today, eggs can be retrieved and stored in a woman's 20s, so if pregnancy is being postponed until after 35, egg freezing may be considered.

Diagnosing Female Infertility

Women under 30 can wait 1 year to become pregnant, but for women over 35 the waiting period for a natural pregnancy drops to 6 months. After a general physical and pelvic examination, specific infertility tests may be performed.

• Ovulation test: Hormone analysis to determine whether ovulation is occurring
• Hysterosalpingography: An X-ray of the uterus taken with contrast dye to check for blockages or other obstructions in the uterus and fallopian tubes.
• Ovarian reserve testing: Hormone tests showing whether the ovaries can develop enough good-quality eggs. Performed at the beginning of the menstrual cycle.
• Other hormone tests: Pituitary hormones, thyroid hormones, androgenic hormones
• Imaging tests

Pelvic ultrasound and saline infusion sonogram

• Hysteroscopy: Evaluation of the uterine cavity and cervix with a lighted endoscopic system
• Laparoscopy: A minimally invasive surgical method used to evaluate the uterus, ovaries and fallopian tubes and to check for endometriosis and other adhesions that may cause blockages.

Diagnosing Male Infertility

• Semen analysis: performed after 3–4 days of sexual abstinence. The amount of seminal fluid and the sperm count, motility and structure are assessed. Sometimes urine is also examined for sperm to check for backflow into the bladder.
• Hormone testing: Testosterone and other male hormones are measured.

• Genetic testing

• Testicular biopsy
• Imaging methods: transrectal or scrotal ultrasound, vasography, brain MRI
• Other specialized tests: Testing for DNA abnormalities in the semen

Treatment of Female Infertility

In some women, infertility can be corrected with one or two treatments. Others may need more complex and longer-term treatment.

• Ovulation induction: Certain fertility drugs are used to stimulate egg development and release.
• Intrauterine insemination: In this method, commonly known as artificial insemination, healthy sperm cells are placed inside the uterus after the developing egg is released (ovulation) to help fertilization occur.
• Fertility surgery: Surgical removal of endometrial polyps, uterine septum, intrauterine adhesions and some fibroids.

Treatment of Male Infertility

Treatment for men aims to resolve general sexual problems or to obtain healthy sperm.

• Lifestyle changes

• Quitting smoking, alcohol and substance use; having frequent and well-timed intercourse

• Medication: Includes drugs to improve testicular function and sperm production and quality.
• Surgery: Aims to correct problems that block the passage of sperm or conditions such as varicocele that impair sperm quality.
• Sperm retrieval: Used when sperm cannot be obtained through normal ejaculation or the sperm count is very low.

Assisted Reproductive Technologies (ART)

The most common approach in this category is IVF, also known as test-tube baby treatment. Multiple mature eggs retrieved from the woman are fertilized with sperm in the laboratory, and the resulting embryo is transferred to the uterus. In this context

• Intracytoplasmic sperm injection (ICSI)
• Assisted hatching
• Use of donor eggs or sperm
• Surrogacy

Complications of Infertility Treatment

• Multiple pregnancy: Twins, triplets or more; as the number of babies increases, preterm birth and other pregnancy complications become more likely.
• Ovarian hyperstimulation syndrome: Some fertility drugs can cause excessive ovulation. It may be accompanied by mild to moderate abdominal pain, marked abdominal bloating and nausea, and usually lasts about 1 week. Rarely, more serious conditions requiring urgent treatment may occur, with rapid weight gain and difficulty breathing.
• Bleeding or infection: Can occur, especially with assisted reproductive techniques.