By definition, infertility is described as the inability to conceive after one year of trying to have a child. Additionally, infertility is defined as the inability to carry a pregnancy to full term.
The age bracket for definitive infertility varies. For women who are 35 years and below, infertility is described as the inability to conceive even after 52 weeks of unprotected sexual intercourse. For women above 35 years, the period is reduced to six months. As women age, their ability to conceive reduces due to a reduction in the production of sexual hormones and the early onset of menopause.
The etiology of infertility is quite diverse, and it ranges from dietary, hormonal, medical, or pathological reasons. Additionally, infertility could be due to lifestyle, environmental, or intrinsic factors. Mental disorders like depression and anxiety also play a role in infertility.
As earlier stated, females contribute to about a third of infertility cases. This could be due to:
As women age, it becomes more challenging for them to conceive. According to WHO, the ideal age of menopausal onset is about 35 years of age. However, recent studies have revealed that menopause can begin from as early as 25 years; this is known as premature menopause.
Concurrently, excessive smoking, alcohol consumption, and substance abuse, particularly with cocaine or marijuana, predispose an individual to infertility. Furthermore, smoking is associated with vasoconstriction that discourages implantation and facilitates miscarriages.
Diet plays an indispensable role in maintaining the body’s overall physiological functions. Likewise, a healthy diet is essential in maintaining a healthy reproductive life. Recent studies show that folic acid deficiencies, vitamin B12, zinc, and iron deficiencies cause anemia and infertility in women.
Some genetic mutations are associated with infertility in women. The genetic mutations could be single genetic mutations leading to no or inadequate production of gonadotropic hormones or chromosomal mutations. An example is Turner’s Syndrome, where a female is born with only one X chromosome, consequently causing failed ovarian development rendering the female infertile.
Inflammation, obstruction, or blockage of the fallopian tube hinders the ovum’s movement that is to be fertilized. Inflammation could be due to infection in the pelvic region or due to a sexually transmitted disease. The obstruction could also arise due to tumors, cysts, or fibroids.
The ovary is the primary female sexual organ. It is responsible for the storage and release of the female egg. Additionally, it is a gland responsible for producing estrogen and progesterone. Any disease or disorder affecting the ovary will inevitably cause infertility. Examples of such conditions include:
Also known as early menopause. Its a condition characterized by a premature drastic reduction in the production of female sex hormones. Women diagnosed with early onset of menopause are given hormone replacement therapy.
Anovulation is a medical term describing failure in releasing an ovum from the ovary for a period exceeding three months. In comparison, oligo ovulation describes infrequent or irregular menstruation. The causes of anovulation and oligo ovulation are primarily hormonal imbalance, stress, obesity, and some ovarian diseases.
Endometriosis is a medical ailment characterized by the presence of endometrial tissue outside the womb. Endometriosis is among the leading causes of female infertility. It is associated with painful cramps and excessive menstrual bleeding.
Prolactin is a hormone that facilitates milk production in nursing mothers. The hormone also inhibits ovulation hence rendering nursing mothers infertile for a certain period. However, women with constant high prolactin levels tend to have irregular or no menses. Antagonist medication is given to such women to reduce prolactin levels and increase their chances of conception.
Oligospermia is a medical terminology used to describe low sperm count in men. On the other hand, azoospermia refers to no sperm production. Individuals diagnosed with oligospermia have a sperm count of less than 15 million sperms per milliliter. Oligospermia lessens the chances of a man to impregnate a woman.
A normal sperm must have a head and tail. However, due to differences in sperm production, some sperms may have a large head, double tail, or crooked tail. Abnormal sperm morphology affects sperm’s ability to swim to the ovum or penetrate the ovum’s defensive zona pellucida layer.
Erectile dysfunction is a disorder characterized by the inability to gain or hold an erection hard enough or long enough during sexual intercourse.
In comparison, ejaculation disorder, or premature ejaculation, an individual lacks control of ejaculation before or during copulation. The exact etiology of erectile dysfunction is unknown; however, it may be attributed to performance anxiety, depression, or an underlying physical condition.
Kleinfelter’s Syndrome is a chromosomal mutation where a man is born with three sex genes, two X chromosomes, and one Y chromosome. A typical presentation of Kleinfelter’s Syndrome in undescended testis. Males born with an undescended testis are at a higher risk of developing impotence and testicular cancer.
For ideal sperm production, the testicular temperature must be lower than the body temperature. Men who frequently visit saunas or work in a hot environment are at risk of being impotent due to inadequate sperm production.
Testosterone is the principal sex hormone in males. It is responsible for spermiogenesis and maturation of the sperm. Low testosterone levels reduce the fecundity definition levels and cause a decline in one’s sex drive.
Varicocele is a medical term describing an inflamed epididymis. Inflammation, obstruction, or blocked epididymis limit sperm’s movement to the urethra for deposition in the female birth canal during sexual intercourse. Consequently causing male infertility.
Anxiety and depression play an indispensable role in one’s fertility. In men, severe anxiety during sexual intercourse causes delayed erection and premature ejaculation. On the other hand, depression and anti-depressive medication can reduce the fecundity definition in females.
For blood analysis, the testosterone levels are checked. Additionally, the physician may recommend the anti-sperm antibodies test. The latter identifies if one’s body is naturally producing antibodies against the sperm.
The gynecologist may recommend an ultrasound of the external male reproductive organs to analyze any blockage in the duct systems or any structural anomaly.
It is done to rule out any underlying genetic or chromosomal mutation.
To rule out any underlying infection that might be the cause of impotence.
Testicular biopsy is done to analyze any anomalies in spermiogenesis (sperm production) and sperm maturation.
Testicular biopsy is done to analyze any anomalies in spermiogenesis (sperm production) and sperm maturation.
The collected blood sample is analyzed for estrogen, progesterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) levels. High FSH and estrogen levels mean lower fertility, while high progesterone and luteinizing hormone facilitate ovulation.
A hysteroscopy is another imaging technique where the doctor inserts a flexible tube with a camera at the end. During a hysteroscopy, a sample tissue is collected for further lab analysis.
A laparoscopy is an invasive technique where the physician cuts a small section in the pelvic region to insert a flexible camera. Laparoscopy is a routine procedure in females suspected of having endometriosis. Laparoscopy aims to visualize the pelvic area.
A routine urinalysis can reveal a lot of information concerning fertility in women. Urine is the ideal sample for the measurement of luteinizing hormone levels, particularly during ovulation. Additionally, urinalysis is a routine procedure in lab diagnosis for sexually transmitted infections, especially for gonorrhea, chlamydia, and syphilis. The three STI’s are commonly implicated as one of the leading causes of secondary infertility in women.
Other testing techniques that may outline the etiology of infertility in women are:
The treatment approach that your doctor chooses is dependent on:
Generally, there are four treatment approaches to infertility. These are:
This involves the use of drugs to enhance ovulation and fertility. Examples of such drugs are:
It is a Selective Estrogen Modulator (SERM) and an ovulation stimulant. Clomiphene acts by increasing the production of gonadotropins in the anterior pituitary, consequently increasing the number of eggs released per ovulation. It is used in women with PCOS, ovulation disorders, and those who want multiple pregnancies.
Letrozole is a non-steroidal aromatase inhibitor. It acts by temporarily lowering estrogen and progesterone levels, thus triggering gonadotropic hormone release from the anterior pituitary. Its uses are similar to clomiphene.
hMG is a synthetic analog of the gonadotropic hormones. It is used in women whose infertility is caused by inadequacy of the anterior pituitary. hMG is given intravenously to stimulate ovulation.
Other drugs used as fertility boosters are:
Surgery is applied as a corrective procedure in treating inflamed or blocked duct systems in both males and females.
Also known as artificial insemination. During this procedure, semen is collected and inserted through the vagina when the woman is ovulating to increase pregnancy chances. In some cases, IUI is coupled with fertility medication to increase the chances of conception.
In assisted reproductive technology, reproductive manipulation is done outside the body. The techniques in ART are:
In IVF, the woman’s eggs are harvested and stored. The egg is later fertilized in the laboratory from a harvested sperm. The fertilized ovum is then embedded in the female womb.
It is a modified version of IVF where a single sperm is injected into an ovum. This technique is used in couples where the male is the main factor for infertility. The fertilized egg is implanted into the woman.
Conclusively, infertility and childbearing is a sensitive topic, especially in a relationship or a marriage. A couple experiencing trouble with conceiving should have open communication with themselves and their doctors. Luckily, there is a variety of solutions to one getting their bundle of joy. All it takes is initiative.
