Overview
Infertility is a medical condition where a heterosexual couple is unable to get a child after one year of attempting to conceive through regular unprotected sex.
Types of infertility;
These include primary, secondary and unexplained infertility.
- Primary infertility: Here, the individual woman has never been pregnant and is unable to conceive after 12 months of regular, unprotected sex. Someone is not able to conceive at all.
- Secondary infertility: Unable to become pregnant again after at least 1 pregnancy that was successful.
- Unexplained infertility: There is no reason found as to why the couple is unable to get pregnant or conceive.
Key Facts
- Infertility affects men and women equally.
- It is a very common condition.
- Globally, more than 40 million couples struggle with infertility.
Risk Factors
- Age. Females above 35 years and males above 40 years.
- Smoking. Smoking increases risk of infertility in both males and females. Passive smoking(inhalation of second-hand smoke) has been linked to reduced fertility.
- Radiation, especially if targeted near organs of reproduction.
- Chemotherapy. Some chemotherapeutic agents can lead to low sperm count or ovarian failure.
- Sexually Transmitted Infections (STIs) such as chlamydia and gonorrhea. Gonorrhea causes infertility in women due to pelvic inflammatory disease (PID) and in men due to epididymitis.
Other risk factors linked to infertility are;
- Exposure to certain chemicals such as pesticides and herbicides, especially if they contain mutagenic agents.
- Narcotic use such as bhang can lead to reduced sperm count.
- Poor nutrition and consumption of unhealthy diet.
- Obesity.
- Excessive consumption of alcoholic drinks.
- Stress.
Causes
In females;
- Endometriosis.
- Blockage or damage to the fallopian tubes.
- Cancer and agents used in cancer treatment.
- Conditions in the uterus such as fibroids and uterine polyps.
- Ovulation disorders.
In males;
- Low testosterone.
- Low sperm count.
- Some prescription medicines taken over long time.
- Cancer treatments(chemotherapeutic and radiotherapeutic agents) which affect can sperm and its production
- Problems with semen reaching female reproductive tract, such as blockage in the testicle.
- Conditions that affect sperm manufacturing and quality, such as hormonal problems, diabetes, undescended testicles and infections(gonorrhea, HIV)
Signs & Symptoms
In females;
Women and people assigned female at birth.
- Menstrual Irregularities
- Irregular or absent periods
- Very light or heavy menstrual flow
- Hormonal Changes
- Hot flashes or night sweats
- Unexplained weight gain or loss
- Pelvic Pain
- Pain during intercourse
- Chronic pelvic pain
- Previous Reproductive Issues
- History of miscarriages
- Previous pelvic infections
- Age Factors
- Advanced maternal age (35 and older)
- Physical Symptoms
- Unusual vaginal discharge
- Signs of endometriosis (e.g., painful periods)
In males;
Men and people assigned male at birth.
- Changes in Sexual Function
- Difficulty with erections or ejaculation
- Reduced libido
- Changes in Sperm Production
- Decreased volume of semen
- Abnormal sperm shape or movement
- Hormonal Imbalances
- Changes in facial or body hair
- Gynecomastia (enlarged breast tissue)
- Health Issues
- History of testicular or prostate issues
- Chronic illnesses (e.g., diabetes)
- Genetic Factors
- Family history of infertility
- Physical Symptoms
- Swelling or lumps in the testicles
- Pain in the testicular area
Diagnostic Procedures
Patient-history taking. This captures crucial medical history such as sexually transmitted infections(gonorrhea, chlamydia, syphilis) that the individual might have had in the past. It also captures medical drugs history since some medicines can cause infertility when taken over long time.
Physical exam conduct a thorough clinical exam to check for;
- Body mass index(BMI). Relate BMI results with normal ranges to see if patient is having obesity.
- Deformities on the testicles.
- Abnormalities on the penis.
- Infection, tenderness or lumps in the pelvic region of females. These can signify pelvic inflammatory disease or presence of ovarian tumors.
Laboratory tests for men;
- Semen analysis
- Genetic testing
- Imaging
- Testicular biopsy
Laboratory tests for women;
- Ovulation testing
- Ovarian reserve testing
- Hysterosalpingography(X-ray test of the womb)
- Thyroid function test
- Laparoscopy
- Hysteroscopy
- Hormone testing
Treatment & Management
Treatment for infertility is dependent upon;
- The cause
- The time period it has been there
- Ages of the couple involved
- Individual preferences
Despite all these, some causes cannot be corrected.
Treatment for men;
- Surgical procedures to correct blockages.
- Prescription medicines to increase likelihood of a successful pregnancy.
- Lifestyle modification. Your clinician can advise you and your partner to have sex more often, especially around ovulation period.
- Sperm retrieval for men who are unable to ejaculate or if there is no or inadequate sperm in semen.
Treatment options for women;
- Fertility medicines. Prescribed for women with ovulation problems.
- Surgical procedures for fertility restoration. Hysteroscopy and laparoscopic surgery can be used to treat some conditions associated with infertility. For example laparoscopic surgery for endometriosis.
- Intrauterine insemination. Introduction of a healthy sperm directly into the uterus around the period of ovulation.
Apart from these, assisted reproductive technology can be used to help couples conceive.
These are;
- In-vitro fertilization(IVF)
- Intra-cytoplasmic sperm injection.
Complications of Treatment
- Multiple pregnancy. Increased chances of getting twins, triplets and even quadruplets.
- Bleeding is a notable risk factor of ART(assisted reproductive technology)
- Ovarian hyperstimulation syndrome(OHSS) due to in-vitro fertilization
Prevention
The following are suggestions on how to control some of the risk factors associated with infertility:
- Maintain healthy weight and normal body mass index ranges.
- Quit smoking.
- Reduce consumption of alcohol
- Embrace a good sleep schedule. At least 7 hours each night.
- Embrace healthy exercises
- Consume good nutritious foods. Diets rich in fruits and vegetables are highly recommended.