Infertility – Woman and Childbirth
About 10% of couples in the United States are affected by infertility. Infertility refers to an inability to conceive after having regular unprotected sex. Infertility can also refer to the biological inability of an individual to contribute to conception, or to a female who cannot carry a pregnancy to full term. In many countries infertility refers to a couple that has failed to conceive after 12 months of regular sexual intercourse without the use of contraception.
According to the Centers for Disease Control, 1/3 of the time the diagnosis is due to female infertility, 1/3 of the time it is linked to male infertility, and the remaining cases of infertility are due to a combination of factors from both partners. For approximately 20% of couples, the cause cannot be determined.
Women are born with a finite number of eggs. Thus, as the reproductive years progress, the number and quality of the eggs diminish. The chances of having a baby decrease by 3% to 5% per year after the age of 30.
There are several risk factors of infertility.
Age – a woman’s fertility starts to drop after she is about 32 years old, and continues doing so. A 50-year-old man is usually less fertile than a man in his 20s (male fertility progressively drops after the age of 40).
Smoking – smoking significantly increases the risk of infertility in both men and women. Smoking may also undermine the effects of fertility treatment. Even when a woman gets pregnant, if she smokes she has a greater risk of miscarriage.
Alcohol consumption – a woman’s pregnancy can be seriously affected by any amount of alcohol consumption. Alcohol abuse may lower male fertility. Moderate alcohol consumption has not been shown to lower fertility in most men, but is thought to lower fertility in men who already have a low sperm count.
Being obese or overweight – in industrialized countries overweight/obesity and a sedentary lifestyle are often found to be the principal causes of female infertility. An overweight man has a higher risk of having abnormal sperm
Dr Green struggled with infertility. She was 50 lbs overweight and her body fat was twice normal at 42 percentage. Her nutritional program successfully treated her infertility. She can do the same for you.
Eating disorders – women who become seriously underweight as a result of an eating disorder may have fertility problems.
Being vegan – if you are a strict vegan you must make sure your intake of iron, folic acid, zinc and vitamin B-12 are adequate, otherwise your fertility may become affected.
Over-exercising – a woman who exercises for more than seven hours each week may have ovulation problems.
Not exercising – leading a sedentary lifestyle is sometimes linked to lower fertility in both men and women.
Sexually transmitted infections (STIs) – chlamydia can damage the fallopian tubes, as well as making the man’s scrotum become inflamed. Some other STIs may also cause infertility.
Exposure to some chemicals – some pesticides, herbicides, metals (lead) and solvents have been linked to fertility problems in both men and women.
Mental stress – studies indicate that female ovulation and sperm production may be affected by mental stress. If at least one partner is stressed it is possible that the frequency of sexual intercourse is less, resulting in a lower chance of conception.
Causes of infertility in women
Ovulation disorders – problems with ovulation are the most common cause of infertility in women, experts say. Ovulation is the monthly release of an egg. In some cases the woman never releases eggs, while in others the woman does not release eggs during come cycles. Ovulation disorders can be due to:
- Damage to Fallopian Tubes
- Hormonal Causes
- Cervical Causes
- Uterine Causes
- Premature ovarian failure
- PCOS (polycystic ovary syndrome)
- Poor egg quality
- Overactive thyroid gland
- Underactive thyroid gland
- Submucosal Fibroids
- Some chronic conditions, such as AIDS or cancer.
How Is the Cause of Infertility Determined?
If male infertility is suspected, a semen analysis is performed. This test will evaluate the number and health of his sperm. A blood test can also be performed to check his level of testosterone and other male hormones.
If female infertility is suspected, your doctor may order several tests, including:
A blood test to check hormone levels
An endometrial biopsy to check the lining of the uterus
Two diagnostic tests that
may be helpful in detecting scar tissue and tubal obstruction are hysterosalpingography and laparoscopy.
Hysterosalpingography (HSG). This procedure involves either ultrasound or X-rays taken of the reproductive organs. Either dye or saline and air are injected into the cervix and travel up through the fallopian tubes. This enables the ultrasound or X-ray to reveal if the fallopian tubes are open or blocked.
Laparoscopy. In this procedure, a laparoscope (a slender tube fitted with a fiberoptic camera) is inserted into the abdomen through a small incision near the belly button. The laparoscope enables the doctor to view the outside of the uterus, ovaries, and fallopian tubes to detect abnormal growths, as in endometriosis. The doctor can also check to see if the fallopian tubes are open at the same time.
Causes of infertility in men
Semen is the milky fluid that a man’s penis releases during orgasm. Semen consists of fluid and sperm. The fluid comes from the prostate gland, seminal vesicle and other sex glands. The sperm is produced in the testicles. During orgasm a man ejaculates (releases semen through the penis). The seminal fluid helps transport the sperm during ejaculation. The seminal fluid has sugar in it – sugar is an energy source for sperm.
Abnormal semen is responsible for about 75% of all cases of male infertility. Unfortunately, in many cases doctors never find out why. The following semen problems are possible:
Low sperm count (low concentration) – the man ejaculates a lower number of sperm, compared to other men. Sperm concentration should be 20 million sperm per milliliter of semen. If the count is under 10 million there is a low sperm concentration (subfertility).
No sperm – when the man ejaculates there is no sperm in the semen.
Low sperm mobility (motility) – the sperm cannot “swim” as well as it should.
Abnormal sperm – perhaps the sperm has an unusual shape, making it more difficult to move and fertilize an egg.
Sperm must be the right shape and able to travel rapidly and accurately towards the egg. If the sperm’s morphology (structure) and motility (movement) are wrong it is less likely to be able to reach the egg and fertilize it.
- The following may cause semen to be abnormal:
- Testicular infection
- Testicular cancer
- Testicular surgery
- Overheating the testicles
- Ejaculation disorders
- Undescended testicle
- Genetic abnormality
- Cystic fibrosis
- Some diseases
- Anabolic steroids
- Illegal drugs
- Diagnosing Infertility
- Tests for males
General physical exam – the doctor will ask the man about his medical history, medications, and sexual habits. The physician will also carry out an examination of his genitals. The testicles will be checked for lumps or deformities, while the shape and structure of the penis will be examined for any abnormalities.
Semen analysis – the doctor may ask for some specimens of semen. They will be analyzed in a laboratory for sperm concentration, motility, color, quality, infections and whether any blood is present. As sperm counts can fluctuate, the man may have to produce more samples.
Blood test – the lab will test for several things, including the man’s level of testosterone and other male hormones.
Ultrasound test – the doctor will determine whether there is any ejaculatory duct obstruction, retrograde ejaculation, or other abnormality.
Chlamydia test – if the man is found to have Chlamydia, which can affect fertility, he will be prescribed antibiotics to treat it.
Tests for females
General physical exam – the doctor will ask the woman about her medical history, medications, menstruation cycle, and sexual habits. She will also undergo a gynecological examination.
Blood test – several things will be checked, for example, whether hormone levels are correct and whether the woman is ovulating (progesterone test).
Hysterosalpingography – fluid is injected into the woman’s uterus which shows up in X-ray pictures. X-rays are taken to determine whether the fluid travels properly out of the uterus and into the fallopian tubes. If the doctor identifies any problems, such as a blockage, surgery may need to be performed.
– a thin, flexible tube with a camera at the end (laparoscope) is inserted into the abdomen and pelvis to look at the fallopian tubes, uterus and ovaries. A small incision is made below the belly button and a needle is inserted into the abdominal cavity; carbon dioxide is injected to create a space for the laparoscope. The doctor will be able to detect endometriosis, scarring, blockages, and some irregularities of the uterus and fallopian tubes.
Ovarian reserve testing – this is done to find out how effective the eggs are after ovulation.
Genetic testing – this is to find out whether a genetic abnormality is interfering with the woman’s fertility.
Pelvic ultrasound – high frequency sound waves create an image of an organ in the body, which in this case is the woman’s uterus, fallopian tubes, and ovaries.
Chlamydia test – if the woman is found to have Chlamydia, which can affect fertility, she will be prescribed antibiotics to treat it.
Thyroid function test – according to the National Health Service (UK) between 1.3% and 5.1% of infertile women have an abnormal thyroid.
What are the treatment options for infertility?
This will depend on many factors, including the age of the patient(s), how long they have been infertile, personal preferences, and their general state of health. Even if the woman has causes that cannot be corrected, she may still become pregnant.
Frequency of intercourse
The couple may be advised to have sexual intercourse more often. Sex two to three times per week may improve fertility if the frequency was less than this. Some fertility experts warn that too-frequent sex can lower the quality and concentration of sperm. Male sperm can survive inside the female for up to 72 hours, while an egg can be fertilized for up to 24 hours after ovulation.
Fertility treatment for men
Erectile dysfunction or premature ejaculation – medication and/or behavioral approaches can help men with general sexual problems, resulting in possibly improved fertility.
Varicocele – if there is a varicose vein in the scrotum, it can be surgically removed.
Blockage of the ejaculatory duct – sperm can be extracted directly from the testicles and injected into an egg in the laboratory.
Retrograde ejaculation – sperm can be taken directly from the bladder and injected into an egg in the laboratory.
Surgery for epididymal blockage – if the epididymis is blocked it can be surgically repaired. The epididymis is a coil-like structure in the testicles which helps store and transport sperm. If the epididymis is blocked sperm may not be ejaculated properly.
Fertility treatment for women
Weightloss and normalizing body fat percentage
Ovulation disorders – if the woman has an ovulation disorder she will probably be prescribed fertility drugs which regulate or induce ovulation.
Clomifene (Clomid, Serophene) – this medication helps encourage ovulation in females who do not ovulate regularly, or who do not ovulate at all, because of polycystic ovary syndrome (PCOS) or some other disorder. It makes the pituitary gland release more FSH (follicle-stimulating hormone) and LH (luteinizing hormone).
Metformin (Glucophage) – women who have not responded to Clomifene may have to take this medication. It is especially effective for women with PCOS, especially when linked to insulin resistance.
Human menopausal gonadotropin, or hMG, (Repronex) – this medication contains both FSH and LH. It is an injection and is used for patients who don’t ovulate on their own because of a fault in their pituitary gland.
Follicle-stimulating hormone (Gonal-F, Bravelle) – this is a hormone produced by the pituitary gland that controls estrogen production by the ovaries. It stimulates the ovaries to mature egg follicles.
Human chorionic gonadotropin (Ovidrel, Pregnyl) – this medication is used together with clomiphene, hMG and FSH. It stimulates the follicle to ovulate.
Gn-RH (gonadotropin-releasing hormone) analogs – for women who ovulate prematurely, before the lead follicle is mature enough during hmG treatment. This medication delivers a constant supply of Gn-RH to the pituitary gland, which alters the production of hormone, allowing the doctor to induce follicle growth with FSH.
Bromocriptine (Parlodel) – this drug inhibits prolactin production. Prolactin stimulates milk production in breast feeding mothers. If non-pregnant, non-breast feeding women have high levels of prolactin they may have irregular ovulation cycles and have fertility problems.
IUI (intrauterine insemination) – a fine catheter is inserted through the cervix into the uterus to place a sperm sample directly into the uterus. The sperm is washed in a fluid and the best specimens are selected. This procedure must be done when ovulation occurs. The woman may be given a low dose of ovary stimulating hormones.
IVF (in vitro fertilization) – sperm are placed with unfertilized eggs in a Petri dish; the aim is fertilization of the eggs. The embryo is then placed in the uterus to begin a pregnancy. Sometimes the embryo is frozen for future use (cryopreserved). Louise Joy Brown, born in England in 1978, was the world’s first IVF baby. Before IVF is done the female takes fertility drugs to encourage the ovaries to produce more eggs than normal.
ICSI (Intracytoplasmic sperm injection) – a single sperm is injected into an egg to achieve fertilization during an IVF procedure. The likelihood of fertilization improves significantly for men with low sperm concentrations.
Donation of sperm or egg – if there is either no sperm or egg in one of the partners it is possible to receive sperm or eggs from a donor. Fertility treatment with donor eggs is usually done using IVF. In the UK and a growing number of countries the egg donor can no longer remain anonymous – the offspring can legally trace his/her biological parent when reaching the age of 18.
Assisted hatching – this improves the chances of the embryo’s implantation; attaching to the wall of the uterus. The embryologist opens a small hole in the outer membrane of the embryo, known as the zona pellucid. The opening improves the ability of the embryo to leave its shell and implant into the uterine lining. Patients who benefit from assistant hatching include women with previous IVF failure, poor embryo growth rate, and older women. In some women, particularly older women, the membrane is hardened, making it difficult for the embryo to hatch and implant.
Electric or vibratory stimulation to achieve ejaculation – ejaculation is achieved with electric or vibratory stimulation. This procedure is useful for men who cannot ejaculate normally, such as those with a spinal cord injury.
Surgical sperm aspiration – the sperm is removed from part of the male reproductive tract, such as the vas deference, testicle or epididymis.
What are the complications of infertility treatment?
Ovarian hyperstimulation syndrome (OHSS)
The ovaries become very swollen, leaking excess fluid into the body. The ovaries produce too many follicles (small fluid sacs in which an egg develops). OHSS usually occurs as a result of taking medications to stimulate the ovaries, such as clomifene and gonadtrophins, and can also develop after IVF.
Symptoms can include:
- Dark urine
- Pain in the abdomen
I am Dr. Allison Haughton-Green, a mother of twins in her 40’s. As this year moves forward, I would like to share my story with you in the hopes that this will be your year, as
2008 was mine: a mixture of good health and successful weight loss.
In 2008, I lost 47 lbs and 18% body fat in 90 days going from a size 12 to size 2. After my own life changing experience with weight loss and wellness, I formed the Orlando Institute of Weight Management and Metabolic Medicine. My greatest accomplishment was developing a weight management program for children and adolescents. My son, Jordon, was my first patient in my program. This was no easy feat. He has special needs and is an extremely picky eater. Before he started my program, his diet consisted of primarily carbohydrates. Because of his high carbohydrate intake, he developed excessive abdominal fat, elevated cholesterol and blood pressure – classic signs of metabolic syndrome (insulin resistance). I started Jordan on a moderate protein, moderate fat, and healthy carbohydrate nutritional plan. Within 90 days, his percentage of body fat, fasting insulin, HA1C, cholesterol, and blood pressure normalized.