What is infertility?

 

  

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• Infertility is defined as the inability of a sexually active couple to achieve pregnancy within one year.

• It can be because of various reasons.

• Understanding those reasons can help in the process of treatment for couples who desire pregnancy.

 

Causes behind Infertility in Men

 

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• For a man to be fertile:

• Healthy sperm has to be produced 

• The sperm has to be motile in the semen

• Number of sperm in the semen has to be optimum. 

• Any issues with these conditions can lead to male infertility. 

• The common causes are: 

 

1. Varicocele

 

• This is a condition found in 16 percent of all men. 

• This is a condition where there is a block in the drainage of the blood from the scrotum.

• As a result of the warm blood staying in the testes for too long, the environment is too warm for the sperm to survive. 

• This can result in infertility. 

 

1. Retrograde ejaculation

 

• In this condition, the sphincter muscles do not contract during an orgasm. 

• The ejaculate travels in the opposite direction in the man i.e. it goes up to the bladder. 

• In these cases, the ejaculate of the man seems dry or too less in volume. 

 

1. Antibodies against sperm cells

 

• In some men, due to hyper activity of the immune system, antibodies are generated against the sperm cells in the body. 

• This causes the sperm to become damaged in structure or motility. This leads to infertility. 

 

1. Blockade in the testicles

 

• As a result of surgical procedures, any blockade in the testicles results in a block in the movement of the sperm.  

• Blockades can also occur due to reasons like testicular cancer, Undescended testes (the testes failing to descend down to the scrotum at birth), any injury to the testicles. 

• Therefore, the sperm is unable to enter the woman’s body during ejaculation. 

 

1. Hormonal Reasons

 

• Any disbalance in the level of hormones like testosterone or the hormones released by the pituitary gland or the hypothalamus can lead to insufficient sperm production.

• Hypogonadism is defined as a condition with low testosterone levels.

• Hypogonadism can occur due to testicular tumours, illegal drug consumption, other birth defects.  

• Hormonal imbalances negatively affect sperm production, resulting in infertility.

 

1. Genetic problems

 

• Certain genetic issues also affect the male fertility, either by directly affecting sperm production or through any impairment in the male reproductive organs. 

• Genetic issues like cystic fibrosis, improper function of the Y chromosome can lead to infertility in men. 

 

1. Medicines and drugs

 

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Medications can also cause issues which result in infertility.

The medications which can cause infertility are:

 

Sulfasalazine 

• Anti-inflammatory drug used to treat Crohn’s disease, rheumatoid arthritis. 

• It has a temporary effect which can be reversed if consumption of the drug is stopped. 

Anabolic Steroids

• Anabolic steroids are largely used as doping by athletes to increase their muscle tone. 

• Long term use can cause loss of sperm count and motility. 

Chemotherapy Drugs

• Chemotherapy medications are generally used for cancer treatment. 

• They can significantly affect sperm production, causing permanent infertility in some men.

Herbal Medicines

• Some herbal medicines like the Chinese herb Tripterygium wilfordii affects sperm production.

Illegal Drugs

• Marijuana and cocaine affect sperm production significantly 

 

When Do you know if you are infertile?

• The signs and symptoms are indications behind infertility in men.

• The symptoms associated with infertility can be different in different men. 

Some of the symptoms of Infertility in men include:

 

Change in sexual desire

Pain in testicles

Erectile Dysfunction (inability to maintain erection)

Issues with ejaculation

Swelling in Testicles

Recurrent respiratory infections

Abnormal breast growth 

Low sperm count 

Issues with urination

 

 

• Moreover, sexually transmitted infections like Gonorrhoea and Chlamydia can also cause infertility in men. 

• The symptoms associated with sexually transmitted infections in men are:

Discharge of fluid from the urethra

Genital itching and rashes

Genital ulcers 

Genital lumps/warts

 

Where is infertility testing done?

• In order to treat infertility in men, a procedure is adapted. 

For infertility in men, the tests performed are:

1. Evaluation of the reproductive structure 

 

• Evaluation of the male reproductive organs and questions related to any related conditions or sexual history are asked.

 

1. Semen evaluations 

 

• The semen sample is collected and is sent to the laboratory in order to assess the number of sperm, shape of the sperm and nature of motility of the sperm. 

• This helps to detect any defects in the sperm present in the semen. 

• The sample is collected by asking the man to ejaculate in a sterile container provided in a fertility clinic or at a chamber in the doctor’s clinic. 

• This is done to get fresh sperm samples as the sperm cells in the sample can die If it is kept for too long without care. 

 

1. Laboratory tests 

 

• Tests are performed on the semen samples to check for any signs of infectious sexually transmitted diseases. 

 

1. Transrectal Ultrasound

 

• Transrectal Ultrasound is performed to check for any problems in the male genitalia due to any conditions, trauma or infections. 

 

1. Post ejaculation urine analysis 

 

• Urine analysis to detect any amount of sperm in urine which might be the reason behind reduced sperm count in semen. 

• This is particularly used to detect retrograde ejaculation which is a cause behind infertility in men. 

 

1. Hormonal testing 

 

• Hormonal testing is performed for testing the levels of testosterone, for hormones produced by hypothalamus and pituitary gland.

• It is also performed to detect hypogonadism which is a cause behind infertility in men. 

 

1. Scrotal ultrasound

 

• Scrotal Ultrasound is performed to detect varicocele or other scrotal conditions which might hinder in the process of production of the sperm cells. 

 

        How Is infertility treated in men?

 

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1. Conditions like varicocele can be treated via surgery 

 

1. Any infections which might be causing infertility can be treated with antibiotics 

 

1. Erectile dysfunction can be treated by therapy or the use of certain prescribed drugs 

 

1. Hormone replacement medication for hormonal reasons behind infertility

 

1. Assisted Reproductive Technology (ART) is used to obtain semen from the donor or the father and inject it into the female’s genital tract or to perform in-vitro fertilisation (fertilisation performed inside a laboratory to form a zygote). 

2. Assisted Reproductive Technology (ART) like Zygote Intrafallopian transfer or Gamete Intrafallopian Transfer is also used as an alternative to traditional methods of conception. 

 

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What is Infertility?

 

 

Image source: Unsplash

 

• Infertility is defined as the inability of a sexually active couple to achieve pregnancy within one year.

• It can be because of various reasons.

• Understanding those reasons can help in the process of treatment for couples who desire pregnancy.

 

Types of infertility in women

There are two types of infertility: primary and secondary infertility. 

1. Primary Infertility: 

• In primary infertility, the woman is unable to bear a child either due to the inability to become pregnant or the inability for the pregnancy to result in the live birth of a child.

• Spontaneous miscarriages, or birth of still born children are some examples of primary infertility.

• In primary infertility, the woman has no history of previous successful pregnancies or live-births in the past. 

1. Secondary Infertility: 

• In secondary infertility, the woman is unable to bear a child either due to the inability to become pregnant or the inability for the pregnancy to result in live birth. 

• Unlike primary infertility, in secondary infertility, the woman will have a history of pregnancy or live-birth in the past. 

 

Causes behind Infertility in Women

 

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• Infertility in women occurs due to issues in several parts of the reproductive system. 

• The reasons behind infertility can be infectious or non-infectious.

 

NON-INFECTIOUS REASONS

1.Damage to fallopian tubes or ovary

• Fallopian tubes are the structures which contain the ovulated egg which needs to be fertilised by the sperm. Ovaries, on the other hand, produce these eggs. 

• Any damage to these structures can result in serious manifestations like infertility. 

• Conditions which can lead to the damage of these parts of the reproductive system are Polycystic ovarian syndrome (PCOS), Diminished ovarian reserve (DOR), Endometriosis (Shedding of the uterine lining where the fused egg is supposed to be implanted).

 

2.Thyroid Problems

 

• An Overactive or underactive thyroid gland can prevent the process of ovulation. 

• This diminishes the available eggs in the reproductive tract which results in infertility. 

 

3.Scarring from Surgery

 

• Any surgery on the pelvic region can cause damage to the fallopian tubes, causing a scar to occur there. 

• Cervical surgery also causes scarring or the shortening of the neck of the womb of the uterus. 

• All of these causes contribute to infertility in women.

 

4.Polycystic Ovarian Syndrome (PCOS)

 

• PCOS is defined as a set of syndromes which occur in some women of reproductive age. 

• The exact cause behind PCOS is unknown but there has been proof of genetic factors and environmental factors contributing to the development of the disease. 

• The symptoms of the disease include abnormal acne growth, facial hair growth, difficult sleeping, high levels of testosterone, ovarian cysts. 

• PCOS also causes irregular menstruation in women and is a leading cause behind infertility.

 

5.Fibroids

• Fibroids are non-cancerous growths in the womb of the uterus.

• Fibroids can prevent implantation- The attachment of the zygote to the wall of the uterus. 

• Fibroids can also block the fallopian tube causing a blockage. 

• These issues contribute to infertility in women. 

 

6.Damage to uterus

• Abnormalities in the uterus can lead to issues in the implantation of the zygote or provide a hostile environment for the sperm. 

• Issues which can cause such problems are: Endometriosis, Fibroids (growth in the wall of the uterus) and uterine polyp growths. 

 

7.Cervical Damages

 

• Due to contribution of any hormones like progesterone, the mucus plug in the cervix might thicken. 

• This can lead to the blockade of the sperm. 

• Hence, chances of fertilisation to occur are reduced. 

• Cervical cancer or polyp growths also contribute to causing infertility in affected women.

 

8.Hormonal Imbalance

 

• There are a complex set of hormones which are responsible for the monthly female menstrual cycle. 

• They are namely progesterone, Human Chorionic Gonadotropin (HCG), Thyroid hormones, oestrogen, prolactin. 

• These hormones help in the initiation or maintenance of pregnancy. 

• Any imbalance in the hormone levels of these hormones can contribute to infertility in women. 

 

9.Menopause

 

• Menopause is a normal event in the life of a woman when at the age of around 50, menstruation stops to occur. 

• This occurs because the viable egg reserve for fertilisation has diminished in the woman and hence, she is no longer fertile. 

• When menopause occurs before 40 years of age, it is known as premature menopause and this also causes infertility. 

 

10.Sterilisation

• Sterilisation is a surgical procedure where the fallopian tube of the woman is blocked to prevent any sperm to travel to the egg or the egg to travel to the womb. 

• This process is mostly irreversible and most attempts for reversal does not restore fertility in women. 

• The chances of permanent infertility are significantly high after performing this procedure. 

 

INFECTIOUS REASONS

 

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Sexually Transmitted Infections (STI)

 

• STIs are infections which spread especially through unprotected sexual intercourse. 

• STIs can also spread through other sexual practices like oral sex. 

• STIs, when left untreated can lead to infertility and is one of the leading causes of infertility in women. 

• Infections like Chlamydia, HPV, Gonorrhoea lead to the development of infertility in women who have been chronically diseased. 

• Moreover, the development of Pelvic Inflammatory Disease (PID) in infected women is a major risk factor for the development of infertility in women. 

 

Pelvic Inflammatory Disease (PID)

 

• PID is defined as the infection of a woman’s reproductive organs, usually caused due to STIs and other local infections of the reproductive system. 

• 1 in 8 women with a history of PID are infertile. 

• This is another major cause behind infertility. 

 

When Do you know if you are infertile? 

 

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• The signs and symptoms of the underlying causes behind infertility indicate possible infertility in women. 

 

Some of the symptoms of Infertility in women include:

 

Irregular periods 

Continuous periods

Reduced sex drive

Facial hair and acne growth 

Weight gain

Vaginal discharge 

Recurrent Redness around the vagina

Issues with urination 

Thinning of scalp hair 

 

• Moreover, if there are any symptoms that align with any of the sexually transmitted infections, one should get tested immediately. 

• STDs are leading causes of infertility in women. 

The symptoms associated with sexually transmitted infections are:

 

Vaginal foul-smelling discharge

Genital Itching and rashes

Genital ulcers

Lower abdominal pain

Chronic pain in vulva (external reproductive organs)

 

Where is infertility testing done?

• There is no singular test to determine infertility. 

• The tests are usually performed to detect the underlying causes behind infertility. 

The tests to detect infertility in women include:

1. Pap Smear

 

• Performed to detect cervical cancer in women.

• Cervical cancer is a cause of infertility in women. 

 

1. Urine test

 

• Urine test is performed to check for any abnormal discharge for signs of infection.

 

1. Hormonal Tests 

 

• Tests to check progesterone levels in body

• Thyroid Hormone Tests

 

1. Basal Body Temperature

 

• The basal body temperature of a woman increases after ovulation occurs, so this can be a test performed every morning by the woman at home to detect the frequency of ovulation. 

 

1. Hysterosalpingogram (HSG)

 

• X-ray of fallopian tube or uterus is assessed to detect any underlying conditions in the fallopian tube or the uterus. 

 

1. Ultrasound checks

 

• USG checks are performed to further look for any conditions in the female reproductive tract which might be contributing to infertility.

 

1. Laparoscopy 

 

• Laparoscopy is a test used to check the pelvis of the woman, in order to detect any problems like Pelvic Inflammatory Diseases (PID)

• PIDs are leading causes of infertility in women

 

1. Genetic Tests

• Genetic tests are performed to check for signs of PCOS (rarely) but to check for signs of underlying conditions like cancer or other factors contributing to infertility. 

 

How is infertility treated in women?

 

1. Hormonal supplements are prescribed to address to a specific hormonal imbalance

 

1. Medications are prescribed to be taken cyclically in order to stimulate ovulation

 

1. Antibiotics are prescribed to treat any underlying infections 

 

1. Any blockage in the cervix or in the fallopian tube or uterus can be removed via surgical procedures.