Infertility

Overview

Infertility is not just a woman’s health issue; men can also be infertile. The stats show that women and men are just as likely to have fertility problems.

A diagnosis of infertility means you have not been able to get pregnant after a year of trying. If you are a woman over 35, it means you have not been able to get pregnant after six months of trying.

Additionally, women who do conceive but can’t carry a pregnancy to term may also receive a diagnosis of infertility.

Sometimes, infertility is defined as primary infertility, where a woman has never achieved a pregnancy and secondary infertility, where a woman has had at least one successful pregnancy.

Although many causes of infertility affect both men and women, in a quarter of cases, the cause is not identified. 

Symptoms

Common Signs of Infertility in Women

Irregular or no periods
The average menstrual cycle is 28 days long. It is considered normal if each menstrual cycle is within a few days of that, and it is also not uncommon for a woman to have no cycle for a month occasionally. However, if a woman’s menstrual cycle varies so much that she can’t estimate when it may arrive, it is worth discussing with a doctor. The same is true if a woman has not had a period in months.

Painful or heavy periods
Again, it is common for most women to have cramps during their periods. However, painful periods disrupt your daily life, which can be a sign of an underlying health condition worth investigating. 

Symptoms of hormone fluctuations

The following symptoms are signs of hormone fluctuations and could indicate potential issues with fertility:

• Skin issues
• Reduced sex drive
• Facial hair growth
• Thinning hair
• Weight gain

Pain during sex

Sex should not be painful, yet some women experience it throughout their lives. It can signify an underlying condition that could also contribute to infertility.

Common Signs of Infertility in Men

For men, the most significant signs relate to their sexual desire and sexual performance because they indicate potential issues with their hormone health. So if you are experiencing the below, please speak with your doctor:

• Changes in sexual desire
• Testicle pain or swelling
• Problems maintaining erection
• Issues with ejaculation
• Small, firm testicles

Diagnosis

Tests for men

Tests for male infertility aim to determine that the man is producing sperm and that it is strong enough to be ejaculated and journey to the female’s egg.

You will likely have a general physical exam, including examining your genitals. Specific fertility tests may include:

• Semen analysis
• Hormone testing
• Genetic testing
• Testicular biopsy
• Imaging

Tests For Women

Fertility tests for women aim to find that they are releasing healthy eggs that they can join with male sperm to be fertilised, travel to the uterus and implant into the lining.

Testing will start with a general physical exam, including a regular gynaecological exam. Specific fertility tests may include:

• Ovulation and hormone tests
• Various scans (e.g. x-rays, ultrasound or scopic procedures to get a closer look at particular areas of the female reproductive system)
• Ovarian reserve testing: This helps determine the number of eggs produced for ovulation

Causes

There is no single cause of Infertility in either men or women, and for 25% of couples, a cause is not identified. Common causes of infertility include: 

• poor quality semen 
• lack of monthly ovulation (the release of an egg) 
• blocked or damaged fallopian tubes 
• endometriosis: this is a tissue that behaves like the lining of the womb, but it is found outside the womb 

Risk factors 

Fertility can be affected by a variety of factors. It can include: 

• Age: fertility declines with age 
• Weight: having a BMI of 30 or more (which is considered overweight or obese) can reduce fertility or ovulation
• Sexually transmitted infections (STIs): some STIs, including chlamydia, can affect fertility if left untreated
• Smoking: The chances of conceiving and semen quality are affected by smoking, including passive smoke
• Alcohol: Sperm quality is affected by having excessive alcohol
• Environmental factors: certain pesticides, solvents and metals have been shown to affect fertility, particularly in men 
• Stress: in cases of severe stress, it can affect ovulation and sperm production

Treatments

There are various treatment options, and the type of treatment offered will depend on various elements, including:

• The cause of infertility, if it is identified
• The length of time that partners have been trying to conceive
• The ages of each partner
• The general health of each partner

Men

Depending on the cause, male infertility is treated in various ways. These include surgery, medication, and assisted reproductive technology (ART).

Surgery is used to fix obstructions that prevent sperm from being present in the semen. Surgery also can retrieve sperm from the testicles that can be used in ART treatments.

For men suffering from issues such as hormone imbalances, medications can help. Additionally, medications can also treat other conditions that can affect male fertility, such as erectile dysfunction or infections that affect sperm count.

ART refers to treatment that handles eggs and sperm outside of the body. It can include in vitro fertilisation (IVF) and intracytoplasmic sperm injection. Sperm for ART treatments can be retrieved from semen, extracted from the testicles or received from a donor.

Women

Treating female infertility can involve surgery, medication, and reproductive assistance such as ART. In some cases, several of these treatments may be needed to help address infertility.

Surgery to treat female infertility is now rarer because of advancements in other treatments. When it does happen, it can involve:

• Unblocking fallopian tubes
• Correcting an abnormally shaped uterus
• Removing fibroids
• Intrauterine insemination (IUI) and ART: IUI injects millions of sperm into a woman’s uterus near the time of ovulation, and IVF (which is a form of ART) removes eggs that are fertilised with sperm in a laboratory, and then after fertilisation, the embryo is placed into the uterus.

Medications encourage or regulate ovulation, like hormones usually present in the body.

Conclusion

Being diagnosed with infertility does not mean that your dreams of having a child have ended. It may take some time, but the treatments can improve your chances of success.

Whether or not a specific infertility treatment results in a pregnancy can depend on many factors, and it may take several attempts and various treatment options.

In some cases, unfortunately, a fertility problem may not be able to be treated directly, but there are alternative routes considering donor sperm or eggs, surrogacy, or adoption.