Why does it happen?
With somewhere between 10 – 15 % of couples in the United States struggling to have a baby, you probably know someone who is experiencing infertility. This is a challenging situation if you’re the one going through it and can lead to many questions. What causes it to happen? What are the ways to treat it?
Definition
Infertility is when you’re unable to get pregnant despite having frequent, unprotected sex for at least a year. Often this inability to get pregnant is the only symptom. It can be caused by a wide variety of factors. Some of these are present at birth and others develop later. A third of the time, it’s an issue with the man. Another third of the time, it’s an issue with the woman. The last third is an issue with both partners or no cause can be found. For men, it can be the result of abnormal sperm production/function due to undescended testicles, genetic defects, enlarged veins in the testes (varicocele) or health problems (diabetes or infections). There could also be difficulty with the delivery of the sperm due to genetic diseases (cystic fibrosis), premature ejaculation, blockage in the testicle or injury to the reproductive organs. Overexposure to environmental factors can play a role. These include pesticides, chemicals, radiation, cigarettes, alcohol, marijuana, anabolic steroids, frequent exposure to heat via sauna/hot tub or taking certain medications. Also, being overweight can play a role in causing infertility for men. For women, infertility can be the result of ovulation disorders that affect the release of the eggs, such as polycystic ovary syndrome, hyperprolactinemia (your body makes too much of the hormone, prolactin), hyperthyroidism (too much thyroid hormones), hypothyroidism (too little thyroid hormones), exercising too much or if you have an eating disorder. Another issue for women is if they have uterine or cervical abnormalities, like polyps in the uterus, the uterus’ shape or uterine fibroids. Also, if a woman has damage to her fallopian tubes, which can result from pelvic inflammatory disease, it can cause a blockage that doesn’t allow the egg to reach the uterus. Some women experience endometriosis (when endometrial tissue grows outside the uterus), pelvic adhesions (bands of scar tissue within the pelvis) or primary ovarian insufficiency (early menopause – onset of menopause before the age of 40). All of these can cause infertility too. Environmental factors, such as cigarettes, alcohol, marijuana or being underweight/overweight can also result in infertility. For both men and women, having cancer or the treatment for cancer can lead to infertility. Another big factor for both genders is age. For women, their fertility gradually declines, especially in the mid-30s, and rapidly declines after the age of 37. For men, fertility starts declining significantly after the age of 40.
Treatment
There are some things that can indicate you might be infertile. If you’re a man and have a low sperm count, history of testicular/prostate/sexual problems, undergone cancer treatment, small testicles, swelling in your scrotum or family members with infertility problems, then you should talk to your doctor, especially if you and your partner are having difficulty getting pregnant. If you’re a woman and have irregular/absent periods, painful periods, known fertility problems, endometriosis, pelvic inflammatory disease, multiple miscarriages or undergone cancer treatment, then you should talk to your doctor. Also, if you’re a woman over 35 and having been trying to conceive for over six months or are over the age of 40 and would like to get pregnant, you should talk to your doctor.
Unfortunately, despite there being many treatment options, not all causes of infertility can be corrected. Treatment depends on the cause, how long you’ve been infertile, your age, your partner’s age and personal preferences regarding treatment options. For men, there are medications that you can take to increase your sperm count, surgeries that can reverse a blockage or procedures that can retrieve sperm (typically used when there is an ejaculation problem or no sperm in the ejaculated fluid). For women, there are medications that can help regulate/induce ovulation, intrauterine insemination (IUI) procedure (healthy sperm are placed in the uterus around the time eggs are released—this can be done in combination with taking fertility medications) or surgeries to restore fertility if there are physical issues. For both genders, changing lifestyle factors is also key to helping reduce the number of variables that could be contributing to infertility.
If necessary, you and your partner could opt for assisted reproductive technology (ART) treatments. There are several different types. The most that people know is in vitro fertilization (IVF), which involves stimulating and retrieving multiple mature eggs and fertilizing them with sperm in a dish in a lab and then implanting the embryos in the uterus several days after fertilization. Some other ART are intracytoplasmic sperm injection (ICSI), which is when a single healthy sperm is injected directly into a mature egg; assisted hatching, which assists the implantation of the embryo into the lining of the uterus by opening the outer covering of the embryo; using donor eggs/sperm and using a gestational carrier (often used if the woman doesn’t have a functional uterus or she would be under significant health risks if she became pregnant).
Finding out you or your partner are infertile can place a huge emotional toll on both of you. Also, going through the process of infertility treatments can be stressful. The treatments are usually expensive and not covered by most insurance companies. The uncertainty of whether or not the treatments will work adds to the psychological stress. The physical process of the treatments can cause physical stress. Therefore, it’s crucial that as you begin the journey of seeking treatment, you keep in mind several things. The first is try to be prepared as best as you possibly can by asking questions and learning as much as you can about the process. It’s also important to set limits as far as what procedures you’re willing to use and how many times you’re going to go through the process based off of your financial resources and your emotional tolerance. It’s key to seriously look at and consider other options, like donor sperm/eggs, gestational carrier, adoption or no children, early in the treatment process. This can help to decrease anxiety about the treatments and reduce feeling hopeless if they don’t work. Another vital element is managing stress because it can actually make it challenging to achieve positive results and cause you to experience a wide variety of health complications.
Prevention
While all types of infertility aren’t preventable, there are things that you can do to help minimize the risk. For both genders, it’s important to avoid tobacco, drugs and alcohol. It’s critical to get enough exercise to maintain a healthy weight, but don’t take it to extreme levels, especially for women. For men, it’s a good idea to avoid exposure to high temperatures of hot tubs/saunas and medications that can impact sperm production (talk to your doctor before stopping any medications that you take on a regular basis). Women should also limit how much caffeine they take in and seek treatment for any eating disorders.
Infertility can be a very challenging situation to be in. Seeking treatment can cause significant financial, physical and psychological stress. It’s important to think through all of your options and find a solution that works best for you and your partner. If you have any questions or concerns about infertility, please speak with your doctor. If you would like more information, please visit the American Pregnancy Association’s Infertility page at https://americanpregnancy.org/infertility/what-is-infertility/