What Is Infertility?
Infertility is when a couple cannot conceive (get pregnant) despite trying to get pregnant naturally through regular unprotected intercourse. Around one in seven couples may have difficulty conceiving. About 84% of couples will conceive naturally within one year if they have
regular unprotected intercourse.
For every 100 couples trying to conceive naturally:
- 84 will conceive within one year
- 92 will conceive within two years
- 93 will conceive within three years
For couples who have been trying to conceive for more than three years without success, the likelihood of pregnancy occurring naturally (with out any treatment) within the next year is 25% or less.
What Causes Infertility?
There are many potential causes of infertility and fertility problems can affect either the man or the woman. However, it is not always possible to identify the cause. Common causes of infertility in women include lack of regular monthly release of an egg (ovulation problem), blockage of the fallopian tubes and endometriosis although the cause is unexplained in 25% of couples. In men, the most common cause is poor quality of semen (low sperm concentration, reduced sperm motility, absent sperm). In some men, problem with erection or ejaculation are seen.
Infertility In Women
Infertility is most commonly caused by problems with ovulation. Some problems stop women releasing eggs at all, and some cause an egg to be released during some cycles, but not others.
Ovulation problems can occur as a result of a number of conditions, listed below.
- Polycystic ovary syndrome (PCOS), a condition that makes it more difficult for your ovaries to produce an egg.
- Thyroid problems, both an overactive thyroid gland (hyperthyroidism) and an underactive thyroid gland (hypothyroidis) can prevent ovulation.
- Excessive Prolactin (milk hormone) production
- Premature ovarian failure, where a woman’s ovaries stop working before she is 40.
The fallopian tubes are the tubes along which an egg travels from the ovary to the womb. The egg is fertilised as it travels down the fallopian tubes. When it reaches the womb, it is implanted into the womb’s lining where it continues to grow. If the womb or the fallopian tubes are damaged, or stop working, it may be difficult to conceive naturally. This can occur following scarring from surgery or previous infection in the pelvis (pelvic inflammatory disease) or endometriosis.
Fibroids in the uterus are benign (non-cancerous) tumours that grow in the uterus. These are very common and are do not usually cause any problem. Depending on its location and size, fertility can be affected. Submucous fibroids (fibroids lying close to the inner lining of the uterus or with in the cavity of uterus) and large intra-mural fibroids (fibroid that are seen with in the muscle of uterus) can reduce fertility, although exactly how they do this is not yet known. It is possible that a fibroid may prevent an embryo from implanting itself into your womb.
Endometriosis is a condition where lining of the uterus, known as the endometrium, starts growing in other places, such as the ovaries. This can cause infertility because the new growths form adhesions (sticky areas of tissue) or cysts (fluid-filled sacs) that can block or distort the pelvis. These make it difficult for an egg to be released and become implanted into the womb. It can disturb the way that a follicle (fluid-filled space in which an egg develops) matures and releases an egg.
The side effects of some types of medication and drugs can affect your fertility.
- Non-steroidal anti-inflammatory disease (NSAIDs): Long-term use or a high dosage of NSAIDs, such as ibuprofen or aspirin, can make it more difficult to conceive.
- Chemotherapy: Medicines used for chemotherapy (a treatment for cancer) can sometimes cause ovarian failure, which means your ovaries will no longer be able to function properly. Ovarian failure can be permanent.
Infertility in women is also linked to age. The biggest decrease in fertility begins during the mid-thirties.
Infertility In Men
Abnormal Semen parameters
Some possible reasons for abnormal semen are listed below.
- Decreased number of sperm – You may have a very low sperm count or no sperm at all.
- Decreased sperm mobility – If you have decreased sperm mobility, it will be harder for your sperm to swim to the egg.
- Abnormal sperm – Sometimes sperm can be an abnormal shape, making it harder for them to move and fertilise an egg.
Many cases of abnormal semen are unexplained. The factors that can affect semen and sperm in some men are Infection or trauma of testes or genital area, testicular cancer, surgery to testes or genital area, undescended testes (testes not descened into the scrotum), congential defect (defect from birth) such as absence of vas deference (tube carrying sperm from testes to penis). Smoking and excessive alcohol intake can also affect semen quality.
Erectile or ejaculation problem
Some men experience erectile or ejaculation problem that can make it difficult for them to ejaculate. Other ejaculation problems include retrograde ejaculation (semen is ejaculated into bladder) and premature ejaculation (ejaculation occurs too quickly before entering into the vagina)
Rarely, abnormal testicular function or pituitary gland function can be a cause for abnormal sperm production. This could be due to a tumour, taking illegal drugs, or Klinefelter’s syndrome (a rare genetic condition where a man is born with an extra female chromosome).
Medicines and drugs
Certain types of medicines can sometimes cause infertility problems.
- Anabolic steroids, often used illegally to build muscle and improve athletic performance. Long-term use of anabolic steroids can reduce sperm count and sperm mobility.
- Chemotherapy – Medicines used in chemotherapy can sometimes severely reduce sperm production.
Infertility In Both Men And Women
There are a number of factors that can affect fertility in both men and women.
Being overweight or obese reduces both male and female fertility. In women, being overweight can affect ovulation. Being underweight can also have an impact on fertility, particularly for women, who will not ovulate if they are severely underweight.
Smoking can adversely affect fertility in addition to its ill effects on general long term health.
Occupational and environmental factors
Exposure to certain pesticides, metals, and solvents can affect fertility in both men and women.
Exposure to heat and working in a hot environment can affect sperm quality.
Stress can affect relationship as well as fertility. Stress can contribute to a loss of libido (sex drive), which in turn can reduce the frequency of sexual intercourse. Severe stress may also affect female ovulation and limit sperm production.