Infertility treatment: causes and treatment

Infertility is a condition where a woman cannot get pregnant after trying for one year or more. There are many causes of infertility, but the most common are problems with ovulation. Treatment for infertility depends on the cause. Often, fertility drugs are used to help stimulate ovulation. If drugs don’t work, surgery may be needed to remove blocked tubes or repair damage to the reproductive organs. In some cases, assisted reproductive technologies (ART) such as in-vitro fertilization (IVF) may be needed.

What is Infertility?

Most people will want to have children at some time in their lives. It’s important to know what determines normal fertility so that a person or couple can tell when it’s time to seek assistance. Most couples (about 85%) will get pregnant within one year of trying, with the first three months being the most probable period for conception. The second-year is the only year in which an additional 7% of couples may conceive.

As a result, infertility has been defined as the inability to conceive within one year.

Around 15% of couples attempting to conceive have this diagnosis. If you haven’t been able to get pregnant in a year, we generally recommend consulting a reproductive endocrinologist. However, there are times when one may need treatment sooner than that. They include:

• Infrequent menstrual periods:

When a woman has regular menstrual cycles, which are defined as occurring every 21 to 35 days, it’s almost certain that she ovulates on a regular basis. Ovulation of the egg happens approximately 2 weeks before the start of the next period.

If a woman’s cycles are more than 35 days apart, it might suggest that she is not ovulating an egg regularly or at all. Ovulation of the egg is necessary for pregnancy. As a result, if a couple are attempting to conceive, we recommend performing an examination to see whether menstrual cycles are brief or irregular.

• Female age of 35 years or older:

Women’s egg counts drop rapidly as they grow older, for unknown reasons. Furthermore, egg quality, or the likelihood of an egg being genetically normal, decreases with age. As a result, if a couple has been trying to conceive for 6 months or more but the woman is 35 years old or older and her fertility is in question, we recommend getting a fertility evaluation.

• A history of pelvic infections or sexually transmitted diseases:

Chlamydia and gonorrhea, for example, are sexually transmitted infections that can damage the fallopian tubes and lead to inflammation and scarring. Natural conception requires that sperm move through the tubes since the ovulated egg must be fertilized by traveling through them. When a woman has had a previous pelvic infection, we recommend immediate evaluation for pregnancy because an HSG is required. We will conduct an HSG during the fertility check in order to determine whether or not the fallopian tubes are open.

• Known uterine fibroids or endometrial polyps:

Impaired endometrial cancer treatment outcomes may be related to a variety of factors, including uterine anomalies such as fibroids that indent the endometrial cavity and endometrial polyps, which can restrict how the endometrium (the lining of the uterus) and embryo interact. These abnormalities can also cause irregular bleeding during menstruation cycles.

In women with a known history of these anomalies or a history of bleeding between menstrual cycles, evaluation should be done after 6 months of attempting pregnancy. Hysteroscopy is the most common method for correcting or removing uterine abnormalities; it involves inserting a tiny scope with a camera into the uterus through a hysteroscope. Instruments may be inserted via the hysteroscope, allowing the surgeon to remove or repair any anatomical faults.

• Known male factor semen abnormalities:

If a male partner has had difficulty conceiving with previous partners or if his semen analysis is abnormal, we recommend that you undertake fertility testing as soon as possible – ideally within 6 months of attempting pregnancy.

Infertility Tests

Tests for men

Male fertility necessitates that the testicles produce enough healthy sperm and that it is successfully ejaculated into the vagina and transported to the egg. Male infertility tests check for any of these processes being defective.

You might have a general physical examination, including a genital check. Specific fertility testing can include the following:

• Semen analysis. Your doctor may request one or more semen samples. Masturbating or ejaculating into a clean container are two methods of collecting semen. Your semen is examined in a lab. Urine may be tested for the presence of sperm in certain situations.
• Hormone testing. You may have a blood test to assess your testosterone and other male hormones levels.
• Genetic testing. Genetic testing may be used to determine whether a genetic fault is the cause of infertility.
• Testicular biopsy. In certain circumstances, a biopsy of the testicles may be done to discover abnormalities that are contributing to infertility or to obtain sperm for assisted reproductive techniques such as IVF.
• Imaging. In certain circumstances, a scan of the brain (MRI), transrectal or scrotal ultrasound, or a test of the vas deferens (vasography) may be utilized.
• Another specialty testing. Occasionally, other tests to assess the quality of the sperm are used, such as testing a semen sample for DNA abnormalities.

Tests for women

The ovaries must produce healthy eggs in order to maintain fertility for women. An egg must go from the reproductive canal into the fallopian tubes and combine with sperm for fertilization. The fertilized egg must travel to the uterus and implant in the uterine wall. Female infertility tests look for abnormalities in any of these processes.

You may get a general medical checkup, including a gynecological examination. Specific fertility tests include:

• Ovulation testing. A blood test determines whether you’re ovulating by looking at hormone levels.
• Hysterosalpingography. Hysterosalpingography (his-tur-o-sal-ping-GOG-ruh-fee) is an X-ray procedure that examines the state of your uterus and fallopian tubes for obstructions or other issues. Contrast radiograph dye is injected into your uterus, and an X-ray is taken to see if the cavity is normal and if the fluid leaks out of your fallopian tubes.
• Ovarian reserve testing. The quantity of the eggs available for ovulation can be determined by this testing. This method frequently begins with hormone testing early in the menstrual cycle.
• Another hormone testing. Ovulatory hormones, as well as pituitary hormones that control reproductive functions, are also measured in hormone tests.
• Imaging tests. A pelvic ultrasound looks for uterine or ovarian disease. A sonohysterogram, also known as a saline infusion sonography, is sometimes used to get more detailed pictures of the uterus that aren’t visible on conventional ultrasound.

Frequently, your testing might include:

• Hysteroscopy. Depending on your symptoms, your doctor may recommend a hysteroscopy to look for uterine disease. To examine any potential problems, your doctor inserts a thin, lighted instrument through your cervix into your uterus during the procedure.
• Laparoscopy. Laparoscopic surgery is a type of minimally invasive surgery that involves making a small incision beneath your navel and inserting a slender viewing instrument into your fallopian tubes, ovaries, and uterus. Endometriosis can be detected during a laparoscopy, as well as scarring in the fallopian tubes, blockages or anomalies in the fallopian tubes, and abnormalities in the ovaries and uterus.

Not everyone needs all if any, of these tests before the cause of infertility is discovered. You and your doctor will determine which tests you’ll undergo and when.

Causes in women

Risk factors

Increased risk is associated with the following factors:

• Age: Between the ages of 32 and 35, conceiving becomes increasingly difficult.
• Smoking: Smoking dramatically raises a person’s risk of infertility in both men and women, and it might counteract the benefits of fertility therapy. Smoking throughout pregnancy increases the incidence of miscarriage. Passive smoking has likewise been linked to decreased fertility levels.
• Alcohol: The quantity of alcohol that a person drinks have an impact on his or her chances of becoming pregnant.
• Being obese or overweight: This can raise the chances of infertility in both genders.
• Eating disorders: Women who have an eating problem that causes them to lose a lot of weight might experience fertility issues as a consequence.
• Diet: A lack of folic acid, iron, zinc, and vitamin B-12 can affect fertility. Women who are at risk, including those on a vegan diet, should ask the doctor about supplements.
• Exercise: Both too much and too little exercise can lead to fertility problems.
• Sexually transmitted infections (STIs): Chlamydia can damage the fallopian tubes in a woman and cause inflammation in a man’s scrotum. Some other STIs may also cause infertility.
• Exposure to some chemicals: Pesticides, herbicides, metals such as lead, and solvents have all been linked to fertility problems in both men and women. Household detergents containing certain chemicals have been found to lower fertility in mice.
• Mental stress: High blood sugar levels can cause irregular ovulation in females, reduced male sperm production, and less sexual activity.

Medical conditions

Infertility is affected by a variety of illnesses.

Ovulation disorders appear to be the most common cause of infertility in women.

Ovulation is the monthly discharge of an egg. Ejaculation may never occur or it may only happen once in a while.

Ovulation disorders can be due to:

• Premature ovarian failure: Before the age of 40 years, the ovaries cease to function.
• Polycystic ovary syndrome (PCOS): Ovulation may occur due to an abnormality in the ovaries.
• Hyperprolactinemia: It’s not unusual for women to experience bloating, nausea, or breast tenderness if their prolactin levels are elevated and they are not pregnant or breastfeeding.
• Poor egg quality: A broken or defective egg is unable to support a pregnancy. The older a woman gets, the more likely it is that she will develop cancer.
• Thyroid problems: A hormonal imbalance can be caused by an overactive or underactive thyroid gland.
• Chronic conditions: These include AIDS or cancer.

Problems in the uterus or fallopian tubes can prevent the egg from traveling from the ovary to the uterus, or womb.

If the egg does not travel, it can be harder to conceive naturally.

Causes include:

• Surgery: Pelvic surgery might induce scarring or damage to the fallopian tubes. Cervical surgery can result in scarring or shortening of the cervix. The cervix is the neck of the uterus.
• Submucosal fibroids: Benign or non-cancerous tumors can develop in the muscular wall of the uterus. They might block the fallopian tube, preventing sperm from fertilizing the egg. Submucosal uterine fibroids that are large may make the cavity of the uterus larger, extending how far away the sperm must travel.
• Endometriosis: The lining of the uterus begins to proliferate outside of the uterus.
• Previous sterilization treatment: In women who have had their fallopian tubes blocked, the procedure can be reversed, but fertility won’t be restored.

Treatment

Infertility treatment depends on:

• What’s causing the infertility
• How long you’ve been infertile
• Your age and your partner’s age
• Personal preferences

Some causes of infertility can’t be corrected.

Couples who cannot get pregnant naturally may still achieve a pregnancy using assisted reproductive technology in most cases. Infertility treatment may be time-consuming, costly, physically demanding, and emotionally draining.

Treatment for men

Men’s treatments for sexual problems in general or poor sperm quality might include:

• Changing lifestyle factors. Certain habits and behaviors, such as quitting cigarettes or drinking alcohol, improving your diet, reducing or eliminating hazardous chemicals from your life, increasing intercourse frequency and timing, exercising on a regular basis, and optimizing other variables that might otherwise interfere with fertility.
• Medications. The sperm count and the possibility of achieving a successful pregnancy can be improved by certain medicines. These drugs may improve testicular function, including sperm production and quality, by increasing testicular function.
• Surgery. Sperm blockage may be treated by surgery in some circumstances. Surgical treatment of a varicocele can improve the chances of getting pregnant in certain situations.
• Sperm retrieval. Noninvasive procedures, such as the ones listed above, are used to extract sperm when ejaculation is a problem or if no sperm are present in the ejaculated fluid. They may also be utilized in scenarios where assisted reproductive techniques are planned and sperm counts are low or abnormal.

Treatment for women

Many women only require a few treatments to boost fertility. Other women may require a variety of different types of therapy to become pregnant.

• Stimulating ovulation with fertility drugs. Ovulation disorders are one of the most common causes of infertility in women. Ovulation drugs, also known as ovulation inductors or pro-ovulators, are a type of fertility treatment used to help infertile couples conceive. These medicines regulate or stimulate ovulation. Discuss with your doctor about eggs.
• Intrauterine insemination (IUI). After IUI, healthy sperm are placed in the uterus around the time the ovary releases one or more eggs for fertilization. The timing of IUI is determined by your normal cycle or fertility medications, depending on the cause of infertility.
• Surgery to restore fertility. Hysteroscopic surgery is used to treat uterine anomalies such as endometrial polyps, a uterine septum, inside uterine scar tissue, and some fibroids. Laparoscopic or abdominal surgery may be required in cases of endometriosis, pelvic adhesions, and bigger fibroids.

Reducing the risk of multiple pregnancies

Injectable fertility medicines can sometimes result in multiple deliveries, such as twins or triplets. Oral fertility medications have a decreased chance of generating multiples.

Increase physical activity and eat a healthy diet during pregnancy to decrease the risk of complications. Premature labor is more probable with each additional fetus.

If a woman needs an HCG injection to induce ovulation and ultrasound scans to reveal that too many follicles have formed, the HCG injection may be withheld. Despite their desire to conceive, couples might choose to go ahead regardless because of the forcefulness of their desire.

The number of embryos that develop in a cycle may be too great, and one or more may need to be excised. This topic will have to be addressed by couples on an ethical and emotional level.

Surgical procedures for women

If the fallopian tubes are blocked or damaged, surgical treatment might assist sperm passage.

Laparoscopic surgery may be used to treat endometriosis. A tiny incision is made in the abdomen and a small, flexible microscope with a light at the end, known as a laparoscope, is inserted through it. Implant removal and scar tissue reduction might help relieve discomfort and boost fertility.

Assisted conception

The following assisted conception techniques are now accessible.

Intrauterine insemination (IUI): A fine catheter is inserted into the uterus through the cervix to place a sperm sample straight into the womb at ovulation. The sperm is cleaned in a solution and the finest specimens are chosen. A low dose of ovary stimulants may be given to the woman.

When the sperm count is low, the sperm does not move effectively, or a male infertility problem has no identifiable cause, in vitro fertilization (IVF) IUI may be used. It can also aid men with severe erectile dysfunction.

In-vitro fertilization (IVF): In a petri dish, sperm are added to unfertilized eggs in order for fertilization to occur. The fetus is then placed in the uterus to start a pregnancy. The embryo may sometimes be frozen for future usage.

Intracytoplasmic sperm injection (ICSI): During an IVF procedure, a single sperm is introduced into an egg to allow fertilization. The chances of fertilization improve considerably among men with low sperm counts.

Sperm or egg donation: If a woman’s own eggs are impossible to obtain, donor sperm or eggs can be used. IVF is the most common technique for treating infertility. Donor eggs may also be retrieved via ICSI (intracytoplasmic sperm injection).

Assisted hatching: The embryologist creates a small hole in the outer membrane of the embryo, termed the zona pellucid, to improve implantation potential. This increases the chance that the fetus will implant on or attach to the uterine wall.

This is a procedure in which one or more mature eggs are removed from the woman’s ovaries and fertilized with her husband’s sperm. It may be used if IVF has failed, if the rate of embryo development has been poor, and if the mother is over 35 years old. The membrane becomes increasingly hard as a person ages. This can make it tough for the fetus to embed itself.

Electric or vibratory stimulation to achieve ejaculation: Ejaculation is brought about by electric or vibratory stimulation. This might assist a guy who can’t ejaculate conventionally as a result of a spinal cord injury.

Surgical sperm aspiration: Sperm is removed from one of the male reproductive organs, such as the vas deferens, testicle, or epididymis.

Inference

Infertility treatment can be a complex and difficult decision for couples. There are many different treatments available, depending on the cause of infertility. Some treatments, such as IVF or ICSI, may be more invasive than others. However, with the help of modern technology and assisted conception techniques, most couples should be able to conceive eventually.

FAQ

How can I stop being infertile?

There is no one-size-fits-all answer to this question. Depending on the cause of infertility, different treatments may be available. If you are unable to conceive naturally, you may want to consider assisted conception techniques such as IVF or ICSI.

How can I solve my infertility naturally?

There are a number of natural infertility treatments available. However, there is no evidence to suggest that any one treatment is more effective than another. Some couples may find that complementary therapies, such as acupuncture or herbal medicine, help to improve their fertility. Others may choose to try lifestyle changes, such as improving their diet or reducing stress levels.

Can you reverse infertility?

Infertility can sometimes be reversed. If the cause of infertility is treated, it may be possible for the woman to conceive naturally. However, this depends on the cause of infertility and may not be possible in all cases.

Can you get pregnant if you are infertile?

Yes, infertility does not always mean that a woman is unable to conceive. If the cause of infertility can be treated, it may be possible for her to conceive naturally. However, this depends on the cause of infertility and may not be possible in all cases.