Infertility is defined as the inability to conceive a pregnancy after 12 months of unprotected sexual intercourse. Infertility is a disease that results in the abnormal functioning of the male or female reproductive system. Infertility affects approximately 10% of the population. Since infertility strikes diverse groups-affecting people from all socioeconomic levels and cutting across all racial, ethnic and religious lines- chances are great that a friend, relative, neighbor or perhaps you are attempting to cope with the medical and emotional aspects of infertility.
Causes of infertility are many and varied and involve male, female or a combination of factors. This includes problems with the production of sperm or eggs, the structure or function of male or female reproductive systems; and/or hormonal and immune conditions.
In 40% of couples the cause of infertility is attributed to a sperm factor, in another 40% the cause is found within the female reproductive system, and a third will have a combination of male and female factors.
Pregnancy is the result of a process that has many steps. To get pregnant –
- A woman’s body must release an egg from one of her ovaries (ovulation).
- The egg must go through a fallopian tube toward the uterus (womb).
- A man’s sperm must join with (fertilize) the egg along the way.
- The fertilized egg must attach to the inside of the uterus (implantation).
- Sufficient embryo quality
Finally, for the pregnancy to progress to full term the embryo must be healthy and the woman’s hormonal environment adequate for its development. If just one of these factors is impaired, infertility can be the result. The diagnosis of infertility is usually given to couples who have been attempting to conceive for at least 1 year without success.
About 6% of married women 15–44 years of age in the United States are unable to get pregnant after one year of unprotected sex (infertility). Also, about 12% of women 15–44 years of age in the United States have difficulty getting pregnant or carrying a pregnancy to term, regardless of marital status (impaired fecundity). Studies found that 7.5% of all sexually experienced men younger than age 45 reported seeing a fertility doctor during their lifetime—this equals 3.3–4.7 million men. Of men who sought help, 18% were diagnosed with a male-related infertility problem, including sperm or semen problems (14%) and varicocele (6%).
Risk Factors
- Age – A woman’s fertility starts to drop after she is about 32 years old, and continues doing so. A 50-year-old man is usually less fertile than a man in his 20s (male fertility progressively drops after the age of 40).
- Smoking – Smoking significantly increases the risk of infertility in both men and women. Smoking may also undermine the effects of fertility treatment. Even when a woman gets pregnant, if she smokes she has a greater risk of miscarriage.
- Alcohol consumption – A woman’s pregnancy can be seriously affected by any amount of alcohol consumption. Alcohol abuse may lower male fertility. Moderate alcohol consumption has not been shown to lower fertility in most men, but is thought to lower fertility in men who already have a low sperm count.
- Being obese or overweight – In industrialized countries overweight/obesity and a sedentary lifestyle are often found to be the principal causes of female infertility. An overweight man has a higher risk of having abnormal sperm.
- Eating disorders – Women who become seriously underweight as a result of an eating disorder may have fertility problems.
- Being vegan – If a person is a strict vegan you must make sure your intake of iron, folic acid, zinc and vitamin B-12 are adequate, otherwise your fertility may become affected.
- Over-exercising – A woman who exercises for more than seven hours each week may have ovulation problems.
- Not exercising – Leading a sedentary lifestyle is sometimes linked to lower fertility in both men and women.
- Sexually transmitted infections (STIs) – Chlamydia can damage the fallopian tubes, as well as making the man’s scrotum become inflamed. Some other STIs may also cause infertility.
- Exposure to some chemicals – Some pesticides, herbicides, metals (lead) and solvents have been linked to fertility problems in both men and women.
- Mental stress – Studies indicate that female ovulation and sperm production may be affected by mental stress. If at least one partner is stressed it is possible that the frequency of sexual intercourse is less, resulting in a lower chance of conception.
Causes
In Men –
Infertility in men can be caused by different factors and is typically evaluated by a semen analysis. A specialist will evaluate the number of sperm (concentration), motility (movement), and morphology (shape). A slightly abnormal semen analysis does not mean that a man is necessarily infertile. Instead, a semen analysis helps determine if and how male factors are contributing to infertility.
Conditions that can contribute to abnormal semen analyses include—
- Varicoceles, a condition in which the veins on a man’s testicles are large and cause them to overheat. The heat may affect the number or shape of the sperm.
- Medical conditions or exposures such as diabetes, cystic fibrosis, trauma, infection, testicular failure, or treatment with chemotherapy or radiation.
- Ejaculation disorders – for some men it may be difficult to ejaculate properly. Men with retrograde ejaculation ejaculate semen into the bladder. If the ejaculatory ducts are blocked or obstructed the man may have a problem ejaculating appropriately.
- Unhealthy habits such as heavy alcohol use, testosterone supplementation, smoking, anabolic steroid use, and illicit drug use.
- Environmental toxins including exposure to pesticides and lead.
In Women
Ovulation – Regular predictable periods that occur every 24–32 days likely reflect ovulation. Ovulation can be predicted by using an ovulation predictor kit and can be confirmed by a blood test to see the woman’s progesterone level. A woman’s menstrual cycle is, on average, 28 days long. Day 1 is defined as the first day of “full flow.”
A woman with irregular periods is likely not ovulating – This may be because of several conditions and warrants an evaluation by a doctor. Potential causes of anovulation include the following –
- Polycystic ovary syndrome (PCOS)
- Functional hypothalamic amenorrhea (FHA)
- Diminished ovarian reserve
- Premature ovarian insufficiency
- Menopause
- Salpingitis (Pelvic inflammatory disease) caused by sexually transmitted disease.
Treatment
Frequency of intercourse – The couple may be advised to have sexual intercourse more often. Sex two to three times per week may improve fertility if the frequency was less than this. Some fertility experts warn that too-frequent sex can lower the quality and concentration of sperm. Male sperm can survive inside the female for up to 72 hours, while an egg can be fertilized for up to 24 hours after ovulation.
For Men
Erectile dysfunction or premature ejaculation – Medication and/or behavioral approaches can help men with general sexual problems, resulting in possibly improved fertility.
Varicocele – If there is a varicose vein in the scrotum, it can be surgically removed.
Blockage of the ejaculatory duct – Sperm can be extracted directly from the testicles and injected into an egg in the laboratory.
Retrograde ejaculation – Sperm can be taken directly from the bladder and injected into an egg in the laboratory.
Surgery for epididymal blockage – If the epididymis is blocked it can be surgically repaired. The epididymis is a coil-like structure in the testicles which helps store and transport sperm. If the epididymis is blocked sperm may not be ejaculated properly.
For Women
Ovulation disorders – If the woman has an ovulation disorder she will probably be prescribed fertility drugs which regulate or induce ovulation. These include –
Clomifene (Clomid, Serophene) – This medication helps encourage ovulation in females who do not ovulate regularly, or who do not ovulate at all, because of polycystic ovary syndrome (PCOS) or some other disorder. It makes the pituitary gland release more FSH (follicle-stimulating hormone) and LH (luteinizing hormone).
Metformin (Glucophage) – Women who have not responded to Clomifene may have to take this medication. It is especially effective for women with PCOS, especially when linked to insulin resistance.
Human menopausal gonadotropin, or hMG, (Repronex) – This medication contains both FSH and LH. It is an injection and is used for patients who don’t ovulate on their own because of a fault in their pituitary gland.
Follicle-stimulating hormone (Gonal-F, Bravelle) – This is a hormone produced by the pituitary gland that controls estrogen production by the ovaries. It stimulates the ovaries to mature egg follicles.
Human chorionic gonadotropin (Ovidrel, Pregnyl) – This medication is used together with clomiphene, hMG and FSH. It stimulates the follicle to ovulate.
Gn-RH (gonadotropin-releasing hormone) analogs – For women who ovulate prematurely, before the lead follicle is mature enough during hmG treatment. This medication delivers a constant supply of Gn-RH to the pituitary gland, which alters the production of hormone, allowing the doctor to induce follicle growth with FSH.
Bromocriptine (Parlodel) – This drug inhibits prolactin production. Prolactin stimulates milk production in breast feeding mothers. If non-pregnant, non-breast feeding women have high levels of prolactin they may have irregular ovulation cycles and have fertility problems.
Fallopian tube surgery – If the fallopian tubes are blocked or scarred surgery may repair them, making it easier for eggs to pass through them.
Laparoscopic surgery – A small incision is made in the woman’s abdomen. A thin, flexible microscope with a light at the end (laparoscope) is inserted through the incision. The doctor can then look at internal organs, take samples and perform small operations. For women with endometriosis, laparoscopy removes implants and scar tissue, reducing pain and often aiding fertility.
Intrauterine insemination (IUI) is an infertility treatment that is often called artificial insemination. In this procedure, specially prepared sperm are inserted into the woman’s uterus. Sometimes the woman is also treated with medicines that stimulate ovulation before IUI. IUI is often used to treat—
- Mild male factor infertility.
- Couples with unexplained infertility.
Assisted Reproductive Technology (ART) includes all fertility treatments in which both eggs and sperm are handled outside of the body. In general, ART procedures involve surgically removing eggs from a woman’s ovaries, combining them with sperm in the laboratory, and returning them to the woman’s body or donating them to another woman. The main type of ART is in vitro fertilization (IVF).
Alternative Treatment
Supplements
Vitamin D- Vitamin D deficiency is very common in America, especially during the winter, and can be very detrimental to overall health. Recent studies link inadequate vitamin D with infertility and miscarriage.
Vitamin C– A potent antioxidant, vitamin C is good for both male and female infertility.
Folic Acid– Folic acid is well known as a necessary vitamin in early pregnancy to prevent complications, but it is most beneficial when taken for several month before the pregnancy as well as during. It helps cell division and promotes ovulation.
Zinc– It is very important for cell division including sperm production and ovulation.
Selenium– Helps protect the body from free radicals and protects sperm and egg.
B-Vitamins– Deficiency of b-vitamins is common in anyone who consumes large amounts of processed foods, grains or sugars. Optimizing b vitamin levels can increase lutenizing hormone and follicle stimulating hormone to improve fertility.
Bioflavonoids – Helps strengthen the uterus by promoting healthy blood vessels.
Flaxseed oil – A healthy fat that can help normalize hormones and is essential to health.
Herbs
Black cohosh (Cimicifuga racemosa)—Balances hormones.
Chaste tree (Vitex castus)—Raises progesterone levels, lowers estrogen levels, and helps correct ovarian dysfunction.
Dong quai (Angelica sinensis)—Nourishes and balances the female reproductive system.
False unicorn (Helonias dioica)—Has a reputation for promoting fertility, is recommended for ovarian dysfunction and as a uterine tonic.
Licorice (Glycyrrhiza glabra)—Balances hormones and is anti-inflammatory and sweet tasting (good flavoring for teas).
Red raspberry (Rubus strigosus)—Nourishes and strengthens the female reproductive system.
Squaw vine (Mitchella repens)—Also known as partridge berry. Recommended for fertility as a uterine tonic.
Wild yam (Dioscorea villosa)—Has a reputation for promoting fertility.
To Avoid –
Avoid Estrogen – Estrogen can have a negative effect on the development of the male reproductive tract, semen volume, and sperm count. Therefore, it is important to reduce or eliminate excess estrogen or estrogen-like chemicals in your body. Avoid all dairy products where cows have been fed hormones. The drop in sperm counts since the 1940s parallels a rise in the consumption of dairy products.
Chemicals, such as PCBs, dioxin, etc. are weakly estrogenic and degenerate very slowly, they hang around for years in our environment. Avoid the use of toxic substances such as fertilizers, cleaners. Also avoid all fatty animal products where chemicals may be stored up without being degraded.
Avoid Heavy Metals – Sperm are affected by lead, cadmium, arsenic, and mercury. There are many sources of exposure to these heavy metals such as deep-sea fish, cigarette smoke, and water from old pipes. Just as with men, lead, cadmium, or mercury can impair fertility by affecting sex hormones.
Avoid free radicals – We have all heard that free radicals (the hungry and unstable oxygen in our bodies) can cause cancer, heart disease, and increase the aging process. Like –
- Cigarette smoke
- Sunlight
- Unsaturated oils (corn oil may be the worst)
- Heating oils to too high a temperature when cooking
- Foods left out of the refrigerator (oxidation causes butter to turn a slight yellow and cut apples to turn brown)
Caffeine and Alcohol – Both can impair female fertility. Excessive alcohol causes prolactin to rise and too much or too little prolactin is associated with infertility. Caffeine causes a decrease in serum prolactin. Caffeinated soft drinks may also reduce the chance of conception.
Others
- Flower Essences – The flowers of plants may be prepared in a similar way to homeopathic remedies so that the “essence” of the plant is harnessed in a medicinal way. An example is Pomegranate. Its use is described as a treatment for imbalance, i.e., women who are ambivalent or confused about the focus of feminine creativity, home or career, creative or procreative, those who attempt to balance both possibilities may feel drained and the psychological tension may be profound resulting in physical illness especially in the female organs.
- Stress Reduction/Relaxation Therapies
- Diaphragmatic Breathing Exercise
Reference –
http://ivf.com.au/about-fertility/infertility-treatment#causes-of-female-infertility
http://www.cdc.gov/reproductivehealth/infertility/pdf/drh_nap_final_508.pdf
http://www.aafp.org/afp/2007/0315/p849.pdf
http://www.medicalnewstoday.com/articles/165748.php?page=2#causes_of_infertility_in_men
http://www.emedicinehealth.com/infertility/page4_em.htm#infertility_treatment
https://www.reddit.com/r/infertility/
https://www.womenshealth.gov/publications/our-publications/fact-sheet/infertility.html
http://www.nhs.uk/conditions/Infertility/Pages/Introduction.aspx