Infertility is an issue that can seriously impact a relationship and cause negative feelings in a family. Currently there are many treatment options for infertility that involve assessing the cause of the problem to offer individualized treatment for the best chances of success.

What is Infertility

Infertility is defined as not being able to get pregnant after one year of regular unprotected sex and six months of unprotected sex if you are over 35. At least 15% of couples have trouble getting pregnant.

Infertility in Women

Oftentimes infertility in women is caused by dysfunction of the reproductive system due to congenital abnormalities, infection, hormonal imbalance that prevents ovulation, issues with the uterine lining, blocked fallopian tubes, adhesions or growths in the uterus, and/or endometriosis.

Assessment usually begins with inspection of the cervix, such as checking the pH balance, testing after sexual intercourse, looking at cervical mucus for fern-like patterns and viscosity during ovulation, culturing cervical mucus, and more.

Causes of Infertility in Women

Physical factors, such as existing medical conditions or other reasons for reduced sexual intercourse, limiting the opportunities for pregnancy
Emotional factors, such as stress or other mental health illnesses that cause dysfunction of the ovaries, limiting ovulation or preventing ovulation entirely
Problems with the reproductive system that directly impacts sexual intercourse, conception, and pregnancy
Problems with the pelvis, such as adhesions or tumors that can put pressure on the fallopian tubes and other reproductive organs
Problems with the endocrine system, such as the hypothalamus, pituitary gland, thyroid, adrenal glands, etc.

Signs of Infertility in Women

Irregular periods

Irregular periods are a common problem for women and often ignored because it may not be considered to be a serious problem, but that is a big mistake.

Problems with menstruation often indicate abnormalities of the reproductive system, such as ovaries that are not producing eggs, anovulation, or dysfunction of the hypothalamus (part of the brain that is responsible for stimulating hormones).

So if you are experiencing problems with your periods, it is important to see a doctor as soon as possible for further testing or treatment.

Excessive weight gain

Being excessively overweight can negatively impact a person’s health, including their reproductive system. Research shows that being overweight makes it three times more difficult for someone to become pregnant in comparison with someone with a healthy weight.

It is important to eat nutritiously and exercise regularly to maintain a healthy weight to increase the chances of becoming pregnant.

Hirsutism

If you have more hair on your body—your arms, legs, and torso—than other people, it may be a sign of infertility. Having excessive body hair may indicate a hormonal imbalance, which also impacts the reproductive system, especially the ovaries, causing them not to work as well as they should.

Nutrition deficiency

Anyone planning to have children in the future should be mindful of the amount of nutrients they consume each day.

Protein is especially important for the reproductive system and it is recommended that you eat 20-30 grams of protein each day from sources like lean beef, chicken, eggs, tofu, and various nuts and legumes.

Furthermore, folic acid is another nutrient that must not be missed. Folic acid is important for conception as it supports the creation of the embryo, especially their brain and nerve cells. Consume at least 600 mcg of folic acid each day, which can be found in liver and spinach.

Hair loss, fragile hair, thinning hair

You may not think that hair problems have anything to do with infertility, but the two are connected as both can be caused by problems with the thyroid, which directly affects the reproductive system.

Hair problems in women can indicate hormonal imbalance and issues with ovulation, both of which makes pregnancy more difficult.

Pain during sexual intercourse

This symptom occurs in women more frequently due to the female biology that experiences more friction during sexual intercourse. Normally sex should not be painful as the vagina is well lubricated naturally.

Pain may indicate a problem with estrogen, which limits the natural lubricant produced, leading to a dryer vagina that can cause pain and burning with intercourse. If you feel pain during sex, please talk to your doctor.

Infertility in Men

Infertility in men is often caused by the quality of sperm, such as having few sperm, having misshapen sperm, or having weak sperm. Men who are planning to have children in the future should undergo a semen analysis to assess their sperm for future planning as appropriate.

Causes of Infertility in Men

Hypogonadism or low hormone levels, which can cause the testicles to work abnormally.
Hormonal imbalance, like hypothyroidism, that can lead to severe obesity.
Varicocele within the scrotum that can impact movement of sperm.
Complications of the nervous system caused by diabetes, which can destroy nerves and impact erection and ejaculation.
Genetic conditions that can impact sperm production, such as Down syndrome.
Testicular torsion that limits circulation to the testicles.
Undescended testicles.

Signs of Infertility in Men

Low sperm count or other problems with sperm.
Problems with the testicles or prostate or sexual problems.
Treatment for cancer.
Varicocele of the scrotum causing it to be abnormally small or swollen.
Family history of infertility.

Unexplained Infertility

Unexplained infertility refers to infertility that, after medical evaluation, has no known cause. In this case, doctors prefer to act quickly, usually by starting with intrauterine insemination (IUI), which is most similar to natural conception. If IUI is unsuccessful, usually after three rounds, the doctor will likely recommend IVF and ICSI.

When to See a Doctor?

If you and your partner have been trying for one year to become pregnant and have not been successful, you are experiencing infertility and should see a fertility doctor.

The doctor will ask you about your health history and carry out a physical examination as well as ultrasound and laboratory tests to discover the cause of infertility. There are usually three main causes of infertility, as follows:

Problems with ovulation.
Narrowed or blocked fallopian tubes, adhesions in the pelvis.
Problems with the number or health of sperm; vasectomy.

Diagnosis for Infertility

Your doctor will assess both female and male partners to find the cause of infertility for the appropriate treatment planning. Assessment starts with medical history and physical evaluation.

Female Fertility Test

Frequency and regularly of periods
Painful menstruation
Abnormal vaginal bleeding; pelvic infection
History of pregnancy and/or miscarriage
Previous birth control methods
Hormone and genetic testing
Ultrasound of the uterus and ovaries
Hysteroscopy
Hysterosalpingography

Male Fertility Test

Semen analysis
Hormone testing
Ultrasound of the testicles and blood vessels
Imaging of the abdomen and scrotum
History of injury or surgery of the reproductive organs; history of sexually transmitted infections, such as gonorrhea or syphilis, which can cause problems with semen

Infertility Treatments

There are many options related to fertility treatment including

Intrauterine Insemination: IUI

Intrauterine insemination (IUI) involves selecting the healthiest sperm and injecting it into the uterus. This process is most like sexual intercourse and is a good choice for a younger couple and sperm and egg that can combine on their own.

In-vitro Fertilization: IVF

In-vitro fertilization (IVF) involves selecting an egg to be fertilized by sperm in a laboratory, where the embryo will grow into a blastocyst (5 days) before it is transferred back into the uterus to grow in pregnancy.

Intracytoplasmic Sperm Injection: ICSI

Intracytoplasmic sperm injection (ICSI) is an additional step in the IVF procedure, one that dramatically increases the chance of success.

An ICSI machine is used to inject sperm directly into the egg instead of waiting for the sperm to travel to the egg itself. Only the healthiest sperm is injected into the egg.

Once the egg is fertilized, scientists will allow the fertilized egg to develop into an embryo in the laboratory in a special solution. Once a blastocyst, the embryo is transferred back into the uterus to grow in pregnancy.

Egg Freezing before Age 35

Egg freezing involves removing eggs from the ovaries and freezing them to stop them from aging, thus preserving their quality. A woman’s eggs deteriorate as she gets older, which can make it more difficult to get pregnant or to have a healthy baby.

Freezing your eggs when you are in your 30’s can make it easier to become pregnant in your 40’s, with a better chance of having a healthy baby.

Natural Ways to Boost Fertility

1. Tracking Ovulation

Tracking ovulation has to do with counting days from menstruation to figure out when you ovulate so you can have sexual intercourse then to increase the chances of pregnancy. For a simple way to become pregnant quickly, track ovulation.

Normally a woman’s body has 200,000 to 500,000 eggs, but only 400-500 eggs can become fertilized. The hormones that manage ovulation are estrogen, progesterone, luteinizing hormone (LH), and follicle stimulating hormone (FSH).

These hormones not only produce eggs, they also choose the one perfect egg each month to be fertilized. This egg can only survive for 24 hours. If not fertilized, the egg will be shed with the uterine lining in a period.

There are two ways to track ovulation:

You can track ovulation yourself if your periods are regular. Generally menstruation occurs every 28 days. The first day of your period is day 1 and ovulation usually occurs on day 14. To increase chances of pregnancy, have sex 1-2 days before ovulation. (This method works best for women who have regular cycles.)

You can also track ovulation using an ovulation kit, which is a urine test (just like a pregnancy test). An ovulation test kit should be taken 10-12 days after your period starts. One line means that you are not ovulating and two means you are. The best time to check ovulation is between 2 pm and 8 pm, when LH is most concentrated. (This method works best for women with irregular cycles.)

2. Plan To Become Pregnant Before 35

Plan to become pregnant before 35. Women are most likely to become pregnant between the ages of 20 and 30 as their bodies are readiest during this time. After 35 pregnancy becomes more difficult and the risk of complications increases.

3. Reduce Stress

Reduce stress as stress is a significant factor that impacts fertility. Stress hormones interfere with reproductive hormones, impacting ovulation. It also makes fertilization and implantation in the uterus more difficult.

4. Eat Nutritious Foods

Eat nutritious foods from the five food groups so both partners have healthy bodies and reproductive systems that are ready for pregnancy.

How to Avoid Infertility

There are many risk factors for infertility, some that can be managed with behavioral changes, including:

Stop smoking as cigarettes impact fertility.
Avoid alcohol and recreational drugs like marijuana and cocaine.
Decrease caffeine consumption.
Exercise regularly, but not too strenuously. Exercise improves sperm quality and increases the chances of pregnancy.
Maintain a healthy body weight as being underweight or overweight can both impact reproductive hormones and lead to infertility.
Avoid very high temperatures or toxic environments as these environments can affect sperm production.
Limit medication that can impact fertility. Discuss the side effects of medication with your doctor, but don’t stop medication on your own without consulting your doctor.
Get adequate rest, eat nutritious foods, and manage stress in your daily life.

To Learn More about Infertility

Infertility is defined as being unable to conceive after one year of unprotected sex. Causes of infertility include problems with ovulation, fallopian tubes, sperm, the uterus and cervix, peritoneum, etc. Treatment options for infertility include intrauterine insemination (IUI), in-vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), and/or egg freezing.

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