What is infertility?

Infertility is a disease that makes it hard for a woman to become pregnant. Infertility is a disease that affects men, as well. Many couples do not have trouble becoming pregnant, but there are factors that can make it difficult for some.

Symptoms of infertility

For women, symptoms would be related to the cause of infertility. A woman is considered infertile if she has tried for one year to get pregnant and didn’t use birth control to prevent pregnancy during that time. A man is considered infertile if he has too few sperm or when the health of his sperm prevents it from combining with a woman’s egg.

Certain factors may interfere with getting pregnant. However, these factors do not guarantee you will be infertile. For women, those factors can include:

  • Painful or irregular periods (menstrual cycle).
  • Age (older than 35).
  • Endometriosis or pelvic inflammatory disease (diseases of a woman’s sex organs).
  • Cancer treatment.

For men, factors include:

  • Infections.
  • A low sperm count (a higher count increases the chance the sperm and egg will meet).
  • Problems with your male sex organs (such as undescended testicles, enlarged prostate, and varicoceles, or enlarged veins in the skin that surround a man’s testicles).
  • Cancer treatment.

Your doctor may recommend you be tested for infertility if any of these factors are concerns.

What causes infertility?

Making a baby (getting pregnant) is complex. Multiple things have to go right for both the man and the woman. Therefore, there are several causes of infertility in women and men.

A woman’s fertility can be affected by:

  • Ovulation. This is the process by which the egg travels from the woman’s ovary to meet the sperm and pregnancy begins. Some women don’t ovulate every month, which makes it harder to become pregnant.
  • Problems with your reproductive system (fallopian tubes, cervix, uterus, ovaries). This might include a blockage, cancerous or noncancerous growths, scarring, enlarged ovaries, and an abnormal opening of the cervix.
  • Disease and disorders. This might include endometriosis (when uterine tissue grows outside the uterus) and polycystic ovary syndrome (PCOS) (enlarged ovaries containing fluid-filled sacs).
  • Early onset menopause. This would occur before the age of 40. It may be tied to an immune system disease, cancer treatments, or a genetic syndrome.
  • Age. As a woman gets older, it becomes more difficult to get pregnant.
  • Cancer treatments. Radiation and chemotherapy affect fertility.
  • Smoking and substance abuse. Smoking, alcohol, and drug use can make it difficult to get pregnant.
  • Stress.
  • Medicines, especially those treating cancer, fungus, and ulcer.
  • Weight. Being overweight or underweight can affect fertility. Even too much or too little exercise can affect a woman’s chances of getting pregnant.
  • Delayed puberty or absence of a period (menstruation) affect fertility.
  • Disease. Uncontrolled diabetes, autoimmune diseases (when your body attacks itself), lupus, and celiac disease can make it difficult for a woman to become pregnant.

A man’s infertility can be affected by:

  • Unhealthy or poorly functioning sperm. This would include a look at the quality of the man’s sperm. It also would include how well and how quickly the sperm moves as it travels to meet the egg.
  • A varicocele — enlarged veins inside the loose skin that surrounds a man’s testicles. It can cause low sperm count.
  • Infection. This can be in the form of a bacterial infection inside the man’s testicles or an infection caused by sexually transmitted disease (STD).
  • Retrograde ejaculation. This is the process by which a man’s sperm goes into his bladder rather than outside the penis as it is supposed to do.
  • Autoimmune disorders (when the body attacks itself).
  • Cancerous or non-cancerous growths.
  • Undescended testicles. One or both of a man’s testicles remain in his abdomen. Testicles are supposed to drop down from the abdomen into the scrotal sac at birth.
  • Hormone imbalance.
  • Blockages within the many tubes that carry a man’s sperm.
  • Certain genetic syndromes, such as Down syndrome.
  • Medicines, especially those treating cancer, fungus, and ulcer.
  • Certain surgeries, including vasectomy (a procedure to prevent sperm from leaving the penis).
  • Smoking and alcohol or drug use.
  • Obesity.
  • Stress.
  • Exposure to industrial chemicals and heavy metals.
  • Radiation and X-rays.
  • Overheating the testicles. This can occur by wearing underwear or pants that are too tight, hot tub use for extended periods, and other conditions that can increase the temperature of your testicles.
  • Sexual dysfunction. Inability to have an erection for sex or problems ejaculating into the vagina (too soon or not at all). This could be due to physical or emotional issues.

How is infertility diagnosed?

For both men and women, your doctor will conduct a routine medical exam and ask you questions about your general health and how long you have been trying to have a baby. Your doctor will decide what additional testing is necessary.

Additional testing would likely begin with a blood test to check hormone levels and genetics (for both men and women), and egg quality. Women would have additional tests, including a hysterosalpingogram and laparoscopy. A hysterosalpingogram is an X-ray that involves injecting dye into your uterus to look for blockages inside your fallopian tubes. It does not require anesthesia. A laparoscopy is a surgical procedure performed in a hospital. A thin, flexible scope is inserted through an incision in your abdomen. This gives your doctor a better look at your fallopian tubes, as well. Both tests also will look for polyps or growths in your uterus.

A transvaginal ultrasound is another test for women. Usually done in the doctor’s office, a medical technician will insert a small wand, covered with latex, into your vagina. The wand is connected to a screen, where the technician can view images of the inside of your uterus and fallopian tubes. The technician will send the images to your doctor to review.

For men, the first test will be to collect a sample of his semen (the fluid that is ejaculated from a man’s penis) to examine his sperm count, quality, and movement. Doctors will ask a man for a sample of his semen to examine the quality of his sperm, sperm count (the higher the count, the better), and how well it moves (which is important in order to meet the woman’s egg).

Men will undergo further physical exams, including a look for past injury to his testicles or penis, discharge (fluid that should not be present in the man’s penis), a swollen or enlarged prostate, a varicocele (enlarged veins inside the skin around a man’s testicles), recent high fevers, and a history of mumps. A biopsy of the man’s testicles may be necessary to get a better sperm sample.

Can infertility be prevented or avoided?

Some causes of infertility can be prevented or avoided. Both men and women can take steps toward healthy living. Healthy living is important when trying to have a baby. Exercise regularly, eat healthy, lose weight if you are overweight, and manage your stress.

Infertility treatment

Infertility treatment is based on the cause of your infertility. For women, it could involve medicine to stimulate your ovaries. This will help your ovaries make more eggs to increase your changes of getting pregnant. Other medicine is designed to stop your period for six to nine months. This approach would be used on women who have endometriosis. Stopping your periods gives your body time to get rid of the endometrial tissue on the outside of your uterus, which interferes with getting pregnant. You cannot get pregnant while you are being treated for endometriosis.

One nonsurgical treatment for women is called intrauterine insemination (IUI). This procedure inserts healthy sperm into the woman’s uterus around the time of ovulation. It can be done in the doctor’s office and is less expensive and complex than in vitro fertilization (IVF). IVF requires stimulating the ovaries with hormones, removing the egg from the woman, fertilizing it in the lab with the sperm, and putting it back into the woman’s uterus. There is no guarantee that IUI or IVF will result in a pregnancy.

For men, treatment might include simple lifestyle changes (healthy living, reducing alcohol, eliminating harmful substances, and keeping your testicles cool). Certain medicines can increase a man’s sperm count. Surgery can reverse a blockage or repair a varicocele. A small surgical procedure can obtain sperm if a man is unable to ejaculate.

Living with infertility

Living with infertility is emotionally difficult. The disappointment of not becoming pregnant after trying each month can be hard on relationships and your own personal emotional health. It’s difficult to see friends, family, and even strangers have babies when you cannot. For those women who try IVF treatment, the hormones and egg-stimulating medicines can affect your emotional health. Long-term studies suggest they can impact your physical health, as well (possible links to breast and ovarian cancer). If you are experiencing infertility, talk with your doctor about how to cope with disappointment each month. Sometimes a support group can help. Some couples turn to adoption after trying unsuccessfully to have a baby through pregnancy.

Questions to ask your doctor

  • If I’m over the age of 35, do I have to wait a year before being tested for infertility?
  • What could be the reason for my infertility if my tests and my male partner’s test are fine?
  • At what age does your fertility decline?
  • What’s the best time in your monthly cycle to get pregnant?
  • If I am currently using birth control, how much should I wait in between stopping the birth control and trying to get pregnant?
  • Do birth control devices cause infertility?