Infertility: Types

Having a family is one of the most primal desires of people across the globe. However, due to various risk factors, many couples find it difficult to conceive.

Millions of people around the world experience infertility problems, without being aware about the condition or knowing the meaning of infertility. This surprisingly common problem can occur because of a number of factors, but infertility can be treated to achieve a healthy pregnancy. There are numerous effective and most importantly safe infertility treatments available today that you can use to start your dream family.

This article serves as a comprehensive guide on infertility and its causes, symptoms, risk factors, preventative measures, and treatment options.

What is infertility?

To understand infertility, let’s first understand how the natural process of conception works; it involves the following:

• Release of a healthy egg from the ovary
• Transfer of that egg to the uterus through the fallopian tube
• Fertilisation of the egg with a sperm
• Implantation of the fertilised embryo in the uterine lining

Any effect on this process can lead to infertility. Infertility is a medical condition that affects the reproductive system. If a couple is trying and failing to get pregnant for 12 months or more by performing regular unprotected sexual intercourse, either one or both are likely infertile. It is a common condition that affects millions of people worldwide and influences their family dynamics and communities.

What are the types of infertility?

Here are the two types of infertility:

1. Primary infertility

Couples with primary infertility are those who cannot conceive after 12 months or more of regular sexual intercourse without using any birth control measures.

2. Secondary infertility

If the woman has been pregnant previously but facing infertility problems right now, they have secondary infertility.

How common is infertility?

According to WHO, it is estimated that one out of every 6 individuals of reproductive age across the globe experience infertility.

Women are most fertile in their mid-to-late 20s. Infertility issues and the rate of miscarriages significantly increase after the woman turns 35. With assisted reproductive technologies (ARTs), such as IVF, you can retrieve your healthy eggs at an early age, in your 20s, and freeze them to be used later. Women who want to delay childbearing can consider this option.

What are infertility symptoms?

The main infertility symptom in females and males is not being able to conceive. There might not be any other evident symptoms to indicate infertility. Infertility symptoms in males can be quite obscure and the condition can be accurately diagnosed only by a doctor with the help of tests; however, some men may experience penile disorders or ejaculation problems. Females may experience symptoms like irregular or missed periods. However, most couples are able to conceive naturally on their own over time or with the help of infertility treatment.

You are recommended to visit the doctor in case you have been trying and failing to get pregnant for at least 1 year. A woman can consider taking to a fertility specialist in case of the following:

• She is aged 35 years or older
• She experiences missed, irregular, or extremely painful periods
• She was diagnosed with infertility previously
• She has gotten through cancer treatment
• She has PCOS, history of PID, or endometriosis or fibroids
• She has experience more than one miscarriage

Men are advised to consult a fertility specialist in case of the following:

• He has or was diagnosed with any health conditions related to the reproductive system
• He has had surgery for hernia
• His testicles appear abnormal in shape or size
• He had experienced infertility in the past
• He has a family history of infertility
• He has gotten through cancer treatment
• He has had any injury to the reproductive system
• Has had any infection

What are the causes of infertility?

Infertility is a complex condition that can occur due to a number of diseases. In a couple, the man, woman, or both can have infertility if they are unable to get pregnant after persistent efforts for at least 1 year.

In males, infertility is often caused by problems with semen ejection, absence of sperm, low levels of sperm in ejection, and/or abnormal movement (also called sperm motility) or shape (also called sperm morphology) of the sperm.

Infertility is more complex in females than males as they require a perfect functioning of the ovaries, uterus, and the fallopian tube in order to get pregnant. If a health condition affects any of these, women can experience infertility.

Infertility in females can be caused by a range of abnormalities occurring in the uterus, fallopian tube, ovaries, and/ or the endocrine system, among other things. Female infertility may occur in case of the following:

• A fertilised egg does not attach and implant in the uterine lining or the womb
• The eggs cannot travel to the womb from the ovaries
• The ovaries are unable to produce healthy eggs

Infertility causes

Some of the female infertility causes include the following:

• Antiphospholipid Syndrome (APS) or other autoimmune disorders
• Birth defects of the reproductive system
• Cancer or tumour
• Diabetes
• Clotting disorders
• Excessive use of alcohol
• Eating disorders
• Being over- or under-weight
• Fibroids or polyps in the uterus and cervix
• Old age
• Polycystic ovarian syndrome (PCOS)
• Poor nutrition
• Chemotherapy drugs
• Smoking
• Scarring from abdominal surgery or sexually transmitted disease
• Thyroid disease
• Tubal ligation surgery, which is done to prevent pregnancy
• Failure of tubal ligation reversal
• Failure to ovulate
• Excessive exercising
• Pelvic infection or pelvic inflammatory disease (PID)

Common male infertility causes are listed below:

• Congenital or birth defects
• Excessive use of alcohol, cocaine, or marijuana
• Uncontrolled diabetes
• Chemotherapy, radiation, and other cancer treatments
• High heat exposure for prolonged time periods
• Benign tumour of the pituitary gland, which causes high level of prolactin in the blood
• Low levels of testosterone or hypogonadism
• Obesity
• Scarring from sexually transmitted infections (STIs), surgery, or injury
• Vasectomy, which is done to prevent pregnancy
• Failure of vasectomy reversal
• Medical history of testicular infection from mumps
• Medicines such as nitrofurantoin, cimetidine, and spironolactone
• Erectile dysfunction
• Retrograde ejaculation, when the semen goes backward into the urinary bladder instead of moving out of the penis
• Toxins in the environment
• Smoking
• Varicocele
• Cystic fibrosis
• Certain types of autoimmune conditions
• Y-chromosome microdeletion
• Klinefelter’s syndrome
• Myotonic dystrophy
• Congenital adrenal hyperplasia
• Exposure to too much testosterone or oestrogen

Risk factors

The below-mentioned factors can contribute to increasing a woman’s risk of infertility:

• Advancing age

Did you know that a woman’s age is one of the most influential risk factors of female infertility? Statistics indicate that approx 1 in every 5 couples with a female who is aged 30-39 years’ experience infertility problems as compared to 1 in every 8 couples with a female who is younger than 30 years old. Aging causes a significant drop in the number and quality of eggs in a woman’s ovaries; additionally, older women are likely to have health problems that can cause infertility and they have a high chance of experiencing miscarriages or giving birth to a genetically abnormal child.

• Excessive use of alcohol
• Extreme fluctuations in bodyweight
• Obesity
• Underweight
• Excessive emotional or physical stress leading to absent periods or amenorrhea

The following factors can contribute to increasing a man’s risk of infertility:

• Advancing age (40 years old or older)
• Smoking
• Exposure to radiation
• Obesity
• Excessive use of alcohol, opioids, and marijuana
• Exposure to testosterone
• Frequent heat exposure to the testicles
• Exposure to certain environmental toxins such as lead, mercury, cadmium, or pesticides
• Exposure to certain medicines such as ketoconazole, cimetidine, spironolactone, bicalutamide, flutamide, or cyproterone

Infertility diagnosis

Depending on your age, your healthcare provide may suggest you try conceiving naturally for a year before getting tested for the cause of infertility in you are under 30. For women who are aged 35 years or older, the doctors may recommend they try getting pregnant for 6 months naturally and then seek medical care for infertility after being tested.

A physical exam, detailed analysis of medical history and sexual history of both partners, and several tests may be recommended to figure out the cause of your or your partner’s infertility. Generally, an array of tests is performed to diagnose infertility and understand the cause for the condition in each individual. Some infertility tests for women include the following:

• Blood test to check hormone levels
• Body temperature log
• Follicle stimulating hormone (FSH) and clomid challenge test
• Hysterosalpingography (HSG)
• Antimullerian hormone testing (AMH)
• Pelvic ultrasound to evaluate the uterus and examine egg quality
• Home urine ovulation detection kit
• Thyroid function test
• Laparoscopy
• Blood test to detect a prior infection of chlamydia
• Tubal evaluation
• Ovarian reserve testing
• Saline sonohysterogram (SIS)
• Hysteroscopy

Few of the infertility tests for males are listed below:

• Physical examination of the testicles and penis
• Blood tests to check hormone levels
• Semen analysis
• Ultrasound of the male genitalia

Semen analysis is one of the most common tests recommended to evaluate infertility in men. During this test, the concentration or the number of sperm and its movement and shape are examined by a specialist. Testicular biopsy may also be recommended to check for infertility in males in rare cases.

How is infertility treated?

Infertility treatment, whether it is for women or men, largely depends on the cause of infertility. Other factors that influence the infertility treatment include the duration of the infertility, age of the female, patient’s treatment preferences. An infertility treatment plan may include the following:

• Awareness and counselling about the infertility, its causes, treatment options, and the chances of curing it
• ARTs such as intrauterine insemination (IUI) and in vitro fertilisation (IVF)
• Medicines to induce ovulation in women
• Medicines to cure the underlying condition that causes infertility, such as infections and clotting disorders
• Surgery
• Lifestyle modifications, including quitting smoking, gaining or losing weight

What are common infertility treatments?

Some of the common female infertility treatments include medication to stimulate ovulation. Such medicines are often taken orally and work by targeting the pituitary gland or lowering progesterone levels in the body; the lower level of progesterone leads to an increase in the FSH levels. They are often used for women with PCOS or other diseases that disrupt ovulation. These may also be prescribed to women who are planning to go through IVF or freeze their eggs to increase the number of mature eggs produced in one cycle.

Some of these medicines may also be given through an injection to target problems of the pituitary gland and stimulate the development of mature eggs. Other medicines to induce ovulation may be given with a nasal spray; these are usually given to women during IVF cycles to extract mature eggs or prepare the womb for embryo transfer. Additionally, women who have insulin resistance require specific medication to lower the levels of male hormones in the body and help with ovulation.

A doctor may try several different approaches for male infertility treatment such as medication, surgery, or ARTs depending on the cause of infertility. A urologist specialising in infertility oversees the medical and surgical therapies to treat infertility. A doctor with a specialisation in the reproductive endocrinology may offer IVF or IUI treatment to help with the male infertility for a couple.

Other common fertility treatments include the following:

• In vitro fertilisation (IVF)
• Assisted hatching
• Intrauterine insemination (IUI)
• Third-party ART such as the use of donor sperm donor eggs, donor embryos, or surrogacy

What are complications of treatment?

Did you know that fertility drugs used to treat infertility increases your chances of having twins, triplets, or multiple children? Having a pregnancy with several foetuses can be problematic for the women and the foetuses. Such pregnancies have a high risk of premature delivery and health problems for the infants, in worst case scenarios neonatal death is also a possibility.

Other complications of infertility treatment include the following:

• Ovarian hyper stimulation syndrome (OHSS)

Fertility medications can sometimes lead to swollen and painful ovaries, which requires medical attention. This condition can become serious and require urgent care.

• Failed cycles

Infertility treatment may take some time to show effect; thus, it is possible for people to experience a failed cycle when they go through the infertility treatment and don’t conceive.

• Ectopic pregnancy

Infertility treatment, such as IVF, increases the risk of ectopic pregnancy. In an ectopic pregnancy, the fertilised egg can implant outside the uterus. In such cases, the foetus can damage nearby organs and cause life-threatening loss of blood or severe autoimmune reaction. Symptoms of an ectopic pregnancy include vaginal bleeding and pelvic pain, and it usually requires surgery at later stages.

Can Infertility be cured?

Depending on the cause of infertility, the treatment for infertility can cure the problem and lead to a successful pregnancy. Research suggests that as many as 1 in every 5 couples who are diagnosed with infertility become pregnant without treatment eventually. Majority of the couples (approximately 9 out of 10) who take infertility treatment also become pregnant after the treatment.

Generally, 85%-90% of infertility cases can be treated by medication, lifestyle modification, ART, or surgery. If you are facing troubles conceiving, consider consulting a fertility expert. The doctors can recommend a suitable treatment course after performing proper analysis of your individual circumstances.

Can I prevent Infertility?

Although you can’t prevent against all the causes of infertility, following some tips can help reduce your chances of being affected by this condition. By practising safe sexual intercourse, you can prevent STIs, such as chlamydia and gonorrhoea; this way you can reduce your risk of infertility. Apart from this, you can use the following to increase your chances of conceiving and experiencing a healthy pregnancy:

• Maintain a healthy, balanced diet
• Work out regularly in moderation
• Lead an overall healthy lifestyle
• Maintain optimum weight
• Use lubricants during sexual intercourse
• Avoid delaying pregnancy

Here are some specific suggestions for males:

• Avoid taking frequent, long baths in hot water
• Limit the use of medications that may lead to infertility by taking to your doctor
• Avoid drugs, alcohol, and tobacco
• Limit your exposure to pesticides, cadmium, mercury, lead, etc.
• Avoid placing laptop on the lap for longer periods

Here are some specific tips for females:

• Quit smoking
• Avoid alcohol and drugs
• Limit caffeine intake

Conclusion

Infertility can be devastating for families and takes an emotional, financial, and physical toll on people. By introducing some lifestyle changes and consulting a fertility specialist, you can help lower your chances of infertility. Healthcare for people with infertility involves prevention, diagnosis, and treatment of the condition.

A complex problem like infertility often requires a holistic approach for treatment. With advancing technologies in medicine, the chances of one becoming pregnant are increasing. Awareness about the condition and access to infertility treatment help in limiting the number of people who are affected by infertility.

FAQS about Infertility

Q. Is infertility a woman’s problem only?

A. No. Infertility is disease of the reproductive system of males or females that prevents them from conceiving a child even after performing unprotected sexual intercourse.

Q. What are the symptoms of infertility?

A. The primary symptom of infertility is not being able to conceive despite having regular unprotected sexual intercourse. Some women may experience missed periods or irregular periods, but there is no sure way of knowing you have infertility without consulting a doctor and getting diagnostic tests done.

Q. What are the most common causes of infertility?

A. Here is a list of common infertility causes:

• Problems with regular ovulation in women
• Poor semen quality in men
• Damaged or blocked fallopian tubes in women
• Endometriosis in women
• PCOS in women
• Advancing age

Q. Can infertility be cured?

A. In some cases, infertility can be cured, and other cases may not lead to a fruitful outcome. It depends on the cause of infertility in individuals. However, with assisted reproductive technologies like IVF and IUI, your chances of become pregnant can increase significantly.

Q. When should I consult a fertility specialist for infertility issues?

A. If a couple has been trying to get pregnant for more than a year with no success, they are recommended to consult a fertility specialist, such as doctors from Nova IVF Fertility. Women who are 35 years or older and trying and failing to get pregnant are recommended to consult the doctors after 6 months of regular unprotected sexual intercourse.

Q. Does infertility stop periods in women?

A. No. A woman can have regular periods with no success in conceiving as infertility can be caused by a number of factors that may or may not have any effect on her menstrual cycle.