Fertility/Infertility

Fertility is the ability to reproduce. Infertility is defined as the inability to get pregnant after one year or more of having unprotected sex. To become pregnant is a many step process, because this is a many step process the cause of infertility may be a result of a problem in any one or many of these steps.

• A woman’s body must release an egg from one of her ovaries (ovulation)
• A man’s sperm must reach the egg and join it
• The fertilized egg must travel through a fallopian tube towards the uterus
• The fertilized egg must attach to the inside of the uterus.

Infertility is quite common, according to the CDC about 6% of married women aged 15-44 years in the U.S. are unable to get pregnant after one year of trying and about 12% of women aged 15-44 years in the U.S. have difficulty getting pregnant or carrying a pregnancy to term regardless of marital status. But infertility is not just a woman’s problem, men and women can contribute to infertility. Many couples struggle with infertility and it has been found that about 35% of couples with infertility have both a male factor and a female factor identified with infertility.

How to Improve Fertility

Your fertility is influenced by your lifestyle. Here are some of the top lifestyle tips to help improve your fertility:

• Don’t smoke, smoking ages your ovaries and eggs and has been associated with lowering fertility
• Limit alcohol, heaving drinking is associated with lower fertility
• Limit caffeine to below 200 mg a day
• Stay active, being active is known to help with fertility
• Avoid illegal drugs
• Maintain a healthy weight
• Avoid excessive physical or emotional stress

What Causes Infertility In Women?

A woman needs functioning ovaries, fallopian tubes, and uterus to get pregnant. Conditions that affect any of these organs could contribute to infertility in women. Some of the most common conditions will be discussed in greater detail below.

Disruption of ovarian function

Disruptions in ovarian function can be caused by many different conditions. Typical dysfunction of the ovaries has to do with ovulation, when a woman doesn’t ovulate during a menstrual cycle it is called anovulation. Ovulation must happen for a woman to become pregnant. Possible causes of anovulation include:

• Polycystic ovary syndrome (PCOS) - this condition causes women to not ovulate or to ovulate irregularly and is the most common cause for infertility in women. PCOS happens when a woman’s ovaries and adrenal glands produce more male hormones than normal. PCOS also causes cysts to grow on the ovaries.
• Diminished ovarian reserve (DOR) - Women are born with all of the eggs they will ever have, and the egg count diminishes over time. DOR happens when there are fewer eggs remaining in the ovaries than normal. 
• Functional hypothalamic amenorrhea (FHA) - FHA is caused by excessive exercise, stress, or low body weight.
• Improper function of the hypothalamus and pituitary glands - The hypothalamus and pituitary glands are responsible for producing the hormones that maintain normal ovarian function. When the pituitary gland produces too much of the hormone prolactin or when the hypothalamus or pituitary gland is not functioning properly it may cause a woman to not ovulate.
• Premature ovarian insufficiency (POI) - POI is also known as premature menopause and happens when a woman’s ovaries fail before the age of 40. POI could be caused by exposure to chemotherapy or pelvic radiation, but most often the cause of POI is unexplained. 
• Menopause - Menopause is an age-appropriate and natural decline in ovarian function that typically occurs around age 50.

Fallopian tube obstruction

Women could have an increased risk of fallopian tube obstruction if they have a history of any of the following: pelvic infection, ruptured appendicitis, gonorrhea, chlamydia, endometriosis, or abdominal surgery. Fallopian tube evaluation can be performed using an x-ray called a hysterosalpingogram (HSG) or by chromopertubation (CP). A hysterosalpingogram is an x-ray of the uterus and fallopian tubes. A radiologist injects dye into the uterus through the cervix, the radiologist takes x-ray pictures during this time to see if the dye moves unobstructedly through the fallopian tubes. A chromopertubation is done in an operating room during a laparoscopy. Dye is passed through the cervix and into the uterus and spillage and the shape of the fallopian tubes are evaluated.

Abnormal uterine characteristics

If there is concern for abnormalities of the uterus evaluation by transvaginal ultrasound can be done to look for fibroids or other abnormalities. A sonohysterogram or hysteroscopy could be performed to further evaluate the uterus if necessary.

What Causes Infertility In Men?

Infertility in men can be caused by a number of factors and can usually be evaluated by a semen analysis. A semen analysis tests for the number of sperm, motility, and shape of sperm. A slightly abnormal semen analysis does not necessarily mean a man is infertile, it simply helps determine if and how the male factors contribute to infertility. Some common causes of infertility in men include:

Disruption of testicular or ejaculatory function

• Varicoceles is a condition when the veins on a man’s testicles are large and cause them to overheat. The increased heat may affect the number or shape of the sperm.
• Trauma to a teste could affect sperm production
• Heavy alcohol use, smoking, anabolic steroid use and illegal drug use could affect sperm production
• Cancer treatment involving chemotherapy, radiation, or surgery to the testicles
• Certain medical conditions like diabetes, cystic fibrosis, certain autoimmune disorders, and some infections could cause testicular failure.

Hormone disorders

These are caused by irregular function of the hypothalamus or pituitary glands. These glands in the brain produce hormones that support normal testicular function. If there is too much prolactin made by the pituitary gland or other conditions that could damage the hypothalamus or pituitary gland it could cause reduced or no sperm production. These conditions could include:

• benign or malignant pituitary tumors
• congenital adrenal hyperplasia
• exposure to too much estrogen or testosterone
• Cushing’s syndrome
• Long-term use of glucocorticoids

Genetic disorders

Certain genetic conditions could cause no sperm to be produced or low numbers of sperm production. These conditions could include:

• Y-chromosome microdeletion
• Myotonic dystrophy
• Other less common genetic disorders

What Are Risk Factors That Could Lead To Infertility?

Men

• Age
• Being overweight or obese
• Smoking
• Excessive alcohol consumption
• Marijuana use
• Exposure to testosterone such as, from prescribed testosterone injections, implants, or topical gel
• Radiation exposure
• Repeated exposure of the testes to high temperatures through frequent sauna or hot tub use.
• Certain medications like flutamide, cyproterone, bicalutamide, spironolactone, ketoconazole, or cimetidine
• Exposure to environmental toxins like pesticides, lead, cadmium, or mercury

Women

• Age decreases a woman’s fertility by:
• Reduced number of eggs left
• Eggs are less healthy
• More likely to have health conditions that lead to fertility issues
• More likely to have a miscarriage
• Smoking
• Excessive alcohol consumption
• Drastic weight gain or loss
• Extreme physical or emotional stress that causes amenorrhea (missing periods)

When To See A Doctor About Fertility Issues

Typically experts recommend waiting to seek help after at least one year of trying unsuccessfully for women age 35 and younger and for women age 35  or older after 6 months of trying unsuccessfully. A woman’s chance of having a baby rapidly declines after the age of 30. Couples who are trying to get pregnant with the following signs should see their health care provider if:

• She is having irregular periods or no periods
• She is having very painful periods
• She has endometriosis
• She has pelvic inflammatory disease
• She has had more than one miscarriage
• There is a suspected male factor like testicular trauma, hernia surgery, or chemotherapy.

Even if you are not having fertility issues it is a good idea for couples to see a health care provider before trying to get pregnant. They can help you get your body ready for a healthy baby and answer any questions on fertility and provide any tips on conceiving.

How Is Infertility Diagnosed?

Your doctor will start by obtaining a thorough medical and sexual history from both partners. Your doctor will evaluate this information and determine if there are any conditions or history that could lead to infertility. If no cause can be determined from the provided information your doctor will recommend testing. For women, testing could include ovaria reserve testing, x-ray of the fallopian tubes and uterus, and laparoscopy. For men, testing is focused on semen analysis.

How Is Infertility Treated?

Treatment for infertility could include medicine, surgery, intrauterine insemination, or assisted reproductive technology like IVF. A doctor will make specific treatment recommendations taking a number of factors into account:

• The specific factors that contribute to the infertility
• The duration of the infertility
• The age of the woman
• The couples treatment preferences after counseling on each treatment option

Medicine

Treating infertility with medication is very common, medicines used to treat infertility in women could include:

• Clomiphene Citrate (Clomid) - this medication causes ovulation by targeting the pituitary gland. It is often used for women with polycystic ovary syndrome (PCOS) or other issues with ovulation. This medication is taken by mouth
• Letrozole (Femara) - this medication has an off-label use for causing ovulation. It works by reducing a woman’s progesterone level which causes the brain to naturally make more FSH.
• Human menopausal gonadotropin or hMG (Menopur, Repronex, Pergonal) - this medication acts on the ovaries to stimulate the development of mature eggs. This is an injectable medication. This is typically recommended for women who do not ovulate due to pituitary gland issues.
• Follicle-stimulating hormone or FSH (Gonal-F, Follistim) - this medication works similarly to hMG by stimulating the development of mature eggs in the ovaries. This is an injectable medication.
• Gonadotropin-releasing hormone (GnRH) analogs and GnRH antagonists - these medications work on the pituitary gland to prevent a woman from ovulating. These are used during in vitro fertilization cycles to help prepare a woman’s uterus for embryo transfer. This medication is either injected or given as a nasal spray.
• Metformin (Glucophage) - this medication is used for women with insulin resistance, diabetes, or PCOS. This medication works to lower high levels of male hormones in women with these conditions and helps the body to ovulate. This medication is taken by mouth.
• Bromocriptine (Parlodel) and Cabergoline (Dostinex) - these medications are used for women with ovulation problems due to high levels of prolactin.

Many of these fertility medications increase a woman’s chance of having twins, triplets, or other multiples. If a woman is pregnant with multiple fetuses it may cause more issues during pregnancy and an increased risk of being born too early.

Intrauterine Insemination (IUI)

IUI is a treatment that is commonly called artificial insemination. IUI is a procedure where specially prepared sperm are inserted into the woman’s uterus. IUI is commonly used alongside medication use in the woman that stimulates ovulation prior to the IUI. IUI is typically used to treat a mild male factor causing infertility or used for couples with unexplained infertility.

Assisted Reproductive Technology (ART)

ART treatments include all fertility treatments where both eggs and embryos are handled outside of the body. These procedures typically involve removing mature eggs from a woman’s ovaries using a needle, combining the eggs with sperm in the laboratory, and returning the created embryos to the woman’s body. The most common type of ART is in vitro fertilization (IVF)

• In vitro fertilization (IVF) - This is the most effective and most common form of ART and it involves fertilization outside of the body.
• Intracytoplasmic Sperm Injection (ICSI) - This is a type of IVF that is commonly used for couples with male factor infertility. ICSI involves a single sperm injected into a mature egg.
• Zygote Intrafallopian Transfer (ZIFT) - this is an old ART method that is rarely used in the U.S. This is similar to IVF where fertilization occurs in the laboratory and the embryo is transferred to the fallopian tube instead of the uterus.
• Gamete Intrafallopian Transfer (GIFT) - this is an old ART method that is rarely used in the U.S. This procedure involves transferring eggs and sperm into a woman’s fallopian tube and the fertilization happens within the woman’s body.

ART procedures can involve the use of donor eggs, donor sperm, or previously frozen embryos. Donor eggs are used for women who can not produce eggs naturally. Donor eggs and donor sperm are commonly used when a man or woman has a genetic condition that could be passed on to the baby.

Where To Get Help With Fertility Online?

The following companies provide various help with fertility like sperm testing, women’s healthcare, hormone testing, or help with fertility costs.

• Dadi
• Let’s Get Checked 
• Kindbody
• Maven Clinic
• Modern Fertility
• Future Family

Whether you are thinking of starting a family or you have been trying for a while it never hurts to speak with a health care professional to discuss ways to boost your fertility or options to treat your infertility. When you are trying to build a family and it’s not happening as quickly as you expected it can put stress on a relationship and be disheartening. Seeking help from a healthcare professional to get to the bottom of the issue and to get help is a great first step. There are many options to seek this kind of help online today. With the use of telemedicine, you can make an appointment with a fertility specialist, order a hormone test kit, or get financial help with fertility treatment costs all from the comfort of your own home. We have created a list of the top online fertility clinics, check them out today to start your fertility journey.