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Infertility

Infertility can be a very difficult and confusing medical condition that can be a condition by itself or a symptom of another disease or problem.

Infertility is defined as an inability to become pregnant when a couple is sexually active for at least 1 year without contraceptives.

The definition in the United Kingdom is slightly different – the NICE guidelines define infertility as “the failure to conceive after regular unprotected sexual intercourse for 2 years in the absence of known reproductive pathology.”

This condition is more common than perceived. The actual cause can be difficult to identify. Up to 25% of couples experience infertility at some point.

In those cases where an identifiable cause is noted – On average, men’s health can be the cause in 30-40% of the situations and women’s health in 60%.

A couple who believes they are having fertility difficulties needs to be interviewed by a medical provider and/or fertility specialist. Questions will be asked regarding the use of cigarettes, alcohol, other drugs.

Other questions will revolve around a possible history of sexually transmitted diseases, psycho-sexual concerns, menstruation patterns, Intrauterine Device History, libido, family history, and more are required.

More than 20% of cases of Infertility will be unexplained.

Potential Risk/Causes

–  DNA Damage  (Can affect female eggs or male sperm)
–  Genetic changes
–  Diabetes
–  Thyroid disorders
–  Adrenal Disease
–  Hyperprolactinemia
–  Hypopituitarism
–  External toxins (glues, solvents, chemicals, Tobacco, dusts, silicone, and many others)
–  Tubal blockage
–  Age-related problems
–  Endometriosis
–  Uterus problems
–  Previous Tubal ligation
–  Pelvic Inflammatory Disease
–  Polycystic Ovarian Syndrome
–  Sperm dysfunction (The main cause in Men)
–  Other

Diagnosis

–  A physical exam should be performed for both partners
–  Lab tests are often essential
–  The women should chart basal body temperatures for several months – Oral temperature taken daily
–  The male partner will have their sperm analyzed
–  An Ultrasound
–  X-ray
–  Exploratory Laparoscopy
–  Biopsies may be performed/considered in some cases

Treatment

*** This largely depends on the cause of infertility.

Weight gain may be necessary as would be the treatment of underlying conditions such as Thyroid, Diabetes, mental conditions, Endometriosis, and others

Induction of Ovulation

  –  Bromocriptine

  –  Clomiphene citrate – causes elevation of LH, gonadotropin, and other hormones or enzymes

–  Human menopausal gonadotropins (hMG)

–  Gonadotropin-releasing hormone (GnRH)

Inadequate Transport of Sperm

–  The implant of sperm into the uterus (insemination)

Artificial insemination

–  Frozen sperm implanted into the uterus

–  Typically seen in men who on analysis have no measurable sperm

Assisted Reproductive Technologies (ART)

Typically artificial means of overcoming infertility such as:

1.)  In vitro fertilization (IVF)
2.)  Gamete intrafallopian transfer (GIFT)
3.)  Zygote intrafallopian transfer (ZIFT)
4.)  Assisted Hatching
5.)  Egg donation
6.)  Tuboplasty
7.)  and others